☰ INDEX
FMGE Aug 2020
FMGE Dec 2018
FMGE Dec 2019
FMGE Dec 2020
FMGE Dec 2021
FMGE Jan 2023
FMGE Jan 2024 Part 1
FMGE Jan 2024 Part 2
FMGE Jan 2025 Part 1
FMGE Jan 2025 Part 2
FMGE Jan 2025
FMGE July 2023
FMGE June 2019
FMGE June 2021
FMGE June 2022
FMGE June 2024 Part 1
FMGE June 2024 Part 2
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following is true about renal tubular transport?", "options": [{"label": "A", "text": "Maximum reabsorption in the distal tubule", "correct": false}, {"label": "B", "text": "Urea is absorbed 100% in PCT", "correct": false}, {"label": "C", "text": "H+ is absorbed in the proximal tubule", "correct": false}, {"label": "D", "text": "Amino acid is reabsorbed in the proximal tubule", "correct": true}], "correct_answer": "D. Amino acid is reabsorbed in the proximal tubule", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mediator of fast vibration sense?", "options": [{"label": "A", "text": "Merkel’s disc", "correct": false}, {"label": "B", "text": "Meissner’s corpuscles", "correct": false}, {"label": "C", "text": "Pacinian corpuscles", "correct": true}, {"label": "D", "text": "Ruffini’s end organ", "correct": false}], "correct_answer": "C. Pacinian corpuscles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5AWi2RNU95pW7zp1Urve1748155728.png", "https://image.prepladder.com/content/1Nf4njMiHlhZLxXYU13G1748155736.png", "https://image.prepladder.com/content/L80fW6iCwXDfVaTxFlM41748155747.png", "https://image.prepladder.com/content/KzhKFrdLjRdgf7QiWTVb1748155754.png", "https://image.prepladder.com/content/lvika7d3quwHFGX2GMP11748155762.png", "https://image.prepladder.com/content/JGtlro8AMxrDP01QFXeM1748155768.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rapidly Adapting Tactile Receptors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Structure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Adaptation </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pacinian Corpuscle</strong><br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Encapsulated nerve ending</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Detect tissue <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> or other rapid changes in the mechanical state of tissues</li>\n<li>Stimulated by rapid local <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the tissue</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediately beneath the skin and deep in the fascial tissues of the body</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adapts in a few hundredths of a second</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Meissner Corpuscle</strong><br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elongated, <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> nerve <span class=\"customMeta\" data-dictid=\"7ae760ae1b169277718794068316b8\">ending</span> of a large <span class=\"customMeta\" data-dictid=\"dd79d3db911692777193c60304ef85\">myelinated</span> <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> nerve fiber</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sensitive to movement of objects over the skin and low-frequency vibrations</li>\n<li>crucial for <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> location discernment of touch sensations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nonhairy skin, particularly abundant in fingertips and lips.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adapts in a fraction of a second</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hair End </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nerve fiber entwined at the base of each hair</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detects :</p>\n<ul>\n<li>Movement of objects on the body surface or</li>\n<li>Initial contact with the body</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hairy skin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adapts readily</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/L80fW6iCwXDfVaTxFlM41748155747.png\" width=\"3724\"/></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/KzhKFrdLjRdgf7QiWTVb1748155754.png\" width=\"3754\"/></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/lvika7d3quwHFGX2GMP11748155762.png\" width=\"3785\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/JGtlro8AMxrDP01QFXeM1748155768.png\" width=\"3716\"/></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Discriminatory touch, Stroking</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Texture, Edges, Braille</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pressure, Vibration</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sustained pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapidly adapting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slowly adapting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapidly adapting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slowly adapting</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following factors is responsible for increasing gastric motility?", "options": [{"label": "A", "text": "Presence of fatty food in the stomach", "correct": false}, {"label": "B", "text": "Distension of the stomach", "correct": true}, {"label": "C", "text": "Presence of tryptophan in the stomach", "correct": false}, {"label": "D", "text": "The presence of acid in the stomach", "correct": false}], "correct_answer": "B. Distension of the stomach", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Effect on <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> Motility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distension of the stomach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stretching of the <span class=\"customMeta\" data-dictid=\"fda3b47a5c16927771994ab38f8a22\">stomach wall</span> activates mechanoreceptors, stimulating motility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastrin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hormone released in response to food, especially proteins, that stimulates <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acetylcholine (ACh)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Released by the <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> nervous system, promoting smooth muscle contraction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Peptides and <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of partially digested proteins or <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids triggers <span class=\"customMeta\" data-dictid=\"212d9c968716927771888fdde3c211\">gastrin</span> release.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastric <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reflex activated when food enters the duodenum, regulating the rate of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Increased <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of <span class=\"customMeta\" data-dictid=\"a32cad4dbc169277718669cfb165a5\">digestive</span> enzymes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The release of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> juices and <span class=\"customMeta\" data-dictid=\"a32cad4dbc169277718669cfb165a5\">digestive</span> enzymes aids in the mixing and movement of food.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child accidentally took a bottle full of iron tablets. Which of the drugs is used as an antidote for iron poisoning?", "options": [{"label": "A", "text": "Luspatercept", "correct": false}, {"label": "B", "text": "Deferoxamine", "correct": true}, {"label": "C", "text": "Deferiprone", "correct": false}, {"label": "D", "text": "DMSA", "correct": false}], "correct_answer": "B. Deferoxamine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Deferoxamine&lt;br/&gt;\n&lt;br/&gt;\nE\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chelator</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Other Information</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Deferoxamine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute iron poisoning</li>\n<li>Transfusion siderosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Given parenterally.</li>\n<li>Not preferred in chronic <span class=\"customMeta\" data-dictid=\"64bbd63a0c1692777190f0c8e06e91\">iron overload</span> (Deferiprone is preferred)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Deferiprone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Iron poisoning</li>\n<li>Transfusion <span class=\"customMeta\" data-dictid=\"e4d583e26b1692777198454df4b41d\">siderosis</span> in <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">thalassemia</span> patients</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral drug.</li>\n<li>Less effective than <span class=\"customMeta\" data-dictid=\"423bba3d10169277718536aa18aea0\">deferoxamine</span> for <span class=\"customMeta\" data-dictid=\"64bbd63a0c1692777190f0c8e06e91\">iron overload</span> due to repeated blood transfusion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dimercaptosuccinic acid (Succimer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Arsenic poisoning</li>\n<li>Mercury poisoning</li>\n<li>Lead poisoning</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It may <span class=\"customMeta\" data-dictid=\"c48d8e1e191692777184c994c083c2\">chelate</span> some essential metals like <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> and zinc.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Adrenaline acting via beta 2 receptors causes bronchodilation, whereas histamine acts through H1 receptors to cause bronchoconstriction. Which type of antagonism is it?", "options": [{"label": "A", "text": "Physiological antagonism", "correct": true}, {"label": "B", "text": "Chemical antagonism", "correct": false}, {"label": "C", "text": "Non-Competitive Antagonist", "correct": false}, {"label": "D", "text": "Competitive antagonism", "correct": false}], "correct_answer": "A. Physiological antagonism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\"&gt;Physiological&lt;/span&gt; antagonism&lt;br/&gt;\n&lt;br/&gt;\nExplanation: </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Antagonist</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Example</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Physiological Antagonist </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves two agents that produce opposite effects on the same <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> function without interacting directly with each other or the same receptor.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Histamine causes bronchoconstriction, while <span class=\"customMeta\" data-dictid=\"35b6a8aeb416927771805fcc2e7dfb\">adrenaline</span> causes bronchodilatation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chemical Antagonist</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Direct interaction between two drugs to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> an inactive product.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Heparin</strong> works by enhancing the activity of <span class=\"customMeta\" data-dictid=\"fa202015a216927771814a0dc268ba\">antithrombin</span> III, which inhibits blood clotting.</li>\n<li><strong>Protamine sulfate</strong> binds to the negatively charged heparin, neutralizing its <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">anticoagulant</span> effect.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-Competitive Antagonist </strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prevents the action of an <span class=\"customMeta\" data-dictid=\"7d8d28cda71692777180c89a3c86ce\">agonist</span> without competing with it for the binding site.</li>\n<li><strong>Irreversible</strong> binding to the <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> reduces the maximum effect of the agonist.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Phenoxybenzamine binds to α-adrenergic receptors, reducing the effect of adrenaline.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Competitive Antagonist</strong></p>\n<p style=\"text-align: center;\"><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Competes with agonists for the same binding site, reducing the <span class=\"customMeta\" data-dictid=\"2a93f2d9a11692777196928bd78855\">potency</span> of the agonist.</li>\n<li><strong>Reversible </strong>binding to the same <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> site as the agonist.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Propranolol (β-blocker) binds to β-adrenergic receptors, reducing the effect of adrenaline.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the management of diabetes mellitus, lactic acidosis is caused by which of the following?", "options": [{"label": "A", "text": "Tolbutamide", "correct": false}, {"label": "B", "text": "Glipizide", "correct": false}, {"label": "C", "text": "Pioglitazone", "correct": false}, {"label": "D", "text": "Metformin", "correct": true}], "correct_answer": "D. Metformin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Metformin</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Metformin</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Stimulates the AMP-dependent protein <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> (AMPK</strong>) in the presence of insulin.</li>\n<li><strong>It inhibits <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> gluconeogenesis</strong>, <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid oxidation, and non-oxidative <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> and <strong>increases <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity.</strong></li>\n<li>Inhibits the <strong>mitochondrial <span class=\"customMeta\" data-dictid=\"124462cc291692777188e1a9cce583\">glycerol</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> dehydrogenase</strong></li>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> resistance to <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> in muscle and <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissues</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dose </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>500 mg OD to 2550 mg/day (max)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First-line oral <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">hypoglycemic</span> </strong>for the treatment of <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes mellitus.</p>\n<p>DOC: <strong>Prophylaxis in</strong> <strong>prediabetes</strong> or impaired <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> tolerance</p>\n<p>Metabolic syndrome</p>\n<p>DOC: Diabetes due to <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance</p>\n<ul>\n<li><strong>In PCOS:</strong> Metformin also promotes ovulation</li>\n<li><strong>Clozapine-induced DM/glucose intolerance</strong>.</li>\n<li>Cushing syndrome</li>\n<li><strong>Gestational diabetes</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other benefits </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Weight loss in <span class=\"customMeta\" data-dictid=\"43663fecf11692777194c870d1d548\">obese</span> patients and weight <span class=\"customMeta\" data-dictid=\"da9ba55df01692777193ed69860f09\">neutrality</span> in thin patients.</li>\n<li>There is no risk of <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> (No effect during the normoglycemic state).</li>\n<li><strong>Reduction of <span class=\"customMeta\" data-dictid=\"e5607ecb0d1692777191a8a4ffa1b2\">lipogenesis</span> (decrease <span class=\"customMeta\" data-dictid=\"482f0bd5841692777200af07c2766c\">triglyceride</span> and LDL levels).</strong></li>\n<li><strong>Decreases micro- and <span class=\"customMeta\" data-dictid=\"c33e0939ff1692777191af7082a7ce\">macrovascular</span> complications of DM</strong>\n<ul>\n<li>Micro: <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> neuropathy, nephropathy, retinopathy</li>\n<li>Macro: MI and stroke</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea/Vomiting/Diarrhoea</li>\n<li>Megaloblastic anaemia: reduces vitamin B12 <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> from GIT</li>\n<li>Lactic acidosis</li>\n<li>Avoid metformin in Renal disorder, liver disease, COPD, CHF, dehydration, and <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> (hypoxia increases <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acid production).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Metformin</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Activates AMP-dependent protein <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> (AMPK), inhibiting <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"724a9faafe1692777188ca8840ec5c\">gluconeogenesis</span> and <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid <span class=\"customMeta\" data-dictid=\"224ea8a9e41692777194e81be113d8\">oxidation</span> while increasing <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dose </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>500 mg OD to 2550 mg/day</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>First-line treatment for <strong>type 2 <span class=\"customMeta\" data-dictid=\"b6a934c67b16927771868fca92baf9\">diabetes mellitus</span> (T2DM).</strong></li>\n<li><strong>Prophylaxis in prediabetes</strong> or impaired <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> tolerance.</li>\n<li>Management of <strong>metabolic syndrome</strong> and <strong>PCOS</strong> (promotes ovulation).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other benefits </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Weight loss in <span class=\"customMeta\" data-dictid=\"43663fecf11692777194c870d1d548\">obese</span> patients and weight <span class=\"customMeta\" data-dictid=\"da9ba55df01692777193ed69860f09\">neutrality</span> in thin patients</li>\n<li>No risk of hypoglycemia, and it leads to a reduction of lipogenesis</li>\n<li>Decreases micro- and <span class=\"customMeta\" data-dictid=\"c33e0939ff1692777191af7082a7ce\">macrovascular</span> complications of DM</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common: Nausea, vomiting, diarrhea.</li>\n<li>Rare but serious: <strong>Lactic acidosis</strong></li>\n<li>Reduces vitamin B12 absorption, causing <strong>megaloblastic anemia.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Beta-blockers are ideally avoided in which of the following?", "options": [{"label": "A", "text": "Essential tremors", "correct": false}, {"label": "B", "text": "Diabetes mellitus with hypertension", "correct": true}, {"label": "C", "text": "Angina pectoris", "correct": false}, {"label": "D", "text": "Migraine prophylaxis", "correct": false}], "correct_answer": "B. Diabetes mellitus with hypertension", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"b6a934c67b16927771868fca92baf9\"&gt;Diabetes mellitus&lt;/span&gt; with hypertension</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses of beta-blockers</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug of choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Migraine <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> <strong>(Option D)</strong></li>\n<li>Essential tremors <strong>(Option A)</strong></li>\n<li>Aortic <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> if they also have hypertension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypertension-second-line drugs</li>\n<li>Stable angina: Decrease the frequency of attacks and increase exercise tolerance. <strong> (Option C)</strong></li>\n</ul>\n<ul>\n<li>Cardiac arrhythmias: Used in both <span class=\"customMeta\" data-dictid=\"619efd9f7b169277719928c9441919\">supraventricular</span> and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> arrhythmias.</li>\n<li>Congestive heart failure: Decreases mortality.</li>\n<li>Thyrotoxicosis: Propranolol controls the <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> symptoms</li>\n<li>Glaucoma: Timolol and Betaxolol are used.</li>\n<li>Hypertrophic Cardiomyopathy (Improves <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output).</li>\n<li>Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (Ml): Secondary <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> of Ml and myocardial <span class=\"customMeta\" data-dictid=\"53d0f40d261692777198244a05ec72\">salvage</span> during evolution of Ml (decreases mortality).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The therapeutic index of a drug serves as a measure for?", "options": [{"label": "A", "text": "Potency", "correct": false}, {"label": "B", "text": "Safety", "correct": true}, {"label": "C", "text": "Efficacy", "correct": false}, {"label": "D", "text": "All of these", "correct": false}], "correct_answer": "B. Safety", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/soRsuuWyy06yqmHEMLDD1747028690.png", "https://image.prepladder.com/content/7djOgvboozBzgnTPAP4j1747028724.png", "https://image.prepladder.com/content/WIG9w26E50hpcpgqDlA21747028752.png"], "explanation": "<p>Correct Answer B - Safety&lt;br/&gt;\n&lt;br/&gt;\nExplanation: </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">TI= <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> <strong>toxic dose</strong>/median <strong>effective dose</strong> ; (TD50/ED50)</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Renin is secreted by?", "options": [{"label": "A", "text": "Lacis cells", "correct": false}, {"label": "B", "text": "Macula densa", "correct": false}, {"label": "C", "text": "JG cells", "correct": true}, {"label": "D", "text": "Intraglomerular mesangial cell", "correct": false}], "correct_answer": "C. JG cells", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Center controlling vomiting?", "options": [{"label": "A", "text": "Apneustic center", "correct": false}, {"label": "B", "text": "Pneumotaxic centre", "correct": false}, {"label": "C", "text": "Area Postrema", "correct": true}, {"label": "D", "text": "Pre Botzinger complex", "correct": false}], "correct_answer": "C. Area Postrema", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is not metabolized by acetylation?", "options": [{"label": "A", "text": "Isoniazid", "correct": false}, {"label": "B", "text": "Hydralazine", "correct": false}, {"label": "C", "text": "Phenytoin", "correct": true}, {"label": "D", "text": "Procainamide", "correct": false}], "correct_answer": "C. Phenytoin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Phenytoin</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acetylation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acetylation: N-acetyltransferase (NAT), adds an <span class=\"customMeta\" data-dictid=\"6ade0969281692777180216b0c3d76\">acetyl</span> group to drugs and compounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Isoniazid <strong>(Option A)</strong></li>\n<li>Hydralazine <strong>(Option B)</strong></li>\n<li>Phenelzine</li>\n<li>Dapsone</li>\n<li>Procainamide<strong> (Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Glycination </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glycination: The drugs are conjugated with glycine.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Salicylates.</li>\n<li>Nicotinic acid.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sulfation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sulfation: The <span class=\"customMeta\" data-dictid=\"8cfbaec254169277719502145be7ce\">phenolic</span> compounds and steroids are sulfated by sulfotransferases.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chloramphenicol.</li>\n<li>Methyldopa.</li>\n<li>Adrenal &amp; sex steroids.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Methylation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Methylation: The amines and phenols are <span class=\"customMeta\" data-dictid=\"4caa8e8b451692777192f014bc8995\">methylated</span> by <span class=\"customMeta\" data-dictid=\"bc09155adc169277719248f9543785\">methyl</span> transferases.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chloramphenicol.</li>\n<li>Methyldopa.</li>\n<li>Captopril.</li>\n<li>Mercaptopurine.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Enteropeptidase enzyme is secreted by?", "options": [{"label": "A", "text": "Stomach", "correct": false}, {"label": "B", "text": "Duodenum", "correct": true}, {"label": "C", "text": "Jejunum", "correct": false}, {"label": "D", "text": "Ileum", "correct": false}], "correct_answer": "B. Duodenum", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mouth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Salivary Amylase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breaks down <span class=\"customMeta\" data-dictid=\"24511b2ef716927771990798c3d939\">starch</span> into maltose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lingual Lipase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Begins <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> of lipids (mainly <span class=\"customMeta\" data-dictid=\"c2680413281692777192c001cf96cb\">milk fat</span> in infants)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stomach </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pepsinogen (activated to Pepsin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breaks down proteins into smaller peptides</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gastric Lipase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breaks down lipids, especially in infants</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Small Intestine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enteropeptidase (Enterokinase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Activates <span class=\"customMeta\" data-dictid=\"f4289daa6816927772007d51f2e486\">trypsinogen</span> to trypsin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pancreatic Amylase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Continues carbohydrate <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> (starches to <span class=\"customMeta\" data-dictid=\"8ea673008d1692777191f46338fc58\">maltose</span> and dextrins)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pancreatic Lipase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breaks down triglycerides into monoglycerides and free <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pancreatic Proteases (Trypsin, Chymotrypsin, Carboxypeptidase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Break down proteins into peptides and <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pancreatic Nucleases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breaks down nucleic acids (DNA, RNA) into nucleotides</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disaccharidases (Sucrase, Lactase, Maltase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Break down disaccharides into monosaccharides (e.g., glucose, galactose, fructose)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aminopeptidases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Break down peptides into <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Large Intestine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bacterial Enzymes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ferment carbohydrates (fiber) into short-chain <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids (SCFAs) and gases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the cardiac muscle, the inhibition of Na +K +ATPase results in?", "options": [{"label": "A", "text": "Hyperpolarization and then depolarization", "correct": false}, {"label": "B", "text": "Depolarization", "correct": true}, {"label": "C", "text": "Hyperpolarization", "correct": false}, {"label": "D", "text": "Repolarization", "correct": false}], "correct_answer": "B. Depolarization", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/33WWAI8HL7BazmBq7pH71748155968.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>PHASES</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>OPENING AND CLOSURE OF CHANNELS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phase 0- Depolarization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Opening of voltage-gated Na+ channels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phase 1- Initial rapid <span class=\"customMeta\" data-dictid=\"40451a27bd1692777197d6c276d0bc\">repolarization</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closure of Na+ channels</p>\n<p>Opening of K+ channel</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phase 2- Plateau phase </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slower but prolonged opening of L-type voltage-gated Ca2+ channels</p>\n<p>K+ channel also remains open.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phase 3- Late rapid repolarization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closure of the Ca2+ channels</p>\n<p>Slow, delayed increase of K+ efflux</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phase 4- Baseline </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resting <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">Membrane</span> Potential About −80 to −90 millivolts.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the subsequent diagnostic step for a 16-year-old girl who was brought to the hospital by her mother due to primary amenorrhea, where the evaluation revealed the presence of axillary and pubic hair along with normal secondary sexual characteristics, and an ultrasound scan indicated the absence of a uterus?", "options": [{"label": "A", "text": "Testosterone levels", "correct": false}, {"label": "B", "text": "Karyotyping", "correct": true}, {"label": "C", "text": "Estrogen measurement", "correct": false}, {"label": "D", "text": "LH and FSH measurement", "correct": false}], "correct_answer": "B. Karyotyping", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Lysosomal enzymes are present ?", "options": [{"label": "A", "text": "Cytosol", "correct": true}, {"label": "B", "text": "Mitochondria", "correct": false}, {"label": "C", "text": "Endoplasmic reticulum", "correct": false}, {"label": "D", "text": "Nucleus", "correct": false}], "correct_answer": "A. Cytosol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not an alkylating agent?", "options": [{"label": "A", "text": "Melphalan", "correct": false}, {"label": "B", "text": "Cyclophosphamide", "correct": false}, {"label": "C", "text": "Busulfan", "correct": false}, {"label": "D", "text": "5-Fluorouracil", "correct": true}], "correct_answer": "D. 5-Fluorouracil", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Wf9xvSmwtGHBVT4TR6Tf1747029386.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>5-Fluorouracil </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits <span class=\"customMeta\" data-dictid=\"e34386023d169277720036d8bccc88\">thymidylate</span> <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">synthase</span> after conversion to FdUMP, leading to decreased <span class=\"customMeta\" data-dictid=\"e32083bfa81692777200f1407487aa\">thymidine</span> production and <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of DNA synthesis</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"554\" src=\"https://image.prepladder.com/content/Wf9xvSmwtGHBVT4TR6Tf1747029386.png\" width=\"771\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Colorectal cancer\n\t\t\t\t<ul>\n<li><strong>FOLFOX Regimen</strong>: Folinic acid , Fluorouracil (5-FU), Oxaliplatin</li>\n<li><strong>FOLFIRINOX Regimen</strong>: Folinic acid, Fluorouracil (5-FU), Irinotecan, Oxaliplatin</li>\n</ul>\n</li>\n<li>All GIT cancer, along with platin</li>\n<li>Breast cancer</li>\n<li>Topical application on skin: For treatment of\n\t\t\t\t<ul>\n<li>Mycosis Fungoides (Sezary Syndrome)</li>\n<li>Basal Cell Carcinoma</li>\n<li>Actinic Keratosis</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> suppression</li>\n<li>Mucositis</li>\n<li>Hand-foot syndrome (palmar-plantar erythrodysesthesia)</li>\n<li>Alopecia</li>\n<li>Rarely - <span class=\"customMeta\" data-dictid=\"5dc2899332169277718350ff2207b9\">cardiotoxicity</span> and neurotoxicity</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented to the ER with a history of a road traffic accident. On examination his vitals were stable, but he could not speak. He had normal handwriting skills, and could understand what was being asked of him to which he responded by nodding. Where could be the lesion for this clinical condition?", "options": [{"label": "A", "text": "Broca’s area", "correct": true}, {"label": "B", "text": "Wernicke’s area", "correct": false}, {"label": "C", "text": "Primary motor cortex", "correct": false}, {"label": "D", "text": "Occlusion of left internal carotid artery", "correct": false}], "correct_answer": "A. Broca’s area", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yxQQnMDcWWStsV1IQbVz1748156083.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:532px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Brodmann Area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1, 2, 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> cortex; processes <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> information.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary motor cortex; controls voluntary movements.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5, 7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Somatosensory association areas; integrate <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> input.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Premotor/supplementary motor areas; plan movements.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>17</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary visual cortex; processes visual data.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>18, 19</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Visual association areas; advanced visual processing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>22</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wernicke's area; facilitates language comprehension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>44, 45</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Broca's area; involved in speech production.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify this movement that takes place in the intestine.", "options": [{"label": "A", "text": "Segmented movement", "correct": false}, {"label": "B", "text": "Peristalsis", "correct": true}, {"label": "C", "text": "Intersegmental contraction", "correct": false}, {"label": "D", "text": "Diffusion", "correct": false}], "correct_answer": "B. Peristalsis", "question_images": ["https://image.prepladder.com/content/3eiA4XXMJPqknkQq1Hxa1747029509.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Neurotransmitter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Role</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acetylcholine (ACh) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates contraction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acts on <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors, increases motility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Substance P </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Promotes <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> contraction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Released by mucosal stimulation, enhances <span class=\"customMeta\" data-dictid=\"9adacf6f38169277719430ad3cd087\">orad</span> contraction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vasoactive Intestinal <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">Peptide</span> (VIP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Promotes relaxation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acts on smooth muscle to induce <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> during peristalsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serotonin (5-HT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regulates <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> and initiates reflex</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Released from <span class=\"customMeta\" data-dictid=\"6c13e383a01692777187ae85e093b6\">enterochromaffin</span> cells, activates 5-HT receptors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nitric <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">Oxide</span> (NO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mediates relaxation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Released by <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> neurons, assists VIP in relaxation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcitonin Gene-Related <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">Peptide</span> (CGRP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Influences <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> signaling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Modulated by serotonin, aids in coordinating reflexes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 65-year-old woman who arrives at the outpatient department with symptoms of breathlessness and fatigue? She has no previous medical history of reactive airway disease or heart disease, but she has undergone breast cancer treatment including breast conservation surgery and chemoradiation. On examination, engorged neck veins and jugular venous pressure (JVP) indicate a rapid x and y descent. The chest x-ray findings are as follows.", "options": [{"label": "A", "text": "Constrictive pericarditis", "correct": true}, {"label": "B", "text": "Cardiac tamponade", "correct": false}, {"label": "C", "text": "Dilated cardiomyopathy", "correct": false}, {"label": "D", "text": "Restrictive cardiomyopathy", "correct": false}], "correct_answer": "A. Constrictive pericarditis", "question_images": ["https://image.prepladder.com/content/RjmsEyFteH1OpYkcC8kh1747029621.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Proton pump inhibitor suppresses gastric acid secretion by acting on?", "options": [{"label": "A", "text": "H+/Cl- ATPase pump", "correct": false}, {"label": "B", "text": "H+/K+ ATPase pump", "correct": true}, {"label": "C", "text": "Na+/K+ ATPase pump", "correct": false}, {"label": "D", "text": "Na+/K+/Cl- ATPase pump", "correct": false}], "correct_answer": "B. H+/K+ ATPase pump", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Proton pump inhibitor</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It inhibits the <strong>H+/K+ ATPase pump </strong>located in the <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> cells of the stomach, thus reducing acid <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> in the stomach.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Potency of PPI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rabeprazole &gt; Lansoprazole &gt; Rabeprazole &gt; Omeprazole &gt; Pantoprazole</li>\n<li>All PPIs have equal efficacy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Properties </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acid production reduction persists for 2 to 4 days even after stopping the drug and resumes later.</li>\n<li>Duration of action is typically 2 to 4 days.\n\t\t\t\t<ul>\n<li>Omeprazole is the fastest acting PPI.</li>\n<li>PPIs are acid labile; Enteric coating can protect from acid degradation.</li>\n<li>They should be taken on an empty stomach when only ~I0% of <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> pumps are active, followed 1 hour later by a meal to <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> the H+/K+/ATPase at a time when <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> concentration of the <span class=\"customMeta\" data-dictid=\"6d17c6d6f1169277719687447037f2\">PPI</span> is maximal.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic use of PPIs can lead to hypergastrinemia, which can further result in:\n\t\t\t\t<ul>\n<li>ECL hyperplasia</li>\n<li>Fundic <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> polyposis</li>\n<li>Atrophic gastritis</li>\n</ul>\n</li>\n<li>Gastrointestinal upset (nausea, constipation, diarrhoea)</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"04f4b6dbf71692777192ca0c4f70fa\">microbial</span> growth leads to a higher risk of bacterial infection</li>\n<li>Increased risk of bone fractures due to <span class=\"customMeta\" data-dictid=\"59f10ee7c31692777189a8544bb404\">hypocalcemia</span> (reduced <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of calcium)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the following LV pressure-volume loop diagram, point C denotes –", "options": [{"label": "A", "text": "Mitral valve closes", "correct": false}, {"label": "B", "text": "Aortic valve opens", "correct": true}, {"label": "C", "text": "Aortic valve closes", "correct": false}, {"label": "D", "text": "Mitral valve opens", "correct": false}], "correct_answer": "B. Aortic valve opens", "question_images": ["https://image.prepladder.com/content/kCFpCh6IJNH6gA4OajSW1748156046.png"], "explanation_images": ["https://image.prepladder.com/content/PCbdOO4N37djQGCUZHNW1748156054.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arjun (32/M) comes to your clinic for a regular health check-up with his wife (28/F). He weighs 65 kgs and his lifestyle is predominantly sedentary. His wife weighs 55 kg, is pregnant, and is in her second trimester. Her lifestyle is sedentary too. According to the ICMR 2020, how many calories should Arjun and his wife respectively consume?", "options": [{"label": "A", "text": "2010 Kcal, 2110 Kcal", "correct": false}, {"label": "B", "text": "2110 Kcal, 2010 Kcal", "correct": true}, {"label": "C", "text": "2180 Kcal, 2110 Kcal", "correct": false}, {"label": "D", "text": "2350 Kcal, 2150 Kcal", "correct": false}], "correct_answer": "B. 2110 Kcal, 2010 Kcal", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>EAR - Energy (Kcal/D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>RDA - Protein (g/D)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Man</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sedentary work</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2110</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">54</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate work</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">2710</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">54</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heavy work</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">3470</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">54</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Woman</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sedentary work</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1660</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">46</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate work</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">2130</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">46</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heavy work</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">2720</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">46</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnancy (2nd trimester)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>+340</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+9.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnancy (3rd trimester)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+452</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+22</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lactation (0-6 months)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+600</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">530</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lactation (6-12 months)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+520</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">660</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infant</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">530</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">8.0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-12 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">660</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">10.5</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the treatment of Zollinger-Ellison syndrome?", "options": [{"label": "A", "text": "Cimetidine", "correct": false}, {"label": "B", "text": "Omeprazole", "correct": true}, {"label": "C", "text": "Misoprostol", "correct": false}, {"label": "D", "text": "Aluminium hydroxide", "correct": false}], "correct_answer": "B. Omeprazole", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Omeprazole&lt;br/&gt;\n&lt;br/&gt;\nE\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What can be done to address the concerns of a woman who is 3 months postpartum, regularly breastfeeding, and experiencing amenorrhea for the past 3 months, before considering surgery?", "options": [{"label": "A", "text": "Laparoscopic ovarian drilling", "correct": false}, {"label": "B", "text": "Contraceptives to be prescribed", "correct": false}, {"label": "C", "text": "Pulsatile GnRH for ovarian stimulation", "correct": false}, {"label": "D", "text": "Reassure", "correct": true}], "correct_answer": "D. Reassure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following agents is not used in the management of bronchial asthma?", "options": [{"label": "A", "text": "Phosphodiesterase inhibitors", "correct": false}, {"label": "B", "text": "Steroids", "correct": false}, {"label": "C", "text": "Beta-agonist", "correct": false}, {"label": "D", "text": "Cholinergic drugs", "correct": true}], "correct_answer": "D. Cholinergic drugs", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\"&gt;Cholinergic&lt;/span&gt; drugs&lt;br/&gt;\n&lt;br/&gt;\nExplanation: </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs used in <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Short-acting beta-agonists (SABAs) </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Albuterol (Salbutamol), Levalbuterol</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates beta-2 <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> receptors, causing bronchial smooth muscle relaxation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute relief of <span class=\"customMeta\" data-dictid=\"9bde62b1091692777183cd433d9d47\">bronchospasm</span> in <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> attacks (rescue medication).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Long-acting beta-agonists (LABAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Salmeterol, Formoterol</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of beta-2 receptors for bronchodilation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance therapy (always used with ICS).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anticholinergics (Short-acting)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipratropium</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors, reducing bronchoconstriction.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Alternative or <span class=\"customMeta\" data-dictid=\"8fabe131a916927771802a448a329c\">additive</span> for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> asthma, especially with SABAs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inhaled Corticosteroids (ICS) (Option B)</strong><br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Beclomethasone, Budesonide, Fluticasone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduces <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and prevents exacerbations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First-line maintenance therapy in persistent asthma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Leukotriene <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Antagonists (LTRAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Montelukast, Zafirlukast</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"5a4fd169911692777191c1cb27b0d7\">leukotriene</span> receptors, reducing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and bronchoconstriction.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance therapy, especially in mild <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> or aspirin-induced asthma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mast Cell Stabilizers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sodium Cromoglycate, Nedocromil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cell degranulation, reducing <span class=\"customMeta\" data-dictid=\"a993f205b0169277719284faad4c87\">mediator</span> release.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preventive therapy for mild persistent <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> or exercise-induced asthma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Biologics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Omalizumab</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Binds to IgE, preventing its interaction with receptors on <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate to severe <span class=\"customMeta\" data-dictid=\"6ca07f1f771692777181a8a66497a2\">allergic asthma</span> uncontrolled with <span class=\"customMeta\" data-dictid=\"e2c420c53d1692777189e40c773793\">ICS</span> and LABAs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Methylxanthines</strong></p>\n<p><strong>(Option A)</strong><br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Theophylline, Aminophylline</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-selective <span class=\"customMeta\" data-dictid=\"646159048c1692777195054877afc9\">phosphodiesterase</span> <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> leads to <span class=\"customMeta\" data-dictid=\"075923f4c01692777183a26fd689e3\">bronchodilation</span> and anti-inflammatory effects.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Add-on therapy in severe or difficult-to-control asthma.</p>\n<p>Most commonly used in COPD rather than asthma.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pharmacodynamics deals with?", "options": [{"label": "A", "text": "Mode of excretion of drug", "correct": false}, {"label": "B", "text": "Mechanism of action of a drug", "correct": true}, {"label": "C", "text": "Transport of drugs across the biological membrane", "correct": false}, {"label": "D", "text": "Latency of onset", "correct": false}], "correct_answer": "B. Mechanism of action of a drug", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Mechanism of action of a drug\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of pelvis shown in the image below.", "options": [{"label": "A", "text": "Gynecoid pelvis", "correct": false}, {"label": "B", "text": "Anthropoid pelvis", "correct": true}, {"label": "C", "text": "Android pelvis", "correct": false}, {"label": "D", "text": "Platypelloid pelvis", "correct": false}], "correct_answer": "B. Anthropoid pelvis", "question_images": ["https://image.prepladder.com/content/ElRAWW2gZlf2JW7CjnN01748069649.png"], "explanation_images": ["https://image.prepladder.com/content/jYpDc6jVdC3xsLrVWv4G1747030428.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gynecoid</strong></p>\n<p style=\"text-align:center\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Android</strong></p>\n<p style=\"text-align:center\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anthropoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Platypelloid</strong></p>\n<p style=\"text-align:center\"><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Round or slightly oval</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heart-shaped</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oval (anteroposterior)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flattened <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> (transverse)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common (~50%)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">~20%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">~25%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Rare (~5%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transversely <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> inlet</li>\n<li>Broad, shallow sacrum</li>\n<li>Blunt, widely spaced <span class=\"customMeta\" data-dictid=\"634b843bb616927771902f143267c0\">ischial</span> spines</li>\n<li>Wide <span class=\"customMeta\" data-dictid=\"960b80125b1692777199739a1db8a7\">subpubic</span> angle (&gt;90°)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Triangular or heart-shaped <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> inlet</li>\n<li>Flat, forward-inclined sacrum</li>\n<li>Prominent, closely spaced <span class=\"customMeta\" data-dictid=\"634b843bb616927771902f143267c0\">ischial</span> spines</li>\n<li>Narrow <span class=\"customMeta\" data-dictid=\"960b80125b1692777199739a1db8a7\">subpubic</span> angle (&lt;70°)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oval <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"42380fc2fb169277719066eff35739\">inlet</span> (anteroposterior &gt; transverse)</li>\n<li>Long, narrow sacrum</li>\n<li>Less prominent, widely spaced <span class=\"customMeta\" data-dictid=\"634b843bb616927771902f143267c0\">ischial</span> spines</li>\n<li>Narrow <span class=\"customMeta\" data-dictid=\"960b80125b1692777199739a1db8a7\">subpubic</span> angle (~70°)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wide, flat <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"42380fc2fb169277719066eff35739\">inlet</span> (transverse &gt; anteroposterior)</li>\n<li>Short, flat sacrum</li>\n<li>Blunt, widely spaced <span class=\"customMeta\" data-dictid=\"634b843bb616927771902f143267c0\">ischial</span> spines</li>\n<li>Wide <span class=\"customMeta\" data-dictid=\"960b80125b1692777199739a1db8a7\">subpubic</span> angle (&gt;90°)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obstetric Significance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ideal for <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> delivery due to spacious <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> and <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> dimensions</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased risk of obstructed labor</li>\n<li>Associated with deep <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> arrest</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Favors occipito-posterior <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> positions</li>\n<li>Vaginal delivery usually possible</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Delayed engagement of the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head</li>\n<li>Higher likelihood of <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">cesarean</span> delivery</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Beta-blockers should be avoided in all except.", "options": [{"label": "A", "text": "Asthma", "correct": false}, {"label": "B", "text": "Glaucoma", "correct": true}, {"label": "C", "text": "Bradycardia", "correct": false}, {"label": "D", "text": "Hypothyroidism", "correct": false}], "correct_answer": "B. Glaucoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Glaucoma&lt;br/&gt;\n&lt;br/&gt;\nExplanation:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of beta-blocker </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-selective beta-blocker </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Propranolol, nadolol</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypertension</li>\n<li>Angina</li>\n<li>Arrhythmias</li>\n<li>Migraine prophylaxis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Beta-1-selective blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metoprolol, Atenolol</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypertension</li>\n<li>Heart failure</li>\n<li>Arrhythmias</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Beta-1-with Alpha-1 blockade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carvedilol, Labetalol</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypertension</li>\n<li>Heart failure</li>\n<li>Post-MI</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects of beta-blocker </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiac</strong> side effects</p>\n<ul>\n<li>Precipitation of an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> MI.</li>\n<li>Sinus <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> and heart block. <strong> (Option C)</strong></li>\n<li>Heart failure may exacerbate symptoms in patients with <span class=\"customMeta\" data-dictid=\"da8747dcd51692777185e1ed0554cc\">decompensated</span> <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> or preexisting myocardial dysfunction.</li>\n</ul>\n<p><strong>Extracardiac</strong> side effects</p>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> resistance; hence, it is contraindicated in patients with <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> due to bronchospasm.<strong> </strong><strong>(Option A)</strong></li>\n<li>Exacerbation of <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease and worsen <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">claudication</span> and <span class=\"customMeta\" data-dictid=\"eba5ba77ec169277719688fab52fb0\">precipitate</span> Raynaud's disease.</li>\n<li>In Hypoglycemia, Beta-blockers mask the signs seen in a <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">hypoglycemic</span> patient, such as tachycardia.</li>\n<li>Hyperkalemia</li>\n<li>Depression, fatigue, and sexual <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> such as <span class=\"customMeta\" data-dictid=\"5cc2a2112e16927771874c5d97065a\">erectile</span> dysfunction.</li>\n<li>Weight gain</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presented with pain and redness in the great toe. The serum uric acid level is 9.4mg/dl. The physician prescribed a drug for the treatment. Which of the following enzyme is likely to be inhibited by this drug?", "options": [{"label": "A", "text": "Phosphoribosyl transferase", "correct": false}, {"label": "B", "text": "Thymidylate synthase", "correct": false}, {"label": "C", "text": "Xanthine oxidase", "correct": true}, {"label": "D", "text": "Dihydrofolate reductase", "correct": false}], "correct_answer": "C. Xanthine oxidase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A new drug is introduced into the market after which phase of the clinical trials?", "options": [{"label": "A", "text": "Phase I", "correct": false}, {"label": "B", "text": "Phase II", "correct": false}, {"label": "C", "text": "Phase III", "correct": true}, {"label": "D", "text": "Phase IV", "correct": false}], "correct_answer": "C. Phase III", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical trials </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phase 0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Design: An open-label trial</strong></li>\n<li><strong>Purpose:</strong>\n<ul>\n<li><strong>Check the target binding of a drug</strong></li>\n<li><strong>Check the <span class=\"customMeta\" data-dictid=\"a8683fba3b1692777195731bac4131\">pharmacokinetics</span> of the drug</strong></li>\n</ul>\n</li>\n<li><strong>Called a micro-dosing trial (100 micrograms dose)</strong></li>\n<li><strong>Non-mandatory clinical trial</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phase I</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Design: An open-label trial</strong></li>\n<li><strong>Purpose:</strong>\n<ul>\n<li><strong>Evaluate drug safety- the most important</strong></li>\n<li><strong>Evaluate MTD (maximum tolerable dose), <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose, and drug half-life.</strong></li>\n<li><strong>Evaluate drug <span class=\"customMeta\" data-dictid=\"a8683fba3b1692777195731bac4131\">pharmacokinetics</span> (absorption, distribution, <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> and excretion)</strong></li>\n</ul>\n</li>\n<li><strong>Called the first human trial</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phase II</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Design: Randomized <span class=\"customMeta\" data-dictid=\"df216bc99216927771841f3321f8cb\">clinical trial</span> (RCT)</strong></li>\n<li><strong>Purpose:</strong>\n<ul>\n<li><strong>Explore drug efficacy</strong></li>\n</ul>\n</li>\n<li><strong>Called a <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> exploratory trial or proof of concept trial</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phase III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Design: Double-blinded RCT</strong></li>\n<li><strong>Purpose:</strong>\n<ul>\n<li><strong>Find the <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> drug dose</strong></li>\n<li><strong>Confirm efficacy</strong></li>\n<li><strong>Safety is priority</strong></li>\n</ul>\n</li>\n<li><strong>Called a <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> confirmatory trial</strong></li>\n<li><strong>Called multi-site trial (done on a <span class=\"customMeta\" data-dictid=\"bbe1b94c491692777188fe4f85b1ce\">heterogeneous</span> population)</strong></li>\n<li><strong>Drugs get market approval</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phase IV</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Design: Open-label</li>\n<li>Purpose:\n\t\t\t\t<ul>\n<li>Find hidden/missed/rare adverse effects.</li>\n<li>Evaluate compliance: <strong>long-term side effects</strong></li>\n<li><strong>Drug interactions</strong></li>\n<li>Food interactions</li>\n</ul>\n</li>\n<li>Called post-marketing surveillance</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of dicrotic notch?", "options": [{"label": "A", "text": "Passive filling of blood in ventricles", "correct": false}, {"label": "B", "text": "Rapid ejection phase", "correct": false}, {"label": "C", "text": "Closure of semilunar valves", "correct": true}, {"label": "D", "text": "Isovolumic contraction", "correct": false}], "correct_answer": "C. Closure of semilunar valves", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:560px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Event</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Upstroke (Systolic Rise)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventricular <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> increases aortic pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systolic Peak</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maximum arterial pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dicrotic Notch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Semilunar <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> and <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> backflow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diastolic Decay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gradual pressure decrease as blood moves into periphery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are lipotropic factors except?", "options": [{"label": "A", "text": "Choline", "correct": false}, {"label": "B", "text": "Lecithine", "correct": false}, {"label": "C", "text": "Arginine", "correct": true}, {"label": "D", "text": "Methionine", "correct": false}], "correct_answer": "C. Arginine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a selective estrogen receptor modulator?", "options": [{"label": "A", "text": "Estrogen", "correct": false}, {"label": "B", "text": "Metformin", "correct": false}, {"label": "C", "text": "Tamoxifen", "correct": true}, {"label": "D", "text": "Adriamycin", "correct": false}], "correct_answer": "C. Tamoxifen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tamoxifen</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Estrogen <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> (ER) Antagonist</p>\n<p> ↓</p>\n<p>Binds to ER</p>\n<p> ↓</p>\n<p>Tissue-specific effects such as :</p>\n<ul>\n<li>Antagonist in breast tissue (prevents <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> binding).</li>\n<li>Agonist in bone and <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> tissues (estrogen-like effects)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drug of choice for <strong>ER-positive breast cancer.</strong></li>\n<li>Decrease the risk of <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> breast cancer.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increased risk of endometrial cancer.</li>\n<li>Thromboembolism</li>\n<li>Hot flashes</li>\n<li>Depression</li>\n<li>Hepatotoxicity</li>\n<li>Cataracts.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug Interactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It should not be combined with <span class=\"customMeta\" data-dictid=\"17dda67959169277720303cc6f5bc1\">fluoxetine</span> and other SSRIs.</li>\n<li>SSRIs <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> the CYP2D6 enzyme, essential for converting tamoxifen into its active form, endoxifen.</li>\n<li>This interaction may lower endoxifen levels, diminishing tamoxifen's effectiveness against <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> receptor-positive breast cancer.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What do chaperones assist in?", "options": [{"label": "A", "text": "Ubiquitinization of proteins", "correct": false}, {"label": "B", "text": "Protein modification", "correct": false}, {"label": "C", "text": "Protein folding", "correct": true}, {"label": "D", "text": "Protein cleavage", "correct": false}], "correct_answer": "C. Protein folding", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is correct regarding Isovolumic relaxation?", "options": [{"label": "A", "text": "AV valves are closed", "correct": true}, {"label": "B", "text": "Corresponds to QT interval", "correct": false}, {"label": "C", "text": "‘C' wave of JVP", "correct": false}, {"label": "D", "text": "Semilunar valves open", "correct": false}], "correct_answer": "A. AV valves are closed", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mSd0Fo3t39giUXSiuMJ41747031274.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>AV Valves</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Semilunar Valves</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Event</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Isovolumic Contraction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventricles contract but no ejection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Ejection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood ejected into <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> &amp; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Isovolumic Relaxation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventricles relax, no <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> yet</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Filling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood flows into ventricles</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which monoclonal antibody is used in cancer treatment?", "options": [{"label": "A", "text": "Omalizumab", "correct": false}, {"label": "B", "text": "Denosumab", "correct": false}, {"label": "C", "text": "Rituximab", "correct": true}, {"label": "D", "text": "Methotrexate", "correct": false}], "correct_answer": "C. Rituximab", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rituximab</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A chimeric murine/human <span class=\"customMeta\" data-dictid=\"b2b82438d6169277719287eb450079\">monoclonal</span> IgG1 <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> targets the CD20 B-cell surface antigen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upon binding to CD20, it induces B-cell <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> through two main mechanisms:</p>\n<ul>\n<li><strong>Complement-Dependent Cytotoxicity (CDC) and </strong></li>\n<li><strong>Antibody-Dependent Cellular Cytotoxicity (ADCC).</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CD-20 positive B-cell non-Hodgkin's lymphoma</li>\n<li>Chronic lymphocytic leukemia</li>\n<li>Rheumatoid arthritis</li>\n<li>Pemphigus vulavaris</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pharmacokinetics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Half-life of 22 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infusion reaction - fever, <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> and joint pain</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections</li>\n<li>Steven johnson syndrome</li>\n<li>Thrombocytopenia</li>\n<li>HBV reactivation</li>\n<li>Tumor <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> syndrome</li>\n<li>Cytokine release syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Note </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pretreatment with antihistamines, antipyretics and glucocorticoids reduces the risk of <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reactions</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "On centrifugation of a cell, LDH will get deposited in:", "options": [{"label": "A", "text": "Mitochondria", "correct": false}, {"label": "B", "text": "Lysosome", "correct": false}, {"label": "C", "text": "Cytoplasm", "correct": true}, {"label": "D", "text": "Golgi complex", "correct": false}], "correct_answer": "C. Cytoplasm", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Nitrogenous waste is excreted from the body in the form of?", "options": [{"label": "A", "text": "Urea", "correct": true}, {"label": "B", "text": "Nitric oxide", "correct": false}, {"label": "C", "text": "Ammonia", "correct": false}, {"label": "D", "text": "Glutamine", "correct": false}], "correct_answer": "A. Urea", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old male presents with complaints of a weak urinary stream and frequent urination in small amounts and is on prazosin. He also mentions that he frequently feels light-headed and has low blood pressure. Which of the following alpha-blockers would you prefer to give him?", "options": [{"label": "A", "text": "Alfuzosin", "correct": false}, {"label": "B", "text": "Terazosin", "correct": false}, {"label": "C", "text": "Tamsulosin", "correct": true}, {"label": "D", "text": "Doxazosin", "correct": false}], "correct_answer": "C. Tamsulosin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Tamsulosin&lt;br/&gt;\nExplanation:</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types</strong></p>\n</td>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Alpha blockers </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-competitive + <span class=\"customMeta\" data-dictid=\"ee77d507701692777190bfcf47b497\">irreversible</span> type</strong></p>\n</td>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Phenoxybenzamine</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Competitive + <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> type</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p><strong>Non-<br/>\n\t\t\tselective</strong></p>\n</td>\n<td colspan=\"3\" rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Phentolamine</li>\n<li>Ergotamine</li>\n<li>Ergotoxine</li>\n<li>Chlorpromazine</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Alpha 1 selective</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha 1 a</strong></p>\n<ul>\n<li>Tamsulosin</li>\n<li>Silodosin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Internal urethral <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> and Iris</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ejaculation failure/retrograde ejaculation, miosis, increased <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> outflow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha 1 b</strong></p>\n<ul>\n<li>Alfuzosin</li>\n<li>Doxazosin</li>\n<li>Prazosin</li>\n<li>Terazosin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vascular Smooth muscle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vasodilatation, <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> tachycardia, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> GFR (thus leading to RAAS activation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha 2 selective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Yohimbine</li>\n<li>Idoxazon</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central nervous system</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Penile <span class=\"customMeta\" data-dictid=\"322d94cd5816927771872f3d8d132b\">erection</span> (used in depression with sexual dysfunction)</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable vitamin deficiency in a patient who displays symptoms of diarrhea, memory impairment, and a distinctive rash as described?", "options": [{"label": "A", "text": "Thiamine", "correct": false}, {"label": "B", "text": "Niacin", "correct": true}, {"label": "C", "text": "Cyanocobalamin", "correct": false}, {"label": "D", "text": "Ascorbic acid", "correct": false}], "correct_answer": "B. Niacin", "question_images": ["https://image.prepladder.com/content/mii1zLHMT50DyrlytsuK1747032840.png"], "explanation_images": ["https://image.prepladder.com/content/byqvPD2crpBBHuwimO1l1747032906.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Diagnosis of Gout is confirmed by which test?", "options": [{"label": "A", "text": "Serum uric acid level", "correct": false}, {"label": "B", "text": "Synovial fluid analysis", "correct": true}, {"label": "C", "text": "Urine uric acid levels", "correct": false}, {"label": "D", "text": "X-ray changes", "correct": false}], "correct_answer": "B. Synovial fluid analysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is not classified as a micromineral?", "options": [{"label": "A", "text": "Calcium", "correct": true}, {"label": "B", "text": "Selenium", "correct": false}, {"label": "C", "text": "lodine", "correct": false}, {"label": "D", "text": "Copper", "correct": false}], "correct_answer": "A. Calcium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Macrominerals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Microminerals (Trace elements)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Calcium <strong>(Option A)</strong></li>\n<li>Magnesium</li>\n<li>Phosphorus</li>\n<li>Sodium</li>\n<li>Potassium</li>\n<li>Chloride</li>\n<li>Sulfur</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Iron</li>\n<li>Iodine <strong>(Option C ruled out)</strong></li>\n<li>Copper <strong>(Option D ruled out)</strong></li>\n<li>Manganese</li>\n<li>Zinc</li>\n<li>Molybdenum</li>\n<li>Selenium <strong>(Option B ruled out)</strong></li>\n<li>Fluoride</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identifying finding seen in TB knee is", "options": [{"label": "A", "text": "Reduction of joint space", "correct": true}, {"label": "B", "text": "Increase in joint space", "correct": false}, {"label": "C", "text": "Degeneration of cartilage", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Reduction of joint space", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 13-year-old with acute flaccid paralysis, the pediatric resident orders an RT-PCR on a CSF sample to identify the causative virus. Which of the following described the enzyme correctly?", "options": [{"label": "A", "text": "DNA-dependent RNA polymerase", "correct": false}, {"label": "B", "text": "RNA-dependent DNA polymerase", "correct": false}, {"label": "C", "text": "DNA-dependent DNA polymerase", "correct": false}, {"label": "D", "text": "RNA-dependent RNA polymerase", "correct": true}], "correct_answer": "D. RNA-dependent RNA polymerase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child complaining of pain and swelling is suspected with supracondylar fracture of right hand (Undisplaced). X-ray of right elbow was not significant. What is the next best step in this case?", "options": [{"label": "A", "text": "Compare with X-ray of left hand", "correct": false}, {"label": "B", "text": "Immobilisation and above the elbow plaster slab (90 degree flexion)", "correct": true}, {"label": "C", "text": "Closed reduction with K wire fixation Cast", "correct": false}, {"label": "D", "text": "Cast", "correct": false}], "correct_answer": "B. Immobilisation and above the elbow plaster slab (90 degree flexion)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 39-year-old male presents to the clinic for a routine checkup. Except for the mild generalized weakness, he does not have any symptoms. On assessment following findings are noted. Which of the following is the most likely cause of the above findings? Parameters Values ALP Normal Calcium High Phosphate High PTH Normal", "options": [{"label": "A", "text": "Vitamin D toxicity", "correct": true}, {"label": "B", "text": "Hyperparathyroidism", "correct": false}, {"label": "C", "text": "Osteoporosis", "correct": false}, {"label": "D", "text": "Osteomalacia", "correct": false}], "correct_answer": "A. Vitamin D toxicity", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:574px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vitamin D Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hyperparathyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excessive <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> or production of Vitamin D.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Overactivity or <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> glands.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vitamin D Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or decreased (primary) / variable (secondary)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid</strong></p>\n<p><strong>Hormone (PTH)</strong></p>\n<p><strong>Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or suppressed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcium Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated (hypercalcemia)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased (primary) / Normal or slightly increased (secondary)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phosphate</strong></p>\n<p><strong>Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated (hyperphosphatemia)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generalized weakness, fatigue, nausea, vomiting, constipation, confusion, excessive thirst, frequent urination.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fatigue, weakness, bone pain, <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> stones, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort, psychiatric symptoms.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The biochemical form of amyloid in hemodialysis-associated amyloidosis is:", "options": [{"label": "A", "text": "AL", "correct": false}, {"label": "B", "text": "AA", "correct": false}, {"label": "C", "text": "Aß2m", "correct": true}, {"label": "D", "text": "ATTR", "correct": false}], "correct_answer": "C. Aß2m", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Type of Amyloidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Responsible Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Organs Affected</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primary (AL) </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Monoclonal light chains</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Heart, kidneys, liver, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> and <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nervous system, GI tract</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Senile <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> (ATTR)</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Wild-type transthyretin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Heart</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hereditary (ATTR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Mutant transthyretin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Heart</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hereditary (AApoA1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Apolipoprotein A1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Heart, kidneys, liver, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> nervous system, skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hereditary (AFib)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Mutant <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">fibrinogen</span> A alpha</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Kidneys, liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hereditary (ALys)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lysozyme</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Kidneys, liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Isolated atrial (AANF)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Atrial <span class=\"customMeta\" data-dictid=\"bd16654d3e169277719371077d7a8c\">natriuretic</span> factor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Heart</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Secondary (AA)</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Kidneys, GI tract, heart</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Dialysis-related (Aβ2M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>β2-microglobulin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Osteoarticular tissue, GI tract, <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> system</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Finnish-type (AGel)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gelsolin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lattice <span class=\"customMeta\" data-dictid=\"04568e3d19169277718672d9da94fd\">dystrophy</span> of cornea, corneal neuropathy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Three point bony relationship has a diagnostic value in:", "options": [{"label": "A", "text": "Monteggia fracture", "correct": true}, {"label": "B", "text": "Elbow fracture", "correct": false}, {"label": "C", "text": "Colles fracture", "correct": false}, {"label": "D", "text": "Galeazzi fracture", "correct": false}], "correct_answer": "A. Monteggia fracture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cBOdLduKTyutxDrsTA7A1747033505.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 year old man fell down while running. He tried to sustain the fall on his elbow resulting in the injury shown below.What will be the appropriate management of the following fracture?", "options": [{"label": "A", "text": "Above elbow plaster slab", "correct": false}, {"label": "B", "text": "Below elbow plaster slab", "correct": false}, {"label": "C", "text": "Close reduction with Tension band wiring", "correct": false}, {"label": "D", "text": "Immobilization of elbow, Above elbow plaster slab with 30 degree flexion", "correct": true}], "correct_answer": "D. Immobilization of elbow, Above elbow plaster slab with 30 degree flexion", "question_images": ["https://image.prepladder.com/content/ynInshJd6U435z1cOtCw1748153548.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is contraindicated in patients with acute intermittent porphyria?", "options": [{"label": "A", "text": "Thiopentone", "correct": true}, {"label": "B", "text": "Propofol", "correct": false}, {"label": "C", "text": "Etomidate", "correct": false}, {"label": "D", "text": "Ketamine", "correct": false}], "correct_answer": "A. Thiopentone", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The diagnosis of the given image", "options": [{"label": "A", "text": "Scapho lunate instability", "correct": true}, {"label": "B", "text": "Lunate injury", "correct": false}, {"label": "C", "text": "Distal radio ulnar joint instability", "correct": false}, {"label": "D", "text": "Wrist dislocation", "correct": false}], "correct_answer": "A. Scapho lunate instability", "question_images": ["https://image.prepladder.com/content/wmuJZw658GpaTI41zxPA1747033741.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Football player gets blow to the outer knee during match.Which structure is most commonly associated with this type of injury? Lateral lemniscus", "options": [{"label": "A", "text": "Anterior cruciate ligament", "correct": false}, {"label": "B", "text": "Medial collateral ligament", "correct": true}, {"label": "C", "text": "Posterior Cruciate ligament", "correct": false}, {"label": "D", "text": "Lateral lemniscus", "correct": false}], "correct_answer": "B. Medial collateral ligament", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Avascular necrosis of the femur head is due to which of the following artery?", "options": [{"label": "A", "text": "Medial circumflex femoral artery", "correct": true}, {"label": "B", "text": "Lateral circumflex femoral artery", "correct": false}, {"label": "C", "text": "Obturator artery", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Medial circumflex femoral artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lT6AkZ1laTMnjPaB2T9J1747033922.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is this device called?", "options": [{"label": "A", "text": "Armored endotracheal tube", "correct": false}, {"label": "B", "text": "Double-lumen endotracheal tube", "correct": true}, {"label": "C", "text": "Ring-adair-elwin type", "correct": false}, {"label": "D", "text": "Endotracheal tubes equipped with bronchial blockers", "correct": false}], "correct_answer": "B. Double-lumen endotracheal tube", "question_images": ["https://image.prepladder.com/content/0UbX2VqRRCvDtAC1N0wu1747979746.png"], "explanation_images": ["https://image.prepladder.com/content/TOHvNfiDY902Uqdfijd21747979907.png", "https://image.prepladder.com/content/41rIm17K2AAALsVP8c8q1747979859.png", "https://image.prepladder.com/content/T1eDAOLj6ugyix9oBrFk1747979829.png", "https://image.prepladder.com/content/WF7zOkjyqsFoBOfnW21y1747979845.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 40-year-old male patient who was admitted to the ICU three days ago due to breathing difficulty and is currently experiencing restlessness and widespread tremors? The patient has reported seeing insects crawling on his bed and body and has had one seizure, which was successfully managed with lorazepam. Further investigation reveals that the patient is a chronic alcoholic.", "options": [{"label": "A", "text": "ICU psychosis", "correct": false}, {"label": "B", "text": "Alcohol intoxication", "correct": false}, {"label": "C", "text": "Wernicke-Korsakoff psychosis", "correct": false}, {"label": "D", "text": "Delirium tremens", "correct": true}], "correct_answer": "D. Delirium tremens", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"74ef5626ab16927771855274381e00\"&gt;Delirium&lt;/span&gt; tremens.</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features of Alcohol Withdrawal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Onset after last drink</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mild withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild anxiety</li>\n<li>Tremulousness</li>\n<li>Nausea</li>\n<li>Headache</li>\n<li>Palpitations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6-8 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderate (Alcoholic hallucinosis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visual, auditory, or <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> hallucinations</li>\n<li>Intact orientation</li>\n<li>Normal vital signs</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8- 12 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe (Withdrawal seizures)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> seizures</li>\n<li>Usually brief and self-limited</li>\n<li>Also known as rum fits</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>12-24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Life threatening (Delirium tremens)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe agitation</li>\n<li>Confusion and disorientation</li>\n<li>Hallucinations (often visual)</li>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"2e780c7fd416927771895c61217c12\">hyperactivity</span> (tachycardia, hypertension, fever)</li>\n<li>Profound sweating</li>\n<li>Tremors</li>\n<li>Insomnia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within 72 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following condition", "options": [{"label": "A", "text": "Osteosarcoma", "correct": true}, {"label": "B", "text": "Ewing sarcoma", "correct": false}, {"label": "C", "text": "Osteiod Osteoma", "correct": false}, {"label": "D", "text": "GCT", "correct": false}], "correct_answer": "A. Osteosarcoma", "question_images": ["https://image.prepladder.com/content/7ym7RI1GJN0Ks04TfND31747033978.png"], "explanation_images": ["https://image.prepladder.com/content/6mNrr1XPK1amUoiDPhLn1748153681.png", "https://image.prepladder.com/content/vDZmEudyV8MsgkgIcxXL1748153714.png", "https://image.prepladder.com/content/YKjlej3zXmjKRdb9PSrX1748153753.png", "https://image.prepladder.com/content/kybHSZ945AvKGVZDJu6I1748153762.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given instrument?", "options": [{"label": "A", "text": "Guedel airway", "correct": false}, {"label": "B", "text": "Laryngeal mask airway", "correct": true}, {"label": "C", "text": "Endotracheal tube", "correct": false}, {"label": "D", "text": "Nasogastric tube", "correct": false}], "correct_answer": "B. Laryngeal mask airway", "question_images": ["https://image.prepladder.com/content/LpnMYex1RlLBIcMWJtUc1747033990.png"], "explanation_images": ["https://image.prepladder.com/content/k44jc59ZVNJ9qef5zLOu1747979956.png", "https://image.prepladder.com/content/IrCFT2rO308eRneSBJsg1747034065.png", "https://image.prepladder.com/content/9mTN1EGEbIngmvcTc1kd1747034078.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Postmenopausal woman slipped and fell down on an outstretched hand in the washroom. X-ray of her distal forearm is given below. Diagnose the following condition?", "options": [{"label": "A", "text": "Colle's Fracture", "correct": true}, {"label": "B", "text": "Monteggia fracture", "correct": false}, {"label": "C", "text": "Smith Fracture", "correct": false}, {"label": "D", "text": "Galeazzi fracture", "correct": false}], "correct_answer": "A. Colle's Fracture", "question_images": ["https://image.prepladder.com/content/qoSt59cu2nMYiOHpMXN81748153842.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fracture Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sites Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Special History</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colles</strong></p>\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dorsal <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal radius</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Falling on an outstretched hand</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Smith's</strong></p>\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Volar <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal radius</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Falling on a flexed wrist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monteggia</strong></p>\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head dislocation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal ulna, <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Direct blow to the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> or forearm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Galeazzi</strong></p>\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint dislocation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal radius, <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fall on an outstretched hand with an <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for a 35-year-old female patient presenting to the psychiatric outpatient department with symptoms of reduced sleep, excessive elation, and increased talkativeness lasting for one month? The patient is exhibiting disruptive behaviour by shouting at the nurses and is difficult to control. She also reports irritability and difficulty in staying focused. There is no known medical history for this patient.", "options": [{"label": "A", "text": "Lithium", "correct": false}, {"label": "B", "text": "Lorazepam", "correct": false}, {"label": "C", "text": "Carbamazepine", "correct": false}, {"label": "D", "text": "Haloperidol", "correct": true}], "correct_answer": "D. Haloperidol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the shown image", "options": [{"label": "A", "text": "Ankle knee stabilizer", "correct": false}, {"label": "B", "text": "Patella tendon bearing brace", "correct": true}, {"label": "C", "text": "Thomas splint", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Patella tendon bearing brace", "question_images": ["https://image.prepladder.com/content/uT6bVa8i4A9kN0VxjFQ01747034246.png"], "explanation_images": ["https://image.prepladder.com/content/jN0tLzHqKgncmsD6aG141748153857.png", "https://image.prepladder.com/content/pBYoDa8tWguUUsfWd5aR1747034272.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the needle shown in the picture?", "options": [{"label": "A", "text": "Whitacre needle", "correct": false}, {"label": "B", "text": "Sprotte needle", "correct": false}, {"label": "C", "text": "Tuohy needle", "correct": true}, {"label": "D", "text": "Quincke-Babcock needle", "correct": false}], "correct_answer": "C. Tuohy needle", "question_images": ["https://image.prepladder.com/content/CKiEL4afIRhfFoLDRDDM1747034214.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 21-year-old girl suspects that the college principal is making a conspiracy against her and is planning to fail her in the upcoming exam. She feels that other teachers have also joined the conspiracy and students are helping them too. What is the diagnosis?", "options": [{"label": "A", "text": "Thought insertion", "correct": false}, {"label": "B", "text": "Delusion of control", "correct": false}, {"label": "C", "text": "Delusion of persecution", "correct": true}, {"label": "D", "text": "Delusion of reference", "correct": false}], "correct_answer": "C. Delusion of persecution", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"a57e3265851692777185e6f4f5b8bc\"&gt;Delusion&lt;/span&gt; of persecution</p>\n<p><strong>References:</strong></p>\n<ul><li>↳ Types of delusions</li><li>↳ Types of delusions</li><li>↳ Types of delusions</li><li>↳ Types of delusions</li><li>↳ Delusion Description</li><li>↳ Delusion</li><li>↳ Delusion</li><li>↳ Delusion</li><li>↳ Description</li><li>↳ Description</li><li>↳ Description</li><li>↳ Delusion of Persecution Belief of being harassed, persecuted, or mistreated by others. Most common type of delusion. (Option C)</li><li>↳ Delusion of Persecution</li><li>↳ Delusion of Persecution</li><li>↳ Delusion of Persecution</li><li>↳ Belief of being harassed, persecuted, or mistreated by others. Most common type of delusion. (Option C)</li><li>↳ Belief of being harassed, persecuted, or mistreated by others. Most common type of delusion. (Option C)</li><li>↳ Belief of being harassed, persecuted, or mistreated by others.</li><li>↳ Most common type of delusion. (Option C)</li><li>↳ Most common type</li><li>↳ (Option C)</li><li>↳ Delusion of Reference The belief that surrounding people are talking about them or spying on them. It is a form of delusion of persecution. (Option D ruled out)</li><li>↳ Delusion of Reference</li><li>↳ Delusion of Reference</li><li>↳ Delusion of Reference</li><li>↳ The belief that surrounding people are talking about them or spying on them. It is a form of delusion of persecution. (Option D ruled out)</li><li>↳ The belief that surrounding people are talking about them or spying on them. It is a form of delusion of persecution. (Option D ruled out)</li><li>↳ The belief that surrounding people are talking about them or spying on them. It is a form of delusion of persecution. (Option D ruled out)</li><li>↳ (Option D ruled out)</li><li>↳ Delusion of Grandiosity Exaggerated belief in one's own importance, power, or identity. Belief in being a significant figure who can help others or may claim to hear the voices of God, which reinforces their belief in their elevated status. Seen in mania (as Mood-congruent delusion)</li><li>↳ Delusion of Grandiosity</li><li>↳ Delusion of Grandiosity</li><li>↳ Delusion of Grandiosity</li><li>↳ Exaggerated belief in one's own importance, power, or identity. Belief in being a significant figure who can help others or may claim to hear the voices of God, which reinforces their belief in their elevated status. Seen in mania (as Mood-congruent delusion)</li><li>↳ Exaggerated belief in one's own importance, power, or identity. Belief in being a significant figure who can help others or may claim to hear the voices of God, which reinforces their belief in their elevated status. Seen in mania (as Mood-congruent delusion)</li><li>↳ Exaggerated belief in one's own importance, power, or identity.</li><li>↳ Belief in being a significant figure who can help others or may claim to hear the voices of God, which reinforces their belief in their elevated status.</li><li>↳ Seen in mania (as Mood-congruent delusion)</li><li>↳ mania</li><li>↳ Mood-congruent</li><li>↳ Nihilistic Delusion Belief that the body/part of body/world or everything related to it has ceased to exist. Also known as the delusion of negation. seen in depression (most commonly) as ( Mood-congruent delusion) Cotard syndrome: Patient with depression having delusions of nihilism (specifically related to parts of the body).</li><li>↳ Nihilistic Delusion</li><li>↳ Nihilistic Delusion</li><li>↳ Nihilistic Delusion</li><li>↳ Belief that the body/part of body/world or everything related to it has ceased to exist. Also known as the delusion of negation. seen in depression (most commonly) as ( Mood-congruent delusion) Cotard syndrome: Patient with depression having delusions of nihilism (specifically related to parts of the body).</li><li>↳ Belief that the body/part of body/world or everything related to it has ceased to exist. Also known as the delusion of negation. seen in depression (most commonly) as ( Mood-congruent delusion) Cotard syndrome: Patient with depression having delusions of nihilism (specifically related to parts of the body).</li><li>↳ Belief that the body/part of body/world or everything related to it has ceased to exist.</li><li>↳ Also known as the delusion of negation.</li><li>↳ seen in depression (most commonly) as ( Mood-congruent delusion)</li><li>↳ depression</li><li>↳ Mood-congruent</li><li>↳ Cotard syndrome: Patient with depression having delusions of nihilism (specifically related to parts of the body).</li><li>↳ Cotard syndrome:</li><li>↳ depression</li><li>↳ Delusion of guilt The patient firmly believes that he is a sinner, though not having committed any sin. Seen in depression (as Mood-congruent delusion)</li><li>↳ Delusion of guilt</li><li>↳ Delusion of guilt</li><li>↳ Delusion of guilt</li><li>↳ The patient firmly believes that he is a sinner, though not having committed any sin. Seen in depression (as Mood-congruent delusion)</li><li>↳ The patient firmly believes that he is a sinner, though not having committed any sin. Seen in depression (as Mood-congruent delusion)</li><li>↳ The patient firmly believes that he is a sinner, though not having committed any sin.</li><li>↳ Seen in depression (as Mood-congruent delusion)</li><li>↳ Mood-congruent</li><li>↳ Delusion of Poverty The patient is convinced that he is poor and in a state of destitution, although he is not.</li><li>↳ Delusion of Poverty</li><li>↳ Delusion of Poverty</li><li>↳ Delusion of Poverty</li><li>↳ The patient is convinced that he is poor and in a state of destitution, although he is not.</li><li>↳ The patient is convinced that he is poor and in a state of destitution, although he is not.</li><li>↳ The patient is convinced that he is poor and in a state of destitution, although he is not.</li><li>↳ Delusion of enormity The patient believes that their action can produce catastrophe. Eg, the patient refuses to urinate because he believes that it may flood the world.</li><li>↳ Delusion of enormity</li><li>↳ Delusion of enormity</li><li>↳ Delusion of enormity</li><li>↳ The patient believes that their action can produce catastrophe. Eg, the patient refuses to urinate because he believes that it may flood the world.</li><li>↳ The patient believes that their action can produce catastrophe. Eg, the patient refuses to urinate because he believes that it may flood the world.</li><li>↳ The patient believes that their action can produce catastrophe.</li><li>↳ Eg, the patient refuses to urinate because he believes that it may flood the world.</li><li>↳ Delusion of Infidelity The belief that one's partner is unfaithful. Associated factor: prolonged alcohol use Also known as Othello syndrome/Morbid jealousy</li><li>↳ Delusion of Infidelity</li><li>↳ Delusion of Infidelity</li><li>↳ Delusion of Infidelity</li><li>↳ The belief that one's partner is unfaithful. Associated factor: prolonged alcohol use Also known as Othello syndrome/Morbid jealousy</li><li>↳ The belief that one's partner is unfaithful. Associated factor: prolonged alcohol use Also known as Othello syndrome/Morbid jealousy</li><li>↳ The belief that one's partner is unfaithful.</li><li>↳ Associated factor: prolonged alcohol use</li><li>↳ alcohol use</li><li>↳ Also known as Othello syndrome/Morbid jealousy</li><li>↳ Othello syndrome/Morbid jealousy</li><li>↳ De clerambault’s syndrome/ Erotomania The patient (often a single woman ) believes that a person of higher status is in love with her. May be a feature of paranoid schizophrenia.</li><li>↳ De clerambault’s syndrome/ Erotomania</li><li>↳ De clerambault’s syndrome/ Erotomania</li><li>↳ De clerambault’s syndrome/ Erotomania</li><li>↳ The patient (often a single woman ) believes that a person of higher status is in love with her. May be a feature of paranoid schizophrenia.</li><li>↳ The patient (often a single woman ) believes that a person of higher status is in love with her. May be a feature of paranoid schizophrenia.</li><li>↳ The patient (often a single woman ) believes that a person of higher status is in love with her.</li><li>↳ single woman</li><li>↳ May be a feature of paranoid schizophrenia.</li><li>↳ Hypochondriacal delusion/Delusion of ill health Characteristically seen in depression, it may also be seen in schizophrenia.</li><li>↳ Hypochondriacal delusion/Delusion of ill health</li><li>↳ Hypochondriacal delusion/Delusion of ill health</li><li>↳ Hypochondriacal delusion/Delusion of ill health</li><li>↳ Characteristically seen in depression, it may also be seen in schizophrenia.</li><li>↳ Characteristically seen in depression, it may also be seen in schizophrenia.</li><li>↳ Characteristically seen in depression, it may also be seen in schizophrenia.</li><li>↳ Various forms of Hypochondriacal delusion:</li><li>↳ Various forms of Hypochondriacal delusion:</li><li>↳ Various forms of Hypochondriacal delusion:</li><li>↳ Various forms of Hypochondriacal delusion:</li><li>↳ Delusion of Infestation/ Parasitosis/ Ekbom syndrome: The patient falsely believes that he is infested with insects,he does not experience sensation. It affects both men and women equally and becomes more common with age. ‘Empty matchbox sign’ may be present (when the patient attempts to catch the insect to show it to the clinician). Delusional dysmorphophobia: The patient believes that his body/part of his body is deformed and wants it to be corrected. Delusional halitosis: The belief that the patient has a malodorous body odour.</li><li>↳ Delusion of Infestation/ Parasitosis/ Ekbom syndrome: The patient falsely believes that he is infested with insects,he does not experience sensation. It affects both men and women equally and becomes more common with age. ‘Empty matchbox sign’ may be present (when the patient attempts to catch the insect to show it to the clinician). Delusional dysmorphophobia: The patient believes that his body/part of his body is deformed and wants it to be corrected. Delusional halitosis: The belief that the patient has a malodorous body odour.</li><li>↳ Delusion of Infestation/ Parasitosis/ Ekbom syndrome:</li><li>↳ Delusion of Infestation/ Parasitosis/ Ekbom syndrome:</li><li>↳ The patient falsely believes that he is infested with insects,he does not experience sensation. It affects both men and women equally and becomes more common with age. ‘Empty matchbox sign’ may be present (when the patient attempts to catch the insect to show it to the clinician).</li><li>↳ The patient falsely believes that he is infested with insects,he does not experience sensation.</li><li>↳ It affects both men and women equally and becomes more common with age.</li><li>↳ ‘Empty matchbox sign’ may be present (when the patient attempts to catch the insect to show it to the clinician).</li><li>↳ ‘Empty matchbox sign’</li><li>↳ Delusional dysmorphophobia:</li><li>↳ Delusional dysmorphophobia:</li><li>↳ The patient believes that his body/part of his body is deformed and wants it to be corrected.</li><li>↳ The patient believes that his body/part of his body is deformed and wants it to be corrected.</li><li>↳ Delusional halitosis:</li><li>↳ Delusional halitosis:</li><li>↳ The belief that the patient has a malodorous body odour.</li><li>↳ The belief that the patient has a malodorous body odour.</li><li>↳ Incorrect Options:</li><li>↳ Incorrect Options:</li><li>↳ Thought insertion (Option A) is a type of delusion where a person believes that someone else is forcing thoughts into their mind. The individual may feel that their thoughts are not their own and are being controlled by an external force. This symptom is commonly associated with schizophrenia but can also occur in other medical and psychiatric conditions.</li><li>↳ Thought insertion</li><li>↳ (Option A)</li><li>↳ schizophrenia</li><li>↳ Delusion of control (Option B) is characterized by the belief that an external force or agency is controlling or manipulating one's thoughts, actions, or body. The individual may feel as though they are not in control of their own behaviour and are being compelled to act against their will. This symptom is often seen in schizophrenia.</li><li>↳ Delusion of control</li><li>↳ (Option B)</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of delusions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Delusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Delusion of Persecution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Belief of being harassed, persecuted, or mistreated by others.</li>\n<li><strong>Most common type</strong> of delusion. <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Delusion of Reference</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The belief that surrounding people are talking about them or spying on them. It is a <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"a57e3265851692777185e6f4f5b8bc\">delusion</span> of persecution. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Delusion of Grandiosity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Exaggerated belief in one's own importance, power, or identity.</li>\n<li>Belief in being a significant figure who can help others or may claim to hear the voices of God, which reinforces their belief in their elevated status.</li>\n<li>Seen in <strong>mania</strong> (as <strong>Mood-congruent </strong>delusion)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nihilistic Delusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Belief that the body/part of body/world or everything related to it has ceased to exist.</li>\n<li>Also known as the <span class=\"customMeta\" data-dictid=\"a57e3265851692777185e6f4f5b8bc\">delusion</span> of negation.</li>\n<li>seen in <strong>depression</strong> (most commonly) as (<strong>Mood-congruent </strong>delusion)</li>\n<li><strong>Cotard syndrome: </strong>Patient with <strong>depression</strong> having delusions of <span class=\"customMeta\" data-dictid=\"1def0e02971692777193bdc49ea7f7\">nihilism</span> (specifically related to parts of the body).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Delusion of guilt</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The patient firmly believes that he is a sinner, though not having committed any sin.</li>\n<li>Seen in depression (as <strong>Mood-congruent</strong> delusion)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Delusion of Poverty</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The patient is convinced that he is poor and in a state of destitution, although he is not.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Delusion of enormity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The patient believes that their action can produce catastrophe.</li>\n<li>Eg, the patient refuses to <span class=\"customMeta\" data-dictid=\"c0b5bbe709169277720177f8c58ad5\">urinate</span> because he believes that it may flood the world.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Delusion of Infidelity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The belief that one's partner is unfaithful.</li>\n<li>Associated factor: prolonged <strong>alcohol use</strong></li>\n<li>Also known as <strong>Othello syndrome/Morbid jealousy</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>De clerambault’s syndrome/ Erotomania</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The patient (often a<strong> single woman</strong>) believes that a person of higher status is in love with her.</li>\n<li>May be a feature of <span class=\"customMeta\" data-dictid=\"39a55021ff16927771946d220fe0db\">paranoid</span> schizophrenia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypochondriacal delusion/Delusion of ill health</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Characteristically seen in depression, it may also be seen in schizophrenia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Various forms of Hypochondriacal delusion:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Delusion of Infestation/ Parasitosis/ Ekbom syndrome:</strong></p>\n<ul>\n<li>The patient falsely believes that he is infested with insects,he does not experience sensation.</li>\n<li>It affects both <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> and women equally and becomes more common with age.</li>\n<li><strong>‘Empty matchbox sign’</strong> may be present (when the patient attempts to catch the insect to show it to the clinician).</li>\n</ul>\n<p><strong>Delusional dysmorphophobia:</strong></p>\n<ul>\n<li>The patient believes that his body/part of his body is deformed and wants it to be corrected.</li>\n</ul>\n<p><strong>Delusional halitosis: </strong></p>\n<ul>\n<li>The belief that the patient has a malodorous body odour.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which surgery should be avoided in a patient with a fibroma and moderate to severe cardiac disease?", "options": [{"label": "A", "text": "Laparoscopic hysterectomy", "correct": true}, {"label": "B", "text": "Abdominal hysterectomy", "correct": false}, {"label": "C", "text": "Total hysterectomy", "correct": false}, {"label": "D", "text": "Subtotal hysterectomy", "correct": false}], "correct_answer": "A. Laparoscopic hysterectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Preoperative assessment of oral cavity for endotracheal intubation in an adult is done by:", "options": [{"label": "A", "text": "Mallampatti score", "correct": true}, {"label": "B", "text": "Conmack lehane", "correct": false}, {"label": "C", "text": "ASA grading", "correct": false}, {"label": "D", "text": "AHA grading", "correct": false}], "correct_answer": "A. Mallampatti score", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The parents of a 13-year-old boy have sought the assistance of a child psychiatrist due to their concerns. They have observed that the child frequently engages in dishonesty both at home and in school, displays disruptive behaviour towards his teacher, often intimidates younger children, and has been caught stealing money multiple times. What is the probable diagnosis for this child?", "options": [{"label": "A", "text": "Oppositional defiant disorder", "correct": false}, {"label": "B", "text": "Conduct disorder", "correct": true}, {"label": "C", "text": "Antisocial personality disorder", "correct": false}, {"label": "D", "text": "Disruptive mood dysregulation", "correct": false}], "correct_answer": "B. Conduct disorder", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Conduct disorder.</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Oppositional Defiant Disorder (ODD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Conduct Disorder</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The persistent pattern of negativistic, defiant, disobedient, and hostile behaviour <strong>toward authority figures.</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A persistent pattern of behaviour involving aggression, violating others' rights, and disregarding social norms.</p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnostic Criteria (DSM-5)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Duration:</strong> ≥6 months.</p>\n</li>\n<li>\n<p><strong>Symptoms (≥4):</strong></p>\n<ul>\n<li>\n<p>Losing temper.</p>\n</li>\n<li>\n<p>Easily annoyed/sensitive.</p>\n</li>\n<li>\n<p>Angry/resentful.</p>\n</li>\n<li>\n<p>Argues with authority figures.</p>\n</li>\n<li>\n<p>Refuses requests/rules.</p>\n</li>\n<li>\n<p>Deliberately annoys others.</p>\n</li>\n<li>\n<p>Blames others for their own mistakes/behaviors.</p>\n</li>\n<li>\n<p>Spiteful/vindictive (at least 2x in 6 months).</p>\n</li>\n<li>\n<p>No severely aggressive or <span class=\"customMeta\" data-dictid=\"c5d4ec0a2816927771858299a89c5e\">delinquent</span> behaviours.</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Duration</strong>: ≥12 months, with 1 symptom present in the last 6 months.</p>\n</li>\n<li>\n<p><strong>Symptoms (≥3)</strong>:</p>\n<ul>\n<li>\n<p>Physical aggression or threats.</p>\n</li>\n<li>\n<p>Destruction of property.</p>\n</li>\n<li>\n<p>Deceitfulness or theft.</p>\n</li>\n<li>\n<p>Harming animals.</p>\n</li>\n<li>\n<p>Violation of rules (e.g., truancy, running away).</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types (DSM-5)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Angry/Irritable Mood:</strong> Frequent temper loss, persistent irritability.</p>\n</li>\n<li>\n<p><strong>Argumentative/Defiant Behavior:</strong> Argues, refuses to comply, blames others.</p>\n</li>\n<li>\n<p><strong>Vindictiveness:</strong> Spiteful/vindictive actions ≥2x in 6 months.</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Childhood-onset</strong>: Symptoms before age 10.</p>\n</li>\n<li>\n<p><strong>Adolescent-Onset</strong>: Symptoms after age 10.</p>\n</li>\n<li>\n<p><strong>Unspecified-Onset</strong>: Age of onset unknown</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Severity Specifiers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Mild:</strong> Symptoms in 1 setting.</p>\n</li>\n<li>\n<p><strong>Moderate:</strong> Symptoms in 2 settings.</p>\n</li>\n<li>\n<p><strong>Severe:</strong> Symptoms in ≥3 settings.</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Mild</strong>: Few conduct problems, minor harm.</p>\n</li>\n<li>\n<p><strong>Moderate</strong>: Intermediate symptoms.</p>\n</li>\n<li>\n<p><strong>Severe</strong>: Many symptoms, significant harm caused.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Family Interventions:</strong> Parent training in child management, reinforcing positive behaviour.</p>\n</li>\n<li>\n<p><strong>Cognitive Behavioral Therapy (CBT):</strong> Parents are taught to discourage the child's oppositional behaviour by not paying much attention to it.</p>\n</li>\n<li>\n<p><strong>Parenting Techniques:</strong> Focus on reducing harsh punishment and increasing positive interactions.</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Psychosocial Interventions</strong>: Early intervention, CBT, school-based programs.</p>\n</li>\n<li>\n<p><strong>Pharmacologic Interventions</strong>: Antipsychotics (risperidone, quetiapine), SSRIs for impulsivity/irritability, sodium valproate.</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the next course of action for a 31-year-old woman who recently went through a divorce and is currently experiencing symptoms such as palpitations, sweating, chest heaviness, and pain? She has had several similar episodes over the past few weeks, but her blood test results, ECG, and chest X-ray show no abnormalities.", "options": [{"label": "A", "text": "Admit for detailed investigations", "correct": false}, {"label": "B", "text": "Start counseling sessions", "correct": false}, {"label": "C", "text": "Use beta-blockers", "correct": false}, {"label": "D", "text": "Use benzodiazepines for symptom relief", "correct": true}], "correct_answer": "D. Use benzodiazepines for symptom relief", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female with a history of recurrent headaches presented for further evaluation. On further workup, haemoglobin and total WBC count were normal, while an elevated platelet count was seen. Bone marrow aspiration showed increased megakaryocytes and a JAK2 mutation. Which is the most likely diagnosis?", "options": [{"label": "A", "text": "Polycythemia vera", "correct": false}, {"label": "B", "text": "Essential thrombocytosis", "correct": true}, {"label": "C", "text": "Primary myelofibrosis", "correct": false}, {"label": "D", "text": "Chronic myelogenous leukaemia", "correct": false}], "correct_answer": "B. Essential thrombocytosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The colour of the nitrous oxide cylinder is?", "options": [{"label": "A", "text": "Blue", "correct": true}, {"label": "B", "text": "Blue body with white shoulder", "correct": false}, {"label": "C", "text": "White", "correct": false}, {"label": "D", "text": "Black", "correct": false}], "correct_answer": "A. Blue", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lxg1WseTtaBDmtcSKPPm1747034889.png", "https://image.prepladder.com/content/oB88Bp68h6cR86dHesYJ1747034897.png", "https://image.prepladder.com/content/oIxe2Nr7Sg5kwYUE7fxn1747034913.png", "https://image.prepladder.com/content/I30uT38baydSYRg0PxKy1747034925.png", "https://image.prepladder.com/content/rSphqriDlTcSMTnxP5xE1747034943.png", "https://image.prepladder.com/content/rXcCvuJCDGy6EZWrJhjk1747034956.png", "https://image.prepladder.com/content/Dld4F2o5cokZT9qd0Z0l1747034967.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cylinder color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>PIN Index system</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Air</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Black body with black &amp; white shoulder</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"419\" src=\"https://image.prepladder.com/content/lxg1WseTtaBDmtcSKPPm1747034889.png\" width=\"177\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>1,5</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oxygen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Black body with white shoulder</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"419\" src=\"https://image.prepladder.com/content/oB88Bp68h6cR86dHesYJ1747034897.png\" width=\"419\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>2,5</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N<sub>2</sub>O</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Blue</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"419\" src=\"https://image.prepladder.com/content/oIxe2Nr7Sg5kwYUE7fxn1747034913.png\" width=\"419\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>3,5</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carbon dioxide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Grey </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"419\" src=\"https://image.prepladder.com/content/I30uT38baydSYRg0PxKy1747034925.png\" width=\"419\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>1,6 (&gt; 7.5%) ; 2,6 (&lt; 7.5%)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Entonox</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Blue body with white shoulders</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"419\" src=\"https://image.prepladder.com/content/rSphqriDlTcSMTnxP5xE1747034943.png\" width=\"419\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>7</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cyclopropane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Orange</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"419\" src=\"https://image.prepladder.com/content/rXcCvuJCDGy6EZWrJhjk1747034956.png\" width=\"419\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>3,6</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Composition:</strong></td>\n<td>\n<ul>\n<li>50% N<sub>2</sub>O + 50% O<sub>2</sub></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Cylinder color:</strong></td>\n<td>\n<ul>\n<li>Blue body with white shoulders</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>PIN Index:</strong></td>\n<td>\n<ul>\n<li><strong>7 </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Uses:</strong></td>\n<td>\n<ul>\n<li><strong>Only provides analgesia</strong></li>\n<li>Used for short-term pain relief such as labor analgesia/dental procedures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Disadvantage:</strong></td>\n<td>\n<ul>\n<li><strong>No <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> </strong>effect</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 35-year-old woman who experiences heightened anxiety and recurrent thoughts about her hands being contaminated, leading her to frequently wash her hands? Despite finding these thoughts distressing, she is unable to resist them, and attempting to refrain from washing only worsens her anxiety.", "options": [{"label": "A", "text": "Phobia", "correct": false}, {"label": "B", "text": "Forced thinking", "correct": false}, {"label": "C", "text": "Obsessive-compulsive disorder", "correct": true}, {"label": "D", "text": "Generalized anxiety disorder", "correct": false}], "correct_answer": "C. Obsessive-compulsive disorder", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Obsessive-compulsive disorder.</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Obsessions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Compulsions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intrusive and unwanted repetitive thoughts, urges, or impulses.</li>\n<li>Most common: Contamination</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Repetitive actions or thoughts carried out in a strict, regulation-bound manner or reaction to obsessions.</li>\n<li>Performed to relieve anxiety or fear.</li>\n<li>Most common: Checking</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptom Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contamination/Cleansing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obsession with contamination, followed by washing/avoidance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathological Doubt/Checking</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obsession with doubt, followed by <span class=\"customMeta\" data-dictid=\"8e09a4a39b1692777184e5e57a8435\">compulsive</span> checking.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intrusive/Forbidden Thoughts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intrusive thoughts of aggression or sexual acts, without compulsion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symmetry/Ordering</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Need for <span class=\"customMeta\" data-dictid=\"73e8d27894169277719960f922b4b5\">symmetry</span> or precision, leading to <span class=\"customMeta\" data-dictid=\"8e09a4a39b1692777184e5e57a8435\">compulsive</span> slowness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Religious obsessions and <span class=\"customMeta\" data-dictid=\"8e09a4a39b1692777184e5e57a8435\">compulsive</span> hoarding.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pharmacotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First line</strong>: SSRIs (preferred), Clomipramine. Treatment for 1-2 years.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Augmenting agents</strong>: Antipsychotics (Risperidone, Aripiprazole), Memantine, Riluzole, Ketamine, Lamotrigine, N-acetylcysteine (NAC).</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Psychotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cognitive Behavioral Therapy (CBT)</strong>: Exposure and response prevention (ERP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Other therapies: Desensitization, Thought-stopping, Flooding, Aversive conditioning, Psychodynamic psychotherapy, and Family therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CBT is preferred in younger patients. Combination of CBT and <span class=\"customMeta\" data-dictid=\"8516658bc716927771957509dfe304\">pharmacotherapy</span> is useful.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Somatic Therapies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior cingulotomy, Capsulotomy, Deep brain <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> with electrodes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 37-year-old man who experienced symptoms after a sudden financial loss? He reported feeling fearful of harm, having sleep and appetite disturbances, and hearing abusive voices. These symptoms lasted for about a week. The patient has no relevant medical history, drug abuse history, or past medical history.", "options": [{"label": "A", "text": "Schizophrenia", "correct": false}, {"label": "B", "text": "Schizophreniform disorder", "correct": false}, {"label": "C", "text": "Brief psychotic episode", "correct": true}, {"label": "D", "text": "Schizoaffective disorder", "correct": false}], "correct_answer": "C. Brief psychotic episode", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ICD-11 Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>DSM-5 Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schizoaffective Disorder<br/>\n\t\t\t(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms of both <span class=\"customMeta\" data-dictid=\"d844b672a616927771988fee71197b\">schizophrenia</span> and mood disorders for <strong> </strong></p>\n<p><strong>≥ 1 month</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Psychotic symptoms without mood disturbances for<strong> ≥ 2 weeks.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Delusional Disorder</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delusions present for <strong>more than three months.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delusions are present for <strong>at least one month.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schizophrenia</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two or more symptoms (e.g., delusions, hallucinations) present for<strong> ≥ one month</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two or more symptoms present for <strong>≥ six months</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Schizophrenia requires two or more symptoms, with at least one from <strong>delusions, hallucinations, thought disorder, or <span class=\"customMeta\" data-dictid=\"eaec97de1d1692777186b2ce902b4d\">distortion</span> of self-experience</strong>. Additional symptoms include negative symptoms, disorganised behaviour, or <span class=\"customMeta\" data-dictid=\"67a8159af716927771964aa6043ac2\">psychomotor</span> disturbances.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ICD-11</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ICD-11</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> disorde</strong>r</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 1 month</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>&lt; 6 months</li>\n<li>Brief <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">Psychotic</span> Disorder: &lt; 1 month</li>\n<li>Schizophreniform disorder: &gt; 1 month- &lt; 6 months</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schizoaffective disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥ 1 month</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥ 2 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Delusional disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 3 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥ 1 month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schizophrenia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥ 1 month</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥ 6 weeks</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is a macrovascular complication that develops in the advanced stages of diabetes?", "options": [{"label": "A", "text": "Coronary artery disease", "correct": true}, {"label": "B", "text": "Foot ulcer", "correct": false}, {"label": "C", "text": "Nephropathy", "correct": false}, {"label": "D", "text": "Retinopathy", "correct": false}], "correct_answer": "A. Coronary artery disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:583px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Increased Rate in Diabetics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Cardiovascular death</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.7 times higher</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Myocardial infarction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.8 times greater</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Stroke hospitalisation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5 times higher</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Non-traumatic amputations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>60% occur in diabetics</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>First <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> event (type 1)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 times higher in women, 2.3 times higher in men</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable cause for a 22-year-old man who has a high-grade fever, a purpuric rash, and a CSF sample showing gram-negative diplococci?", "options": [{"label": "A", "text": "Neisseria meningitidis", "correct": true}, {"label": "B", "text": "Pseudomonas aeruginosa", "correct": false}, {"label": "C", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "D", "text": "E.coli", "correct": false}], "correct_answer": "A. Neisseria meningitidis", "question_images": ["https://image.prepladder.com/content/gt4axtk4XUEElIB9mN4I1747981967.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Consciousness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased level of consciousness occurs in &gt;75% of cases, ranging from <span class=\"customMeta\" data-dictid=\"7f737d5d2f1692777191ac675cbf29\">lethargy</span> to coma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Kernig's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive when <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> extension of the knee elicits pain; indicative of meningeal irritation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Brudzinski's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive when <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of the neck results in <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of the hips and knees; also indicative of meningeal irritation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pupils</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May present as dilated and poorly <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> due to increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure (ICP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posturing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Possible <span class=\"customMeta\" data-dictid=\"b992edcc081692777186b24fecb86f\">decerebrate posturing</span> as a sign of severe CNS dysfunction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Signs of Increased ICP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Includes elevated CSF opening pressure (&gt;180 mmH2O), papilledema, and potential cerebral <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> (1–8% incidence).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Additional Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nausea, vomiting, photophobia; seizures in 15–40% (focal or generalized).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Meningococcemia Rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erythematous <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> rash</strong> that quickly becomes petechial, commonly on the trunk and lower extremities.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Stain used to demonstrate fungal elements are?", "options": [{"label": "A", "text": "Acid fast stain", "correct": false}, {"label": "B", "text": "Gabbet's stain", "correct": false}, {"label": "C", "text": "Methenamine silver", "correct": true}, {"label": "D", "text": "Leifson &amp;amp; Ryu's stain", "correct": false}], "correct_answer": "C. Methenamine silver", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Use</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Direct Microscopic Examination</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>KOH Preparation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dissolves <span class=\"customMeta\" data-dictid=\"d0e68b82ed1692777190fa10f7d4ba\">keratin</span> in clinical specimens (e.g., skin scrapings, nail clippings) to visualise fungal elements.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosing <span class=\"customMeta\" data-dictid=\"84b9a43a7816927771867efa42a2dd\">dermatophyte</span> infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Calcofluor White Staining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enhances fungal visibility by binding to <span class=\"customMeta\" data-dictid=\"b24b4918a916927771844114519396\">chitin</span> in cell walls, causing them to fluoresce under UV light.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Observing fungal morphology</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gram Stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Traditionally for bacterial identification; also useful for yeasts, which typically <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> Gram-positive (purple).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detecting certain fungi</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>India Ink Preparation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> method for <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> yeasts (e.g., Cryptococcus neoformans), revealing a clear <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> around cells.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identifying <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> yeasts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Methenamine Silver and <span class=\"customMeta\" data-dictid=\"1e835060d3169277719499350aabe5\">PAS</span> Staining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Histochemical techniques that <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> black (methenamine) or <span class=\"customMeta\" data-dictid=\"9038419f6f169277719188195b72b5\">magenta</span> (PAS) in tissue sections.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highlighting <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> in tissues</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lactophenol Cotton Blue (LCB) Mount</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enhances contrast in teased fungal colonies for <span class=\"customMeta\" data-dictid=\"55beab619216927771925caac38373\">morphological</span> observation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Microscopic examination of fungi</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Serology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antibody Detection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identifies antibodies produced by the host in response to <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> using methods like ELISA.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tracking <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> to fungal infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antigen Detection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects fungal antigens in body fluids using techniques such as <span class=\"customMeta\" data-dictid=\"60088572d31692777191346a90b73f\">latex</span> <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">agglutination</span> tests.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identifying fungal presence in the body</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Skin Tests</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Delayed-Type Hypersensitivity (DTH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses previous exposure to <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> through localised reactions to <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> antigens.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluating past fungal exposure</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Newer Rapid Diagnostic Tests</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nucleic Acid Hybridisation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses labelled DNA probes for rapid fungal DNA <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> in clinical samples.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quick identification of fungal pathogens</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Polymerase Chain Reaction (PCR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amplifies specific fungal DNA sequences, enabling early diagnosis even with low fungal loads.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of fungal infections</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old former pilot visits a neurologist, accompanied by his wife, exhibiting symptoms of rapidly advancing dementia, myoclonus, ataxia, and visual impairments. The provided FLAIR MRI scans can assist in confirming the diagnosis. What is the probable diagnosis?", "options": [{"label": "A", "text": "Alzheimer's disease", "correct": false}, {"label": "B", "text": "Vascular dementia", "correct": false}, {"label": "C", "text": "Sporadic CJD", "correct": false}, {"label": "D", "text": "Variant CJD", "correct": true}], "correct_answer": "D. Variant CJD", "question_images": ["https://image.prepladder.com/content/Y4IIFGXNlHbjWhonAWxP1747036610.png"], "explanation_images": ["https://image.prepladder.com/content/XPtNNaFTejm4kPR8p0Vp1748163525.png", "https://image.prepladder.com/content/IjTdCue4nlXImfhGyG3X1747036633.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Creutzfeldt-Jakob disease (CJD) findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Electroencephalography (EEG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Periodic sharp wave complexes (PSWC)</li>\n<li>These can be either lateralized in earlier stages or generalized in later stages.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dirzius, Edgaras &amp; Balnytė, Renata &amp; Steibliene, Vesta &amp; Gleizniene, Rymante &amp; Gudinaviciene, Inga &amp; Radziunas, Andrius &amp; Petrikonis, Kestutis.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Electroencephalography-at-week-18-Legend-periodic-sharp-wave-complexes-in-frontal_fig2_310735862\" data-tags=\"\" height=\"5856\" src=\"https://image.prepladder.com/content/XPtNNaFTejm4kPR8p0Vp1748163525.png\" width=\"6738\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>MRI findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>DWI or FLAIR MRI has a sensitivity of 98% and <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> of 93%</li>\n<li>DWI: Increased intensity in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia, thalamus, and cortex</li>\n<li><strong>Cortical ribboning</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Pract Neurol\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Practneurol-2016-001571f02.jpg\" data-tags=\"\" height=\"574\" src=\"https://image.prepladder.com/content/IjTdCue4nlXImfhGyG3X1747036633.png\" width=\"448\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Hockey stick or <span class=\"customMeta\" data-dictid=\"b36e8ba0101692777196f1b3621e90\">pulvinar</span> sign </strong>is seen in <strong>variant</strong>, infectious, or <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> CJD</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An HIV-positive patient presents with the following finding. What is the diagnosis &amp;amp; WHO clinical stage of HIV?", "options": [{"label": "A", "text": "Oral candidiasis &amp;amp; WHO stage 2", "correct": false}, {"label": "B", "text": "Oral hairy leukoplakia &amp;amp; WHO Stage 3", "correct": false}, {"label": "C", "text": "Oral candidiasis &amp;amp; WHO stage 3", "correct": true}, {"label": "D", "text": "Oral hairy leukoplakia &amp;amp; WHO stage 2", "correct": false}], "correct_answer": "C. Oral candidiasis &amp; WHO stage 3", "question_images": ["https://image.prepladder.com/content/q7nRh5LnnTPVpVuz3xDA1747041803.png"], "explanation_images": ["https://image.prepladder.com/content/8R4s4D1itjrZVDXLU9o41747041856.png", "https://image.prepladder.com/content/EmYspCfYY8X6q0Wh0ZjK1747041856.png", "https://image.prepladder.com/content/sKZ22GQ6etVmHyUJXdAQ1747041856.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complications of HIV/AIDS</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gastrointestinal tract</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Candidiasis </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Oral_candidiasis#/media/File:Human_tongue_infected_with_oral_candidiasis.jpg\" data-tags=\"\" height=\"344\" src=\"https://image.prepladder.com/content/8R4s4D1itjrZVDXLU9o41747041856.png\" width=\"291\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral, Esophageal and Tracheal candidiasis</li>\n<li>Presents with odynophagia</li>\n<li>Treatment: <strong>IV <span class=\"customMeta\" data-dictid=\"e3d616618b16927772022df400a411\">fluconazole</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Black <span class=\"customMeta\" data-dictid=\"a4789768d21692777188e77f1969cd\">hairy</span> tongue </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Zay Yar Aung, Muhammad Samar Iqbal, Abobakr Fahdawi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Black-hairy-tongue-at-first-presentation_fig1_380128100\" data-tags=\"\" height=\"387\" src=\"https://image.prepladder.com/content/EmYspCfYY8X6q0Wh0ZjK1747041856.png\" width=\"291\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Due to the Ebstein-Barr virus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic diarrhoea </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Due to Cryptosporidium or Isospora Belli</li>\n<li>Investigation: Microscopy reveals\n\t\t\t\t<ul>\n<li>Cyst &lt; 10 μm - Cryptosporidium</li>\n<li>Larger <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> - Isospora belli</li>\n</ul>\n</li>\n<li>Treatment\n\t\t\t\t<ul>\n<li>Cryptosporidium: <strong>Nitazoxanide </strong></li>\n<li>Isospora: <strong>Cotrimoxazole </strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Neoplastic diseases </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Kaposi sarcoma</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CC BY 3.0\" data-hash=\"\" data-license=\"OpenStax College - Anatomy &amp; Physiology\" data-source=\"https://en.wikipedia.org/wiki/Kaposi%27s_sarcoma#/media/File:Kaposis_Sarcoma_Lesions.jpg\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/sKZ22GQ6etVmHyUJXdAQ1747041856.png\" width=\"292\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Due to <strong>HHV-8</strong></li>\n<li>Vascular tumours on the skin, <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> or organs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Hodgkin's <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immunoblastic lymphoma</li>\n<li>Burkitt’s lymphoma</li>\n<li>Primary CNS lymphoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Respiratory system</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pneumocystis <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Due to <strong>pneumocystis jirovecii </strong></li>\n<li>Presents with non-productive cough, fever and weight loss</li>\n<li>Investigation\n\t\t\t\t<ul>\n<li>CXR: Bilateral <span class=\"customMeta\" data-dictid=\"b78b1bdf6c1692777195170be3d18f\">perihilar</span> opacities</li>\n<li>Beta-1,3-glucan test positive</li>\n<li>Broncho-alveolar Lavage (BAL): Giemsa <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> or <span class=\"customMeta\" data-dictid=\"cb3712727816927771925665b0b1e0\">methenamine</span> <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> shows oval-shaped fungi.</li>\n</ul>\n</li>\n<li>Treatment: <strong>Trimethoprim-sulfamethoxazole </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Others</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HIV associated Nephropathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CVS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Myocardial infarction, cardiomyopathy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As seen below, a 49-year-old man presents with flu-like symptoms and a palmoplantar rash. On examination, he has epitrochlear lymphadenopathy. Which of the following is the likely diagnosis?", "options": [{"label": "A", "text": "Primary syphilis", "correct": false}, {"label": "B", "text": "Secondary syphilis", "correct": true}, {"label": "C", "text": "Pyoderma gangrenosum", "correct": false}, {"label": "D", "text": "Steven Johnson syndrome", "correct": false}], "correct_answer": "B. Secondary syphilis", "question_images": ["https://image.prepladder.com/content/DkCGzoBH1QuF6X0Rbgzd1748163602.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the condition in which the cherry red spot, as shown in the image below, is observed?", "options": [{"label": "A", "text": "Central retinal artery occlusion (CRAO)", "correct": true}, {"label": "B", "text": "Central retinal venous occlusion (CRVO)", "correct": false}, {"label": "C", "text": "Branched retinal artery occlusion (BRAO)", "correct": false}, {"label": "D", "text": "Branched retinal vein occlusion (BRVO)", "correct": false}], "correct_answer": "A. Central retinal artery occlusion (CRAO)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/eFHwNIq2f9d4KNkEL8y61747042325.png", "https://image.prepladder.com/content/8Z6R0S6NY03gqQhdTzoi1747042336.png", "https://image.prepladder.com/content/Gr1wZcTjwo0Fm84PuptQ1748069820.png"], "explanation": "<p>Correct Option A - Central &lt;span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\"&gt;retinal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\"&gt;artery&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\"&gt;occlusion&lt;/span&gt; (CRAO)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male patient with a penetrating injury to the left eye was treated with corneoscleral suturing. Two months later, he returned with complaints of reduced near vision, pain, redness, and sensitivity to light in his right eye. Direct ophthalmoscopy revealed nodules in the fundus. Which part of the eye is affected?", "options": [{"label": "A", "text": "Uvea", "correct": true}, {"label": "B", "text": "Cornea", "correct": false}, {"label": "C", "text": "Conjunctiva", "correct": false}, {"label": "D", "text": "Sclera", "correct": false}], "correct_answer": "A. Uvea", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KNYQosAoeuh8yjb9Cuvs1747042589.png"], "explanation": "<p>Correct Option A - Uvea</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sympathetic <span class=\"customMeta\" data-dictid=\"722c35f97c169277719457b4886144\">ophthalmitis</span> (SO)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bilateral, granulomatous, <span class=\"customMeta\" data-dictid=\"4049e22a6b169277719429cb6c9514\">panuveitis</span> (Option A)</strong> occurring after <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> trauma where <strong>uveal prolapse</strong> may have been a feature of the trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology and pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trauma to one eye <strong>(exciting eye) </strong>— 2 weeks to 3 months — <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">Uveitis</span> in the uninjured eye <strong>(sympathizing eye).</strong></li>\n<li><strong>T-cell mediated <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reaction to <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> S antigen. </strong></li>\n<li>Maximum risk upon injury to the <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> body.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diffuse lymphocytic <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> of the choroid.</li>\n<li>Scattered aggregates of <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> cells are seen, many of which contain fine granules of melanin.</li>\n<li><strong>Dalen–Fuchs nodules</strong> - granulomas located between Bruch <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and the RPE (also seen in VKH syndrome)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Xi K Chu,Chi-Chao Chan\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/Montage-fundus-photograph-of-a-sympathetic-ophthalmia-retina-Yellow-white-subretinal_fig1_237001131\" data-tags=\"\" height=\"443\" src=\"https://image.prepladder.com/content/KNYQosAoeuh8yjb9Cuvs1747042589.png\" width=\"507\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"da55d37dc51692777187ee41eeebc5\">exciting eye</span> is frequently red and irritable.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"659d09e49516927771995a19c72a5f\">sympathizing eye</span> develops irritation, blurred vision, <span class=\"customMeta\" data-dictid=\"46e2a1c298169277719583f46ff587\">photophobia</span> and loss of <span class=\"customMeta\" data-dictid=\"c0682eacfc1692777180ad2c556c19\">accommodation</span> causing difficulty in near vision <strong>(first symptom)</strong></li>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">uveitis</span> develops in both eyes, which may be mild or severe and is usually granulomatous</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fundus exam: </strong>Dalen–Fuchs nodules, Exudative <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> detachment, <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> and <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc swelling.</li>\n<li>As <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> settles, <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> <span class=\"customMeta\" data-dictid=\"3e48c7feaa169277718485430831dd\">chorioretinal</span> <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> may confer a <strong>‘sunset glow’ appearance</strong> similar to VKH.</li>\n<li><strong>B-scan ultrasonography</strong>: Choroidal thickening and <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> detachment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Enucleation of a severely injured eye</strong> within 10 to 14 days of the injury is effective in preventing or reducing the severity of SO</li>\n<li><strong>Steroids</strong> are the basis of initial treatment. <strong>Intravenous</strong> <span class=\"customMeta\" data-dictid=\"c3adf9f403169277719294351e8fb8\">methylprednisolone</span> followed by high-dose <strong>oral</strong> <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> is given for several months and gradually tapered according to response. Supplementary <strong>topical</strong> steroids and cycloplegics may be given</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of the patient having the following type of karyotype, as shown in the image?", "options": [{"label": "A", "text": "Turner Syndrome", "correct": false}, {"label": "B", "text": "Down Syndrome", "correct": true}, {"label": "C", "text": "Klinefelter syndrome", "correct": false}, {"label": "D", "text": "Edward syndrome", "correct": false}], "correct_answer": "B. Down Syndrome", "question_images": ["https://image.prepladder.com/content/KMlkPvXHCMqQE029LwuL1747042477.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which diseases are microaneurysms observed?", "options": [{"label": "A", "text": "Retinal detachment", "correct": false}, {"label": "B", "text": "Diabetic retinopathy", "correct": true}, {"label": "C", "text": "Uveitis", "correct": false}, {"label": "D", "text": "Glaucoma", "correct": false}], "correct_answer": "B. Diabetic retinopathy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MEf6Nsh7x6qCTMcE8ydd1747042804.png", "https://image.prepladder.com/content/f9gtJaXpvFAWWfs0Kb4Z1747042812.png"], "explanation": "<p>Correct Option B - Diabetic retinopathy</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Early NPDR or Background Diabetic Retinopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Severe NPDR or Preproliferative Diabetic Retinopathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Affects small <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> vessels.</li>\n<li><strong>Earliest sign: Microaneurysm (Option B) </strong>\n<ul>\n<li><strong>Fluorescein <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">angiography</span> (FA):</strong> Tiny hyperfluorescent dots.</li>\n</ul>\n</li>\n<li><strong>Retinal hemorrhages: </strong>Both deep, i.e., in the inner nuclear or outer <span class=\"customMeta\" data-dictid=\"946db798c6169277719544d7b31041\">plexiform</span> layer (dot and <span class=\"customMeta\" data-dictid=\"2bc990c16116927771830255971ff6\">blot</span> hemorrhage) and superficial, i.e., in nerve fiber layer (splinter or flame-shaped) hemorrhages</li>\n<li><strong>Hard exudates: </strong>\n<ul>\n<li>White or yellow <span class=\"customMeta\" data-dictid=\"b8ccccd9b81692777202ca2fa976d6\">waxy</span> patches with well-defined margins, often at the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pole, in the outer <span class=\"customMeta\" data-dictid=\"946db798c6169277719544d7b31041\">plexiform</span> layer.</li>\n<li><strong>FA: </strong>Hypofluorescence with dense exudates.</li>\n</ul>\n</li>\n<li>Edema is not marked.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Increased inner <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hypoxia:</strong> Leads to multiple <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hemorrhages, <span class=\"customMeta\" data-dictid=\"ef5bc669a416927771854943d1cfa8\">cotton-wool</span> spots, <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> beading, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> loops, <span class=\"customMeta\" data-dictid=\"871f3dc691169277719044c0f27f98\">intraretinal</span> <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> abnormalities (IRMAs), and large areas of <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> nonperfusion.</li>\n<li><strong>Cotton-Wool Spots: </strong>\n<ul>\n<li>Also called soft exudates or nerve fiber infarcts.</li>\n<li>Result from ischemia, not exudation.</li>\n<li>Caused by <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of axoplasmic flow, leading to <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and a white, fluffy appearance.</li>\n<li><strong>FA:</strong> <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">Focal</span> hypofluorescence due to local ischemia.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Venous Beading: </strong>\n<ul>\n<li>Indicates sluggish <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> circulation.</li>\n<li>Typically adjacent to large areas of <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> nonperfusion.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Intraretinal <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">Microvascular</span> Abnormalities (IRMA):</strong>\n<ul>\n<li>Dilated capillaries act as <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> channels.</li>\n<li>Bypass <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> bed and is often seen adjacent to <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> nonperfusion.</li>\n<li><strong>FA: </strong>Focal hypofluorescence</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"487\" src=\"https://image.prepladder.com/content/MEf6Nsh7x6qCTMcE8ydd1747042804.png\" width=\"487\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mona Leeza, Humera Farooq\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Pathological-images-with-labelled-anomalies_fig1_332293685\" data-tags=\"\" height=\"379\" src=\"https://image.prepladder.com/content/f9gtJaXpvFAWWfs0Kb4Z1747042812.png\" width=\"379\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which medication can be administered to a patient diagnosed with acute anterior uveitis, presenting with symptoms of photophobia and blurred vision?", "options": [{"label": "A", "text": "Moxifloxacin", "correct": false}, {"label": "B", "text": "Atropine", "correct": true}, {"label": "C", "text": "Acetazolamide", "correct": false}, {"label": "D", "text": "Methotrexate", "correct": false}], "correct_answer": "B. Atropine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement correctly describes X-linked hypophosphatemic rickets?", "options": [{"label": "A", "text": "FGF-23 levels decreased", "correct": false}, {"label": "B", "text": "PHEX gene is affected", "correct": true}, {"label": "C", "text": "It is the most common cause of rickets", "correct": false}, {"label": "D", "text": "Excretion of phosphorus is decreased", "correct": false}], "correct_answer": "B. PHEX gene is affected", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lelcq7vEHLwXb1PGg1Sq1748153977.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>X-Linked Hypophosphatemic (XLH) Rickets</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevalence </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 in 20,000. Most common among genetic disorders causing rickets</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inheritance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X-linked dominant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gene Mutated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>PHEX</strong> (phosphate-regulating gene with <span class=\"customMeta\" data-dictid=\"e5b7385ccc1692777189b674f97aea\">homology</span> to endopeptidases on X chromosome)</li>\n<li>Normally, product of this gene appears to have an<strong> <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> role in inactivating FGF-23 </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"475\" src=\"https://image.prepladder.com/content/lelcq7vEHLwXb1PGg1Sq1748153977.png\" width=\"972\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower limb deformities:\n\t\t\t\t<ul>\n<li>Coxa vara</li>\n<li>Genu valgum</li>\n<li>Genu varum</li>\n</ul>\n</li>\n<li>Poor growth</li>\n<li>Maxillofacial abnormalities</li>\n<li>Skull deformities: Due to <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> sutures</li>\n<li>Delayed dentition</li>\n<li>Short stature</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> excretion</li>\n<li>Hypophosphatemia</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> (ALP)</li>\n<li>Normal PTH and <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> calcium</li>\n<li>Low or inappropriately normal levels of 1,25-D</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Phosphorus Supplementation: </strong>\n<ul>\n<li>1-3 g elemental <span class=\"customMeta\" data-dictid=\"bfea0730ac16927771959eb551740f\">phosphorus</span> daily, divided into 4-5 doses</li>\n<li>Can be given in the <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of Joulie solution (30.4 mg phosphate/mL) or as neutral <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> <span class=\"customMeta\" data-dictid=\"201a8ee765169277718724b780d674\">effervescent</span> tablets</li>\n<li>Frequent dosing helps to prevent prolonged decrements in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"bfea0730ac16927771959eb551740f\">phosphorus</span> because there is rapid decline after each dose</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Calcitriol: </strong>30-70 ng/kg/day in 2 doses</li>\n<li><strong>Burosumab-twza: </strong>Monoclonal <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> FGF-23, an alternative for children &gt;1 year</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally good response to therapy, though frequent dosing can affect compliance</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the subsequent diseases is collagen cross-linking therapy utilized?", "options": [{"label": "A", "text": "Keratoconus", "correct": true}, {"label": "B", "text": "Corneal ulcer", "correct": false}, {"label": "C", "text": "Band keratopathy", "correct": false}, {"label": "D", "text": "Uveitis", "correct": false}], "correct_answer": "A. Keratoconus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Keratoconu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has bruising, petechiae, and occasional minor epistaxis, which has very little interference with his daily activities. Based on further workup, a diagnosis of a mild case of ITP is made. How will you manage the patient?", "options": [{"label": "A", "text": "Short course corticosteroid therapy", "correct": false}, {"label": "B", "text": "Intravenous anti-D administration", "correct": false}, {"label": "C", "text": "A single dose of intravenous immunoglobulin", "correct": false}, {"label": "D", "text": "Education, counseling, and watchful expectancy", "correct": true}], "correct_answer": "D. Education, counseling, and watchful expectancy", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management of Immune thrombocytopenic <span class=\"customMeta\" data-dictid=\"0acd34c758169277719644923511e5\">purpura</span> in children</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Based on <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> count: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Platelet Count &gt;30,000 cells/μL + No severe bleeding- Monitor closely</li>\n<li>Platelet Count &lt; 30,000 cells/μL + No severe <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> + <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">Platelet</span> Count ≥ 5,000 cells/μL: Glucocorticoids (e.g.,<strong> Prednisone</strong>, Dexamethasone)</li>\n<li>Platelet Count &lt; 5,000 cells/μL or Severe Bleeding: i.v.i.g.+ Glucocorticoids</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other modalities:</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immediate Need to Raise <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">Platelet</span> Count like surgery or trauma- <strong>Platelet Transfusion </strong></li>\n<li>Persistent or Severe Cases- Monitor with <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> i.v.i.g.</li>\n<li>If necessary, consider <strong>Splenectomy </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alternative Medications:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti-CD20 Antibody: Rituximab</li>\n<li>TPO Receptor Agonists: Romiplostim, Eltrombopag</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What's the main risk for a 37-year-old man with blurred vision and severe pain in his right eye? He revealed that recently, he went swimming in a pond. During examination, a ring-like lesion was found, as seen in the image.", "options": [{"label": "A", "text": "Diabetes", "correct": false}, {"label": "B", "text": "Hypertension", "correct": false}, {"label": "C", "text": "Steroids", "correct": false}, {"label": "D", "text": "Soft Contact lenses", "correct": true}], "correct_answer": "D. Soft Contact lenses", "question_images": ["https://image.prepladder.com/content/QwTVVUNE75sJ0cHpMwDU1747043234.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Soft C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the specific sign that is pathognomonic for acute anterior uveitis among the options provided?", "options": [{"label": "A", "text": "Aqueous flare", "correct": false}, {"label": "B", "text": "Keratic precipitates", "correct": true}, {"label": "C", "text": "Festooned pupil", "correct": false}, {"label": "D", "text": "Bussaca’s nodules", "correct": false}], "correct_answer": "B. Keratic precipitates", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VArPK7YmFWI3zxwoca6r1747043395.png", "https://image.prepladder.com/content/fu7uwRRvPjeVG4yAkr0s1747043408.png", "https://image.prepladder.com/content/IGcbx0qg8izTmzbda5ih1747043425.png"], "explanation": "<p>Correct Option B - K\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a female patient, aged 65, who has a history of chickenpox and presents at the clinic with the following findings?", "options": [{"label": "A", "text": "Chicken pox exacerbation", "correct": false}, {"label": "B", "text": "Drug allergy to acyclovir", "correct": false}, {"label": "C", "text": "Herpes zoster ophthalmicus", "correct": true}, {"label": "D", "text": "Herpes zoster oticus", "correct": false}], "correct_answer": "C. Herpes zoster ophthalmicus", "question_images": ["https://image.prepladder.com/content/lyVqKf7UZVbDwoL7xVV81747043599.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\"&gt;Herpes&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"03350c16f71692777202dbca70976e\"&gt;zoster&lt;/span&gt; ophthalmicu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following malignant tumors, commonly found in children, has a high tendency to spread to the bone marrow?", "options": [{"label": "A", "text": "Wilms tumor", "correct": false}, {"label": "B", "text": "Neuroblastoma", "correct": true}, {"label": "C", "text": "Adrenal gland tumors", "correct": false}, {"label": "D", "text": "Granulosa cell tumor of ovary", "correct": false}], "correct_answer": "B. Neuroblastoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Neuroblastoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition &amp; Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neural crest-derived tumor</li>\n<li>Most common <span class=\"customMeta\" data-dictid=\"ae83c0cf40169277718732a723c610\">extracranial</span> solid tumor in children</li>\n<li>7-8% of all childhood cancers</li>\n<li>Most common in first year of life</li>\n<li>Median age at diagnosis: 19 months</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MYCN <span class=\"customMeta\" data-dictid=\"13e14b31b21692777181520d7c651c\">amplification</span> (~20% of cases)</li>\n<li>Loss of heterozygosity: 1p, 11q, 14q, 17q</li>\n<li>TERT and <span class=\"customMeta\" data-dictid=\"77399c6ee0169277718492fb8fd58f\">chromatin</span> <span class=\"customMeta\" data-dictid=\"c182a5c58f1692777197ad47b9c2ef\">remodeling</span> genes</li>\n<li>1-2% show family history</li>\n<li>Higher MYCN <span class=\"customMeta\" data-dictid=\"061348eada16927771853267503805\">copy number</span> indicates worse prognosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Sites:</strong></p>\n<ul>\n<li>Abdominal (65%)</li>\n<li>Mediastinal (40%)</li>\n<li>Paraspinal (19%)</li>\n<li>Head/neck (5%)</li>\n</ul>\n<p> </p>\n<p><strong>Symptoms:</strong></p>\n<ul>\n<li>Pain, fever, irritability</li>\n<li>Weight loss</li>\n<li>Abdominal distension</li>\n<li>Periorbital ecchymosis</li>\n<li>Opsoclonus-myoclonus syndrome (rare)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>International Staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage L1:</strong> Localized tumor, complete excision</p>\n<p><strong>Stage IIA:</strong> Incomplete gross excision</p>\n<p><strong>Stage IIB:</strong> Complete/incomplete <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n<p><strong>Stage III: </strong>Midline crossing or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> involvement</p>\n<p><strong>Stage IV:</strong> Distant metastasis<strong> (Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> (MC), bone, liver, regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes)</strong></p>\n<p><strong>Stage IVS</strong>: Localized primary with limited dissemination (infants)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunohistochemistry:</strong></p>\n<ul>\n<li>Synaptophysin</li>\n<li>Tyrosine hydroxylase</li>\n<li>PHOX2B</li>\n<li>Neuron-specific enolase</li>\n</ul>\n<p> </p>\n<p><strong>Other Markers:</strong></p>\n<ul>\n<li>Desmin</li>\n<li>Myogenin</li>\n<li>Keratin</li>\n<li>CD99</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Treatments:</strong></p>\n<ul>\n<li>Surgery</li>\n<li>Chemotherapy</li>\n<li>Radiation therapy</li>\n</ul>\n<p> </p>\n<p><strong>Chemotherapy Regimens:</strong></p>\n<ul>\n<li>OPEC (vincristine, cyclophosphamide, cisplatin)</li>\n<li>CADO (vincristine, cyclophosphamide, doxorubicin)</li>\n<li>PECADO (cisplatin, etoposide)</li>\n</ul>\n<p> </p>\n<p><strong>Additional Therapies:</strong></p>\n<ul>\n<li>13-cis retinoic acid</li>\n<li>Autologous <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> transplantation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient who has had contact with a COVID-19 patient, presenting with symptoms such as redness, sensitivity to light, excessive tearing, and overall discomfort, a thorough examination was conducted with no eye abnormality. Based on this information, which specific part of the eye is most likely to be affected in this patient?", "options": [{"label": "A", "text": "Conjunctiva", "correct": true}, {"label": "B", "text": "Uvea", "correct": false}, {"label": "C", "text": "Choroid", "correct": false}, {"label": "D", "text": "Retina", "correct": false}], "correct_answer": "A. Conjunctiva", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Conjunctiv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arlt’s line is seen in?", "options": [{"label": "A", "text": "Vernal keratoconjunctivitis", "correct": false}, {"label": "B", "text": "Phlyctenular keratoconjunctivitis", "correct": false}, {"label": "C", "text": "Trachoma", "correct": true}, {"label": "D", "text": "Pterygium", "correct": false}], "correct_answer": "C. Trachoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qswSBCXGfd8LyAixvLh61747044246.png", "https://image.prepladder.com/content/sY3uY4JKZ7TuugtZMG6m1747044252.png", "https://image.prepladder.com/content/J5Yko4IzZcC98cs6Gjh61747044257.png", "https://image.prepladder.com/content/wSCAaEyHqEITTRZNBth41747044268.png", "https://image.prepladder.com/content/leYjdkN712YWsXEn3NCg1747044284.png", "https://image.prepladder.com/content/fiHOE0qmfSmhwXiTaItd1747044292.png", "https://image.prepladder.com/content/bdBhPTe53mj16IYi3wJy1747044302.png", "https://image.prepladder.com/content/qEtOPrcZZQ4yMhXtV2T51747044307.png", "https://image.prepladder.com/content/7ZFD57ZFxu1MPxfnRZLJ1747044312.png"], "explanation": "<p>Correct Option C - Trachoma</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Signs of active trachoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Signs of <span class=\"customMeta\" data-dictid=\"315587fa991692777184026693ef7f\">cicatricial</span> trachoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conjunctival signs:</strong></p>\n<ul>\n<li>Conjunctival congestion</li>\n<li>Follicles in the upper <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> conjunctiva: Look like sago-grains</li>\n<li>Papillary enlargement: red, velvety</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conjunctival signs:</strong></p>\n<ul>\n<li><strong>Scarring </strong>\n<ul>\n<li>It may be irregular, star-shaped, or linear</li>\n<li>Linear <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> in the <span class=\"customMeta\" data-dictid=\"2a56f52a921692777199df43853eba\">sulcus</span> subtarsalis is called <strong>Arlt’s line (Option C) </strong></li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>accumulation of dead epithelial cells and <span class=\"customMeta\" data-dictid=\"11d92ee2d916927771907f5dfc40d1\">inspissated</span> <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> in the glands of Henle</li>\n<li>Pseudocyst</li>\n<li>Xerosis</li>\n<li>Symblepharon</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corneal signs:</strong></p>\n<ul>\n<li>Superficial <span class=\"customMeta\" data-dictid=\"f1711947d41692777190ce56ef2f7d\">keratitis</span> on <span class=\"customMeta\" data-dictid=\"7fbb9ec5b716927771981c011f4299\">slit</span> lamp and fluorescein</li>\n<li><strong>Herbert’s follicles </strong></li>\n<li><strong>Progressive </strong>pannus/<strong>Trachomatous pannus</strong>: The <strong>upper part of the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> is cloudy</strong></li>\n<li><strong>Corneal ulcers </strong>are common at the advancing edge of the pannus\n\t\t\t\t<ul>\n<li>Shallow, little infiltrated</li>\n<li>Cause <span class=\"customMeta\" data-dictid=\"7b8d2e6b3a1692777191cfff333306\">lacrimation</span> and photophobia</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corneal signs:</strong></p>\n<ul>\n<li><strong>Regressive </strong>pannus or <strong>pannus siccus</strong>:\n\n\t\t\t\t<ul>\n<li>Receding infiltration</li>\n<li>Vessels extend beyond the area of <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> and haze</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Herbert pits</strong>: <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> or <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> pitted scars <strong>formed after the <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> of Herbert’s follicles in the <span class=\"customMeta\" data-dictid=\"71928251b41692777191a31e57c47f\">limbal</span> area</strong></li>\n<li>Vascularized and <strong>opaque cornea.</strong></li>\n<li>Corneal xerosis</li>\n<li>Corneal ectasia</li>\n<li>Total corneal <span class=\"customMeta\" data-dictid=\"388a4ccfbf1692777194a8f6a2d3b4\">pannus</span> (blinding sequelae)</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lid signs:</strong></p>\n<ul>\n<li>Distortion of the lids</li>\n<li><strong>Tylosis </strong>: Thickening of the <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> plate/lid margin</li>\n<li><strong>Trichiasis </strong>due to <span class=\"customMeta\" data-dictid=\"97ae59957c1692777197359406f6f4\">rubbing</span> of lashes on the cornea</li>\n<li><strong>Trachomatous <span class=\"customMeta\" data-dictid=\"e18c2053271692777194e62a208e01\">ptosis</span> </strong>(sleepy appearance)</li>\n<li><strong>Entropion</strong></li>\n<li>Madarosis</li>\n<li>Ankyloblepharon</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lacrimal <span class=\"customMeta\" data-dictid=\"5a70fb96bf1692777181823f42fcf0\">apparatus</span> sequelae:</strong></p>\n<ul>\n<li>Chronic dacryocystitis</li>\n<li>Chronic dacryoadenitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Active <span class=\"customMeta\" data-dictid=\"bc4fb02c561692777200c9effa5471\">Trachoma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Diane K. Lavett, Van C Lansingh, Marissa J Carter, Kristen A Eckert, Juan Carlos Silva\" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Inflammatory-trachoma-with-Follicular-trachoma-TI-TF-stage-Figure-courtesy-of_fig6_237843559\" data-tags=\"\" height=\"258\" src=\"https://image.prepladder.com/content/qswSBCXGfd8LyAixvLh61747044246.png\" width=\"359\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\">Follicles in upper palpebral conjunctiva</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"William Charles Caccamise, Sr, MD\" data-hash=\"\" data-license=\"CC BY NC ND\" data-source=\"https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/Pannus-superior-limbus-with-Morgagnian-cataract.html#gsc.tab=0\" data-tags=\"\" height=\"188\" src=\"https://image.prepladder.com/content/sY3uY4JKZ7TuugtZMG6m1747044252.png\" width=\"345\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\">Trachomatous pannus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"269\" src=\"https://image.prepladder.com/content/J5Yko4IzZcC98cs6Gjh61747044257.png\" width=\"269\"/></p>\n<p style=\"text-align:center\">Progressive pannus</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Cicatricial </strong></p>\n<p><strong>Trachoma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Diane K. Lavett, Van C Lansingh, Marissa J Carter, Kristen A Eckert, Juan Carlos Silva\" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Trachomatous-scarring-TS-stage-Figure-courtesy-of-Hollman-Miller-Vaupes-Colombia_fig8_237843559\" data-tags=\"\" height=\"200\" src=\"https://image.prepladder.com/content/wSCAaEyHqEITTRZNBth41747044268.png\" width=\"359\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n\t\t\t<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Justin Risma, MD ,Stefani Karakas, CRA\" data-hash=\"\" data-license=\"CC BY NC ND\" data-source=\"https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/herberts-pits.htm#gsc.tab=0\" data-tags=\"\" height=\"165\" src=\"https://image.prepladder.com/content/leYjdkN712YWsXEn3NCg1747044284.png\" width=\"345\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"269\" src=\"https://image.prepladder.com/content/fiHOE0qmfSmhwXiTaItd1747044292.png\" width=\"269\"/></p>\n<p style=\"text-align:center\">Regressive pannus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"William Charles Caccamise, Sr, MD\" data-hash=\"\" data-license=\"CC BY NC ND\" data-source=\"https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/trachoma.html#gsc.tab=0\" data-tags=\"\" height=\"331\" src=\"https://image.prepladder.com/content/bdBhPTe53mj16IYi3wJy1747044302.png\" width=\"359\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\">Conjunctival concretions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"William Charles Caccamise, Sr, MD\" data-hash=\"\" data-license=\"CC BY NC ND\" data-source=\"https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/trachoma.html#gsc.tab=0\" data-tags=\"\" height=\"227\" src=\"https://image.prepladder.com/content/qEtOPrcZZQ4yMhXtV2T51747044307.png\" width=\"345\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\">Trichiasis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"William Charles Caccamise, Sr, MD\" data-hash=\"\" data-license=\"CC BY NC ND\" data-source=\"https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/trachoma.html#gsc.tab=0\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/7ZFD57ZFxu1MPxfnRZLJ1747044312.png\" width=\"269\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\">Tylosis (thickening of <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> border of eyelid)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man presented the findings shown in the given image. What is this physical finding called?", "options": [{"label": "A", "text": "Spoon-shaped nails", "correct": false}, {"label": "B", "text": "Raynaud's phenomenon", "correct": false}, {"label": "C", "text": "Pallor", "correct": false}, {"label": "D", "text": "Clubbing", "correct": true}], "correct_answer": "D. Clubbing", "question_images": ["https://image.prepladder.com/content/Mx10vOXCLsNjLtKuKabz1747044463.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clubbing of fingers</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Enlargement of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> segments of fingers and toes</li>\n<li>Proliferation of <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue</li>\n<li>Particularly on the <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> surface</li>\n<li>Changes at the base of clubbed nail</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Connective tissue proliferation</li>\n<li>Exact mechanism unknown</li>\n<li>Platelet-derived growth factors implicated<strong> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bulbous Enlargement of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> Phalanges</li>\n<li>Loss of the Normal Angle Between the Nail and the Nailbed (Lovibond’s Angle)</li>\n<li>Increased Sponginess of the Soft Tissue at the Base of the Nail</li>\n<li>Nail Changes:</li>\n<li><strong>Nail flattening</strong>/<strong>nail curvature</strong></li>\n<li><strong>Hippocratic fingers</strong>: The <span class=\"customMeta\" data-dictid=\"e399ea3b4616927772004e16d5999d\">tips</span> of the fingers become enlarged, and the nails curve downward</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schamroth’s Sign:</strong></p>\n<ul>\n<li><strong>Normal</strong>: A small diamond-shaped window should be visible between the nails when the fingers are positioned in this way.</li>\n<li><strong>Positive Schamroth’s Sign</strong>: The window disappears, and there is no gap between the nails, indicating the loss of the normal angle at the nail bed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cyanotic <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart disease</li>\n<li>Infective endocarditis</li>\n<li>Bronchiectasis</li>\n<li>Cystic Fibrosis</li>\n<li>Lung cancer</li>\n<li>Tuberculosis</li>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Can be <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> or acquired</li>\n<li>May be <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> in certain circumstances</li>\n<li>Associated with hypertrophic osteoarthropathy</li>\n<li>Can cause pain and arthritis-like changes</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the disease depicted in the image below?", "options": [{"label": "A", "text": "Acromegaly", "correct": false}, {"label": "B", "text": "PCOS", "correct": false}, {"label": "C", "text": "Cushing’s syndrome", "correct": true}, {"label": "D", "text": "Advanced obesity", "correct": false}], "correct_answer": "C. Cushing’s syndrome", "question_images": ["https://image.prepladder.com/content/RNrMBIVlCmHrhrSWDn6C1747044583.png"], "explanation_images": ["https://image.prepladder.com/content/baUu6eeAhnr8t58XQmnu1747044609.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which laser is considered the most appropriate for cataract surgery?", "options": [{"label": "A", "text": "Nd-YAG", "correct": false}, {"label": "B", "text": "Diode", "correct": false}, {"label": "C", "text": "Excimer", "correct": false}, {"label": "D", "text": "Femtosecond laser", "correct": true}], "correct_answer": "D. Femtosecond laser", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - F\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The X-ray image of a child with muscle weakness and failure to thrive is attached below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Scurvy", "correct": false}, {"label": "B", "text": "Rickets", "correct": true}, {"label": "C", "text": "Osteomalacia", "correct": false}, {"label": "D", "text": "Osteopetrosis", "correct": false}], "correct_answer": "B. Rickets", "question_images": ["https://image.prepladder.com/content/n1Glf4m8GbAS9qmKZSH61748154105.png"], "explanation_images": ["https://image.prepladder.com/content/ntB58KdxhjguUZHZHN911747044485.png", "https://image.prepladder.com/content/pfrpiMu1hT9C4nfwFAZL1748154136.png", "https://image.prepladder.com/content/vLQ0Ij173mf6wVRqGrru1748154198.png", "https://image.prepladder.com/content/KqqLZxcLoexLWXYW0add1748154206.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following animals is most likely responsible for biting a 10-year-old child who presented with symptoms of tachycardia, hypertension, tongue fasciculation, hypersalivation, dilated pupils, and mild erythema at the site of the wound? The child recalls that the animal had a curved tail pointing upwards.", "options": [{"label": "A", "text": "Sea urchin", "correct": false}, {"label": "B", "text": "Caterpillar", "correct": false}, {"label": "C", "text": "Scorpion", "correct": true}, {"label": "D", "text": "Shellfish", "correct": false}], "correct_answer": "C. Scorpion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the picture depict in terms of the investigation?", "options": [{"label": "A", "text": "Fundus fluorescein angiography", "correct": true}, {"label": "B", "text": "Optical coherence tomography", "correct": false}, {"label": "C", "text": "Retinal CT", "correct": false}, {"label": "D", "text": "Retinal MRI", "correct": false}], "correct_answer": "A. Fundus fluorescein angiography", "question_images": ["https://image.prepladder.com/content/CQdgzAkFsDnhNhCOvfbJ1747044780.png"], "explanation_images": ["https://image.prepladder.com/content/tnCQg6wbPO0mbeujqGDP1747044889.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Fluorescence Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hyperfluorescence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Window <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> (RPE)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Atrophy showing background <span class=\"customMeta\" data-dictid=\"cea77d01ce1692777184854450c378\">choroidal</span> fluorescence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pooling of <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> under detached RPE</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Age-related <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> (ARMD)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pooling of <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> under <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> retina</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Central <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">retinopathy</span> (<strong>CSR</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Leakage into the <span class=\"customMeta\" data-dictid=\"0d7d7c885216927771935437653141\">neurosensory</span> <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> due to the <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of the inner blood-retinal barrier</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cystoid <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (<strong>CME</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Leakage from <span class=\"customMeta\" data-dictid=\"cea77d01ce1692777184854450c378\">choroidal</span> or <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> neovascularization</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Proliferative <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> retinopathy, <span class=\"customMeta\" data-dictid=\"7c6ceacf801692777199b31cdb3fc6\">subretinal</span> <span class=\"customMeta\" data-dictid=\"624c00049d1692777193b1a9d81379\">neovascular</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> in ARMD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Staining (long <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> of <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> by tissues)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Drusen, normal <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Leakage from <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve head</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Papilloedema</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hypofluorescence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Blockage of background fluorescence</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Retinal hemorrhage, hard exudates, <span class=\"customMeta\" data-dictid=\"85dafbf32f1692777195b9d9f035d8\">pigmented</span> clumps</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Occlusion of retinal/choroidal vasculature</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Central <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> , <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">retinopathy</span> <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> occlusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Loss of vasculature</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Choroideremia, myopic degeneration</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following agents is most likely causing the condition in a 60-year-old woman, who had a kidney transplant 2 months ago, and is now experiencing a high fever, severe difficulty in breathing, and a dry cough with a hacking sound? A chest x-ray shows widespread interstitial infiltrates in both lungs, and urine examination reveals the presence of cells with an 'owl-eye' appearance.", "options": [{"label": "A", "text": "Adenovirus", "correct": false}, {"label": "B", "text": "Cytomegalovirus", "correct": true}, {"label": "C", "text": "Influenza virus", "correct": false}, {"label": "D", "text": "Respiratory syncytial", "correct": false}], "correct_answer": "B. Cytomegalovirus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complications following <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> transplant</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Graft rejection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperacute, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> and chronic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Opportunistic infections</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>&lt; 1 Month: </strong>Wound infection, HSV, UTI, Oral candidiasis</li>\n<li><strong>1-6 Months: CMV</strong> (most common), HBV, HCV, Pneumocystis carinii, Listeria</li>\n<li><strong>&gt;6 Months: BK Virus</strong>, Aspergillus, Nocardia, HBV, HCV, HZV</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypercalcemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This may indicate failure of <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> post-transplant.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common post-transplant, often due to <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> medications. Gastrointestinal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> can occur from <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic hepatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Particularly from <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> B virus, which can progress over time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin and lip cancers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Most common malignancy</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>The leading causes of death among <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> transplant recipients include:</strong></p>\n<ul>\n<li>Cardiovascular events (29%)</li>\n<li>Infections (18%)</li>\n<li>Malignancies (17%)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presents with unsteady gait, forgetfulness, and labile moods. During a physical exam, the neurologist notices the findings shown in the image below. The most likely diagnosis is:", "options": [{"label": "A", "text": "Neurofibromatosis 2", "correct": false}, {"label": "B", "text": "Wilson’s disease", "correct": true}, {"label": "C", "text": "Neurofibromatosis 1", "correct": false}, {"label": "D", "text": "Cataract", "correct": false}], "correct_answer": "B. Wilson’s disease", "question_images": ["https://image.prepladder.com/content/Fo7LhGhfQFkC4M6IObxU1747045034.png"], "explanation_images": ["https://image.prepladder.com/content/Hr33GW2mYm2p8J9CIngC1747982276.png", "https://image.prepladder.com/content/1s3fue7rh4nom73G0ubO1747982315.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 53-year-old patient was brought to the emergency room with a history of alcohol abuse, altered sensorium, and rapid shallow breathing. His abdomen is distended with palpable hepatomegaly and splenomegaly and sclerae are icteric. The other examination findings are given below. Laboratory tests show that the AST: ALT ratio is 3:1. What is the most likely cause of this patient’s presentation?", "options": [{"label": "A", "text": "Alcoholic liver disease", "correct": true}, {"label": "B", "text": "Acute viral hepatitis", "correct": false}, {"label": "C", "text": "Autoimmune hepatitis", "correct": false}, {"label": "D", "text": "Acetaminophen poisoning", "correct": false}], "correct_answer": "A. Alcoholic liver disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alcohol Metabolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ethanol is primarily metabolized in the liver by enzymes, particularly <span class=\"customMeta\" data-dictid=\"4c1279cdf1169277718118b18c10ab\">alcohol dehydrogenase</span> (ADH) and <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> P450 2E1 (CYP2E1).</li>\n<li>This <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> produces acetaldehyde, a toxic intermediate, which can cause <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oxidative Stress</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> of alcohol generates <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> oxygen species (ROS) and increases <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> stress within liver cells.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> damage leads to <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> peroxidation, protein modifications, and DNA damage, contributing to <span class=\"customMeta\" data-dictid=\"d92a2c1a2f1692777188848354f32b\">hepatocyte</span> injury and inflammation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inflammatory Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcohol consumption stimulates the <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of immune cells (e.g., Kupffer cells) leading to the release of pro-inflammatory cytokines (TNF-α, IL-6).</li>\n<li>These cytokines promote <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and can further damage hepatocytes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Altered <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">Lipid</span> Metabolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcohol disrupts normal <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> metabolism, leading to fat accumulation in liver cells (steatosis).</li>\n<li>This accumulation can progress to steatohepatitis, where <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and liver cell injury occur.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fibrosis and Cirrhosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and injury stimulate the <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">stellate</span> cells, which produce <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> and lead to fibrosis.</li>\n<li>Over time, repeated injury can result in cirrhosis, characterized by <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> and loss of normal liver architecture.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>General</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Usually asymptomatic</li>\n<li>Fever, malaise, jaundice, history of alcohol <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> + (at least within last 8 weeks before symptom onset)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Abdominal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain, tender hepatomegaly, splenomegaly, ascites</li>\n<li><strong>Caput medusae:</strong> enlarged veins radiating from the umbilicus</li>\n<li>Bleeding <span class=\"customMeta\" data-dictid=\"c3b47c6c6b16927772018ebcc5b5a9\">varices</span> (portal hypertension)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dermatological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Spider angioma</strong>, <strong>palmar erythema</strong>, ecchymosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reproductive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gynaecomastia, gonadal atrophy, loss of libido, amenorrhea</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral neuropathy: <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> and <span class=\"customMeta\" data-dictid=\"a6a2c6342d1692777193c3414d0cc8\">numbness</span> usually over feet</li>\n<li><strong>Wernicke-Korsakoff syndrome:</strong> Ophthalmoplegia, confusion, <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> + <span class=\"customMeta\" data-dictid=\"6f04a43a8c16927771816dd61a4f17\">anterograde</span> amnesia</li>\n<li><strong>Hepatic encephalopathy:</strong> <strong>Asterixis (most prominent finding)</strong>, altered sensorium, sleep disturbances, lethargy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Others</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dupuytren’s contracture</strong>, <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> muscle wasting, <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> enlargement</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:521px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>AST (Aspartate aminotransferase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Non-specific ; ↑ (&lt;300-400)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ALT (Alanine aminotransferase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specific for liver injury ; ↑ (&lt;300-400)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>AST/ALT ratio: ≥ 2: 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Specific for ALD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ALP (Alkaline phosphatase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated in <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> pathologies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>GGT (γ-glutamyl transferase)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-specific marker of ALD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5’-Nucleotidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specific marker for <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> pathologies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S.Bilirubin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually normal/mildly ↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S.Albumin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ in chronic liver disease (cirrhosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carbohydrate-deficient <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> (CDT)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> marker for <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> liver disease.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man is experiencing chronic pain in his hands, knees, and hips, with increased pain in the hands during writing or typing. Additionally, he has morning stiffness in his joints that lasts for about 30 minutes. On examination, Heberden's and Bouchard's nodes are visible in the hands, and an X-ray of the knee shows narrowed joint space with osteophytes. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteoporosis", "correct": false}, {"label": "B", "text": "Osteoarthritis", "correct": true}, {"label": "C", "text": "Rheumatoid arthritis", "correct": false}, {"label": "D", "text": "Bone tumour", "correct": false}], "correct_answer": "B. Osteoarthritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Osteoarthritis (OA)</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Psoriatic Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gout</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reactive Arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Joint Involvement Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symmetrical involvement of small joints (MCP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, especially DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, often DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically involves a single joint (e.g., big toe)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, often larger joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morning Stiffness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lasts over 1 hour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resolves within 30 minutes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varies, often significant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely significant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable often follows infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling, tenderness, deformities (e.g., <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pain and <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> with use</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dactylitis, nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sudden, severe pain and swelling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Joint pain following an infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Affected Joints</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MCP, PIP, wrists, knees</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Knees, hips, hands (DIP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MCP, PIP, and can include spine and tendons</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically big toe (1st MTP joint)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Larger joints (e.g., knees, ankles)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiographic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soft tissue swelling, joint space narrowing</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Osteophytes, joint space narrowing</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erosions, possible nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erosions and <span class=\"customMeta\" data-dictid=\"23ed22c5821692777200820f6150ac\">tophi</span> possible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar to RA but typically larger joints</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A girl experiences prolonged menstrual bleeding and has normal platelet count, PT, and aPTT, but an increased bleeding time, which was determined to be due to a deficiency of GpIIb-IIIa after further analysis. What is the diagnosis?", "options": [{"label": "A", "text": "Bernard Soulier syndrome", "correct": false}, {"label": "B", "text": "Glanzmann thrombasthenia", "correct": true}, {"label": "C", "text": "Haemophilia A", "correct": false}, {"label": "D", "text": "Von Willebrand disease", "correct": false}], "correct_answer": "B. Glanzmann thrombasthenia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:468px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Results</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>aPTT, PT, and <span class=\"customMeta\" data-dictid=\"94ec122d611692777197d287df7f88\">ristocetin</span> <span class=\"customMeta\" data-dictid=\"a416d7580c1692777184952da793d1\">cofactor</span> activity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding time</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Light transmission <span class=\"customMeta\" data-dictid=\"895694f7ec16927771804a7a8e1592\">aggregometry</span> (LTA) (gold standard test)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Altered <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"a00e90be0416927771803afbbf099b\">aggregation</span> with ADP, collagen, and epinephrine.</p>\n<p>Normal <span class=\"customMeta\" data-dictid=\"a00e90be0416927771803afbbf099b\">aggregation</span> with ristocetin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flow cytometry</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defective expression of <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> IIb <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> 3 integrin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Molecular genetic tests</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gene mutations in ITGA2B or ITGB3</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:465px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical setting</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmopressin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild bleeding<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Platelets and/or <span class=\"customMeta\" data-dictid=\"b566321fe8169277719716b1cf4df0\">recombinant</span> activated <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factor VII (rFVIIa)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery prophylaxis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tranexamic acid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mucocutaneous bleeding</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recombinant FVIIa</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Platelet <span class=\"customMeta\" data-dictid=\"761a0230a6169277719742118ccc9c\">refractoriness</span> cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child is brought to the OPD with a history of repeated fractures for the past 2 years. On examination, blue sclera and dental abnormalities are noted. There is a family history of similar complaints. Which of the following is the diagnosis?", "options": [{"label": "A", "text": "Scurvy", "correct": false}, {"label": "B", "text": "Rickets", "correct": false}, {"label": "C", "text": "Osteogenesis imperfecta", "correct": true}, {"label": "D", "text": "Osteomalacia", "correct": false}], "correct_answer": "C. Osteogenesis imperfecta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AMfGJyx8Wu0ieGwd9Z8I1748154460.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Defective type I <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> synthesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic Mutations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I-IV:</strong> COL1A1, COL1A2</p>\n<p><strong>Type V:</strong> IFITM5</p>\n<p><strong>Type VI:</strong> SERPINF1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recurrent fractures from minimal trauma, blue sclerae, hearing loss, joint hypermobility, osteopenia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cardiopulmonary issues (pneumonia, <span class=\"customMeta\" data-dictid=\"4534214488169277718575e08a9bc0\">cor</span> pulmonale), neurological complications (basilar invagination, <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> compression)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rickets, osteopetrosis, and disorders related to <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> metabolism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Physical rehabilitation, Bisphosphonates, growth hormone, <span class=\"customMeta\" data-dictid=\"0b8eb98a3f16927771945b310aec42\">orthopedic</span> management (fracture care, surgery)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient exhibits symptoms of increased urination, nighttime urination, and involuntary urination, along with a recorded 24-hour urine volume of 7 litres. He has a urine osmolarity of 260 mOsm/L. The ADH assay shows a recorded value of 0.8 pg/ml, and an MRI of the brain reveals the absence of a bright spot on T1-weighted imaging. What is the probable diagnosis?", "options": [{"label": "A", "text": "Nephrogenic DI", "correct": false}, {"label": "B", "text": "Primary polydipsia", "correct": false}, {"label": "C", "text": "Pituitary DI", "correct": true}, {"label": "D", "text": "Mannitol infusion", "correct": false}], "correct_answer": "C. Pituitary DI", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:783px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Central DI</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nephrogenic <span class=\"customMeta\" data-dictid=\"7194dbeaed1692777186e2554f8ebf\">DI</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary Polydipsia</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gestational DI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deficiency of AVP (Arginine vasopressin) <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> from the <strong>pituitary gland</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Kidneys are unable to respond to AVP, even if levels are normal.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excessive water <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> suppresses AVP secretion.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased activity of <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> degrading AVP during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired</strong>: Head trauma, tumours, granulomas, infections, inflammation, toxins, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> events, hypoxia.</p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired</strong>: Drugs (lithium, demeclocycline), <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders (hypercalcaemia, hypokalaemia), obstruction, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> issues, granulomas, tumours, and infiltration.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dipsogenic</strong>: Inappropriate thirst, head trauma, brain diseases.</p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"6937cb294a1692777201467ccb0597\">vasopressinase</span> activity.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psychogenic</strong>: Psychiatric conditions, <span class=\"customMeta\" data-dictid=\"8e09a4a39b1692777184e5e57a8435\">compulsive</span> water drinking.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic</strong>: Mutations in the AVP–neurophysin II or WFS1 genes.</p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic</strong>: Mutations in the V2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> or aquaporin-2 genes.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iatrogenic</strong>: Belief in the health benefits of excessive water intake.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Basal <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> AVP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low or undetectable (&lt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or elevated (&gt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low due to <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> by excessive water intake.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low due to increased degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urine Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L) but can temporarily concentrate with fluid deprivation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plasma Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluid <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">Deprivation</span> Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urine does not concentrate.</li>\n<li>AVP or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> increases <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> in severe CDI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urine does not concentrate.</li>\n<li>AVP or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> does not affect severe NDI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plasma <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> and sodium increase above normal without <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> concentration.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not typically performed during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot absent or small.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright- spot may be faint or absent.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot present.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not routinely used for diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Desmopressin (DDAVP) Trial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abolishes <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> and polydipsia; reduces <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No effect on <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, fluid intake, or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eliminates <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> but not polydipsia, leading to hyponatremia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Effective in controlling symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plasma Copeptin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low or undetectable.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be normal or elevated.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suppressed due to low AVP.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be low due to AVP degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thiazide diuretics, amiloride, low-sodium diet, <span class=\"customMeta\" data-dictid=\"42815e46071692777196c90c46f78b\">prostaglandin</span> inhibitors.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Behavioural therapy, education about overhydration.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lifelong treatment is usually needed for <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> CDI</li>\n<li>Genetic forms may improve.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependent on the underlying cause</li>\n<li>Lithium-induced NDI may persist.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependent on behavioural <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> and addressing the underlying cause.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Usually, it resolves after delivery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was asked to copy the face of a clock and his drawing is shown below. What is the correct term to be used here?", "options": [{"label": "A", "text": "Confabulation", "correct": false}, {"label": "B", "text": "Hemispatial neglect", "correct": true}, {"label": "C", "text": "Kinetic apraxia", "correct": false}, {"label": "D", "text": "Asterixis", "correct": false}], "correct_answer": "B. Hemispatial neglect", "question_images": ["https://image.prepladder.com/content/IO2ioJUck4IQvKy6TcB91748163624.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient in his youth comes to the clinic complaining of a persistent high fever over the past 5 days. During the examination of his hands, painless lesions are observed, and a new regurgitant murmur is detected. The echocardiogram reveals the existence of a mass on the mitral valve. Based on these findings, which of the following abdominal findings would be expected in this case?", "options": [{"label": "A", "text": "Ascites", "correct": false}, {"label": "B", "text": "Splenomegaly", "correct": true}, {"label": "C", "text": "Hepatomegaly", "correct": false}, {"label": "D", "text": "Portal hypertension", "correct": false}], "correct_answer": "B. Splenomegaly", "question_images": ["https://image.prepladder.com/content/qMd4Yi5wVODVXViwTAgM1747046217.png"], "explanation_images": ["https://image.prepladder.com/content/hrsAuG1Ovh1vR58MDjvS1747046294.png", "https://image.prepladder.com/content/jVthHNKSGgT0kUpXzUOh1747046268.png", "https://image.prepladder.com/content/3ivFo1zIr7qrRbHZ6TcU1747046268.png", "https://image.prepladder.com/content/nYNYWPVsCj2OCYA8H9s81747046268.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Janeway lesions:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Painless, erythematous macules on palms and soles. Related to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> microembolization,</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Warfieldian - Own work\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Janeway_lesion#/media/File:Janeway_lesion.JPG\" data-tags=\"\" height=\"397\" src=\"https://image.prepladder.com/content/hrsAuG1Ovh1vR58MDjvS1747046294.png\" width=\"543\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osler’s nodes: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small painful pea-shaped nodules located at the <span class=\"customMeta\" data-dictid=\"e399ea3b4616927772004e16d5999d\">tips</span> of fingers and toes (Immune complex-mediated).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Roberto J. Galindo - Own work\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Osler%27s_node#/media/File:Osler_Nodules_Hand.jpg\" data-tags=\"\" height=\"444\" src=\"https://image.prepladder.com/content/jVthHNKSGgT0kUpXzUOh1747046268.png\" width=\"363\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subungual haemorrhages/Splinter haemorrhages; </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More common in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> S. aureus IE. Haemorrhages below nails- multiple <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> lesions, initially red then turning brown or black.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Splarka - Own work\" data-hash=\"\" data-license=\"OPEN ACESS\" data-source=\"https://en.wikipedia.org/wiki/Splinter_hemorrhage#/media/File:Splinter_hemorrhage.jpg\" data-tags=\"\" height=\"413\" src=\"https://image.prepladder.com/content/3ivFo1zIr7qrRbHZ6TcU1747046268.png\" width=\"357\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Roth spots: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pale-centred <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> haemorrhages that are seen in the <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> examination</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CC BY-NC 2.0\" data-hash=\"\" data-license=\"Community Eye Health. Published by the International Centre for Eye Health www.iceh.org.uk, London School of Hygiene &amp; Tropical Medicine.\" data-source=\"https://www.flickr.com/photos/communityeyehealth/7603597760\" data-tags=\"\" height=\"504\" src=\"https://image.prepladder.com/content/nYNYWPVsCj2OCYA8H9s81747046268.png\" width=\"504\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 47-year-old woman was brought to the casualty in an unconscious state after having suddenly collapsed. As there was no pulse, cardiopulmonary resuscitation was started and the monitor showed the following rhythm. What is the next step?", "options": [{"label": "A", "text": "Defibrillation", "correct": true}, {"label": "B", "text": "Synchronized cardioversion", "correct": false}, {"label": "C", "text": "1mg epinephrine", "correct": false}, {"label": "D", "text": "0.5mg atropine", "correct": false}], "correct_answer": "A. Defibrillation", "question_images": ["https://image.prepladder.com/content/SQVG35ZJVzgCX9F9bQKB1747046506.png"], "explanation_images": ["https://image.prepladder.com/content/s0yqR7XTt3aA63EMQiD51747046549.png", "https://image.prepladder.com/content/5kZT01pT9Y6Du480oTS31747046549.png", "https://image.prepladder.com/content/miKvyzu6nbmxnv5q2eU21747046549.png", "https://image.prepladder.com/content/QgOb89OfDwr8zGeQoCbt1747046549.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Shockable Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Non-Shockable Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Fibrillation</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"448\" src=\"https://image.prepladder.com/content/s0yqR7XTt3aA63EMQiD51747046549.png\" width=\"446\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asystole</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"138\" src=\"https://image.prepladder.com/content/5kZT01pT9Y6Du480oTS31747046549.png\" width=\"447\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Tachycardia </strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"230\" src=\"https://image.prepladder.com/content/miKvyzu6nbmxnv5q2eU21747046549.png\" width=\"447\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulseless Electrical Activity</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"128\" src=\"https://image.prepladder.com/content/QgOb89OfDwr8zGeQoCbt1747046549.png\" width=\"447\"/></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Shockable Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Non-Shockable Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Immediate Recognition</strong></p>\n<p style=\"text-align:center\"><strong>Identify Shockable Rhythm:</strong> Recognize VF or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> VT.</p>\n<p style=\"text-align:center\"><strong>Activate Emergency Response: </strong>Call for advanced life support.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Initiate CPR</strong></p>\n<p style=\"text-align:center\"><strong>Start High-Quality CPR: </strong>Perform chest compressions at a rate of 100-120/min, with a depth of 5-6 cm. Continue CPR for 2 minutes.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Defibrillation (Option A)</strong></p>\n<p style=\"text-align:center\">After 2 minutes of CPR, deliver a Non-Synchronized DC Shock to restore normal rhythm.</p>\n<p style=\"text-align:center\">If no change, administer a second shock immediately.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Continue CPR</strong></p>\n<p style=\"text-align:center\">Resume CPR for 2 Minutes</p>\n<p style=\"text-align:center\">Place an <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> or <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> line for drug administration.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Administer Epinephrine</strong></p>\n<p style=\"text-align:center\"><strong>Epinephrine 1 mg (Option C)</strong> (1:10,000): Given IV/IO after 2 minutes of CPR to enhance <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> pressure.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Management</strong></p>\n<p style=\"text-align:center\"><strong>Secure Airway: </strong>Perform <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> if necessary.</p>\n<p style=\"text-align:center\"><strong>Capnography:</strong> Monitor <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO2 levels.</p>\n<p style=\"text-align:center\"><strong>Ventilation:</strong> Provide 1 breath every 6 seconds post-intubation.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Further Defibrillation</strong></p>\n<p style=\"text-align:center\"><strong>Third Shock:</strong> If VF or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> VT persists, deliver a third non-synchronized shock.</p>\n<p style=\"text-align:center\">Continue CPR for 2 More Minutes: Follow with additional CPR.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Administer Antiarrhythmic Medication</strong></p>\n<p style=\"text-align:center\"><strong>Amiodarone 300 mg IV: </strong>Administer for shock-refractory VT to stabilize heart rhythm.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Identify and Treat <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Immediate Recognition</strong></p>\n<p style=\"text-align:center\"><strong>Identify Non-Shockable Rhythm:</strong> Recognize <span class=\"customMeta\" data-dictid=\"91769de9d4169277718220e09c463f\">asystole</span> or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> (PEA).</p>\n<p style=\"text-align:center\"><strong>Activate Emergency Response:</strong> Call for advanced life support.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Initiate CPR</strong></p>\n<p style=\"text-align:center\"><strong>Start High-Quality CPR: </strong>Perform chest compressions at a rate of 100-120/min, with a depth of 5-6 cm. Continue CPR for 2 minutes.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Establish <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> or <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> lines for medication administration.</strong></p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Administer Epinephrine</strong></p>\n<p style=\"text-align:center\"><strong>Epinephrine 1 mg (1:10,000):</strong> Administer IV/IO after the first 2 minutes of CPR.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Identify Rhythm</strong></p>\n<ul>\n<li style=\"text-align:center\"><strong>Non-Shockable Rhythm: </strong>Continue CPR and administer <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> every 3-5 minutes.</li>\n</ul>\n<p style=\"text-align:center\"><strong>Goal: </strong>To increase the likelihood of developing a shockable rhythm, such as <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> (VF), which is necessary for effective defibrillation.</p>\n<ul>\n<li style=\"text-align:center\"><strong>Shockable Rhythm:</strong> Administer a Non-Synchronized DC Shock to restore normal rhythm.</li>\n</ul>\n<p style=\"text-align:center\">↓<br/>\n<strong>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Management</strong></p>\n<p style=\"text-align:center\"><strong>Airway: </strong>Secure the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> with <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> if necessary.</p>\n<p style=\"text-align:center\"><strong>Capnography: </strong>Monitor <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO2 levels.</p>\n<p style=\"text-align:center\"><strong>Ventilation: </strong>Provide 1 breath every 6 seconds post-intubation for adequate oxygenation.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Continue CPR</strong></p>\n<p style=\"text-align:center\">Resume chest compressions for 2 minutes.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Identify and Treat <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n<p style=\"text-align:center\"><strong>Primary Focus:</strong> Address <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> causes, especially hypothermia.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Repeat CPR and Epinephrine</strong></p>\n<p style=\"text-align:center\"><strong>Cycle: </strong>Continue repeating CPR and <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> administration every 3-5 minutes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man presents with sudden onset of a headache, palpitation, and profuse sweating. He had several such episodes in the past. During these episodes, his BP is found to be high. A 24-hour urinary metanephrine is elevated. What is the most likely aetiology?", "options": [{"label": "A", "text": "Fibromuscular dysplasia", "correct": false}, {"label": "B", "text": "Renal artery stenosis", "correct": false}, {"label": "C", "text": "Pheochromocytoma", "correct": true}, {"label": "D", "text": "Hyperthyroidism", "correct": false}], "correct_answer": "C. Pheochromocytoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dmPNTQOt3U6fXq0rnOtu1747046654.png", "https://image.prepladder.com/content/B7SMf25uUVskpsWbSlv71747046654.png", "https://image.prepladder.com/content/HMqC285Rh8aLJp9MmTUp1747046654.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Pheochromocytomas are rare tumours arising from <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells of the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> medulla.</li>\n<li>The clinical features result from excessive <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of catecholamines.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Estimated to occur in 2 to 8 of 1 million persons per year.</li>\n<li>The mean age at diagnosis is 40 years, although the tumours can occur from early childhood until late in life.</li>\n<li>The classic ‘rule of tens’ is 10% bilateral, 10% <span class=\"customMeta\" data-dictid=\"5d5198131c16927771873e61ef8092\">extra-adrenal</span> (Paragangliomas), and 10% metastatic. It is <strong>not used </strong>nowadays.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>These tumors can be <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> or <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> and are frequently associated with <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> syndromes like\n\t\t\t\t<ul>\n<li><strong>Neurofibromatosis type 1, </strong></li>\n<li><strong>multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> type II, and </strong></li>\n<li><strong>Von-Hippel Lindau disease.</strong></li>\n</ul>\n</li>\n<li>Catecholamines are produced in the <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells starting with the rate-limiting step of tyrosine <span class=\"customMeta\" data-dictid=\"0b592280091692777189e27f90a885\">hydroxylase</span> (TH), regulating the conversion of tyrosine to dihydroxyphenylalanine (DOPA).</li>\n<li>Pheochromocytomas release these catecholamines in various patterns ranging from paroxysmal, continuous, and mixed patterns. Norepinephrine is released continuously and can result in persistent hypertension, while <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> is released in a <span class=\"customMeta\" data-dictid=\"cd15fe58221692777194fbb9eec8d1\">paroxysmal</span> pattern resulting in tachyarrhythmias.\n\t\t\t\t<ul>\n<li>Ryanodine-2 receptors (RyR2).</li>\n<li>Beta-2 adrenoceptors</li>\n<li>Alpha(1)-adrenoreceptors</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Histology of the <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> characteristically shows zellballen nests of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells with strong positivity to chromogranin, synaptophysin, CD56, and focally to S100.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron - Own work\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Paraganglioma#/media/File:Carotid_body_tumour_2_intermed_mag.jpg\" data-tags=\"\" height=\"437\" src=\"https://image.prepladder.com/content/dmPNTQOt3U6fXq0rnOtu1747046654.png\" width=\"653\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>The presence of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells in the <span class=\"customMeta\" data-dictid=\"5d5198131c16927771873e61ef8092\">extra-adrenal</span> tissue is the only <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> characteristic of the <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of the entity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Classical <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> </strong>\n<ul>\n<li>Episode of palpitation</li>\n<li>Headache</li>\n<li>Profuse sweating</li>\n</ul>\n</li>\n<li><strong>The dominant sign is Hypertension</strong></li>\n<li>Tachycardia</li>\n<li>Anxiety</li>\n<li>Subcutaneous neurofibromas</li>\n<li>Cafe-au-lait macules</li>\n<li>Thyroid mass</li>\n<li>Axillary freckling</li>\n<li>Lisch nodules on the iris</li>\n<li>Retinal angiomas</li>\n<li>Abdominal mass</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diagnosis of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> can be established by biochemical confirmation of <strong>hypersecretion of metanephrines and catecholamines.</strong></li>\n</ul>\n<p><strong>24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> test</strong></p>\n<ul>\n<li>Catecholamines</li>\n<li>Fractionated metanephrines</li>\n<li><strong>Total metanephrines</strong></li>\n</ul>\n<p><strong>Imaging</strong>:</p>\n<ul>\n<li>CT scan of the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> to locate the tumour.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Campos A, Weerakkody Y, et al. Pheochromocytoma. Reference article, Radiopaedia.org (Accessed on 29 Nov 2024) https://doi.org/10.53347/rID-8642\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/phaeochromocytoma-1\" data-tags=\"\" height=\"441\" src=\"https://image.prepladder.com/content/B7SMf25uUVskpsWbSlv71747046654.png\" width=\"668\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>18F-FDG PET <span class=\"customMeta\" data-dictid=\"c497b556951692777198b599e4ba86\">scanning</span> is recommended for metastatic disease.</li>\n<li>MIBG scintigraphy</li>\n<li>Somatostatin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> scintigraphy</li>\n<li>Gallium DOTATATE PET scanning</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jorge A. Carrasquillo, Clara C. Chen, Abhishek Jha, Alexander Ling, Frank I. Lin, Daniel A. Pryma and Karel Pacak Journal of Nuclear Medicine August 2021, 62 (8) 1033-1042; DOI: https://doi.org/10.2967/jnumed.120.259689\" data-hash=\"\" data-license=\"NA\" data-source=\"https://jnm.snmjournals.org/content/62/8/1033\" data-tags=\"\" height=\"406\" src=\"https://image.prepladder.com/content/HMqC285Rh8aLJp9MmTUp1747046654.png\" width=\"724\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyperthyroidism</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis</li>\n<li>Hyperaldosteronism</li>\n<li>Cardiomyopathy</li>\n<li>Postural <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> syndrome (POTS)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> is <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> resection.</li>\n<li>Preoperative preparation of the patient has to be considered, and <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> should be consistently &lt; 160/90 mm Hg.</li>\n<li>Blood pressure is controlled by alpha-adrenergic blockers(phenoxybenzamine 0.5-4 mg/kg of body weight)</li>\n<li>Oral Prazosin or IV <span class=\"customMeta\" data-dictid=\"4b193b485f169277719585706f10f3\">phentolamine</span> can be used to control paroxysm.</li>\n</ul>\n<p> </p>\n<p><strong>Unilateral Pheochromocytoma:</strong></p>\n<ul>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> adrenalectomy: Preferred treatment for most <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> pheochromocytomas.</li>\n<li>Open adrenalectomy</li>\n</ul>\n<p> </p>\n<p><strong>Bilateral pheochromocytomas: </strong></p>\n<ul>\n<li>Bilateral total <span class=\"customMeta\" data-dictid=\"d111e1e6a116927771806eedcac2eb\">adrenalectomy</span> is associated with a lifelong need for <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> replacement with long-term side effects.</li>\n<li>Bilateral partial or <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> sparing <span class=\"customMeta\" data-dictid=\"d111e1e6a116927771806eedcac2eb\">adrenalectomy</span> (open or laparoscopic)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Myocardial infarction</li>\n<li>Cardiogenic shock</li>\n<li>Renal Failure</li>\n<li>Pulmonary edema</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (ARDS)</li>\n<li>Lactic acidosis</li>\n<li>Hypertensive retinopathy</li>\n<li>Hypertensive encephalopathy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who is 66 years old and has a history of chronic hypertension, arrives at the emergency room with changes in mental state and high blood pressure measuring 210/110 mm Hg. A brain CT scan shows bleeding within the brain tissue. The typical location of this bleeding in similar cases is?", "options": [{"label": "A", "text": "Putamen", "correct": true}, {"label": "B", "text": "Thalamus", "correct": false}, {"label": "C", "text": "Pons", "correct": false}, {"label": "D", "text": "Cerebellum", "correct": false}], "correct_answer": "A. Putamen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:687px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Cerebral <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">Amyloid</span> </strong></p>\n<p><strong>Angiopathy (CAA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Berry Aneurysm Rupture </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Hypertensive Crisis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Venous Sinus Thrombosis </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Elderly (&gt;60 years)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Younger</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Older, with chronic HTN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Younger, hypercoagulable states</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Chronic HTN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hemorrhage Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Multiple <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> haemorrhages</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Subarachnoid, single-event</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Deep (e.g., <strong>putamen</strong>, thalamus)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hemorrhagic infarction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hemorrhage Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cortical-subcortical regions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Subarachnoid space</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Deep brain structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Venous infarction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lobar haemorrhages, microbleeds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Single, <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> bleed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Deep hemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Venous <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Acute neurological symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Thunderclap headache</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Often no symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Seizures, <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Acute neurological presentation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sudden, thunderclap headache</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Acute, with chronic HTN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Acute, gradual progression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Spares deep structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Focal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Deep brain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Venous infarction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 40-year-old man whose lab reports indicate positive IgG Anti-HBc and negative HBsAg?", "options": [{"label": "A", "text": "Recovering from hepatitis B", "correct": false}, {"label": "B", "text": "Hepatitis B in the remote past", "correct": true}, {"label": "C", "text": "Immunization with HBsAg", "correct": false}, {"label": "D", "text": "Both B &amp;amp; C", "correct": false}], "correct_answer": "B. Hepatitis B in the remote past", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ceCubdVsJqD520sSFmh91747046970.png", "https://image.prepladder.com/content/jjAZtju1nKDyJ3XsyRgn1747046970.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:586px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Phase/Condition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>HBsAg</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>Anti-HBs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>HBeAg</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>Anti-HBe</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>Anti-HBc</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Acute HBV </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IgM</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Window Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IgM</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chronic HBV/ Infective carrier </strong>(High infectivity)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chronic HBV/Healthy carrier </strong>(Low infectivity)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n<p><strong>+</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Remote infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Nil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>IgG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Recovery</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n<p><strong>+</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IgG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Immunised</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Nil</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old woman presented with changes in the hand as shown below. There is decreased motion in the small joints and loss of wrinkle lines on the facial skin. Her chest radiograph showed prominent bilateral lower lobe infiltrates. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Rheumatoid arthritis", "correct": false}, {"label": "B", "text": "Scleroderma", "correct": true}, {"label": "C", "text": "Systemic lupus Erythematosus", "correct": false}, {"label": "D", "text": "Pneumonia", "correct": false}], "correct_answer": "B. Scleroderma", "question_images": ["https://image.prepladder.com/content/yKSizBHKlSkH2wL1qHAU1747047039.png"], "explanation_images": ["https://image.prepladder.com/content/jWv9nfXi6wxSBz5CQBhn1747047071.png", "https://image.prepladder.com/content/ozFZtrOMlR2iUSkCEXXz1747047071.png", "https://image.prepladder.com/content/dn3CPS8QUfIecdnztlSz1747047071.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman presents with weakness in right arm for 6 hours. The weakness gradually became lesser and later resolved. She is a known case of diabetes and hypertension and is obese. Which of the following is the probable diagnosis of this case?", "options": [{"label": "A", "text": "Compressive neuropathy", "correct": false}, {"label": "B", "text": "Transient ischaemic attack", "correct": true}, {"label": "C", "text": "Ischaemic stroke", "correct": false}, {"label": "D", "text": "Diabetic neuropathy", "correct": false}], "correct_answer": "B. Transient ischaemic attack", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 60 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BP ≥ 140/90</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> without weakness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilateral weakness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 points</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10–59 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥ 60 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 points</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of diabetes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 point</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:409px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stroke Risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 90</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0–3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.2%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3.1%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4–5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4.1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5.9%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9.8%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6–7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8.1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>11.7%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>17.8%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the formula of crude birth rate?", "options": [{"label": "A", "text": "(Total number of births / Estimated midyear Population) 1,000", "correct": false}, {"label": "B", "text": "(Number of live births / Estimated midyear women Population) 1,000", "correct": false}, {"label": "C", "text": "(Number of live births/ Estimated midyear Population) 1,000", "correct": true}, {"label": "D", "text": "(Number of live births / Estimated midyear Population) 1,0000", "correct": false}], "correct_answer": "C. (Number of live births/ Estimated midyear Population) 1,000", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SfyyGc6F1ryWG8xnotQO1748156339.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:395px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Crude birth rates</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Number of live births per 1000 estimated</p>\n<p>mid-year population in a given year.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Formula</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"268\" src=\"https://image.prepladder.com/content/SfyyGc6F1ryWG8xnotQO1748156339.png\" width=\"1567\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Statistics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>India’s current CBR is 19.5/1000 mid-year population. (2020)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drawbacks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It gives a rough measure of <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">fertility</span> by giving birth rates, and not everyone in the population is exposed to childbirth.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What clinical examination is being performed in the image?", "options": [{"label": "A", "text": "Shifting dullness", "correct": false}, {"label": "B", "text": "Ascites", "correct": false}, {"label": "C", "text": "Puddle sign", "correct": false}, {"label": "D", "text": "Fluid thrill", "correct": true}], "correct_answer": "D. Fluid thrill", "question_images": ["https://image.prepladder.com/content/FKuPXhGL31xurWi9YotH1747047657.png"], "explanation_images": ["https://image.prepladder.com/content/5DKr08fsat5WHxL7jG141747047689.png", "https://image.prepladder.com/content/4KRCusGf52ZtJXRtfbAF1747047689.png", "https://image.prepladder.com/content/pwa9yo46NXMlSWtcgC431747047689.png", "https://image.prepladder.com/content/ElpppcRzB6FtCx57e20c1747047689.png", "https://image.prepladder.com/content/itQqB5gxa12eGv0AuspP1747047689.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following leads to a continuous murmur?", "options": [{"label": "A", "text": "Peripheral Pulmonic stenosis", "correct": true}, {"label": "B", "text": "Severe Pulmonary artery hypertension", "correct": false}, {"label": "C", "text": "Type A aortic dissection", "correct": false}, {"label": "D", "text": "Rupture of cardiac chamber", "correct": false}], "correct_answer": "A. Peripheral Pulmonic stenosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JZciwfTXclgVMvdYit1J1748163650.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Continuous murmur</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Murmur that persists across <span class=\"customMeta\" data-dictid=\"13941ea4ec1692777199fc8cfd1a7a\">systole</span> and diastole</li>\n<li>Begins in at S1, continues through <span class=\"customMeta\" data-dictid=\"ddbe945c10169277719841fa6a7fa2\">second heart sound</span> (S2) and tapers at next S1</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"5495\" src=\"https://image.prepladder.com/content/JZciwfTXclgVMvdYit1J1748163650.png\" width=\"6517\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Patent Ductus Arteriosus (PDA)</li>\n<li><strong>Peripheral <span class=\"customMeta\" data-dictid=\"5ebe3b1fbd1692777196b3ced12100\">Pulmonic</span> stenosis</strong></li>\n<li>Valsalva aneurysm</li>\n<li>Aortopulmonary window</li>\n<li>Great vessel <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> fistula</li>\n<li>Coronary to <span class=\"customMeta\" data-dictid=\"5ebe3b1fbd1692777196b3ced12100\">pulmonic</span> fistula</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mitral Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Low-pitched <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> with opening snap, best at the apex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aortic Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systolic <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur, crescendo-decrescendo pattern, radiating to carotids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Patent Ductus Arteriosus / Peripheral Pulmonic Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A continuous, machine-like murmur, heard at the left <span class=\"customMeta\" data-dictid=\"71409dc88a1692777190aedbc558b6\">infraclavicular</span> area</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypertrophic Cardiomyopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Harsh <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> murmur, crescendo-decrescendo pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mitral Regurgitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Holosystolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> radiating to the axilla</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aortic Regurgitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early diastolic decrescendo murmur, best heard at the left sternal border</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Graham Steell Murmur</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early diastolic decrescendo <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> regurgitation, heard best at the left upper sternal border.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Austin Flint Murmur</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low-pitched, rumbling <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> due to severe <span class=\"customMeta\" data-dictid=\"32a29a166b1692777182d46c390c42\">aortic regurgitation</span> causing <span class=\"customMeta\" data-dictid=\"66c04c3ac01692777201f1d43f0964\">turbulent flow</span> in the left ventricle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carvallo's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased intensity of a <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> with inspiration, heard along the left lower sternal border.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which factor has the greatest impact on positive predictive value?", "options": [{"label": "A", "text": "Sensitivity", "correct": false}, {"label": "B", "text": "Prevalence", "correct": true}, {"label": "C", "text": "Specificity", "correct": false}, {"label": "D", "text": "Relative risk", "correct": false}], "correct_answer": "B. Prevalence", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B) Prev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Yaws is caused by:", "options": [{"label": "A", "text": "T. Pertunae", "correct": true}, {"label": "B", "text": "T. endemicum", "correct": false}, {"label": "C", "text": "T. Carateum", "correct": false}, {"label": "D", "text": "Hemophilus", "correct": false}], "correct_answer": "A. T. Pertunae", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0y1fUouX8o3u2JxlsnL71747050395.png", "https://image.prepladder.com/content/0sGc6u7GVQSQjE4gi3sq1747050411.png"], "explanation": "<p>Correct Answer A - T. Pertu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a crucial element involved in activating the complement through the alternative pathway?", "options": [{"label": "A", "text": "C1", "correct": false}, {"label": "B", "text": "C2", "correct": false}, {"label": "C", "text": "C3", "correct": true}, {"label": "D", "text": "C4", "correct": false}], "correct_answer": "C. C3", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/g7VBWQaCuA4Q7F844UIr1747050871.png"], "explanation": "<p>Correct Answer C - C3:</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Trigger Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Key Components Involved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Classical Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Binding of C1q to antigen-antibody complexes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C1q <strong>(Option A ruled out)</strong>, C3 convertase, <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">Membrane</span> Attack Complex (MAC)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Alternative Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Direct binding of <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> proteins to pathogens</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C3, factors B and D, C3 convertase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Lectin Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Binding of mannose-binding <span class=\"customMeta\" data-dictid=\"32850def99169277719135597fc165\">lectin</span> (MBL) to mannose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MBL, MASP1, MASP2, C4 <strong>(Option D ruled out)</strong>, C2 <strong>(Option B ruled out)</strong>, C3 convertase</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ng, Nicole &amp; Powell, Charles.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Complement-activation-pathways-The-classical-pathway-is-activated-by-the-binding-of_fig1_351724955\" data-tags=\"\" height=\"756\" src=\"https://image.prepladder.com/content/g7VBWQaCuA4Q7F844UIr1747050871.png\" width=\"955\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is an enrichment medium?", "options": [{"label": "A", "text": "Alkaline peptone water", "correct": false}, {"label": "B", "text": "Monsur's taurocholate tellurite peptone water", "correct": false}, {"label": "C", "text": "Selenite F broth", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - All of the abov\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about tremors are true? PD is characterized by resting tremor Tremor consist of alternate contraction of agonist and antagonist muscle in an oscillating rhythmic manner Essential tremor is an uncommon movement disorder. Normal individuals can have physiologic tremors that manifest as mild high frequency, postural or action tremors", "options": [{"label": "A", "text": "1,2,3 only", "correct": false}, {"label": "B", "text": "2,3,4 only", "correct": false}, {"label": "C", "text": "1,2,4 only", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. 1,2,4 only", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Exacerbating Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Alleviating Factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resting Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Parkinson's disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Occurs at rest</li>\n<li>Pill-rolling movement</li>\n<li>Asymmetrical</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Emotional stress</li>\n<li>Fatigue</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Voluntary movement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Action Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cerebellar disorders</li>\n<li>Multiple sclerosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tremor occurs with voluntary movement</li>\n<li>Intention <span class=\"customMeta\" data-dictid=\"bb6d2476421692777200c2af1ac0c8\">tremor</span> (worsens near target)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Movement initiation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rest</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Postural Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Essential tremor</li>\n<li>Physiologic tremor</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tremor when maintaining <span class=\"customMeta\" data-dictid=\"115643fed616927771961316effc71\">posture</span> against gravity</li>\n<li>Fine or <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> oscillations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anxiety</li>\n<li>Fatigue</li>\n<li>Caffeine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcohol</li>\n<li>Beta-blockers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intention Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cerebellar damage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases in <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> as the target is approached</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Goal-directed movements</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rest</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physiologic Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal individuals</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fine, rapid, low-amplitude tremor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anxiety</li>\n<li>Caffeine</li>\n<li>Hyperthyroidism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rest</li>\n<li>Sleep</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Essential <span class=\"customMeta\" data-dictid=\"bb6d2476421692777200c2af1ac0c8\">Tremor</span> (Most Common Tremors)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unknown (often familial)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bilateral, symmetric</li>\n<li>Affects hands, head, voice</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stress</li>\n<li>Fatigue</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcohol</li>\n<li>Beta-blockers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dystonic Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dystonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Irregular tremor</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> postures</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Movement or sustained posture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sensory tricks (geste antagonists)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug-induced Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lithium</li>\n<li>Valproate</li>\n<li>SSRIs</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symmetric, postural, or action tremor</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Drug use</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dose reduction or discontinuation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psychogenic Tremor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Functional neurologic disorder</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden onset</li>\n<li>Inconsistent tremor</li>\n<li>Disappears with distraction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Psychological stress</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distraction</li>\n<li>Psychotherapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is amplified in an RT-PCR test for the COVID-19 virus?", "options": [{"label": "A", "text": "RNA", "correct": false}, {"label": "B", "text": "DNA", "correct": true}, {"label": "C", "text": "Structural protein", "correct": false}, {"label": "D", "text": "Envelope", "correct": false}], "correct_answer": "B. DNA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - DNA\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most important pathophysiological mechanism for Berry aneurysm?", "options": [{"label": "A", "text": "Endothelial injury of vessel due to HTN", "correct": false}, {"label": "B", "text": "Muscle intimal elastic lamina layer defect", "correct": true}, {"label": "C", "text": "Endothelial layer defect", "correct": false}, {"label": "D", "text": "Adventitia defect", "correct": false}], "correct_answer": "B. Muscle intimal elastic lamina layer defect", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Berry Aneurysm</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Saccular <span class=\"customMeta\" data-dictid=\"9573d4999216927771943e3f309d90\">outpouching</span> of <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> arterial wall</li>\n<li>Represents 90% of cerebral aneurysms</li>\n<li>Primary location: Circle of Willis</li>\n<li>Most common sites:\n\t\t\t\t<ul>\n<li>Anterior communicating/anterior cerebral junction</li>\n<li>Posterior communicating/internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> junction</li>\n<li>Middle cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> bifurcation</li>\n<li>Basilar apex</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiological Mechanisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Structural Changes:</strong></p>\n<ul>\n<li><strong>Most important-</strong> Internal <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> disruption</li>\n<li>Media layer thinning</li>\n<li>Adventitial layer remodeling</li>\n</ul>\n<p><strong>Molecular Mechanisms:</strong></p>\n<ul>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"a993f205b0169277719284faad4c87\">mediator</span> activation</li>\n<li>Matrix <span class=\"customMeta\" data-dictid=\"392e6d28d916927771923364b31e89\">metalloproteinase</span> upregulation</li>\n<li>Vessel wall <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> degradation</li>\n</ul>\n<p><strong>Hemodynamic Factors:</strong></p>\n<ul>\n<li>Wall <span class=\"customMeta\" data-dictid=\"1a9e83a309169277719859946ca445\">shear</span> stress elevation</li>\n<li>Flow-related endothelial injury</li>\n<li>Intramural stress distribution alterations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathological Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. Mycotic:</strong></p>\n<ul>\n<li>Infectious arterial wall damage</li>\n<li>Distal vessel predilection</li>\n<li>Inflammatory cell infiltration</li>\n</ul>\n<p><strong>2. Arteriosclerotic:</strong></p>\n<ul>\n<li>Intimal hyperplasia</li>\n<li>Media degeneration</li>\n<li>Elastic fiber fragmentation</li>\n</ul>\n<p>3. Traumatic:</p>\n<ul>\n<li>Transmural disruption</li>\n<li>False <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> formation</li>\n<li>Adventitial hemorrhage</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rupture Risk Stratification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphological Criteria:</strong></p>\n<ul>\n<li>Size &gt;7mm: high risk</li>\n<li>Aspect ratio &gt;1.6</li>\n<li>Daughter <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> presence</li>\n<li>Wall irregularity</li>\n</ul>\n<p><strong>Hemodynamic Factors:</strong></p>\n<ul>\n<li>Systolic BP &gt;140 mmHg</li>\n<li>Flow pattern alterations</li>\n<li>Intrasaccular pressure gradients</li>\n</ul>\n<p><strong>Genetic Markers:</strong></p>\n<ul>\n<li>Collagen deficiency</li>\n<li>Elastic fiber abnormalities</li>\n<li>Matrix <span class=\"customMeta\" data-dictid=\"392e6d28d916927771923364b31e89\">metalloproteinase</span> polymorphisms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subarachnoid Hemorrhage:</strong></p>\n<ul>\n<li>Hunt-Hess grading scale correlation</li>\n<li>Fisher scale for CT findings</li>\n<li>Modified Rankin Scale outcomes</li>\n</ul>\n<p><strong>Mass Effect:</strong></p>\n<ul>\n<li>Cranial nerve <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> syndromes</li>\n<li>Brainstem <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> sequelae</li>\n<li>Hydrocephalus development</li>\n</ul>\n<p><strong>Thromboembolic Events:</strong></p>\n<ul>\n<li>Watershed <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> patterns</li>\n<li>Perforator <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> syndromes</li>\n<li>Distal <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> phenomena</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options below could have been discarded in the white bag by the compounder as biomedical waste?", "options": [{"label": "A", "text": "Anatomical waste", "correct": false}, {"label": "B", "text": "Sharp waste", "correct": true}, {"label": "C", "text": "Glassware", "correct": false}, {"label": "D", "text": "Plastic waste", "correct": false}], "correct_answer": "B. Sharp waste", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B) Sharp waste </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Waste Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of bag or container to be used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Method of disposal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>All <strong>infectious </strong>waste.</li>\n<li>Human <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste. <strong>(Option A ruled out)</strong></li>\n<li>Animal <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste</li>\n<li><strong>Soiled </strong>waste (contaminated with blood, body fluids, dressings and swabs, <strong>blood bags</strong>).</li>\n<li>Expired or discarded medicines</li>\n<li>Chemical waste.</li>\n<li><strong>Microbiological </strong>and other <span class=\"customMeta\" data-dictid=\"3ec60edb4a16927771842bb9fd9aa4\">clinical laboratory</span> waste.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Yellow coloured <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> <span class=\"customMeta\" data-dictid=\"b0628f561616927771849023eb3a3d\">chlorinated</span> plastic bags.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incineration</li>\n<li>Plasma pyrolysis</li>\n<li>Deep burial</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Contaminated waste (recyclable)</strong>: Tubing, bottles, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> tubes and sets, catheters, <strong>urine bags</strong>, syringes (without needles), vacutainers and gloves. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Red coloured <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> <span class=\"customMeta\" data-dictid=\"b0628f561616927771849023eb3a3d\">chlorinated</span> plastic bags.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoclaving or microwaving/hydroclaving, and then sent for recycling (not to landfill).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Glassware:</strong> Broken or discarded and contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic waste. <strong>(Option C ruled out)</strong></li>\n<li><strong>Metallic body implants</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardboard boxes with blue coloured markings.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Disinfection or autoclaving/microwaving, hydroclaving and then sent to recycling.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>White</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Waste <strong>sharps </strong>including metals: Needles, syringes with fixed needles, scalpels or any other sharp object that may cause <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> and cuts. <strong>(Option B)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Puncture proof and leak proof containers.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Auto or <span class=\"customMeta\" data-dictid=\"2d95ddf7b8169277718654aee27077\">dry heat</span> <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> followed by shredding and <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> or encapsulation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year patient working in a factory for the past 20 years presents with breathlessness. HRCT chest shows pleural thickening and fibrosis. Diagnosis is?", "options": [{"label": "A", "text": "Asbestosis", "correct": true}, {"label": "B", "text": "Coal worker pneumoconiosis", "correct": false}, {"label": "C", "text": "Silicosis", "correct": false}, {"label": "D", "text": "Berylliosis", "correct": false}], "correct_answer": "A. Asbestosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old male child presents with headache and cola-colored urine. His parents report throat pain 2 weeks ago. On examination, red blood cells are present in urine and his KFT is increased two fold. What is the likely diagnosis?", "options": [{"label": "A", "text": "Minimal change disease", "correct": false}, {"label": "B", "text": "Membranous Glomerulonephritis", "correct": false}, {"label": "C", "text": "Post-infectious Glomerulonephritis", "correct": true}, {"label": "D", "text": "IgA nephropathy", "correct": false}], "correct_answer": "C. Post-infectious Glomerulonephritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tCmHWFzweLQymn7MJIQm1747982840.png", "https://image.prepladder.com/content/IHnxGoHjNHS2ZpVaA1gu1747051514.png", "https://image.prepladder.com/content/5YwQHFjtEIUhDsI3AaVr1747051514.png", "https://image.prepladder.com/content/tJHKjgVn4qO2Dfvo2pOI1747051514.png", "https://image.prepladder.com/content/9tu8mPAQcWxI32jdmM7q1747051514.png", "https://image.prepladder.com/content/qOmkDcvg7oeBgHdxVoxH1747051514.png", "https://image.prepladder.com/content/1696QmTYNswxCG2cPM9p1747051514.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:712px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Post-streptococcal <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> (PSGN)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Group A β-Hemolytic streptococci</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immune-complex mediated (<strong>Type III </strong>hypersensitivity reaction)</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1176\" src=\"https://image.prepladder.com/content/tCmHWFzweLQymn7MJIQm1747982840.png\" width=\"6811\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is more common in children and young adults.</li>\n<li>History of<strong> <span class=\"customMeta\" data-dictid=\"7e23404d13169277718994a4692d6d\">impetigo</span> (2-6 weeks) </strong>or <strong>pharyngitis (1-3 weeks</strong>).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD \" data-hash=\"\" data-license=\"CC-BY-SA-4.0\" data-source=\"https://en.wikipedia.org/wiki/Impetigo\" data-tags=\"\" height=\"559\" src=\"https://image.prepladder.com/content/IHnxGoHjNHS2ZpVaA1gu1747051514.png\" width=\"491\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Pulmonary oedema (shortness of breath, cough, chest pain)</li>\n<li>Periorbital and <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> oedema</li>\n<li>Hypertensive encephalopathy:\n\t\t\t\t<ul>\n<li>Abrupt rise in BP</li>\n<li>Headache</li>\n<li>Loss of consciousness</li>\n</ul>\n</li>\n<li>Features of <span class=\"customMeta\" data-dictid=\"42294b4a0b16927772016b8a93bba0\">uremia</span> include fatigue, weakness, confusion, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> over body parts, shortness of breath, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, nausea, and vomiting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Test for antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti- DNAse</li>\n<li>Anti-Hyaluronidase</li>\n<li>ASO (antistreptolysin O) titer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab findings </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Urine analysis: </strong>Red-colored urine, which turns dark (<strong>cola-colored</strong>) on standing (<strong>hematuria</strong>).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD \" data-hash=\"\" data-license=\"CC-BY-SA-4.0\" data-source=\"https://en.wikipedia.org/wiki/Hematuria\" data-tags=\"\" height=\"470\" src=\"https://image.prepladder.com/content/5YwQHFjtEIUhDsI3AaVr1747051514.png\" width=\"315\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Raised values of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function test</strong> (serum creatinine, urea, etc).</li>\n<li>Raised <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> potassium</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> levels of C3, IgG &amp; CH50</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> C4 level.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathological findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Gross findings: </strong>Flea-bitten appearance of kidneys</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nzegwu, Martin\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Flea-bitten-finely-granular-kidneys-of-malignant-hypertension_fig2_282505373\" data-tags=\"\" height=\"386\" src=\"https://image.prepladder.com/content/tJHKjgVn4qO2Dfvo2pOI1747051514.png\" width=\"465\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Light microscopy: Hypercellular glomeruli</strong> (increased number of neutrophils, macrophages, endothelial and mesangial cells).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.m.wikipedia.org/wiki/File:Post-infectious_glomerulonephritis_-_very_high_mag.jpg\" data-tags=\"\" height=\"413\" src=\"https://image.prepladder.com/content/9tu8mPAQcWxI32jdmM7q1747051514.png\" width=\"472\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Electron microscopy: Subepithelial humps </strong>(due to immune complex deposition)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kari, Jameela &amp; Bamaga, Ahmed &amp; Jalalah, Sawsan.\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Transmission-electron-micrograph-showing-numerous-large-hump-like-dense-deposits-located_fig2_236614663\" data-tags=\"\" height=\"445\" src=\"https://image.prepladder.com/content/qOmkDcvg7oeBgHdxVoxH1747051514.png\" width=\"412\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Immunofluorescence study: </strong>A <strong>starry-sky appearance (Granular)</strong> is observed (due to immune complex deposition).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kakajiwala, Aadil &amp; Bhatti, Tricia &amp; Kaplan, Bernard &amp; Ruebner, Rebecca &amp; Copelovitch, Lawrence.\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/A-The-starry-sky-IF-pattern-shows-distinct-granular-staining-of-mesangial-areas-and_fig2_303363829\" data-tags=\"\" height=\"521\" src=\"https://image.prepladder.com/content/1696QmTYNswxCG2cPM9p1747051514.png\" width=\"593\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Self-limiting disorder</li>\n<li>Conservative and supportive management involves:\n\t\t\t\t<ul>\n<li><strong>HTN crisis</strong>: Labetalol (IV), sodium nitroprusside</li>\n<li><strong>Pulmonary edema: </strong>Furosemide</li>\n<li>Antibiotics (Benzathine penicillin)</li>\n<li>Dialysis if needed</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following fertility indicator can change with changes in age-specific mortality rates?", "options": [{"label": "A", "text": "General fertility rate", "correct": false}, {"label": "B", "text": "Total fertility rate", "correct": false}, {"label": "C", "text": "Gross reproduction rate", "correct": false}, {"label": "D", "text": "Net reproductive rate", "correct": true}], "correct_answer": "D. Net reproductive rate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Net <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> rate (NRR)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>NRR is the number of daughters or girls a <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> will bear or have throughout her <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> lifespan, considering the current age-specific <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">fertility</span> patterns and mortality rates.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Interpretation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is the most sensitive indicator to evaluate National family planning program</li>\n<li>It is a mortality-dependent <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">fertility</span> indicator.<strong> (Option D)</strong></li>\n<li>It is the best measure of growth of a population.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a village with a given population, the total number of live births in a year is 4000. 40 newborns died within the first 7 days of life whereas 40 died due to various causes between 8 to 28 days of life. There were 50 deaths between the age of 1 month to 6 months of life and O of them died in utero. What is the neonatal mortality rate in this population?", "options": [{"label": "A", "text": "10", "correct": false}, {"label": "B", "text": "20", "correct": true}, {"label": "C", "text": "30", "correct": false}, {"label": "D", "text": "40", "correct": false}], "correct_answer": "B. 20", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B) 20</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Early <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> mortality rate</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>(No. of deaths of children (neonate) 0 – 7 days of life / live births) x 1000)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Late <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> mortality rate</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(No. of deaths of children (neonate) 8th – 28 days of</p>\n<p>life / live birth) x 1000)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Post <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> mortality rate</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(No. of deaths of children (neonate) 29th day - 1 year of life / live births) x 1000)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How many individuals are allocated to one ASHA worker for the population in rural areas?", "options": [{"label": "A", "text": "500", "correct": false}, {"label": "B", "text": "1200", "correct": false}, {"label": "C", "text": "2500", "correct": false}, {"label": "D", "text": "1000", "correct": true}], "correct_answer": "D. 1000", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fungus shown in the image given below which is stained by India ink dye.", "options": [{"label": "A", "text": "Aspergillus", "correct": false}, {"label": "B", "text": "Penicillium", "correct": false}, {"label": "C", "text": "Cryptococcus", "correct": true}, {"label": "D", "text": "Candida", "correct": false}], "correct_answer": "C. Cryptococcus", "question_images": ["https://image.prepladder.com/content/iiwkZIYrGWPBXbPaqvz61747052271.png"], "explanation_images": ["https://image.prepladder.com/content/H3LRqe00olHigpjpfbmu1747052603.png"], "explanation": "<p>Correct Answer C - Cryptococcus</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cryptococcus Spp. </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cryptococcus is a true yeast.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Capsule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polysaccharide <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> - helps in serotyping and protection against <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> .</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Serotypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A, D, AD serotypes - Cryptococcus variety neoformans<strong> </strong></p>\n<p>B, C serotypes -Cryptococcus variety gattii</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Virulence factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Polysaccharide Capsule</strong>: The primary <span class=\"customMeta\" data-dictid=\"d325b5afd71692777202405d5f5c59\">virulence</span> factor. It helps the <span class=\"customMeta\" data-dictid=\"ed4634701d16927771942c4408495f\">pathogen</span> evade <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> and suppresses the host’s local immune responses, enabling the organism to survive and spread.</p>\n</li>\n</ul>\n<ul>\n<li>\n<p><strong>Melanin Production</strong>: <em>Cryptococcus</em> produces <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> via the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> oxidase, which contributes to its <span class=\"customMeta\" data-dictid=\"d325b5afd71692777202405d5f5c59\">virulence</span> by protecting the <span class=\"customMeta\" data-dictid=\"ed4634701d16927771942c4408495f\">pathogen</span> from <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> stress and immune defenses.</p>\n</li>\n<li>\n<p><strong>Enzyme Production</strong>: The <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> secretes several enzymes, including:</p>\n<ul>\n<li>\n<p><strong>Phospholipase</strong>: Aids in tissue invasion and damage.</p>\n</li>\n<li>\n<p><strong>Urease</strong>: Helps the <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> survive in the host environment by neutralizing <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> conditions, enhancing its ability to colonize and spread.</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Risk of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunocompromised States:</strong></p>\n<ul>\n<li>\n<p>HIV/AIDS, cancer, organ transplant recipients, those on <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> therapies, extremes of age are at higher risk.</p>\n</li>\n</ul>\n<p><strong>Geographic Location:</strong></p>\n<ul>\n<li>\n<p>Exposure to environments where Cryptococcus gattii is endemic, such as tropical and subtropical regions</p>\n</li>\n</ul>\n<p><strong>Environmental Exposure:</strong></p>\n<ul>\n<li>\n<p>Exposure to bird droppings or decaying wood can increase the likelihood of infection, especially with C. neoformans.</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong><strong> of cryptococcosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Microscopy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>India ink</strong>- Demonstrates the capsule, which appears as clear space surrounding the round <span class=\"customMeta\" data-dictid=\"38e3eb755216927771834bb7e72a61\">budding</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells</p>\n</li>\n<li>\n<p><strong>Mucicarmine stain:</strong> It stains the carminophilic <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> of C. neoformans</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Sabouraud Dextrose Agar</strong>, forming smooth, mucoid, cream-coloured colonies.</p>\n</li>\n<li>\n<p><strong>Niger seed <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> </strong>and <strong>bird seed agar</strong>: Demonstrates <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> production (brown colored colonies) due to <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> oxidase/laccase enzyme.</p>\n</li>\n<li>\n<p>The ability to grow at <strong>37°C</strong> and <strong>hydrolyse <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> </strong>differentiates C. neoformans from non-pathogenic cryptococci</p>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dhoubhadel, Bhim &amp; Laghu, Ujjwal &amp; Paudel, Raju &amp; Morimoto, Konosuke &amp; Ariyoshi, Koya.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Culture-of-CSF-showing-white-smooth-colonies-of-Cryptococcus-neoformans-in-Sabouraud_fig2_353574146\" data-tags=\"\" height=\"443\" src=\"https://image.prepladder.com/content/H3LRqe00olHigpjpfbmu1747052603.png\" width=\"456\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Antigen <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Demonstration of the capsular <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> by <strong>Precipitation </strong>and <strong>Latex agglutination</strong> <strong>test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Initial Treatment with <strong>liposomal Amphotericin B </strong>and <strong>Flucytosine</strong></p>\n</li>\n<li>\n<p>Maintenance Therapy<strong> </strong>with <strong>Fluconazole</strong> for 6-12 months, depending on immune status.</p>\n</li>\n<li>\n<p>Monitoring: Regularly check CSF for fungal clearance, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, and electrolytes.</p>\n</li>\n<li>\n<p>Management of Underlying Conditions: Optimize ART to reduce <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk.</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organism is the cause of perianal itching in a child who experiences symptoms primarily at night, leading to sleep disturbances? The eggs of the responsible organism can be observed in the accompanying image.", "options": [{"label": "A", "text": "Enterobius vermicularis", "correct": true}, {"label": "B", "text": "Trichuris trichiura", "correct": false}, {"label": "C", "text": "Trichinella spiralis", "correct": false}, {"label": "D", "text": "Strongyloides stercoralis", "correct": false}], "correct_answer": "A. Enterobius vermicularis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NySFWOKpBQG1pmA64SAW1747052750.png", "https://image.prepladder.com/content/mNVmnbAxBK96YCEuEsKL1747052760.png", "https://image.prepladder.com/content/jTotZz7bHJA8wxgWjo9M1747052777.png", "https://image.prepladder.com/content/OdPHmp14iHMhJjrGftuP1747052787.png"], "explanation": "<p>Correct Answer A - Enterobius vermicularis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Epidemiology:</strong></p>\n<ul>\n<li>The most common age group being <strong>school children</strong>.</li>\n<li>Infections can persist for years due to<strong> auto-infective cycles</strong>.</li>\n<li>Factors contributing to infection include:\n\t\t\t\t<ul>\n<li>Overcrowding</li>\n<li>Impaired hygiene</li>\n<li>Poor personal care practices (such as nail-biting and inadequate handwashing).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adult worm</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The adults are short, white, and fusiform, resembling bits of white thread.</li>\n<li>The mouth is surrounded by three wing-like structures called <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> alae, which are transversely striated.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"594\" src=\"https://image.prepladder.com/content/NySFWOKpBQG1pmA64SAW1747052750.png\" width=\"593\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Female <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">worm</span> </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Females are long.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> third tapers into a thin, pointed, pin-like tail.</li>\n<li>Females are oviparous.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Male worm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> end is tightly curved ventrally, sharply truncated, and has a prominent copulatory spicule.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eggs </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The eggs are <strong>colorless </strong>and <strong>not bile-stained</strong></li>\n<li>They <strong>float in <span class=\"customMeta\" data-dictid=\"bd2ac838bb16927771983dd9afc74c\">saturated</span> salt solution</strong> and have an <strong>elongated <span class=\"customMeta\" data-dictid=\"879f3da46a169277719497d18b5251\">ovoid</span> </strong>shape.</li>\n<li>Each egg contains a tadpole-shaped, coiled <span class=\"customMeta\" data-dictid=\"30bf2366951692777187735fffe4b4\">embryo</span> that becomes <strong>infectious only 6 hours after being deposited</strong>.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"DPDx, PHIL\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Enterobius_vermicularis.png\" data-tags=\"\" height=\"341\" src=\"https://image.prepladder.com/content/mNVmnbAxBK96YCEuEsKL1747052760.png\" width=\"506\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following viruses are associated with the development of nasopharyngeal carcinoma?", "options": [{"label": "A", "text": "Adenovirus", "correct": false}, {"label": "B", "text": "EBV", "correct": true}, {"label": "C", "text": "Herpes virus", "correct": false}, {"label": "D", "text": "Papillomavirus", "correct": false}], "correct_answer": "B. EBV", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - EBV</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carcinoma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Gastric <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (most common)</strong></li>\n<li><strong>Nasopharyngeal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphoma </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hodgkin’s <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> (most common <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> and mixed cellularity)</li>\n<li>Non-Hodgkin's lymphoma\n\t\t\t\t<ul>\n<li>Burkitt’s lymphoma</li>\n<li>DLBCL (diffuse large B cell lymphoma)</li>\n<li>Post-transplant lymphoma</li>\n<li>T or NK cell lymphoma</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sarcoma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Leiomyosarcoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the time interval between points A and B in the flowchart depicting the natural progression of the disease?", "options": [{"label": "A", "text": "Lead time", "correct": false}, {"label": "B", "text": "Screening time", "correct": true}, {"label": "C", "text": "Generation time", "correct": false}, {"label": "D", "text": "Lag time", "correct": false}], "correct_answer": "B. Screening time", "question_images": ["https://image.prepladder.com/content/EIKXQszEZhC0MejhWgkj1748156423.png"], "explanation_images": ["https://image.prepladder.com/content/QtJYGgRBNTUi1vz0I18K1748156463.png"], "explanation": "<p>Correct Option B) Screening\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old boy developed bloody diarrhea and abdominal cramps. The bacteria isolated from the stool specimen was non motile and did not ferment lactose or mannitol. Which of the following organisms is implicated here?", "options": [{"label": "A", "text": "Shigella dysenteriae", "correct": true}, {"label": "B", "text": "E. coli", "correct": false}, {"label": "C", "text": "Salmonella", "correct": false}, {"label": "D", "text": "Shigella sonnei", "correct": false}], "correct_answer": "A. Shigella dysenteriae", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Shig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mandatory exploration is required in the injuries. Which zones of retroperitoneum are required?", "options": [{"label": "A", "text": "1", "correct": true}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "1 &amp;amp; 3", "correct": false}], "correct_answer": "A. 1", "question_images": ["https://image.prepladder.com/content/BtrUh1JnQzwqZHIzi0YH1748160116.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Zones of retroperitoneum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pelvic</p>\n<p>(retroperitoneal zone of the pelvis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Structures involve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> &amp; its <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> branches</li>\n<li>Inferior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> &amp; its <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tributaries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vessels</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iliac vessels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n<p><strong>(Other options ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exploration with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> &amp; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> control</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> (renal in origin) - managed nonoperatively (angioembolization)</li>\n<li>Pulsatile <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> injury present - exploration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> is exceptionally difficult to control.</li>\n<li>Usually, it should not be opened. It is managed by packing/angioembolisation.</li>\n<li>Explored only if there is expanding or <span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\">pulsatile</span> or <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> injury present.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes Ayushman Bharat?", "options": [{"label": "A", "text": "Launched in 2019", "correct": false}, {"label": "B", "text": "Aim is to achieve universal health coverage in India", "correct": true}, {"label": "C", "text": "Covers only tertiary health care centres", "correct": false}, {"label": "D", "text": "Cashless, paperless service by only government hospitals", "correct": false}], "correct_answer": "B. Aim is to achieve universal health coverage in India", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yXUV5MBIz8O36jizoG5X1748156545.png"], "explanation": "<p>Correct Option B) Aim is to achieve universal health coverage in I\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What structures are contained within the anterior pararenal space? Head, neck, and body of the pancreas Adrenal gland, kidney, ureters Aorta, inferior vena cava Ascending and descending colon", "options": [{"label": "A", "text": "1,4", "correct": true}, {"label": "B", "text": "3,4", "correct": false}, {"label": "C", "text": "2,3", "correct": false}, {"label": "D", "text": "1,2", "correct": false}], "correct_answer": "A. 1,4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5czx302KQ7xSRXKAfzaV1748160174.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Retroperitoneal spaces</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"bcca994ca11692777194239a21b52c\">pararenal</span> space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It contains the<strong> head, neck, and body of the pancreas</strong> (the tail of the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> is within the <span class=\"customMeta\" data-dictid=\"e244a577831692777199eecf7e9f47\">splenorenal</span> ligament), the <strong>ascending and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> colon, and the duodenum</strong> (except for the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> first segment).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Perirenal space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This includes the <strong>adrenal gland, kidney, ureters, and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vessels. (Statement 2 ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"bcca994ca11692777194239a21b52c\">pararenal</span> space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is surrounded by the <strong>posterior leaf of the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> and muscles of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</strong>, contains no major organs and is composed primarily of fat, blood vessels, and lymphatics.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>There is also a fourth, less well-defined space known as the <strong>great vessel space</strong>. It lies <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the vertebral bodies and <span class=\"customMeta\" data-dictid=\"1ca45620ed1692777196a47f648338\">psoas</span> muscles and contains the aorta, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> cava, and surrounding fat. <strong>(Statement 3 ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Goran Mitreski and Tom Sutherland\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Retroperitoneal_spaces.png\" data-tags=\"\" height=\"2255\" src=\"https://image.prepladder.com/content/5czx302KQ7xSRXKAfzaV1748160174.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old man came to the clinic with a headache, palpitations, and sweating. As there is a history of renal problems in his brother and father, he requested an abdominal ultrasound, which revealed the presence of multiple renal and pancreatic cysts. 24-hour urinary metanephrine was sent, which was elevated. What is the most likely diagnosis?Multiple endocrine neoplasia type I", "options": [{"label": "A", "text": "Multiple endocrine neoplasia type I", "correct": false}, {"label": "B", "text": "Von Hippel-Lindau disease", "correct": true}, {"label": "C", "text": "Birt-Hogg-Dube syndrome", "correct": false}, {"label": "D", "text": "Tuberous sclerosis", "correct": false}], "correct_answer": "B. Von Hippel-Lindau disease", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Number of live births per 1000 women in the reproductive age group in a year refers to:", "options": [{"label": "A", "text": "Gross reproduction rate", "correct": false}, {"label": "B", "text": "Total fertility rate", "correct": false}, {"label": "C", "text": "Net reproduction rate", "correct": false}, {"label": "D", "text": "General fertility rate", "correct": true}], "correct_answer": "D. General fertility rate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uICLBPGERfpufYhfH6vS1748156640.png"], "explanation": "<p>Correct Option D) General &lt;span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\"&gt;fertility&lt;/span&gt; rate</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:400px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>General <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">Fertility</span> rate </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The total number of live births in an area in a year per 1000 women in the</p>\n<p>reproductive age group (15- 44 or 49 years).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages and advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantage</strong>:</p>\n<p>Not everyone in the <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> age group is exposed to the risk of childbirth</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What electrolyte imbalance is commonly observed in patients with this postoperative condition, as depicted in the provided x-ray?", "options": [{"label": "A", "text": "Hypocalcemia", "correct": false}, {"label": "B", "text": "Hypokalemia", "correct": true}, {"label": "C", "text": "Hyperkalemia", "correct": false}, {"label": "D", "text": "Hypercalcemia", "correct": false}], "correct_answer": "B. Hypokalemia", "question_images": ["https://image.prepladder.com/content/eDEVAAKbdfHXxtaqD7E21748160201.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:635px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Paralytic ileus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abdominal surgery.</li>\n<li>Uremia.</li>\n<li>Mesenteric ischemia.</li>\n<li>Retroperitoneal hematoma.</li>\n<li>Intra-abdominal sepsis.</li>\n<li>Dyselectrolytemia (e.g. hypokalemia)<strong> (Option B)</strong></li>\n<li>Drugs affecting intestinal motility:\n\t\t\t\t<ul>\n<li>Opiates.</li>\n<li>Antipsychotics.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abdominal distension.</li>\n<li>Abdominal discomfort.</li>\n<li><strong>Non-colicky pain.</strong></li>\n<li>Vomiting.</li>\n<li>Non-passage of <span class=\"customMeta\" data-dictid=\"7f789a76331692777202a90df3adb4\">feces</span> and flatus.</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> sounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IOC: </strong>Abdominal X-ray.</p>\n<p><strong>Findings:</strong></p>\n<ul>\n<li>Dilated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops.</li>\n<li>Gas in the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> and rectum.</li>\n<li>Multiple air-fluid levels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Decompression: </strong>Nasogastric aspiration.</p>\n<p> </p>\n<p><strong>Diet: </strong>Restrict oral <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> until <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> sounds return or the patient starts passing faeces and flatus.</p>\n<p> </p>\n<p><strong>Treatment of Underlying Cause:</strong></p>\n<ul>\n<li>Correct dyselectrolytemia (e.g., hypokalemia).</li>\n<li>Discontinue medications affecting <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> (e.g., opiates).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with diffuse abdominal pain. He has a past history of peptic ulcer disease. Physical examination reveals rigidity. An X-ray of the abdomen is shown below. What is the next best step in the management of this patient?", "options": [{"label": "A", "text": "Antibiotics and NPO (nothing by mouth)", "correct": false}, {"label": "B", "text": "Upper GI endoscopy", "correct": false}, {"label": "C", "text": "Urgent surgical exploration", "correct": true}, {"label": "D", "text": "CT abdomen", "correct": false}], "correct_answer": "C. Urgent surgical exploration", "question_images": ["https://image.prepladder.com/content/6Nsbdblg4DYZIDauULRo1747113713.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presents with a low backache and weight loss. He has progressive difficulty in urination and had an episode of urinary retention two days back, which was relieved by catheterisation. PSA was done, which was 5.2 ng/ml, and an x-ray of the LS spine showed osteoblastic changes. What is the clinical diagnosis?", "options": [{"label": "A", "text": "Benign prostatic hypertrophy", "correct": false}, {"label": "B", "text": "Carcinoma bladder", "correct": false}, {"label": "C", "text": "Prostate cancer", "correct": true}, {"label": "D", "text": "Renal cell cancer", "correct": false}], "correct_answer": "C. Prostate cancer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:581px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigations for <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> Cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DRE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Physical examination detects nodules but is limited in early-stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PSA Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Measures PSA levels; elevated levels suggest cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TRUS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imaging with the rectal <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> detects abnormalities</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>mpMRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Advanced imaging; superior for <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> and capsular spread</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prostate Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The gold standard for diagnosis; tissue <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> for cancer cells</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "NITI Aayog has replaced the?", "options": [{"label": "A", "text": "Medical council of India (MCI)", "correct": false}, {"label": "B", "text": "National institute of health &amp;amp; family welfare (NIHFW)", "correct": false}, {"label": "C", "text": "National planning commission (NPC)", "correct": true}, {"label": "D", "text": "National board of examinations (NBE)", "correct": false}], "correct_answer": "C. National planning commission (NPC)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C) National planning commission (NPC)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old farmer from Ohio presents to a physician with a chronic cough. A chest x-ray demonstrates a cavitary lesion with hilar lymphadenopathy. Biopsy of the lymph node and staining with lactophenol cotton blue demonstrates the following characteristics as shown in the image. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Histoplasmosis", "correct": true}, {"label": "B", "text": "Coccidioidomycosis", "correct": false}, {"label": "C", "text": "Cryptococcus", "correct": false}, {"label": "D", "text": "Blastomycosis", "correct": false}], "correct_answer": "A. Histoplasmosis", "question_images": ["https://image.prepladder.com/content/jQrCLBEsE81A3D4eh3hi1747114223.png"], "explanation_images": ["https://image.prepladder.com/content/zxZO0NbjkTkrjDDVNpuE1747114322.png", "https://image.prepladder.com/content/skyeJwcILlrmfru3JbZm1747114329.png"], "explanation": "<p>Correct Answer A - Histoplasmosis:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Histoplasmosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Histoplasma capsulatum; thermally <span class=\"customMeta\" data-dictid=\"132fe0557f1692777186f7d81c3999\">dimorphic</span> fungus.</p>\n<ul>\n<li><strong>H. capsulatum var. capsulatum:</strong> Causes classical histoplasmosis.</li>\n<li><strong>H. capsulatum var. duboisii:</strong> Causes African histoplasmosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endemic to central and eastern USA; also found in Africa.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Route of transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thrives in soil, decaying trees, and bird droppings.</p>\n<p>Inhalation of fungal spores.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Classical <span class=\"customMeta\" data-dictid=\"006d878cdb1692777189ed467e63d2\">histoplasmosis</span> is often <strong>asymptomatic.</strong></p>\n<p>Calcified lesions.</p>\n<p>Pulmonary disease mimics tuberculosis.</p>\n<p>Disseminated <span class=\"customMeta\" data-dictid=\"006d878cdb1692777189ed467e63d2\">histoplasmosis</span> can occur.</p>\n<p>Infection of the <span class=\"customMeta\" data-dictid=\"77c058b3b21692777197f5fd539d12\">reticuloendothelial</span> system causes:</p>\n<ul>\n<li>Lymphadenopathy, hepatosplenomegaly, fever, and anaemia</li>\n</ul>\n<p>Skin and <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membrane: <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">Granulomatous</span> and <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> lesions.</p>\n<p><strong>African Histoplasmosis:</strong></p>\n<ul>\n<li>It primarily affects the skin, <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissues, and bones</li>\n<li>Lungs are rarely involved, and <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> cases are infrequent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Specimens for Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood, urine, bone marrow, lesions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopy:</strong></p>\n<ul>\n<li>Stained smears of the specimens show small <strong>intra- and <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Guemas, Emilie &amp; Sobanska, Loïc &amp; Demar, Magalie.\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Histoplasma-capsulatum-var-capsulatum-on-bone-marrow-smear-intramacrophagic-yeast-form_fig1_342687493\" data-tags=\"\" height=\"377\" src=\"https://image.prepladder.com/content/zxZO0NbjkTkrjDDVNpuE1747114322.png\" width=\"559\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Culture:</strong></p>\n<ul>\n<li>Blood <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> and Sabouraud <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> show characteristic growth</li>\n<li>White, cottony, mycelial growth with large thick-walled spherical spores with <span class=\"customMeta\" data-dictid=\"899653e02816927772017fb07eaaa0\">tuberculate</span> <strong>(finger-like projections)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Emilie Guemas, Loïc Sobanska and Magalie Demar\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://www.intechopen.com/chapters/72531\" data-tags=\"\" height=\"366\" src=\"https://image.prepladder.com/content/skyeJwcILlrmfru3JbZm1747114329.png\" width=\"601\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Serodiagnosis:</strong></p>\n<ul>\n<li>Antibody titers increase in progressive disease</li>\n<li>Antigen tests on <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and serum, are helpful for <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> individuals</li>\n</ul>\n<p><strong>Skin Test:</strong></p>\n<ul>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> to<strong> histoplasmin</strong> confirms exposure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Amphotericin-B for two to four weeks followed by a year of itraconazole</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options is considered a high-level disinfectant?", "options": [{"label": "A", "text": "Isopropyl alcohol", "correct": false}, {"label": "B", "text": "Glutaraldehyde", "correct": true}, {"label": "C", "text": "lodophores", "correct": false}, {"label": "D", "text": "Phenol", "correct": false}], "correct_answer": "B. Glutaraldehyde", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Glutaraldehyde</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk category </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Recommended method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medical device/Equipment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. Critical device</strong> (high risk): Items that enter a <strong>normally <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> site</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sterilisation</strong></p>\n<ul>\n<li>If<strong> heat resistant</strong>: Hot air oven or autoclave</li>\n<li>If <strong>heat-sensitive</strong>: Ionising radiation or <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">ethylene</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> sterilisation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical instruments</strong>, <strong>implants</strong>/prostheses, <strong>rigid endoscopes</strong>, syringes, needles, CuT, Urinary catheter</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2. <strong>Semi-critical device </strong>(intermediate risk): Items in contact with <strong>mucous membranes</strong> or<strong> body fluids</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>High-level <span class=\"customMeta\" data-dictid=\"6c1d540906169277718659e8eb7f9c\">disinfection</span> (HLD)</strong>:</li>\n<li>Such as <strong>glutaraldehyde</strong>, ortho-phthalaldehyde, <span class=\"customMeta\" data-dictid=\"59e3af5975169277720384661ff5bf\">formaldehyde</span> and <strong>hydrogen peroxide</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory equipment</strong>, non-invasive flexible endoscopes, <strong>bedpans</strong>, <strong>urine bottles </strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3. <strong>Non-critical (low-risk)</strong></p>\n<p>Items in contact with <strong>intact skin.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Intermediate </strong>or<strong> Low-level <span class=\"customMeta\" data-dictid=\"6c1d540906169277718659e8eb7f9c\">disinfection</span> </strong>(ILD or LLD):</li>\n<li>Such as<strong> phenols (Option D ruled out)</strong>, chlorhexidine, <strong>isopropyl alcohol (Option A ruled out)</strong>, <strong>povidone-iodine</strong>, iodophores<strong> (Option C ruled out)</strong>, etc</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Patient items include <strong>blood pressure cuffs</strong>, ECG electrodes, <strong>thermometer</strong> and <strong>stethoscopes</strong>.</li>\n<li>Environmental surfaces include computers, <strong>bed rails</strong>, food utensils, <strong>bedside tables</strong>, patient furniture and floor.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A barber aged 42 years presented with a healed ulcer as below, over the lower medial aspect of the right leg. On examination, he has varicose veins on both his legs. What is the most likely type of ulcer he had?", "options": [{"label": "A", "text": "Neuropathic ulcer", "correct": false}, {"label": "B", "text": "Arterial ulcer", "correct": false}, {"label": "C", "text": "Venous ulcer", "correct": true}, {"label": "D", "text": "Tubercular ulcer", "correct": false}], "correct_answer": "C. Venous ulcer", "question_images": ["https://image.prepladder.com/content/wCsFvw59dLRFGmQai0cS1747114580.png"], "explanation_images": ["https://image.prepladder.com/content/em8o2chIWf7TGSrXwxhz1747114899.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:763px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Venous ulcer</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Arterial ulcer</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Neuropathic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pressure ulcer</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gaiter’s area</strong> (area between <span class=\"customMeta\" data-dictid=\"6a7ff3e34716927771914c22e9fe4e\">malleolus</span> and calf)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ends of limbs, such as toes, <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> and legs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Over toe joints, under the heel, over malleoli, under the <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> head, etc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seen over pressure points, most common are ischium, greater trochanter, sacrum, hee, malleolus, occiput, etc</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vertically <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> with a sloping edge and will not penetrate deep fascia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Punched-out edges </strong>are seen in this type of ulcer.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ulcers can be associated with <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> and abscesses; <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> can be seen here.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Punched out <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with<strong> bone as a base.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\">ambulatory</span> chronic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> due to <strong>varicose veins.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This occurs due to severe arterial <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> of digital and medium-sized arteries, leading to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and tissue death in the region.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is caused due to repeated trauma and <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> due to <strong>microangiopathy</strong> in <strong>diabetic patients</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is tissue <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> due to prolonged pressure on any part of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is initially painful, then chronically becomes painless.</p>\n<p>It heals on rest and treatment but reforms again.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is intensely painful, and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses are not palpable, and associated with shiny skin, <span class=\"customMeta\" data-dictid=\"e30073048816927771830d431eabfe\">brittle</span> nails and loss of hair over the region.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is also known as <strong>diabetic ulcer</strong> since it is seen in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is common in bedridden patients with head injuries, neurological deficits, and <span class=\"customMeta\" data-dictid=\"60dcb15b7616927771846fa5872355\">comatose</span> and stroke-ridden patients.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"938\" src=\"https://image.prepladder.com/content/em8o2chIWf7TGSrXwxhz1747114899.png\" width=\"938\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the underlying cause of the symptoms exhibited by a 55-year-old male, including fever, fatigue, and abnormal vital signs, along with the identification of the causative agent based on the microscopic examination of his peripheral blood smear?", "options": [{"label": "A", "text": "Plasmodium vivax", "correct": false}, {"label": "B", "text": "Plasmodium falciparum", "correct": true}, {"label": "C", "text": "Plasmodium ovale", "correct": false}, {"label": "D", "text": "Plasmodium malariae", "correct": false}], "correct_answer": "B. Plasmodium falciparum", "question_images": ["https://image.prepladder.com/content/njcFMwRz5kUXzFBlaC4E1747114680.png"], "explanation_images": ["https://image.prepladder.com/content/TaPrJIh264RfX2mm3LnR1748068598.png"], "explanation": "<p>Correct Answer B - Plasmodium falciparum:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vivax </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Falciparum </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Malariae </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ovale </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>RBC size </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enlarged</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enlarged with frayed margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pigments </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yellowish brown</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dark brown</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schizont </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large (9-10 μm)</p>\n<p>Fills the RBC</p>\n<p>Contains 12-24 merozoite</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not seen in the periphery</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small (6 μm), almost fills the RBC and contains 8 merozoites</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gametocytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spherical</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crescentic</p>\n<p>Larger than RBC</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spherical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ring <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5 μm</p>\n<p>Occupies ⅙ of RBC size</p>\n<p>It may be</p>\n<ul>\n<li>Multiple forms</li>\n<li>Accole (attached to RBC membrane)</li>\n<li>Double dot/headphone shaped with fragment nucleus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Band form</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In Plasmodium falciparum, only <span class=\"customMeta\" data-dictid=\"36514f2a4416927771881b27e74758\">gametocyte</span> and ring forms are demonstrated in the PBS, as later stages of the <span class=\"customMeta\" data-dictid=\"7d53fd92541692777187195e87ab70\">erythrocytic</span> cycle occur in deep vessels and not in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the initial course of action for a patient who has presented with a pelvic fracture and a rupture in the membranous urethra?", "options": [{"label": "A", "text": "A suprapubic catheter should be inserted as soon as possible", "correct": true}, {"label": "B", "text": "IVP should be done", "correct": false}, {"label": "C", "text": "Immediate urethroplasty", "correct": false}, {"label": "D", "text": "MCU should be done", "correct": false}], "correct_answer": "A. A suprapubic catheter should be inserted as soon as possible", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigations, Management &amp; Complications of <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> Urethral Injuries</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde Urethrography (RGU): Gold standard for initial assessment</strong></li>\n<li><strong>CT Urethrography</strong>: Useful in evaluating complex injuries</li>\n<li>Pelvic CT Scan: Important for associated <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li><strong>Cystoscopy: </strong>Sometimes performed for further evaluation</li>\n<li>If injury at Prostatomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> - High lying <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> → On IVP- <strong>Pie in-sky appearance</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial Management:</strong> <strong>Suprapubic catheterisation for <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> diversion</strong></li>\n<li><strong>Delayed Urethroplasty (Definitive management):</strong> 3-6 months post-injury after <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> have subsided <strong>(Option B ruled out)</strong></li>\n<li><strong>Primary Realignment:</strong> Occasionally attempted if conditions permit</li>\n<li><strong>Endoscopic Realignment:</strong> For selected cases, though often reserved for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> management</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Urethral <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> </strong>(most common long-term complication)</li>\n<li><strong>Urinary incontinence</strong> (due to <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> damage)</li>\n<li><strong>Erectile <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> </strong>(common due to injury near <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> structures)</li>\n<li><strong>Bladder neck contracture</strong></li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> syndrome</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old boy presents with lower abdominal pain and diarrhea. The stool examination finding is shown below. Which of the following is most likely causative organism?", "options": [{"label": "A", "text": "Giardia lamblia", "correct": false}, {"label": "B", "text": "Shigella dysenteriae", "correct": false}, {"label": "C", "text": "Entamoeba histolytica", "correct": true}, {"label": "D", "text": "Campylobacter jejuni", "correct": false}], "correct_answer": "C. Entamoeba histolytica", "question_images": ["https://image.prepladder.com/content/BOGzPtQKBkAdplMjClFN1748068724.png"], "explanation_images": ["https://image.prepladder.com/content/bTeEyOWmkIV0ziLctawL1748068770.png", "https://image.prepladder.com/content/hJu9WHTsYFqFMkwbaOsu1748068777.png", "https://image.prepladder.com/content/Bfzaz77O8mOyQqywkRCf1748068828.png"], "explanation": "<p>Correct Answer C - Entamoeba histolytica</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Entamoeba histolytica</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Trophozoite</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cyst</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pointed pseudopodia</li>\n<li>Single nucleus</li>\n<li>Central karyosome</li>\n<li><strong>Cartwheel </strong>nucleus</li>\n<li>Erythrophagocytosis (engulfed RBCs)</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/bTeEyOWmkIV0ziLctawL1748068770.png\" width=\"4167\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>1 to 4 <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> – Quadrinucleate</li>\n<li>Thick <span class=\"customMeta\" data-dictid=\"a3ac5358ae1692777184b5d568f7cc\">Chromatoid</span> body/ bar:\n\t\t\t\t<ul>\n<li>Composition: <strong>Ribonucleoprotein</strong> (RNP)</li>\n<li>Stain: Iron hematoxylin</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/hJu9WHTsYFqFMkwbaOsu1748068777.png\" width=\"4167\"/></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Entamoeba histolytica </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Entamoeba coli</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trophozoite</strong></p>\n<ul>\n<li>Pointed pseudopodia</li>\n<li>1 nucleus</li>\n<li>Central karyosome</li>\n<li>Cartwheel nucleus</li>\n<li>Erythrophagocytosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trophozoite</strong></p>\n<ul>\n<li>Blunt pseudopodia</li>\n<li>1 nucleus</li>\n<li>Eccentric karyosome</li>\n<li>No cartwheel nucleus</li>\n<li>No erythrophagocytosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cyst</strong></p>\n<ul>\n<li>1 to 4 nuclei- Quadrinucleate</li>\n<li>Thick <span class=\"customMeta\" data-dictid=\"a3ac5358ae1692777184b5d568f7cc\">chromatoid</span> body/bar</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cyst</strong></p>\n<ul>\n<li>1 to 8 nuclei- Octanucleate</li>\n<li>Thin <span class=\"customMeta\" data-dictid=\"c7247fbd3a1692777202a138609acb\">filamentous</span> <span class=\"customMeta\" data-dictid=\"a3ac5358ae1692777184b5d568f7cc\">chromatoid</span> body/bar</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of the following appearance in IVP?", "options": [{"label": "A", "text": "Horseshoe kidney", "correct": false}, {"label": "B", "text": "Ureterocoele", "correct": true}, {"label": "C", "text": "Bladder tumour", "correct": false}, {"label": "D", "text": "Posterior urethral valve", "correct": false}], "correct_answer": "B. Ureterocoele", "question_images": ["https://image.prepladder.com/content/5nz06qI9NvZRvGWxJYIR1747115096.png"], "explanation_images": ["https://image.prepladder.com/content/8TrBBDPK2yViWmRWU1YN1747115130.png", "https://image.prepladder.com/content/HiVBjgtcldX1iOU3tREB1747115130.png", "https://image.prepladder.com/content/m74wB59sW33x9YUb9Kvi1748160399.png", "https://image.prepladder.com/content/Jui3HCafooMDBRhMRrmd1748160427.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ureterocoele</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Simple <span class=\"customMeta\" data-dictid=\"98f6e9073016927772015bfd684cac\">Ureterocele</span> </strong>(Intravesical - 20%): Found entirely within the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> and associated with a single ureter. It is less complex and easier to manage.</li>\n<li><strong>Ectopic <span class=\"customMeta\" data-dictid=\"98f6e9073016927772015bfd684cac\">Ureterocele</span> </strong>(80%)<strong>:</strong> Extends beyond the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> and often involves a duplicated ureter. This is more complicated due to its location, which may involve the bladder, neck, or urethra.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> is caused by an <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in the development of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> during <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> growth, leading to <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> at the ureteral orifice.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">Tract</span> Infections (UTIs)/ Urosepsis.</li>\n<li>Unilateral Hydroureteronephrosis.</li>\n<li>Palpable Abdominal Mass: Particularly in children, where a distended <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> or large <span class=\"customMeta\" data-dictid=\"98f6e9073016927772015bfd684cac\">ureterocele</span> might be felt as a mass.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound (USG):</strong> The first-line <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> revealing <span class=\"customMeta\" data-dictid=\"45d418d3f61692777189bccae8e1ca\">hydroureteronephrosis</span> and a <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> structure in the bladder.</li>\n<li><strong>Micturating Cystourethrogram (MCU):</strong> Demonstrates a <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> caused by the ureterocele.</li>\n<li><strong>Cystoscopy:</strong> Allows direct visualisation of the <span class=\"customMeta\" data-dictid=\"98f6e9073016927772015bfd684cac\">ureterocele</span> as a <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> structure that enlarges and collapses with <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> flow in the bladder.</li>\n<li><strong>Intravenous Pyelogram (IVP):</strong> The <strong>investigation of choice</strong> (IOC) for diagnosing ureterocele, showing the characteristic <strong>\"adder head\" or \"cobra head\" appearance</strong> due to the dilated <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> within the bladder.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"388\" src=\"https://image.prepladder.com/content/8TrBBDPK2yViWmRWU1YN1747115130.png\" width=\"388\"/></p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Niknejad M, Evangelou K, Elfeky M\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/cobra-head-sign-ureter\" data-tags=\"\" height=\"479\" src=\"https://image.prepladder.com/content/HiVBjgtcldX1iOU3tREB1747115130.png\" width=\"394\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Cobra head or adder head appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The treatment approach depends on the type of ureterocele:</p>\n<ul>\n<li><strong>Intravesical Ureterocele:</strong> Typically managed with an <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> over the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> wall to allow free flow of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> into the bladder, relieving the obstruction.</li>\n<li><strong>Ectopic Ureterocele:</strong> More complex, often requiring <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the <span class=\"customMeta\" data-dictid=\"98f6e9073016927772015bfd684cac\">ureterocele</span> and <span class=\"customMeta\" data-dictid=\"c6c1d34cf81692777197049241e98d\">reimplantation</span> of the <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> into the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> to correct the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> anatomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> Abnormalities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The most common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> of the upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> is <strong>ureteral duplication</strong>, which can be associated with ureterocele.</li>\n<li><strong>Vesicoureteric <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> (VUR)</strong>, another common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> abnormality, may occur in conjunction with ureterocele, particularly in cases involving ureteral duplication.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man developed abdominal pain for which he was being evaluated. You notice the following in his CECT. What is the likely condition indicated by the arrow in the image?", "options": [{"label": "A", "text": "Appendicitis", "correct": false}, {"label": "B", "text": "Horseshoe kidney", "correct": true}, {"label": "C", "text": "Wilms tumor", "correct": false}, {"label": "D", "text": "Abdominal aortic aneurysm", "correct": false}], "correct_answer": "B. Horseshoe kidney", "question_images": ["https://image.prepladder.com/content/JYn1HbkPFZaG9u6dVUQt1748162721.png"], "explanation_images": ["https://image.prepladder.com/content/Uf6qIkrBYlM1isdc7tJ31747115233.png", "https://image.prepladder.com/content/SDf42wkx49viv6xM1Ijo1747115236.png", "https://image.prepladder.com/content/ySFk9LVDDO22NFI8YbOS1748162634.png", "https://image.prepladder.com/content/OWfCub9YgiAmCcEexA1L1747115251.png", "https://image.prepladder.com/content/AXUz9y52y0dI6mH510ID1747115215.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Horseshoe kidney</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>During <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development, the kidneys <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> at their lower poles, forming a U-shaped structure.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> results in the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> mesenteric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> preventing the ascent of the <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> to its normal position in the abdomen, leading to an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> location lower in the abdomen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mostly<strong> </strong>asymptomatic.</li>\n</ul>\n<ul>\n<li>Pain: due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones.</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections (UTIs).</li>\n<li>Hydronephrosis.</li>\n<li>Hematuria</li>\n<li><strong>Rovsing's syndrome:</strong> Hyperextension of the spine- nausea, vomiting, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CT Angiography (CT Angio):</strong> This is the <strong>investigation of choice</strong> for diagnosing a horseshoe kidney, as it allows for detailed visualisation of the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> anatomy, the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> supply, and associated complications.</li>\n<li><strong>Contrast-Enhanced CT (CECT): </strong>Used when CT Angio is not available</li>\n<li><strong>Intravenous Pyelogram (IVP) - </strong>characteristic findings include<strong>:</strong>\n<ul>\n<li>Medial Orientation of Calyces: Referred to as the \"<strong>Hand Joining Sign.\"</strong></li>\n</ul>\n</li>\n</ul>\n<p>High Insertion of Ureters with Anterior Transposition: This creates a <strong>\"Flower Vase\" appearance of the ureters.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Aditya Shetty\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/horseshoe-kidney-intravenous-urogram\" data-tags=\"\" height=\"410\" src=\"https://image.prepladder.com/content/Uf6qIkrBYlM1isdc7tJ31747115233.png\" width=\"323\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Natsis, Konstantinos &amp; Piagkou, Maria &amp; Skotsimara, Antonia &amp; Protogerou, Vassilis &amp; Tsitouridis, Ioannis &amp; Skandalakis, Panagiotis. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/ntravenous-pyelogram-IVP-in-a-male-patient-demonstrating-a-horseshoe-kidney_fig2_277016641\" data-tags=\"\" height=\"405\" src=\"https://image.prepladder.com/content/SDf42wkx49viv6xM1Ijo1747115236.png\" width=\"294\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment depends on the presence and severity of symptoms:</p>\n<ul>\n<li><strong>Asymptomatic Patients:</strong> Typically do not require treatment but should be monitored periodically.</li>\n<li><strong>Symptomatic Patients:</strong>\n<ul>\n<li><strong>UPJ Obstruction:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention such as pyeloplasty</li>\n<li><strong>Kidney Stones:</strong> Management may include conservative measures like increased fluid intake, medical therapy, or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> removal</li>\n<li><strong>UTIs:</strong> Treated with antibiotics, and <span class=\"customMeta\" data-dictid=\"e684325d851692777196af9e64013b\">preventive</span> measures may be considered if infections are recurrent.</li>\n<li><strong>Isthmus Management:</strong> The <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> of the <span class=\"customMeta\" data-dictid=\"2c8df9337316927771897a1681efe1\">horseshoe kidney</span> should not be divided surgically as it contains functional <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tissue.</li>\n<li><strong>Pregnancy Considerations:</strong> A <span class=\"customMeta\" data-dictid=\"2c8df9337316927771897a1681efe1\">horseshoe kidney</span> can lead to <span class=\"customMeta\" data-dictid=\"e700acb813169277718658466e6e33\">dystocia</span> (difficult labour) due to the kidney's <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> position.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for the lesion developed by a patient after 6 months of undergoing heart surgery, as depicted below?", "options": [{"label": "A", "text": "Hypertrophic scar", "correct": false}, {"label": "B", "text": "Atrophic scar", "correct": false}, {"label": "C", "text": "Keloid scar", "correct": true}, {"label": "D", "text": "Contracture", "correct": false}], "correct_answer": "C. Keloid scar", "question_images": ["https://image.prepladder.com/content/P9GDqB9kPFankwrqORKW1747115286.png"], "explanation_images": ["https://image.prepladder.com/content/Kl3mGfV300eqISVKO8uo1747115314.png", "https://image.prepladder.com/content/lphK4ENmaBkLMsf6EXUe1748162804.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Receptor used for the entry of HIV virus into the host cell is?", "options": [{"label": "A", "text": "CCR7", "correct": false}, {"label": "B", "text": "CCR5", "correct": true}, {"label": "C", "text": "CD6", "correct": false}, {"label": "D", "text": "CD8", "correct": false}], "correct_answer": "B. CCR5", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ObYWiGGKaV4nz0LMcLIS1748068894.png"], "explanation": "<p>Correct Answer B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the vector responsible for transmitting the Zika virus among the options listed?", "options": [{"label": "A", "text": "Aedes australis", "correct": false}, {"label": "B", "text": "Aedes albopictus", "correct": true}, {"label": "C", "text": "Aedes mitchellae", "correct": false}, {"label": "D", "text": "Aedes polynesiensis", "correct": false}], "correct_answer": "B. Aedes albopictus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RFff9kHfi8XVwnz77qd11748068907.png"], "explanation": "<p>Correct Answer B - Aedes albopictu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a patient who visited the outpatient department (OPD) experiencing intense pain during erection and a deviated penis for the past half-year?", "options": [{"label": "A", "text": "Peyronie’s disease", "correct": true}, {"label": "B", "text": "Priapism", "correct": false}, {"label": "C", "text": "Marion’s disease", "correct": false}, {"label": "D", "text": "Erectile dysfunction", "correct": false}], "correct_answer": "A. Peyronie’s disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/v3wwtbg2wvGYksCuIaCU1748162864.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Peyronie’s disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is characterised by <strong>fibrous plaques in the <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> <span class=\"customMeta\" data-dictid=\"31f0ff95651692777181fcca56acfe\">albuginea</span> of the penis,</strong> causing <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> during erections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plaque Location: Typically on the <span class=\"customMeta\" data-dictid=\"4c94b3faab16927771861e13308510\">dorsolateral</span> aspect of the penis.</strong></p>\n<p><strong>Curvature:</strong> Resulting from <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> contraction.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Charles Turner\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"Charles Turner\" data-tags=\"\" height=\"710\" src=\"https://image.prepladder.com/content/v3wwtbg2wvGYksCuIaCU1748162864.png\" width=\"1164\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trauma/Injury: Repeated minor trauma to the penis.</li>\n<li>Genetic Factors: Possible genetic predisposition.</li>\n<li><strong>Connective Tissue Disorders:</strong> Associated with conditions like <strong>Dupuytren’s contracture.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Galezia’s Triad:</strong></p>\n<ul>\n<li><strong>Dupuytren’s Contracture:</strong> Thickening and shortening of <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue in fingers.</li>\n<li><strong>Retroperitoneal Fibrosis:</strong> Fibrosis in the <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">retroperitoneal</span> space.</li>\n<li><strong>Peyronie’s Disease</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painful Erection</li>\n<li>Erectile Dysfunction</li>\n<li>Penile Curvature</li>\n<li>Palpable Plaques</li>\n<li>Impotence &amp; Infertility (in severe cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Observation:</strong></p>\n<ul>\n<li>Spontaneous Resolution: Often improves without treatment.</li>\n</ul>\n<p><strong>Medical Management:</strong></p>\n<ul>\n<li><strong>Oral Medications: </strong>Pentoxifylline, colchicine, vitamin E (efficacy varies).</li>\n</ul>\n<p><strong>Surgical Intervention </strong>(If Spontaneous Resolution Does Not Occur):</p>\n<ul>\n<li><strong>Nesbit Operation:</strong> Placement of a non-absorbable <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> opposite the <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> to correct the curvature.</li>\n<li>Plication Surgery: Shortens the longer side of the penis.</li>\n<li>Plaque Excision and Grafting: Removes <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> and replaces it with <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> material.</li>\n<li>Penile Prosthesis: For severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a 5-year-old boy who has weight loss, fever, and a painless swelling in his jaw area? CBC results indicate anaemia and lymphocytosis. The image below shows biopsy findings from the swelling.", "options": [{"label": "A", "text": "Kikuchi disease", "correct": false}, {"label": "B", "text": "Infectious mononucleosis", "correct": false}, {"label": "C", "text": "Hodgkins lymphoma", "correct": false}, {"label": "D", "text": "Burkitt lymphoma", "correct": true}], "correct_answer": "D. Burkitt lymphoma", "question_images": ["https://image.prepladder.com/content/catbX5mH7Xi8gDl5YlaC1747115752.png"], "explanation_images": ["https://image.prepladder.com/content/Uerx41sJBrRYOxbUIsfK1747115805.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Burkitt's lymphoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An aggressive <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <strong>non-Hodgkin lymphoma</strong> characterised by the <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> of <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> B-cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Endemic (African) form</strong>: Common in children, associated with <strong>Epstein-Barr virus (EBV)</strong> infection.</li>\n<li><strong>Sporadic form</strong>: Worldwide distribution, more common in children and young adults.</li>\n<li><strong>Immunodeficiency-related</strong>: Often seen in HIV/AIDS patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Strong association with <strong>EBV</strong> (especially in the <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> form).</li>\n<li><strong>Translocations involving the MYC gene</strong> (chromosome 8).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic Abnormality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>t(8;14):</strong> MYC gene translocated next to the <strong>IgH locus</strong> (most common).</li>\n<li><strong>t(2;8) or t(8;22)</strong>: Less common, involving MYC and Ig <span class=\"customMeta\" data-dictid=\"578fe8d7dd16927771913c847ed254\">light chain</span> loci.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Endemic form</strong>: Presents with jaw or <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> bone tumours.</li>\n<li><strong>Sporadic form</strong>: Often involves the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> (e.g., ileum, cecum) and may cause <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction.</li>\n<li><strong>Systemic symptoms</strong>: Fever, night sweats, weight loss.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Histology</strong>: \"Starry-sky\" appearance due to numerous apoptotic cells and macrophages.</li>\n<li>Tumor cells are medium-sized with round nuclei, <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> chromatin, and high mitotic activity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunophenotype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Positive for <strong>CD19</strong>, <strong>CD20</strong> (B-cell markers), and <strong>CD10</strong>.</li>\n<li>Expresses surface <strong>IgM</strong>.</li>\n<li>High <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> index (Ki-67 &gt; 95%).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Biopsy</strong>: Histological examination showing \"starry-sky\" appearance.</li>\n<li><strong>Cytogenetics</strong>: Detection of MYC translocations.</li>\n<li><strong>Immunohistochemistry</strong>: Positive for B-cell markers (CD19, CD20).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Highly aggressive but potentially curable with prompt treatment.</li>\n<li>Favorable response to <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> in many cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Chemotherapy</strong>: Intensive regimens like <strong>cyclophosphamide, doxorubicin, vincristine, and <span class=\"customMeta\" data-dictid=\"a98f8182f116927771927e607ba8c8\">methotrexate</span> (CODOX-M)</strong>.</li>\n<li><strong>CNS prophylaxis</strong>: <span class=\"customMeta\" data-dictid=\"a98f8182f116927771927e607ba8c8\">Methotrexate</span> or cytarabine.</li>\n<li>Supportive care for tumour <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> syndrome.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Risk of <strong>tumour <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> syndrome</strong> due to rapid tumour breakdown.</li>\n<li>It may progress to involve <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> or CNS if untreated.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diffuse large B-cell lymphoma.</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"ffb779b5ad1692777189091a0aef76\">high-grade</span> B-cell lymphomas.</li>\n<li>Lymphoblastic lymphoma.</li>\n<li>Hodgkin <span class=\"customMeta\" data-dictid=\"5a31d184f21692777191a2e457d646\">lymphoma</span> (rarely resembles).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Graft from an identical twin is called:", "options": [{"label": "A", "text": "Allograft", "correct": false}, {"label": "B", "text": "Autograft", "correct": false}, {"label": "C", "text": "Isograft", "correct": true}, {"label": "D", "text": "Xenograft", "correct": false}], "correct_answer": "C. Isograft", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:716px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Type of Graft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Autograft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>An organ or tissue is taken from an individual and grafted on him/ herself</p>\n<p><strong>(Option B ruled out) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Isograft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Grafts between genetically identical individuals, such as identical twins</p>\n<p><strong>(Option C) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Allograft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Graft between two genetically non-identical members of the same species (e.g. organ transplants between two non-identical and <span class=\"customMeta\" data-dictid=\"8baf7b24c316927771847e2b2ae466\">compatible</span> individuals.<strong> (Option A ruled out) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Xenograft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Graft from one species to another (e.g., pig skin is a temporary <span class=\"customMeta\" data-dictid=\"02f0c206e716927771999e45b2d63b\">substitute</span> for burn treatment). <strong> (Option D ruled out) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Synthetic Graft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Artificial materials or bioengineered constructs replace or support damaged tissue (e.g., artificial skin substitutes, <span class=\"customMeta\" data-dictid=\"c293dda462169277718335b755e1a9\">bone graft</span> substitutes).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate presented with mild intermittent upper abdominal pain. On examination, the infant has a scaphoid abdomen and breath sounds are decreased on both sides. The X-ray is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Bochdalek hernia", "correct": true}, {"label": "B", "text": "Pneumonia", "correct": false}, {"label": "C", "text": "Gastric volvulus", "correct": false}, {"label": "D", "text": "Eventration of diaphragm", "correct": false}], "correct_answer": "A. Bochdalek hernia", "question_images": ["https://image.prepladder.com/content/7T7HmW0qKbJuhXMY9vgJ1747115903.png"], "explanation_images": ["https://image.prepladder.com/content/R9lnarz4wmeN8Bckla9w1747115954.png", "https://image.prepladder.com/content/pwC0h6eYHbzAqZTmAGc31748162916.png", "https://image.prepladder.com/content/5XLDRVy2ildL8MjQLL8I1748162934.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bochdalek hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is due to the failure of the <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the <span class=\"customMeta\" data-dictid=\"8f7c89df6e16927771951d19c26422\">pleuroperitoneal</span> canal, which leads to direct communication between the <span class=\"customMeta\" data-dictid=\"8067ea0c85169277719561c9591e9d\">pleura</span> and <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> on the<strong> left side.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Colon, occasionally small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> or stomach</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypoplasia (potentially bilateral)</li>\n<li>Decreased bronchial branch generation</li>\n<li>Extension of <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> media beyond <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> bronchioles</li>\n<li>Decreased total lung mass</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Pulmonary hypoplasia</li>\n<li>Pulmonary hypertension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Respiratory embarrassment</li>\n<li>Scaphoid abdomen</li>\n<li>Bowel sounds on the left side of the chest</li>\n<li>Mediastinal shift towards the right side</li>\n<li>Intestinal obstruction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term for a stone obstructing the cystic duct, causing dilation of the common hepatic duct, resulting in CBD obstruction and jaundice?", "options": [{"label": "A", "text": "Acute cholecystitis", "correct": false}, {"label": "B", "text": "Porcelain gallbladder", "correct": false}, {"label": "C", "text": "Cholesterolosis", "correct": false}, {"label": "D", "text": "Mirizzi’s syndrome", "correct": true}], "correct_answer": "D. Mirizzi’s syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/25YL4ccIK5LGxnEl8Kqp1748162999.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mirizzi’s syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> usually impacts from the Hartmann's pouch, leading to <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the CHD/CBD.</li>\n<li>Can also occur from the <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> of the <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> into the CBD.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Abdominal pain</li>\n<li>Obstructive jaundice</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> on the right side</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> soft, enlarged liver</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Csendes Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I - Extrinsic compression</strong> of the CBD/CHD by a large <span class=\"customMeta\" data-dictid=\"ab375457da16927771891fcf9431da\">impacted</span> stone in Hartmann's pouch;</p>\n<ul>\n<li>IA- the presence of <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> duct</li>\n<li>IB- is obliterated <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> duct</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II - </strong>The stone has eroded the CBD/CHD less than 1/3rd of the <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the CBD/CHD, forming a fistula</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III - </strong>Involving up to 2/3rd of the <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of CBD/ CHD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV - </strong>Cholecystocholedochal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> (&gt;2/3rd) involving the entire <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the CBD/CHD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type V - </strong>Cholecystocholedochal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> with cholecystoenteric <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> without <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> (VA) or with</p>\n<p>gallstone <span class=\"customMeta\" data-dictid=\"1e35d75e001692777189901f759828\">ileus</span> (VB)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Klekowski, Jakub &amp; Piekarska, Aleksandra &amp; Góral, Marta &amp; Kozula, Marta &amp; Chabowski, Mariusz\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Anatomical-sketch-of-Mirizzi-Syndrome-according-to-Csendes-and-Beltran-2008_fig1_354514987\" data-tags=\"\" height=\"270\" src=\"https://image.prepladder.com/content/25YL4ccIK5LGxnEl8Kqp1748162999.png\" width=\"926\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasonography (USG):</strong> Initial <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> to assess <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> and ducts.</li>\n<li><strong>CT Scan: </strong>Provides detailed <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> of the <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system.</li>\n<li><strong>ERCP/ MRCP:</strong> Essential for delineating <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and identifying the site of obstruction.</li>\n<li><strong>HIDA Scan:</strong> Useful for <span class=\"customMeta\" data-dictid=\"c7de83b272169277720260f08186c4\">functional assessment</span> of the <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system.</li>\n<li><strong>Findings:</strong> Dilatation of the <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system with a block at the common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (CHD).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman comes to the OPD with a history of a lump in the left breast. On clinical examination, the size of the lump in the left breast is 9x10 cm with the following appearance and no axillary lymphadenopathy. The histopathology of the biopsy from the lump shows increased stromal cellularity and typical leaflike architecture. What is your likely diagnosis?", "options": [{"label": "A", "text": "Phyllodes tumour", "correct": true}, {"label": "B", "text": "Giant fibroadenoma", "correct": false}, {"label": "C", "text": "Inflammatory carcinoma", "correct": false}, {"label": "D", "text": "Ductal carcinoma", "correct": false}], "correct_answer": "A. Phyllodes tumour", "question_images": ["https://image.prepladder.com/content/d79JUMsTq9YVRORpAoQE1747116110.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 9-month-old boy presents with progressive pallor and abdominal distention. On investigations, hepatosplenomegaly and malar eminence are seen, and his peripheral blood smear is shown below. He has a low Hb; the Mentzer index is less than 13. What diagnosis would this signify for this patient?", "options": [{"label": "A", "text": "Megaloblastic anemia", "correct": false}, {"label": "B", "text": "Iron deficiency anaemia", "correct": false}, {"label": "C", "text": "Thalassemia", "correct": true}, {"label": "D", "text": "Pernicious anemia", "correct": false}], "correct_answer": "C. Thalassemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Vpifn3csAFOtELnhV7nH1747116120.png", "https://image.prepladder.com/content/O5SrmNKUVmK7Ul4nOFSg1748155158.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Thalassemia Major (β-Thalassemia Major)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A severe <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of β-thalassemia caused by homozygous or compound heterozygous mutations in the β-globin gene (HBB) on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 11, leading to absent or markedly <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> β-globin chain production.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder, caused by mutations in the β-globin gene leading to <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> synthesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduced or absent β-globin chains lead to <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> α-globin chains, which <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> unstable precipitates, causing ineffective erythropoiesis, hemolysis, and severe anaemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms appear around 6 months of age (as <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> haemoglobin declines); severe anaemia, growth retardation, hepatosplenomegaly, skeletal deformities (crew-cut appearance on skull X-ray, <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> bossing), jaundice, and delayed puberty.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hematological Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Peripheral smear</strong>: <span class=\"customMeta\" data-dictid=\"d09dc1da551692777192706b7f882e\">Microcytic</span> <span class=\"customMeta\" data-dictid=\"07ccd8f461169277718970a6f1a131\">hypochromic</span> anaemia, target cells, anisopoikilocytosis, <span class=\"customMeta\" data-dictid=\"a6f7ad44aa1692777193665a7f5d9a\">nucleated</span> RBCs.</li>\n<li><strong>Bone marrow</strong>: Erythroid <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> with expansion of <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> cavities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemoglobin Electrophoresis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent or very low HbA, markedly increased HbF (&gt;90%), variable HbA2.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Iron overload</strong> (due to repeated transfusions leading to secondary hemochromatosis)</li>\n<li><strong>Cardiac failure</strong> (due to iron deposition)</li>\n<li>E<strong>ndocrinopathies</strong> (diabetes, hypothyroidism, hypogonadism)</li>\n<li><strong>Osteopenia/osteoporosis</strong></li>\n<li>I<strong>ncreased infection risk</strong> (especially from Yersinia and <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infections).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood tests</strong> (CBC, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> smear), <strong>Hb electrophoresis/HPLC</strong>, <strong>Serum ferritin</strong> (for iron overload), <strong>Genetic testing</strong> (HBB gene mutations), <strong>Prenatal diagnosis</strong> (chorionic <span class=\"customMeta\" data-dictid=\"b0bb7d5b6716927772028625a93e1e\">villus</span> <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> or amniocentesis).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regular <strong>blood transfusions</strong>, <strong>iron <span class=\"customMeta\" data-dictid=\"11199cbd1816927771841f1eb35b86\">chelation</span> therapy</strong> (deferoxamine, deferasirox, deferiprone), <strong>splenectomy</strong> (in <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases), and <strong>hematopoietic <span class=\"customMeta\" data-dictid=\"467c0b4fc016927771997e1043aeda\">stem cell transplantation</span> (HSCT)</strong> (only <span class=\"customMeta\" data-dictid=\"0968038e2a1692777185ed087c7fd8\">curative</span> option).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carrier screening, genetic counselling, <span class=\"customMeta\" data-dictid=\"d554413593169277719693b8e38638\">prenatal</span> diagnosis, <span class=\"customMeta\" data-dictid=\"191d7c663a1692777196d6e0afdfb3\">preimplantation genetic diagnosis</span> (PGD) in high-risk couples.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Beta <span class=\"customMeta\" data-dictid=\"baed0c93841692777200be26c8b9d2\">Thalassemia</span> Minor</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Microcytic <span class=\"customMeta\" data-dictid=\"07ccd8f461169277718970a6f1a131\">hypochromic</span> anemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Microcytic <span class=\"customMeta\" data-dictid=\"07ccd8f461169277718970a6f1a131\">hypochromic</span> anemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>RBC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MCV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal to low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>RDW(size variance)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mentzer index: MCV/RBC </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;13</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;13</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reticulocyte count</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal to slightly increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HbA2 - confirmatory test </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;3.5%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;3.5%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a neonate who is brought to the hospital with complaints of forceful vomiting that is not accompanied by bile after feeding? The child appears lethargic and dehydrated, and abdominal examination shows visible movements of the stomach. A barium meal was conducted, and the image provided is shown below.", "options": [{"label": "A", "text": "Hirschsprung’s disease", "correct": false}, {"label": "B", "text": "Congenital hypertrophic pyloric stenosis", "correct": true}, {"label": "C", "text": "Jejunal atresia", "correct": false}, {"label": "D", "text": "Duodenal atresia", "correct": false}], "correct_answer": "B. Congenital hypertrophic pyloric stenosis", "question_images": ["https://image.prepladder.com/content/27CaXZTBGu9cUPn8z99i1747116174.png"], "explanation_images": ["https://image.prepladder.com/content/kfZkaOWcR6b7dPmtFAZY1747116203.png", "https://image.prepladder.com/content/heeBWIfoTh3AocNTBXEt1747116203.png", "https://image.prepladder.com/content/8AuSr5uK4hcc4UVVV2Hv1747116203.png", "https://image.prepladder.com/content/eM70tKpTGxKz3NQUkEta1747116203.png", "https://image.prepladder.com/content/yyvflF4B9R2yB3l0qJLT1747116203.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Congenital <span class=\"customMeta\" data-dictid=\"2cf4f27ae616927771895f410747ad\">hypertrophic pyloric stenosis</span> (CHPS) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a condition involving <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> of the pyloric muscle, leading to <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> outlet <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in male infants, typically between 2 and 6 weeks of age.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Symptoms:</strong> <strong>Projectile, non-bilious <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> after feeds, starting around 2 to 6 weeks of age. </strong>\n<ul>\n<li>Persistent <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> leads to <strong>dehydration, <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> </strong>and <strong>hypochloremic <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> </strong>because the body loses <strong>hydrochloric acid (HCl)</strong> in the vomitus.</li>\n</ul>\n</li>\n<li><strong>Physical Examination: Visible <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> from left to right</strong> and a palpable<strong> “olive-shaped”</strong> mass in the epigastric region.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound (USG) </strong>is the Investigation of choice for CHPS, characterised by\n\t\t\t\t<ul>\n<li>Pyloric muscle <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of<strong> &gt; 3 mm </strong></li>\n<li>Pyloric length <strong>&gt; 14 mm </strong></li>\n<li>The pyloric channel appears elongated and thickened <strong>(10-14 mm)</strong></li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"570\" src=\"https://image.prepladder.com/content/kfZkaOWcR6b7dPmtFAZY1747116203.png\" width=\"568\"/></p>\n<ul>\n<li><strong>Contrast Studies (Upper GI Series): </strong>Less frequently used, demonstrating the classic <strong> ¸</strong> with a thin line of contrast through the<strong> elongated and narrowed pyloric channel and <span class=\"customMeta\" data-dictid=\"6cad6b72af16927771868f07a43773\">delayed <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</span> without duodenal dilation. </strong></li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Adityagupta95, \" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hypertrophic_pyloric_stenosis.png\" data-tags=\"\" height=\"598\" src=\"https://image.prepladder.com/content/heeBWIfoTh3AocNTBXEt1747116203.png\" width=\"470\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male patient presented with anaemia and hepatosplenomegaly. A peripheral smear showed teardrop cells, nucleated RBCs, and giant abnormal platelets. A biopsy showed marrow fibrosis and a few characteristics, as given below. The most likely diagnosis is:", "options": [{"label": "A", "text": "Polycythemia vera", "correct": false}, {"label": "B", "text": "Essential thrombocythemia", "correct": false}, {"label": "C", "text": "Primary myelofibrosis", "correct": true}, {"label": "D", "text": "Chronic myeloid leukemia", "correct": false}], "correct_answer": "C. Primary myelofibrosis", "question_images": ["https://image.prepladder.com/content/RFMZEQn2Z325qkFBM2hn1748155212.png"], "explanation_images": ["https://image.prepladder.com/content/uewpJnVjm46XNOho3SkD1748155217.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A teenager developed swelling of the face, lips, and tongue and also found it difficult to breathe within a few minutes of consuming prawns. What type of hypersensitivity is seen here?", "options": [{"label": "A", "text": "Type 1", "correct": true}, {"label": "B", "text": "Type 2", "correct": false}, {"label": "C", "text": "Type 3", "correct": false}, {"label": "D", "text": "Type 4", "correct": false}], "correct_answer": "A. Type 1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Immune Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I: Immediate</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgE-mediated <span class=\"customMeta\" data-dictid=\"adb3e39bbf1692777185215fad237b\">degranulation</span> of <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells and basophils after <span class=\"customMeta\" data-dictid=\"7396dd35a41692777181bd7038fa9b\">allergen</span> binding.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>IgE antibodies</strong></li>\n<li>Mast cells</li>\n<li>Histamine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid onset (minutes)</li>\n<li>Localised or <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> reactions</li>\n<li>Mediated by histamine.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anaphylaxis</li>\n<li>Allergic rhinitis</li>\n<li>Asthma</li>\n<li>Urticaria (hives)</li>\n<li>Food allergies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II: Cytotoxic</strong></p>\n<p><strong>(Option B ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibody-mediated destruction or <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> of target cells.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>IgG</strong>, <strong>IgM antibodies</strong></li>\n<li>Complement</li>\n<li>Phagocytes</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Targets specific cells or tissues.</li>\n<li>Cell <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> or dysfunction.</li>\n<li>Involves <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> activation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoimmune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia</li>\n<li>Goodpasture syndrome</li>\n<li>Myasthenia gravis</li>\n<li>Graves' disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III: Immune Complex</strong></p>\n<p><strong>(Option C ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deposition of immune complexes in tissues, leading to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and damage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>IgG</strong>, <strong>IgM Antibodies</strong></li>\n<li>Complement</li>\n<li>Neutrophils</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immune complex deposition in vessels.</li>\n<li>Tissue <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and damage (vasculitis).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus (SLE)</li>\n<li>Post-streptococcal glomerulonephritis</li>\n<li>Serum sickness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV: Delayed</strong></p>\n<p><strong>(Option D ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T-cell-mediated immune response, leading to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and tissue damage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>T cells (CD4+, CD8+)</strong></li>\n<li>Macrophages</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Delayed onset (48–72 hours).</li>\n<li>Involves <span class=\"customMeta\" data-dictid=\"0ac01cc0c31692777185cae5f28175\">cytokine</span> release and <span class=\"customMeta\" data-dictid=\"2748357f451692777191377abbe2a6\">macrophage</span> recruitment.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contact dermatitis</li>\n<li>Tuberculin skin test (PPD)</li>\n<li>Granulomatous <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> (e.g., tuberculosis)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Tau protein inclusions are involved in:", "options": [{"label": "A", "text": "Alzheimer’s disease", "correct": true}, {"label": "B", "text": "Huntington's disease", "correct": false}, {"label": "C", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "D", "text": "CNS lymphoma", "correct": false}], "correct_answer": "A. Alzheimer’s disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2urFQH3rtshdjjZdsrBO1748155302.png", "https://image.prepladder.com/content/yM7gdesAr5Y2K8zLWuES1748155327.png", "https://image.prepladder.com/content/Il3LLCPejz1MJwTqUevw1748155311.png", "https://image.prepladder.com/content/H7DjhVp5q06y1pT5aOf01748155359.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:603px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Plaques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Deposits of Aβ peptides in the neuropil.</li>\n<li>They are of two types: Diffuse and <span class=\"customMeta\" data-dictid=\"5413c6a72b16927771933daef75a28\">neuritic</span> (senile).</li>\n<li>Neuritic plaques contain both Aβ 40 and Aβ 42.</li>\n<li>Diffuse plaques are predominantly made up of Aβ 42 and seen in <span class=\"customMeta\" data-dictid=\"5e54fdc4d3169277720003f231621d\">trisomy</span> 21 patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tangles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Aggregates of the microtubule-binding protein tau.</li>\n<li>Demonstrated by silver (Bielschowsky) staining.</li>\n<li>Commonly found in <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> neurons, especially in the <span class=\"customMeta\" data-dictid=\"433fcc5f441692777187d3963abc73\">entorhinal</span> cortex, and in other sites such as <span class=\"customMeta\" data-dictid=\"d3b981dbf916927771961c29f24614\">pyramidal</span> cells of the hippocampus, amygdala, <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> forebrain, and <span class=\"customMeta\" data-dictid=\"127f1d277616927771975f15621776\">raphe</span> nuclei.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hirano bodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intracellular <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> inclusions are typically found in conditions like Alzheimer's disease and Creutzfeldt–Jakob disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Granulovacuolar degeneration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Formation of small, clear vacuoles within the neurons.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mikael Haggstrom\" data-hash=\"\" data-license=\"CC0 1.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Histopathology_of_amyloid_plaque_in_Alzheimer's_disease_-_annotated.jpg\" data-tags=\"\" height=\"3172\" src=\"https://image.prepladder.com/content/2urFQH3rtshdjjZdsrBO1748155302.png\" width=\"4168\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Plaques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mikael Haggstrom\" data-hash=\"\" data-license=\"CC0 1.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Histopathology_of_neurofibrillary_tangles_in_Alzheimer%27s_disease_-_annotated.jpg\" data-tags=\"\" height=\"4168\" src=\"https://image.prepladder.com/content/yM7gdesAr5Y2K8zLWuES1748155327.png\" width=\"3593\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Neurofibrillary tangles</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Patho\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hirano_bodies_in_the_Hippocampus_in_an_old_person_with_Alzheimer-related_pathology,_HE_2.JPG\" data-tags=\"\" height=\"3017\" src=\"https://image.prepladder.com/content/Il3LLCPejz1MJwTqUevw1748155311.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Hirano bodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CC BY SA 4.0\" data-hash=\"\" data-license=\"Tulemo\" data-source=\"https://commons.wikimedia.org/wiki/File:GVDs_Wiki_Final_Bar%3D20um.jpg\" data-tags=\"\" height=\"3134\" src=\"https://image.prepladder.com/content/H7DjhVp5q06y1pT5aOf01748155359.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Granulovacuolar degeneration</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The body of an 82-year-old man has been seen for a post-mortem to determine the cause of death. You are examining a histopathological slide containing a section of his cardiac tissue where you notice some pigmentation. Which is the substance that is seen in the image given below?", "options": [{"label": "A", "text": "Melanin", "correct": false}, {"label": "B", "text": "Lipofuscin", "correct": true}, {"label": "C", "text": "Hemosiderin", "correct": false}, {"label": "D", "text": "Iron", "correct": false}], "correct_answer": "B. Lipofuscin", "question_images": ["https://image.prepladder.com/content/DBBjOUWzSbIPgKkvm0za1748155442.png"], "explanation_images": ["https://image.prepladder.com/content/rBOhDa6lOeWjN2tUo4Vh1748155453.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis based on the X-ray given below?", "options": [{"label": "A", "text": "Renal calculi", "correct": false}, {"label": "B", "text": "Bladder calculi", "correct": true}, {"label": "C", "text": "Schistosomiasis", "correct": false}, {"label": "D", "text": "Ureteric calculi", "correct": false}], "correct_answer": "B. Bladder calculi", "question_images": ["https://image.prepladder.com/content/7kqNxP5FKPTLXRkfUCq91747116785.png"], "explanation_images": ["https://image.prepladder.com/content/VrrtQQesaqmKM3JxWpZB1747116812.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:660px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Stones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Secondary <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Stones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nutritional <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (Vitamins A, B6, magnesium, protein-carbohydrate imbalance)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bladder outlet obstruction, infection, foreign body presence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ammonium urate, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> oxalate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uric acid, <span class=\"customMeta\" data-dictid=\"0f125a33661692777199eec6125223\">struvite</span> (infection-related)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Population</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Children in developing countries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adults with <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> or infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or present with dysuria, hematuria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hematuria, dysuria, frequency and urgency,</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A simple X-ray, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> or CT scan</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presents with nosebleeds, bleeding gums, and multiple ecchymoses. Lab investigations show: Haemoglobin: 8.5 g/dL Platelet count: 12,000 platelets/mm3 Total leucocyte count: 52,000 cells/mm3 with 83% blasts, as seen below. The blasts are CD33 +ve. The most likely diagnosis is:", "options": [{"label": "A", "text": "Acute myeloid leukemia", "correct": true}, {"label": "B", "text": "Acute lymphoblastic leukemia", "correct": false}, {"label": "C", "text": "Chronic lymphocytic leukemia", "correct": false}, {"label": "D", "text": "Myelodysplastic syndrome", "correct": false}], "correct_answer": "A. Acute myeloid leukemia", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>ALL</strong><br/>\n\t\t\t </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>AML</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CML</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B cell -ALL</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T cell -ALL</strong><br/>\n\t\t\t </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less common (15%)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>M2 (M/C)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Children</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Teenagers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adults (15-40 years)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Middle-Elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Loss of function PAX5, E2A, EBF</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gain of function NOTCH1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>t(15:17) in M3,<br/>\n\t\t\tt (8:21) in M2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>t(9:22) BCR-ABL <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> gene.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Organ<br/>\n\t\t\tInvolvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No tissue involvement</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CNS, Mediastinum, Testes, Bone pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hepatosplenomegaly, <span class=\"customMeta\" data-dictid=\"09980563461692777188b0de904031\">gum</span> hyperplasia, chloroma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Massive splenomegaly, hepatomegaly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PAS+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acid Phosphatase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MPO+, NSE +</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased NAP/LAP score</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CD 19,20,21</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CD 1,2,<strong>3</strong>,<strong>5</strong>,7,<strong>10 (CALLA antigen)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CD 13, 33, and 117</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CD 25</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A boy fell down while playing and presented with deviated nose. The septum however was found to be normal. Following is the CT finding of the patient. What is the next step in management?", "options": [{"label": "A", "text": "Septo-rhinoplasty", "correct": false}, {"label": "B", "text": "Open reduction", "correct": false}, {"label": "C", "text": "Closed reduction after edema subsides in 20 days", "correct": false}, {"label": "D", "text": "Closed reduction and swelling will decrease automatically", "correct": true}], "correct_answer": "D. Closed reduction and swelling will decrease automatically", "question_images": ["https://image.prepladder.com/content/MWSVjogAH93m2fqBGjHf1747981527.png"], "explanation_images": [], "explanation": "<p>Correct Answer D- &lt;span class=\"customMeta\" data-dictid=\"da014870171692777184980beab405\"&gt;Closed reduction&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\"&gt;swelling&lt;/span&gt; will decrease au\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young adult presents with a deformed nose after falling from a ladder. The CT scan shows a displaced nasal fracture. What is the ideal time to reduce the fracture in this patient?", "options": [{"label": "A", "text": "Within 12 hours following the injury", "correct": false}, {"label": "B", "text": "5-7 days following injury", "correct": true}, {"label": "C", "text": "After 2 weeks of injury", "correct": false}, {"label": "D", "text": "After 4 weeks of injury", "correct": false}], "correct_answer": "B. 5-7 days following injury", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- 5-7 days following inju\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hallpike maneuver aids in the assessment of which of the following?", "options": [{"label": "A", "text": "Vestibular function", "correct": true}, {"label": "B", "text": "Audiometry", "correct": false}, {"label": "C", "text": "Cochlear function", "correct": false}, {"label": "D", "text": "Corneal test", "correct": false}], "correct_answer": "A. Vestibular function", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6ICLwW6153OtnUWyiEku1747121098.png"], "explanation": "<p>Correct Answer A- &lt;span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\"&gt;Vestibular&lt;/span&gt; fu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old patient undergoes TURP, and after 3 days, the patient develops altered sensitiveness and drowsiness. The most probable diagnosis is:", "options": [{"label": "A", "text": "Hypernatremia", "correct": false}, {"label": "B", "text": "Hyponatremia", "correct": true}, {"label": "C", "text": "Stroke", "correct": false}, {"label": "D", "text": "Meningitis due to spinal anaesthesia", "correct": false}], "correct_answer": "B. Hyponatremia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>TURP Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is because fluid is absorbed intravascularly due to high volumes of <span class=\"customMeta\" data-dictid=\"6c1412e72916927771893d06180642\">hypotonic</span> <span class=\"customMeta\" data-dictid=\"ea6a429a6b1692777190801502ba55\">irrigation</span> fluid used during the resection, causing <span class=\"customMeta\" data-dictid=\"306696ad491692777186226c17193f\">dilutional hyponatremia</span> and various neurologic symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Size of <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> &gt; 75g</li>\n<li>Duration of surgery &gt; 90 minutes</li>\n<li>Pre-existing hyponatremia</li>\n<li>Renal failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Confusion,</li>\n<li>Agitation,</li>\n<li>Nervousness,</li>\n<li>Nausea,</li>\n<li>Hemolysis,</li>\n<li>Visual disturbances,</li>\n<li>Coma and shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drug of choice: <strong>IV furosemide.</strong></li>\n<li><strong>Mild to moderate cases:</strong> IV <span class=\"customMeta\" data-dictid=\"b1527c07251692777203d317fb2eb0\">furosemide</span> and normal saline</li>\n<li><strong>Severe or <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> patients:</strong> IV 3% Saline</li>\n<li>Fluid restriction: Useful after initial stabilisation and <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> of severe <span class=\"customMeta\" data-dictid=\"44b22766411692777189eb80d6416e\">hyponatremia</span> to prevent further fluid overload.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 5-year-old child with abdominal swelling, mild discomfort, no pain or vomiting, and a fluctuant soft swelling that moves freely in a plane perpendicular to the mesentery attachment, as seen in the outpatient department?", "options": [{"label": "A", "text": "Peritoneal cyst", "correct": false}, {"label": "B", "text": "Lipoma", "correct": false}, {"label": "C", "text": "Chylolymphatic cyst", "correct": true}, {"label": "D", "text": "Pseudocyst", "correct": false}], "correct_answer": "C. Chylolymphatic cyst", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Rhinolalia clausa occurs in all except:", "options": [{"label": "A", "text": "Nasopharyngeal polyp", "correct": false}, {"label": "B", "text": "Nasopharyngeal carcinoma", "correct": false}, {"label": "C", "text": "Cleft palate", "correct": true}, {"label": "D", "text": "Nasopharyngeal angiofibroma", "correct": false}], "correct_answer": "C. Cleft palate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- &lt;span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\"&gt;Cleft&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old woman had her routine follow-up, and her USG of the liver is shown below. She is asymptomatic at present but has a history of mild right hypochondriac pain, which is relieved by taking analgesics. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Gallstones", "correct": true}, {"label": "B", "text": "Amoebic liver abscess", "correct": false}, {"label": "C", "text": "Hydatid cyst", "correct": false}, {"label": "D", "text": "Acute cholecystitis", "correct": false}], "correct_answer": "A. Gallstones", "question_images": ["https://image.prepladder.com/content/2rZH90yQw5DNom1dHDUK1747121460.png"], "explanation_images": ["https://image.prepladder.com/content/rPEY8cDIi5u21M6Hk58e1748163093.png", "https://image.prepladder.com/content/ByjAZEGPEsFrgwnAlkAv1747121486.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred management of the condition in the image below?", "options": [{"label": "A", "text": "Surgical excision", "correct": true}, {"label": "B", "text": "Radiotherapy", "correct": false}, {"label": "C", "text": "Antibiotics", "correct": false}, {"label": "D", "text": "Intralesional steroids", "correct": false}], "correct_answer": "A. Surgical excision", "question_images": ["https://image.prepladder.com/content/wVHBRcR4U9F7rUEC00NB1747121564.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Angular Dermoid</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It commonly occurs as<strong> a smooth, non-tender, soft <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> at the fronto-zygomatic suture.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>They are most often located near the <strong>lateral canthus</strong>, which is the outer corner of the eye where the upper and lower eyelids meet. They may also occur near <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines of the skull.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>They are usually <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> unless they become large enough to cause pressure effects on adjacent structures or become infected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ultrasound or CT scans may be used to evaluate the extent of the cyst, especially if deep or <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> involvement is suspected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Excision: Complete <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> is the treatment of choice</strong>, especially if the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> is causing <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> concerns or other symptoms.</p>\n<ul>\n<li>Careful <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> is required to ensure the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> is fully removed and avoid recurrence.</li>\n<li>If left untreated, <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> dermoids sometimes undergo <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> or <span class=\"customMeta\" data-dictid=\"cdb5523e491692777190f8bc3775ff\">indentation</span> of the underlying base. CT is done to rule out <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> attachments.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the with a three-day history of severe headache, fever, and nausea. He also reports experiencing pain and swelling behind his left ear and blood-tinged ear discharge. On examination tenderness and bluish discoloration over the mastoid process of the left temporal bone is observed. His CT showed an empty delta sign. What is the likely diagnosis?", "options": [{"label": "A", "text": "Meningitis", "correct": false}, {"label": "B", "text": "Lateral sinus thrombosis", "correct": true}, {"label": "C", "text": "Brain Abscess", "correct": false}, {"label": "D", "text": "Extradural Abscess", "correct": false}], "correct_answer": "B. Lateral sinus thrombosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\"&gt;Lateral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\"&gt;sinus&lt;/span&gt; th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image below shows an image of the anus. What is the most likely diagnosis, and it occurs when one of your anus glands becomes clogged and infected? Pus and fluid accumulate in the anal gland, resulting in an excruciatingly painful abscess around your anus?", "options": [{"label": "A", "text": "Hemorrhoids", "correct": false}, {"label": "B", "text": "Pelvirectal abscess", "correct": false}, {"label": "C", "text": "Perianal abscess", "correct": true}, {"label": "D", "text": "Pilonidal sinus", "correct": false}], "correct_answer": "C. Perianal abscess", "question_images": ["https://image.prepladder.com/content/TT0ZUp7CPlKtqS0fi6k61748163177.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most probable diagnosis for a 38-year-old male patient who visited the surgery OPD with a history of occasional discharge of pus with a slight presence of blood from an external opening in the perianal region, despite multiple attempts at drainage? The examination of the perianal region is depicted below.", "options": [{"label": "A", "text": "Pilonidal sinus", "correct": false}, {"label": "B", "text": "Perianal abscess", "correct": false}, {"label": "C", "text": "Hemorrhoids", "correct": false}, {"label": "D", "text": "Fistula-in-ano", "correct": true}], "correct_answer": "D. Fistula-in-ano", "question_images": ["https://image.prepladder.com/content/20M6baMzU3BdU6CUaRfQ1748163195.png"], "explanation_images": ["https://image.prepladder.com/content/nPBAClMBDTtebExPR4iL1748163203.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fistula-in-ano</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Idiopathic/Cryptoglandular: The most common cause, often associated with prior <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> sepsis.<strong> </strong></li>\n<li>Associated Conditions:\n\t\t\t\t<ul>\n<li>Crohn’s disease</li>\n<li>Tuberculosis</li>\n<li>Lymphogranuloma venereum</li>\n<li>Actinomycosis</li>\n<li>Rectal duplication</li>\n<li>Foreign bodies</li>\n<li>Malignancy (rare, can develop within a longstanding fistula)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intermittent <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge: This may be bloody and purulent. Discomfort typically increases until the <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> discharges, providing temporary relief.</li>\n<li>Previous history of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">Anorectal</span> abscess</li>\n<li>Passage of <span class=\"customMeta\" data-dictid=\"c952bab9c2169277720207dd4f48d0\">flatus</span> or faeces: Through the external opening (indicative of a rectal rather than an anal internal opening).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parks classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 1</strong> - Inter- sphincteric (most common, 70%)</p>\n<p><strong>Type 2</strong> - Trans- sphincteric (25%)</p>\n<p><strong>Type 3</strong> - Supra- sphincteric (4%)</p>\n<p><strong>Type 4 </strong>- Extra- sphincteric (1%)</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kenneth Voon Kher Ti\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Parks-Classification-in-1976-4-main-types-with-its-sub-types-diagrams-obtained-from_fig1_355104986\" data-tags=\"\" height=\"684\" src=\"https://image.prepladder.com/content/nPBAClMBDTtebExPR4iL1748163203.png\" width=\"736\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what age frontal sinuses appear on X ray?", "options": [{"label": "A", "text": "1 years", "correct": false}, {"label": "B", "text": "2 years", "correct": false}, {"label": "C", "text": "3 years", "correct": false}, {"label": "D", "text": "4 years", "correct": true}], "correct_answer": "D. 4 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D- 4\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The authority who investigates the death of a 14-year-old girl who was abducted by a man and subsequently died while in police custody will be?", "options": [{"label": "A", "text": "Coroner", "correct": false}, {"label": "B", "text": "Police", "correct": false}, {"label": "C", "text": "Medical examiner", "correct": false}, {"label": "D", "text": "Judicial magistrate", "correct": true}], "correct_answer": "D. Judicial magistrate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An infant of 12 weeks presented with the following defect in the umbilical area. Identify the condition.", "options": [{"label": "A", "text": "Omphalocele", "correct": false}, {"label": "B", "text": "Gastroschisis", "correct": false}, {"label": "C", "text": "Umbilical hernia", "correct": false}, {"label": "D", "text": "Paraumbilical hernia", "correct": true}], "correct_answer": "D. Paraumbilical hernia", "question_images": ["https://image.prepladder.com/content/6HIJ7N8eAvKAg0aF1Y1j1748163304.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the given options is most likely to cause sensory neural hearing loss?", "options": [{"label": "A", "text": "Labyrinthitis", "correct": true}, {"label": "B", "text": "Otosclerosis", "correct": false}, {"label": "C", "text": "Ear wax", "correct": false}, {"label": "D", "text": "CSOM", "correct": false}], "correct_answer": "A. Labyrinthitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Labyrinth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A dead body was found with a wound on the neck, with clean-cut edges, crushed tissues along with the disruption of the vertebral bones.Identify the type of wound.", "options": [{"label": "A", "text": "Incised wound", "correct": false}, {"label": "B", "text": "Chop wound", "correct": true}, {"label": "C", "text": "Lacerated wound", "correct": false}, {"label": "D", "text": "Avulsion", "correct": false}], "correct_answer": "B. Chop wound", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zCGr5vPSuYDQ6aoxtc2s1747122063.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image below shows a procedure that was done on the patient. What is the procedure?", "options": [{"label": "A", "text": "Endotracheal intubation", "correct": false}, {"label": "B", "text": "Needle cricothyroidotomy", "correct": false}, {"label": "C", "text": "Tracheostomy", "correct": true}, {"label": "D", "text": "Oropharyngeal airway", "correct": false}], "correct_answer": "C. Tracheostomy", "question_images": ["https://image.prepladder.com/content/N1173BmkJvvCER9BoLZy1747981579.png"], "explanation_images": ["https://image.prepladder.com/content/qf571g5aeFjq1BkK2z041747122204.png"], "explanation": "<p>Correct Answer C- Tracheostomy</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (tumors, foreign body)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged mechanical ventilation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurological conditions (e.g., <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord injury)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incision made below vocal cords, tube inserted into trachea.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tube Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cuffed:</strong> for <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> support.</p>\n<p><strong>Uncuffed:</strong> for stable <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> or weaning.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection, bleeding, <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> stenosis, <span class=\"customMeta\" data-dictid=\"fb7ff97e071692777180252299cf10\">accidental</span> dislodgement, <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> difficulty.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regular cleaning, monitoring for infection, and tube changes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Comfortable for long-term ventilation, lower risk of <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> damage compared to intubation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis from the given abdominal x-ray?", "options": [{"label": "A", "text": "Ureterocoele", "correct": false}, {"label": "B", "text": "Pelvic bone fracture", "correct": false}, {"label": "C", "text": "Rectal foreign body", "correct": true}, {"label": "D", "text": "Bladder stone", "correct": false}], "correct_answer": "C. Rectal foreign body", "question_images": ["https://image.prepladder.com/content/MyC6v9qsXI7vAK7gc0TR1748163282.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A cricket player was initially hit on the head with a cricket ball, appearing fine but later collapsing, regaining consciousness to play well, and then found unconscious in the dressing room. What is the probable diagnosis based on the result of the CT scan provided?", "options": [{"label": "A", "text": "Extradural hemorrhage", "correct": true}, {"label": "B", "text": "Artifact", "correct": false}, {"label": "C", "text": "Subdural hemorrhage", "correct": false}, {"label": "D", "text": "Subarachnoid hemorrhage", "correct": false}], "correct_answer": "A. Extradural hemorrhage", "question_images": ["https://image.prepladder.com/content/B4B0hZfZOuD4oqfvYgaE1747122444.png"], "explanation_images": ["https://image.prepladder.com/content/X29IbYxy4CWDfvA1TVdb1747122469.png", "https://image.prepladder.com/content/Hyz1oV2JoofvsPXjItcE1747122470.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 70-year-old man who has neck nodes and exhibits a dull tympanic membrane, along with symptoms of deafness and tinnitus in the left ear, and a type B graph on tympanometry?", "options": [{"label": "A", "text": "Chronic suppurative otitis media", "correct": false}, {"label": "B", "text": "Glomus tumor", "correct": false}, {"label": "C", "text": "Nasopharyngeal carcinoma", "correct": true}, {"label": "D", "text": "Sensorineural hearing loss", "correct": false}], "correct_answer": "C. Nasopharyngeal carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- &lt;span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\"&gt;Nasopharyngeal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "False regarding deep second-degree burns:", "options": [{"label": "A", "text": "Heal by scar deposition", "correct": false}, {"label": "B", "text": "No blanching", "correct": false}, {"label": "C", "text": "Damage to the deeper dermis", "correct": false}, {"label": "D", "text": "Painless", "correct": true}], "correct_answer": "D. Painless", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:610px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Deep Partial-Thickness Burns</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Affected Area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidermis and <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> (bottom layer of dermis) (Option C ruled out).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painful</li>\n<li>Loss of epidermis</li>\n<li>Less moist dermis</li>\n<li>Fixed <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> staining</li>\n<li>Reduced sensation</li>\n<li>No blanching with pressure <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Healing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Takes<strong> 3+ weeks</strong>: often leads to <strong>scarring (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May require <strong>surgical intervention</strong> (e.g., skin grafting)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fingerprint pattern shown in the image:", "options": [{"label": "A", "text": "Whorl", "correct": false}, {"label": "B", "text": "Composite", "correct": false}, {"label": "C", "text": "Loop", "correct": false}, {"label": "D", "text": "Arch", "correct": true}], "correct_answer": "D. Arch", "question_images": ["https://image.prepladder.com/content/kB2xhvafHFdx4rUteQ9d1747122294.png"], "explanation_images": ["https://image.prepladder.com/content/vdqiVnoocVV3u4EAR5MZ1748245943.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cause of Opisthotonus is?", "options": [{"label": "A", "text": "Cocaine", "correct": false}, {"label": "B", "text": "Codeine", "correct": false}, {"label": "C", "text": "Strychnine", "correct": true}, {"label": "D", "text": "Curare", "correct": false}], "correct_answer": "C. Strychnine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9BzD8dpWGNfzS0REeif11747122648.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man presents with complaints of a facial deformity, as shown in the image below. His medical records show a history of acne rosacea. What is the likely diagnosis?", "options": [{"label": "A", "text": "Rhinophyma", "correct": true}, {"label": "B", "text": "Rhinoscleroma", "correct": false}, {"label": "C", "text": "Rhinosporidiosis", "correct": false}, {"label": "D", "text": "Scleroderma", "correct": false}], "correct_answer": "A. Rhinophyma", "question_images": ["https://image.prepladder.com/content/rDOaVabsGEvoIjBUMxTi1747122657.png"], "explanation_images": [], "explanation": "<p>Correct Answer A- Rhinoph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the substance identified by Barberio's test, which was conducted on the stains from a sexual assault incident involving an 18-year-old female and a 20-year-old male?", "options": [{"label": "A", "text": "Spermine", "correct": true}, {"label": "B", "text": "Acid phosphatase", "correct": false}, {"label": "C", "text": "Choline", "correct": false}, {"label": "D", "text": "Fructose", "correct": false}], "correct_answer": "A. Spermine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CwzUs3FrO9fHtdn7fvwl1747122762.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Best way to localise extra-adrenal pheochromocytoma:", "options": [{"label": "A", "text": "X-ray", "correct": false}, {"label": "B", "text": "Nucleotide scan", "correct": true}, {"label": "C", "text": "VMA excretion", "correct": false}, {"label": "D", "text": "Clinical examination", "correct": false}], "correct_answer": "B. Nucleotide scan", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old boy was brought by his parents with concerns about being increasingly clumsy for the past 6 months. On examination, there is leukocoria with an absence of the red reflex in the left eye. As further workup reveals a tumour, the eye is enucleated, and the microscopic appearance is as shown in the image. Molecular analysis of the tumour indicates a loss of cell cycle control in the tumour cells. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Wilms tumor", "correct": false}, {"label": "B", "text": "Retinoblastoma", "correct": true}, {"label": "C", "text": "Ependymoma", "correct": false}, {"label": "D", "text": "Neuroblastoma", "correct": false}], "correct_answer": "B. Retinoblastoma", "question_images": ["https://image.prepladder.com/content/ci43XPaNpmpTQgtCtIKK1747121921.png"], "explanation_images": ["https://image.prepladder.com/content/fyIKpKNN6yNtDGWclWnN1747122861.png", "https://image.prepladder.com/content/cYLfKjQYZQ4vzndcZRpj1747122894.png", "https://image.prepladder.com/content/aGnzg90SNnBE6gKBkgW11747122925.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Gof6P6D0xjsm2w2ula5L1749405838.mp3", "video": ""}, {"text": "What is the term used to describe the sign depicted in the contrast-enhanced CT scan of the head shown below in a 14-year-old football player who presented to the casualty with complaints of epistaxis while playing football, along with a history of recurrent spontaneous nasal bleeding, unilateral nasal obstruction, and denasal speech, without any history of trauma or falls?", "options": [{"label": "A", "text": "Aquino Sign", "correct": false}, {"label": "B", "text": "Holman Miller sign", "correct": true}, {"label": "C", "text": "Teardrop sign", "correct": false}, {"label": "D", "text": "Hanging drop sign", "correct": false}], "correct_answer": "B. Holman Miller sign", "question_images": ["https://image.prepladder.com/content/wBHk6e27LtdNbAYPbAIA1747122926.png"], "explanation_images": [], "explanation": "<p>Correct Answer B- Holman Miller Sign.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Grey-Turner's sign is seen in:", "options": [{"label": "A", "text": "Acute appendicitis", "correct": false}, {"label": "B", "text": "Acute pancreatitis", "correct": true}, {"label": "C", "text": "Acute cholecystitis", "correct": false}, {"label": "D", "text": "Acute hepatitis", "correct": false}], "correct_answer": "B. Acute pancreatitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/N64enWH3mXR40dR9pBYL1747122975.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the active toxin extracted from the poisonous plant in the image below?", "options": [{"label": "A", "text": "Calotropis gigantea", "correct": false}, {"label": "B", "text": "Digitalis", "correct": false}, {"label": "C", "text": "Ricin", "correct": false}, {"label": "D", "text": "1-Hyoscyamine", "correct": true}], "correct_answer": "D. 1-Hyoscyamine", "question_images": ["https://image.prepladder.com/content/g7mjXsFJklTexFwvZeZM1747981862.png"], "explanation_images": ["https://image.prepladder.com/content/StUuCXV4rxK6LbJrdXl11747981868.png", "https://image.prepladder.com/content/7LuuYdjCFqafxV7eltFe1748246207.png", "https://image.prepladder.com/content/dJZmizQwSDGC86wtJVqr1747122946.png", "https://image.prepladder.com/content/cTnuuyGKtrOfo0vePJ7i1747122946.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the type of cell from which the cell displayed below originates?", "options": [{"label": "A", "text": "NK cells", "correct": false}, {"label": "B", "text": "CD4 cells", "correct": false}, {"label": "C", "text": "B cells", "correct": true}, {"label": "D", "text": "CD8 cells", "correct": false}], "correct_answer": "C. B cells", "question_images": ["https://image.prepladder.com/content/hPPWXCuLCWpF9LhFhnjy1747123041.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person was found dead in the bushes with his hands tied. On examination of the body, there was cyanosis petechial hemorrhages, abrasions, and bruises around the mouth and lips.There was associated facial congestion and edema. What is the least likely cause of death here?", "options": [{"label": "A", "text": "Asphyxia", "correct": false}, {"label": "B", "text": "Suicide", "correct": true}, {"label": "C", "text": "Smothering", "correct": false}, {"label": "D", "text": "Homicide", "correct": false}], "correct_answer": "B. Suicide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis based on the image below?", "options": [{"label": "A", "text": "Botryomycosis", "correct": false}, {"label": "B", "text": "Erysipelas", "correct": false}, {"label": "C", "text": "Ecthyma", "correct": false}, {"label": "D", "text": "Carbuncle", "correct": true}], "correct_answer": "D. Carbuncle", "question_images": ["https://image.prepladder.com/content/xZ4CbcUq22SRWli99FaV1747123032.png"], "explanation_images": ["https://image.prepladder.com/content/mY4ZXhjdqt3fh1xiQKcD1747123070.png", "https://image.prepladder.com/content/RumVylNEUCv619LcHixD1748163373.png", "https://image.prepladder.com/content/cxz0c1grlOtXi6sHGVgz1747123070.png", "https://image.prepladder.com/content/Zk1YHBzfsHRfGPScw5XT1748163399.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Carbuncle </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Infection of hair follicles extending into surrounding and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Staphylococcus aureus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Nape of neck, back.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Red, painful nodule; tender, <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> lesion; multiple draining sinuses;</strong> fever, lymphadenopathy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Septicemia, abscess, necrosis, requiring possible <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> or skin graft.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Control of diabetes; antibiotics; drainage, debridement, possible excision.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Medicalpal,\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Carbuncle.jpg\" data-tags=\"\" height=\"506\" src=\"https://image.prepladder.com/content/mY4ZXhjdqt3fh1xiQKcD1747123070.png\" width=\"566\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common cause of berry aneurysm?", "options": [{"label": "A", "text": "Endothelial injury of the vessel due to hypertension", "correct": false}, {"label": "B", "text": "Muscle intimal elastic lamina layer defect", "correct": true}, {"label": "C", "text": "Muscle and adventitial layer defect", "correct": false}, {"label": "D", "text": "Adventitia defect", "correct": false}], "correct_answer": "B. Muscle intimal elastic lamina layer defect", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which clinical test is being shown in the image?", "options": [{"label": "A", "text": "Epley’s maneuver", "correct": false}, {"label": "B", "text": "Heimlich maneuver", "correct": false}, {"label": "C", "text": "Cottle’s test", "correct": true}, {"label": "D", "text": "Trotter’s method", "correct": false}], "correct_answer": "C. Cottle’s test", "question_images": ["https://image.prepladder.com/content/bbZBeqEk3WJyHCJmJoEw1747123167.png"], "explanation_images": [], "explanation": "<p>Correct Answer C- Cottle’s test.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient, after heavy drinking of alcohol presents with multiple episodes of vomiting and hematemesis. The most likely diagnosis is:", "options": [{"label": "A", "text": "Mallory-Weiss syndrome", "correct": true}, {"label": "B", "text": "Esophageal carcinoma", "correct": false}, {"label": "C", "text": "Achalasia cardia", "correct": false}, {"label": "D", "text": "Boerhaave's syndrome", "correct": false}], "correct_answer": "A. Mallory-Weiss syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mallory-Weiss syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is defined as mucosal lacerations in the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> at the <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> (GE) <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> that are caused by forceful vomiting, retching, coughing, or straining.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It accounts for 10-15% of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> upper <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> haemorrhages.</li>\n<li>The greatest risk for massive haemorrhage is <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> patients with preexisting <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcoholic patients with intense <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> after <span class=\"customMeta\" data-dictid=\"45c64c16b516927771832de6bd0523\">binge</span> drinking.</li>\n<li>Forceful <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> contractions against a closed cardia.</li>\n<li>Any patient with repeated episodes of emesis.</li>\n<li>Portal <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> in <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The patient's history is crucial.</li>\n<li>It can be confirmed with endoscopy.</li>\n<li>Retroflexion manoeuvre during <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> is used to view the area below the <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> junction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vomiting, hematemesis, upper <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, hypotension, tachycardia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely massive <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> associated with <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endoscopic methods (multipolar electrocoagulation, <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> injection, band ligation), angiographic transarterial embolisation, rarely surgery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally good with appropriate <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> treatment</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The treatment of choice for inguinal hernia in infants is:", "options": [{"label": "A", "text": "Herniotomy", "correct": true}, {"label": "B", "text": "Herniorrhaphy", "correct": false}, {"label": "C", "text": "TRUSS", "correct": false}, {"label": "D", "text": "Hernioplasty", "correct": false}], "correct_answer": "A. Herniotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old girl is brought by her mother, with the complaint that the child is experiencing difficulties breathing through her nose. The girl's face appears elongated and lacks expression, and her mouth remains open. Upon examination, it is observed that she has a palate with a high arch and her upper teeth are crowded. An X-ray image is provided for reference. Based on these findings, what is the most probable diagnosis?", "options": [{"label": "A", "text": "Lingual tonsils", "correct": false}, {"label": "B", "text": "Quinsy", "correct": false}, {"label": "C", "text": "Tonsillar hypertrophy", "correct": false}, {"label": "D", "text": "Adenoid hypertrophy", "correct": true}], "correct_answer": "D. Adenoid hypertrophy", "question_images": ["https://image.prepladder.com/content/4tOI4ltoaH2Mh1H9Px4v1747981666.png"], "explanation_images": [], "explanation": "<p>Correct Answer D- &lt;span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\"&gt;Adenoid&lt;/span&gt; hypertrophy.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old male patient visits you reporting a nasal discharge that appears like the image shown on a handkerchief. Which of the following characteristics aids in identifying the presence of CSF rhinorrhoea in this patient?", "options": [{"label": "A", "text": "Halo sign", "correct": true}, {"label": "B", "text": "Handkerchief sign", "correct": false}, {"label": "C", "text": "Schwartz sign", "correct": false}, {"label": "D", "text": "Phelps sign", "correct": false}], "correct_answer": "A. Halo sign", "question_images": ["https://image.prepladder.com/content/0iHk0aqaDwSpNaIbHAt61747123549.png"], "explanation_images": [], "explanation": "<p>Correct Answer A- &lt;span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\"&gt;Halo&lt;/span&gt; sig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female homemaker arrives with symptoms of nasal congestion, reduced sense of smell, and a dry discharge from the nose that is greenish and crusty. Upon examination, the nasal passages appear spacious, and the turbinates are found to be shriveled. Which surgical procedure would be suitable for this patient?", "options": [{"label": "A", "text": "Submucous resection", "correct": false}, {"label": "B", "text": "Young’s operation", "correct": true}, {"label": "C", "text": "Septoplasty", "correct": false}, {"label": "D", "text": "Vidian neurectomy", "correct": false}], "correct_answer": "B. Young’s operation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- Young\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement accurately describes BERA (Brainstem Evoked Response Audiometry)?", "options": [{"label": "A", "text": "It can be used for screening for hearing loss", "correct": false}, {"label": "B", "text": "It is an invasive procedure", "correct": false}, {"label": "C", "text": "It can be used for assessing sensorineural hearing loss", "correct": true}, {"label": "D", "text": "It is a subjective investigation", "correct": false}], "correct_answer": "C. It can be used for assessing sensorineural hearing loss", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- It can be used for assessing &lt;span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\"&gt;sensorineural&lt;/span&gt; hearing loss.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the disease shown in the image below", "options": [{"label": "A", "text": "Syphilis", "correct": false}, {"label": "B", "text": "Leprosy", "correct": false}, {"label": "C", "text": "Elephantiasis", "correct": true}, {"label": "D", "text": "Leishmaniasis", "correct": false}], "correct_answer": "C. Elephantiasis", "question_images": ["https://image.prepladder.com/content/O4PZHHkCRh2b3dqjmPU41747123315.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient developed the following deformity, after overhead (weight-lifting) exercises. Which of the following muscles is involved?", "options": [{"label": "A", "text": "Trapezius", "correct": false}, {"label": "B", "text": "Serratus anterior", "correct": true}, {"label": "C", "text": "Lattisimus dorsi", "correct": false}, {"label": "D", "text": "Supraspinatus", "correct": false}], "correct_answer": "B. Serratus anterior", "question_images": ["https://image.prepladder.com/content/l3fk9N3Wam2Fy7QhFsgx1747126882.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer presented to the outpatient department with a swelling over his palm as shown in the photo. A few months back he got injured with a thorn. What is the presentation given below?", "options": [{"label": "A", "text": "Ameloblastoma", "correct": false}, {"label": "B", "text": "Embryogenic dermoid", "correct": false}, {"label": "C", "text": "Sequestration dermoid", "correct": false}, {"label": "D", "text": "Implantation dermoid", "correct": true}], "correct_answer": "D. Implantation dermoid", "question_images": ["https://image.prepladder.com/content/qQC67DBMpktiC6GHj4dp1747981230.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following arises from 6th pharyngeal arch?", "options": [{"label": "A", "text": "Medial pterygoids", "correct": false}, {"label": "B", "text": "Lateral pterygoids", "correct": false}, {"label": "C", "text": "Ductus arteriosus", "correct": true}, {"label": "D", "text": "Tensor veli palatini", "correct": false}], "correct_answer": "C. Ductus arteriosus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:785px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Arch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nerve of arch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Artery of arch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Skeletal derivatives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Muscles of arch</strong></p>\n<p><strong>(Options A, B, and D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maxillary (Sensory) and mandibular (Motor and sensory) branches of <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maxillary artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Meckel's cartilage</strong>\n<ul>\n<li><strong>Malleus</strong></li>\n<li>Incus</li>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of malleus</li>\n<li>Sphenomandibular ligament</li>\n</ul>\n</li>\n<li>Mandible</li>\n<li>Maxilla</li>\n<li>Zygomatic</li>\n<li>Palatine</li>\n<li>Temporal (part)</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Masseter</li>\n<li>Temporalis</li>\n<li>Medial pterygoid</li>\n<li>Lateral pterygoids</li>\n<li>Mylohyoid</li>\n<li>Anterior belly of digastric</li>\n<li>Tensor tympani, and</li>\n<li>Tensor palati</li>\n</ul>\n<p> </p>\n<p>All are <span class=\"customMeta\" data-dictid=\"5ee3e4a7a81692777192f6d4d042a9\">migratory</span> except T. tympani<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Second</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Facial nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyoid artery</li>\n<li>Stapedial artery</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> of the second <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> (Reichert’s) forms the</p>\n<p>Following:<strong> </strong></p>\n<ul>\n<li>Stapes</li>\n<li>Styloid process</li>\n<li>Stylohyoid ligament</li>\n<li>Lesser <span class=\"customMeta\" data-dictid=\"24f587bae816927771855c97872891\">cornu</span> of hyoid</li>\n<li>Upper half of body of hyoid</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stapedius</li>\n<li>Stylohyoid</li>\n<li>Posterior belly of digastric</li>\n<li>Epicranius</li>\n<li>Orbicularis oculi</li>\n<li>Orbicularis oris</li>\n<li>Zygomaticus</li>\n<li>Buccinator</li>\n<li>Nasal muscles</li>\n<li>Platysma</li>\n<li>Levator labii superioris, <span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\">levator</span> labii inferioris</li>\n<li>Levator <span class=\"customMeta\" data-dictid=\"d3a4dc0d2d16927771811c069bbe7d\">anguli</span> oris</li>\n<li>Auricular muscles</li>\n</ul>\n<p> </p>\n<p><strong>All are <span class=\"customMeta\" data-dictid=\"5ee3e4a7a81692777192f6d4d042a9\">migratory</span> except stapedius, stylohyoid</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Third</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glossopharyngeal nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Greater <span class=\"customMeta\" data-dictid=\"24f587bae816927771855c97872891\">cornu</span> of hyoid</li>\n<li>Lower half of body of hyoid</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stylopharyngeus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fourth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superior laryngeal branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Arch of <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> (left side)</li>\n<li>Subclavian <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (right side)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thyroid</li>\n<li>Cricoid</li>\n<li>Corniculate</li>\n<li>Cuneiform</li>\n<li>Arytenoid</li>\n<li>Thyrohyoid ligament</li>\n<li>Epiglottis—from mesodermal core of <span class=\"customMeta\" data-dictid=\"d3169c09a116927771893e69784932\">hypobranchial</span> eminence</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Larynx–Cricothyroid</li>\n<li>Muscles of pharynx</li>\n<li>Intrinsic muscles of soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> except <span class=\"customMeta\" data-dictid=\"72dbd9ec8716927772005127a031ac\">tensor</span> palati</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sixth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recurrent laryngeal branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ductus arteriosus (left side)</li>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (right side)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>All <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> muscles of <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> except cricothyroid</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Auspitz sign is seen in?", "options": [{"label": "A", "text": "Psoriasis vulgaris", "correct": true}, {"label": "B", "text": "Pustular psoriasis", "correct": false}, {"label": "C", "text": "Pemphigus", "correct": false}, {"label": "D", "text": "Bullous pemphigoid", "correct": false}], "correct_answer": "A. Psoriasis vulgaris", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fWYUXfC17EJwKsFVTv2m1747981327.png", "https://image.prepladder.com/content/S9XAUz4fU5NFRNmaWq0u1747981348.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of cells are implicated in the development of contact dermatitis in a 12-year-old boy who presented to the emergency department?", "options": [{"label": "A", "text": "Helper T cells", "correct": true}, {"label": "B", "text": "Neutrophils", "correct": false}, {"label": "C", "text": "NK cells", "correct": false}, {"label": "D", "text": "Cytotoxic T cells", "correct": false}], "correct_answer": "A. Helper T cells", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kHbhkz57f3xMqHEko0px1748155053.png", "https://image.prepladder.com/content/UgAD35NJYDroRq5PlUa71748155070.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanisms of Type IV hypersensitivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cytokine-mediated inflammation<br/>\n\t\t\t(mediated by CD4+ T cells)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CD4+ T cells recognise protein antigens presented by APCs and <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> into Th1 and Th17 cells<strong>.</strong></li>\n<li>Th1 cells <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> cytokines like IFN-γ, activating macrophages to cause tissue damage and fibrosis.</li>\n<li>Th17 cells produce IL-17 to recruit neutrophils, promoting inflammation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tuberculin test (a classic example of delayed-type hypersensitivity)</li>\n<li>Granulomas</li>\n<li>Contact dermatitis</li>\n<li>Rheumatoid arthritis</li>\n<li>Multiple sclerosis</li>\n<li>IBD</li>\n<li>Psoriasis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"227\" src=\"https://image.prepladder.com/content/kHbhkz57f3xMqHEko0px1748155053.png\" width=\"541\"/></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T <span class=\"customMeta\" data-dictid=\"5f09d353dd1692777184d29afdb259\">cell-mediated cytotoxicity</span> (mediated by CD8+ T cells)</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cytotoxic T lymphocytes </strong>(CTLs) directly kill antigen-bearing target cells, including tumour cells, virus-infected cells, and <span class=\"customMeta\" data-dictid=\"812d0ddedb1692777181aaf62743b1\">allogeneic</span> tissue, during <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> rejection.</li>\n<li>CTLs use <strong>perforin-granzyme-dependent</strong> killing and <strong>Fas-Fas ligand-dependent killing</strong> mechanisms to induce <span class=\"customMeta\" data-dictid=\"4bfa3e6f2c1692777181c53b124cf7\">apoptosis</span> in target cells.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type 1 DM</li>\n<li>Hepatic injury in HBV infection</li>\n<li>Graft vs host disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"214\" src=\"https://image.prepladder.com/content/UgAD35NJYDroRq5PlUa71748155070.png\" width=\"596\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old boy came to the emergency room with the following X-ray. On examination, he had a sensory loss in the lateral arm and sensory loss in the posterior aspect of the forearm. Which of the following is true about his condition?", "options": [{"label": "A", "text": "Fracture-dislocation of the elbow", "correct": false}, {"label": "B", "text": "Surgical neck humerus fracture with axillary nerve injury", "correct": false}, {"label": "C", "text": "Spine fracture with foot drop", "correct": false}, {"label": "D", "text": "Humerus shaft fracture with radial nerve palsy", "correct": true}], "correct_answer": "D. Humerus shaft fracture with radial nerve palsy", "question_images": ["https://image.prepladder.com/content/fixYtgiGxU4eSucd3hSY1747127094.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Root origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Common causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Radial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C5-T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Compression in <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> (crutches, \"Saturday night palsy\")</li>\n<li><strong>Midshaft <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of humerus</strong></li>\n<li>Repetitive pronation/supination (screwdriver use, \"finger drop\")</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Above elbow injury:</p>\n<ul>\n<li>Loss of sensation over <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arm/forearm and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> hand</li>\n<li>Wrist drop (loss of elbow, wrist, and finger extension)</li>\n<li>Decreased grip strength (wrist extension necessary for <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> action of flexors)</li>\n</ul>\n<p>Below elbow injury:</p>\n<ul>\n<li>Distal paresthesias without wrist drop</li>\n</ul>\n<p>Midshaft fracture:</p>\n<ul>\n<li>Tricep function and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arm sensation spared</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Median</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C5-T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Supracondylar <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> (proximal lesion)</li>\n<li>Carpal tunnel syndrome and wrist <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> (distal lesion)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>\"Ape hand\" and \"Hand of benediction\"</li>\n<li>Loss of wrist flexion</li>\n<li>Loss of function of LOAF muscles (Lumbricals (lateral two), Opponens pollicis, Abductor pollicis brevis, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> pollicis brevis)</li>\n<li>Loss of sensation over <span class=\"customMeta\" data-dictid=\"48c587f4c51692777200fe869f1699\">thenar</span> <span class=\"customMeta\" data-dictid=\"c7cd7c82631692777187abb016ed2e\">eminence</span> and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> and <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> aspects of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 3 1/2 fingers with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> lesion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ulnar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C8-T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Fracture of <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> (proximal lesion)</li>\n<li>Fractured hook of <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">hamate</span> (distal lesion) from fall on outstretched hand</li>\n<li>Compression of nerve against <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">hamate</span> during cycling</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>\"Ulnar claw\" on <span class=\"customMeta\" data-dictid=\"02e6b5c95316927771867eba7818b1\">digit</span> extension</li>\n<li>Radial <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of wrist upon <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (proximal lesion)</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> fingers</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">adduction</span> of fingers (interossei)</li>\n<li>Loss of thumb adduction</li>\n<li>Loss of action of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> 2 <span class=\"customMeta\" data-dictid=\"1e06b348b91692777191544ba23785\">lumbrical</span> muscles</li>\n<li>Loss of sensation over <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> 1 1/2 fingers including <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">hypothenar</span> eminence</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A sexually active male presented with warts on his penis as shown below. Similar lesions were present near the anal canal. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Penile cancer", "correct": false}, {"label": "B", "text": "Condyloma acuminata", "correct": true}, {"label": "C", "text": "Bowen disease", "correct": false}, {"label": "D", "text": "Haemorrhoids", "correct": false}], "correct_answer": "B. Condyloma acuminata", "question_images": ["https://image.prepladder.com/content/YvAZvx2Im61M3uk9mMY81747127200.png"], "explanation_images": ["https://image.prepladder.com/content/LDw9oXGNocPmxzdBdpkK1747981417.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:562px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Oncogenic potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HPV types</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plantar warts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common skin warts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2, 4, 27, 57</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epidermodysplasia verrucosa</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mostly benign, rarely progresses to malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5, 8, 9, 12, 17</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anogenital warts</p>\n<p>Laryngeal papilloma</p>\n<p>Intraepithelial neoplasia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 11</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Palmar warts in butchers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carcinomas of the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> &amp; other <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> mucosa/larynx/oesophagus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16, 18, 31, 33, 45, 51, 52, 56, 58, 59, 68</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which amino acid is necessary for the production of nitric oxide in the blood vessels?", "options": [{"label": "A", "text": "Citrulline", "correct": false}, {"label": "B", "text": "Arginine", "correct": true}, {"label": "C", "text": "Histidine", "correct": false}, {"label": "D", "text": "Tryptophan", "correct": false}], "correct_answer": "B. Arginine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The girl seen in the image has had a history of severe sunburns after just a few minutes in the sun, severe freckling in the sun-exposed areas. The most likely diagnosis is.", "options": [{"label": "A", "text": "Bloom syndrome", "correct": false}, {"label": "B", "text": "Xeroderma pigmentosum", "correct": true}, {"label": "C", "text": "Warts", "correct": false}, {"label": "D", "text": "Systemic lupus", "correct": false}], "correct_answer": "B. Xeroderma pigmentosum", "question_images": ["https://image.prepladder.com/content/FQDgr2sBAVBR14GYk4Up1747127341.png"], "explanation_images": ["https://image.prepladder.com/content/yxgulbTMZ1ot7AXdKu271747127405.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An exhausted man was brought to the casualty with minimal response. He had a progressive history of weakness in his body for 2 days with facial droop, and slurring speech. Which vessel is likely to be thrombosed?", "options": [{"label": "A", "text": "Posterior cerebral artery", "correct": false}, {"label": "B", "text": "Anterior cerebral artery", "correct": false}, {"label": "C", "text": "Middle cerebral artery", "correct": true}, {"label": "D", "text": "Posterior inferior cerebellar artery", "correct": false}], "correct_answer": "C. Middle cerebral artery", "question_images": ["https://image.prepladder.com/content/jjIuY0D40Nnc53xV3Yys1747980437.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:645px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Supplies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Occlusion: Affected Areas and Deficits</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Anterior cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Medial aspect of hemisphere</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>- <strong>Paracentral lobule:</strong> <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> loss in the lower <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> and perineum, <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> weakness and <span class=\"customMeta\" data-dictid=\"0ae01203b4169277718914c4efe843\">hyperreflexia</span> in the lower extremity, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> incontinence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Middle cerebral artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lateral surface</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Frontal lobe:</strong> <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> weakness and weakness in upper limb, <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">conjugate</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the eye to the affected side, Broca aphasia</li>\n<li><strong>Temporal lobe:</strong> Deafness, Wernicke aphasia, <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> hallucinations</li>\n<li><strong>Parietal lobe:</strong> Gerstmann syndrome (dominant <span class=\"customMeta\" data-dictid=\"d702dfe10816927771881b37be4e4a\">hemisphere</span> lesion), <span class=\"customMeta\" data-dictid=\"81203ae99a1692777188b245ee4376\">hemi</span> <span class=\"customMeta\" data-dictid=\"bc4fd945b61692777193cadcf42cfb\">neglect</span> syndrome (nondominant hemisphere)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Posterior cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Occipital lobe, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> aspect of <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> lobe, <span class=\"customMeta\" data-dictid=\"2c808950f11692777199ccd2c1f2c1\">splenium</span> of <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> callosum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Occipital lobe: </strong>Contralateral <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">homonymous</span> <span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\">hemianopia</span> with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> sparing</li>\n<li><strong>Temporal lobe:</strong> Incapacity to create and store new memory</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby assessed five minutes after birth is found to have a blue, absent pulse, minimal response to stimulation, slightly flexed arms and legs, and slow, irregular respiratory movement. What is the APGAR score for this newborn?", "options": [{"label": "A", "text": "2", "correct": false}, {"label": "B", "text": "3", "correct": true}, {"label": "C", "text": "4", "correct": false}, {"label": "D", "text": "5", "correct": false}], "correct_answer": "B. 3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:591px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>APGAR Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Score:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Completely blue or pale</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The body is pink, and the extremities are blue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Completely pink</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulse rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;100/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;100/min</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grimace</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grimaces only</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coughs/sneezes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Activity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limp and flaccid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Some <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flexed <span class=\"customMeta\" data-dictid=\"115643fed616927771961316effc71\">posture</span> and actively moving limbs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory effort</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slow and irregular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal/strong</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The shown instrument is:", "options": [{"label": "A", "text": "Single cutting razor", "correct": false}, {"label": "B", "text": "Double cutting razor", "correct": false}, {"label": "C", "text": "Humby’s knife", "correct": true}, {"label": "D", "text": "Finochietto knife", "correct": false}], "correct_answer": "C. Humby’s knife", "question_images": ["https://image.prepladder.com/content/imX31NFaLCHNR5jiEwht1747127610.png"], "explanation_images": ["https://image.prepladder.com/content/rnXQWp6OsOp7K395h06i1747981468.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Harvesting <strong>split-thickness skin grafts (STSGs)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blade Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Single cutting blade</strong>, adjustable for thickness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alternative Instruments</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Watson’s knife, Padgett dermatome, and Brown’s dermatome</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cost-effective, reusable, allows controlled thickness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires <strong>manual skill</strong>, risk of <strong>irregular <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> thickness</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male patient presents to the OPD complaining of pain in the medial part of the elbow for the past 4-6 weeks. He states that the pain worsens while lifting weights in the gym. On examination, there is tenderness over the medial epicondyle, and reverse Cozen's test is positive. Which of the following nerves is most likely to be injured in this patient?", "options": [{"label": "A", "text": "Median nerve", "correct": false}, {"label": "B", "text": "Ulnar nerve", "correct": true}, {"label": "C", "text": "Radial nerve", "correct": false}, {"label": "D", "text": "Axillary nerve", "correct": false}], "correct_answer": "B. Ulnar nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Root origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Common causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Radial (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C5-T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Compression in <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> (crutches, \"Saturday night palsy\")</li>\n<li><strong>Midshaft <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of humerus</strong></li>\n<li>Repetitive pronation/supination (screwdriver use, \"finger drop\")</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Above elbow injury:</p>\n<ul>\n<li>Loss of sensation over <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arm/forearm and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> hand</li>\n<li>Wrist drop (loss of elbow, wrist, and finger extension)</li>\n<li>Decreased grip strength (wrist extension necessary for <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> action of flexors)</li>\n</ul>\n<p>Below elbow injury:</p>\n<ul>\n<li>Distal paresthesias without wrist drop</li>\n</ul>\n<p>Midshaft fracture:</p>\n<ul>\n<li>Tricep function and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arm sensation spared</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Median (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C5-T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Supracondylar <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> (proximal lesion)</li>\n<li>Carpal tunnel syndrome and wrist <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> (distal lesion)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>\"Ape hand\" and \"Hand of benediction\"</li>\n<li>Loss of wrist flexion</li>\n<li>Loss of function of LOAF muscles (Lumbricals (lateral two), Opponens pollicis, Abductor pollicis brevis, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> pollicis brevis)</li>\n<li>Loss of sensation over <span class=\"customMeta\" data-dictid=\"48c587f4c51692777200fe869f1699\">thenar</span> <span class=\"customMeta\" data-dictid=\"c7cd7c82631692777187abb016ed2e\">eminence</span> and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> and <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> aspects of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 3 1/2 fingers with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> lesion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ulnar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C8-T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Fracture of <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> (proximal lesion)</li>\n<li>Fractured hook of <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">hamate</span> (distal lesion) from fall on outstretched hand</li>\n<li>Compression of nerve against <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">hamate</span> during cycling</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>\"Ulnar claw\" on <span class=\"customMeta\" data-dictid=\"02e6b5c95316927771867eba7818b1\">digit</span> extension</li>\n<li>Radial <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of wrist upon <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (proximal lesion)</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> fingers</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">adduction</span> of fingers (interossei)</li>\n<li>Loss of thumb adduction</li>\n<li>Loss of action of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> 2 <span class=\"customMeta\" data-dictid=\"1e06b348b91692777191544ba23785\">lumbrical</span> muscles</li>\n<li>Loss of sensation over <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> 1 1/2 fingers including <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">hypothenar</span> eminence</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The structure marked in the image drains into:", "options": [{"label": "A", "text": "Junction of superior vena cava and left brachiocephalic veins", "correct": false}, {"label": "B", "text": "Thoracic Duct", "correct": true}, {"label": "C", "text": "Directly into the coronary sinus", "correct": false}, {"label": "D", "text": "Azygos vein", "correct": false}], "correct_answer": "B. Thoracic Duct", "question_images": ["https://image.prepladder.com/content/52KHPhXTz7ZjojxGVe7e1747980622.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what age is it recommended to introduce solid foods to an infant while continuing breastfeeding?", "options": [{"label": "A", "text": "2 months", "correct": false}, {"label": "B", "text": "6 months", "correct": true}, {"label": "C", "text": "12 months", "correct": false}, {"label": "D", "text": "18 months", "correct": false}], "correct_answer": "B. 6 months", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-year-old boy is presented by his parents at a nearby village hospital, reporting loose stools over the past 3 days. The child's mother observes that he has become lethargic and refuses to eat. Upon examination, the child displays lethargy, dry mouth, sunken eyes, and delayed skin pinch recovery. How much fluid should be administered within the initial three hours if the child weighs 10 kg?", "options": [{"label": "A", "text": "1000 ml", "correct": true}, {"label": "B", "text": "100 ml", "correct": false}, {"label": "C", "text": "200 ml", "correct": false}, {"label": "D", "text": "500 ml", "correct": false}], "correct_answer": "A. 1000 ml", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Dehydration - Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>No dehydration:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Continue normal diet</li>\n<li>Zinc: Reduces duration and severity of <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> in children from developing countries:</li>\n</ol>\n<ul>\n<li>Dose: 2-6-month age: 10 mg/day</li>\n<li>≥ 6-month age: 20 mg/day</li>\n<li>Duration: 10-14 days</li>\n</ul>\n<ol>\n<li>Replacement of ongoing losses by WHO-ORS (5-10 ml/kg/loose stool)</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Some dehydration:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>75 ml/kg over 4 hours (if cannot accept orally, give IV fluid)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe dehydration: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>100 ml/kg fluid</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>1st 30ml/kg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Next 70 ml/kg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Total</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 1 year</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Over 1 hour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Over 5 hour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 1 year</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Over ½ hour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Over 2 ½ hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 hours</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IV fluid of choice:</strong> Ringer <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> in 5% Dextrose &gt; Ringer lactate</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the tendon marked in the image", "options": [{"label": "A", "text": "Flexor carpi radialis", "correct": true}, {"label": "B", "text": "Flexor carpi ulnaris", "correct": false}, {"label": "C", "text": "Palmaris longus", "correct": false}, {"label": "D", "text": "Median nerve", "correct": false}], "correct_answer": "A. Flexor carpi radialis", "question_images": ["https://image.prepladder.com/content/V8sKUUkCr0j69dPvkKp11747980554.png"], "explanation_images": ["https://image.prepladder.com/content/d5IAiAWtiNokJACZ2SQq1747980560.png", "https://image.prepladder.com/content/vDMLfwc9g6ixKWp1V8ap1747980592.png", "https://image.prepladder.com/content/XlBY90FCrSVPqf6NGrfP1747980603.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man who was on crutches now presents with tingling and paraesthesia on the medial side of the arm, forearm, and hand. Which structure is most likely to be affected?", "options": [{"label": "A", "text": "A", "correct": true}, {"label": "B", "text": "B", "correct": false}, {"label": "C", "text": "C", "correct": false}, {"label": "D", "text": "D", "correct": false}], "correct_answer": "A. A", "question_images": ["https://image.prepladder.com/content/KdA2rbnpCYVahFiGRlo21747981117.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Root origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Common causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Radial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C5-T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Compression in <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> (crutches, \"Saturday night palsy\")</strong></li>\n<li>Midshaft <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of humerus</li>\n<li>Repetitive pronation/supination (screwdriver use, \"finger drop\")</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Above elbow injury:</p>\n<ul>\n<li>Loss of sensation over <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arm/forearm and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> hand</li>\n<li>Wrist drop (loss of elbow, wrist, and finger extension)</li>\n<li>Decreased grip strength (wrist extension necessary for <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> action of flexors)</li>\n</ul>\n<p>Below elbow injury:</p>\n<ul>\n<li>Distal paresthesias without wrist drop</li>\n</ul>\n<p>Midshaft fracture:</p>\n<ul>\n<li>Tricep function and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arm sensation spared</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Median</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C5-T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Supracondylar <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> (proximal lesion)</li>\n<li>Carpal tunnel syndrome and wrist <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> (distal lesion)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>\"Ape hand\" and \"Hand of benediction\"</li>\n<li>Loss of wrist flexion</li>\n<li>Loss of function of LOAF muscles (Lumbricals (lateral two), Opponens pollicis, Abductor pollicis brevis, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> pollicis brevis)</li>\n<li>Loss of sensation over <span class=\"customMeta\" data-dictid=\"48c587f4c51692777200fe869f1699\">thenar</span> <span class=\"customMeta\" data-dictid=\"c7cd7c82631692777187abb016ed2e\">eminence</span> and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> and <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> aspects of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 3 1/2 fingers with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> lesion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ulnar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C8-T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Fracture of <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> (proximal lesion)</li>\n<li>Fractured hook of <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">hamate</span> (distal lesion) from fall on outstretched hand</li>\n<li>Compression of nerve against <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">hamate</span> during cycling</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>\"Ulnar claw\" on <span class=\"customMeta\" data-dictid=\"02e6b5c95316927771867eba7818b1\">digit</span> extension</li>\n<li>Radial <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of wrist upon <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (proximal lesion)</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> fingers</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">adduction</span> of fingers (interossei)</li>\n<li>Loss of thumb adduction</li>\n<li>Loss of action of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> 2 <span class=\"customMeta\" data-dictid=\"1e06b348b91692777191544ba23785\">lumbrical</span> muscles</li>\n<li>Loss of sensation over <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> 1 1/2 fingers including <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">hypothenar</span> eminence</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Specific sign of kwashiorkor is:", "options": [{"label": "A", "text": "Pitting edema", "correct": true}, {"label": "B", "text": "Weight loss", "correct": false}, {"label": "C", "text": "Flag sign", "correct": false}, {"label": "D", "text": "Muscle wasting", "correct": false}], "correct_answer": "A. Pitting edema", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xuLXnXhden3gVZ7DidFj1748154019.png", "https://image.prepladder.com/content/xZrbW7XM9fYvHLGWNBYr1748154031.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"text-align:center\"><strong>Features of Kwashiorkar and Marasmus</strong></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Kwashiorkor </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Marasmus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pitting Edema:</strong> Specific sign of Kwashiorkar Characterized by swelling, often starting in the legs and feet, leaving a persistent <span class=\"customMeta\" data-dictid=\"cdb5523e491692777190f8bc3775ff\">indentation</span> when pressed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe Wasting:</strong> The child appears extremely thin, with prominent bones and little body fat.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sugar Baby Appearance:</strong> The child may look deceptively healthy due to oedema, despite being malnourished.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monkey Facies:</strong> A sunken appearance of the cheeks due to loss of fat, giving an aged look.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscle Wasting:</strong> Despite the swollen appearance, muscle loss is present, leading to weakness and hypotonia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Baggy Pants Appearance:</strong> Loose, sagging skin around the <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> caused by significant muscle and fat loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mental and Neurological Symptoms:</strong> The child is apathetic, irritable, and may have <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> difficulties.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alertness: </strong>Children with <span class=\"customMeta\" data-dictid=\"122de6274d169277719141ab2c8004\">marasmus</span> remain mentally alert.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hair Changes:</strong> Hair may lose colour, become thin, and show <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> bands of colour (\"flag sign\").</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Absence of Edema:</strong> Unlike kwashiorkor, <span class=\"customMeta\" data-dictid=\"122de6274d169277719141ab2c8004\">marasmus</span> does not involve <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or oedema.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Skin Changes:</strong> Includes hyperpigmentation, peeling skin (\"flaky paint\" appearance), and colour changes, particularly in the buttocks, perineum, and thighs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hypoglycemia Risk:</strong> The liver's <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> capacity to produce <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> increases the risk of low blood sugar.</p>\n</td>\n</tr>\n<tr>\n<td><strong>Gastrointestinal Issues:</strong> Anorexia, vomiting, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension. <strong>Anaemia is</strong> present due to nutritional deficiencies.</td>\n<td><strong>Hypothermia Risk:</strong> The child may struggle to maintain <span class=\"customMeta\" data-dictid=\"4a7581c8b01692777183819f38c633\">body temperature</span> due to energy depletion.</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dr. Lyle Conrad, \" data-hash=\"\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Starved_girl.jpg\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/xuLXnXhden3gVZ7DidFj1748154019.png\" width=\"2184\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Content Providers(s): CDC/ Don Eddins,\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Starved_child.jpg\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/xZrbW7XM9fYvHLGWNBYr1748154031.png\" width=\"2624\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Comment on the diagnosis of the CT chest shown below.", "options": [{"label": "A", "text": "Aortic dissection", "correct": true}, {"label": "B", "text": "Pulmonary embolism", "correct": false}, {"label": "C", "text": "Cardiac myxoma", "correct": false}, {"label": "D", "text": "Aortic aneurysm", "correct": false}], "correct_answer": "A. Aortic dissection", "question_images": ["https://image.prepladder.com/content/bcaHwQQKARLkAd2K2lT81748158578.png"], "explanation_images": ["https://image.prepladder.com/content/dHFfzqv3StIXZJFROjll1747128765.png", "https://image.prepladder.com/content/SCepFixrRNlYnw1Maq0G1748158595.png", "https://image.prepladder.com/content/KSJtXksWt1yMp3lCZWwd1748158622.png", "https://image.prepladder.com/content/BmKsT3FEFVY5xg9fErPx1748158666.png", "https://image.prepladder.com/content/CTaIrI494WjZBbZ5x90B1747128830.png", "https://image.prepladder.com/content/mgMzFp21kOgG03VkvvEW1748158688.png"], "explanation": "<p>Correct Answer A- A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The mother of a premature newborn is concerned because the baby has not yet had a bowel movement containing meconium. How long is it safe to wait for the passage of meconium in this infant?", "options": [{"label": "A", "text": "12 hours", "correct": false}, {"label": "B", "text": "48 hours", "correct": true}, {"label": "C", "text": "24 hours", "correct": false}, {"label": "D", "text": "72 hours", "correct": false}], "correct_answer": "B. 48 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked in the below image.", "options": [{"label": "A", "text": "Caudate nucleus", "correct": false}, {"label": "B", "text": "Insula", "correct": false}, {"label": "C", "text": "Lentiform nucleus", "correct": true}, {"label": "D", "text": "Third ventricle", "correct": false}], "correct_answer": "C. Lentiform nucleus", "question_images": ["https://image.prepladder.com/content/ICUZcIMXC9q2NWxeuGFV1747981092.png"], "explanation_images": ["https://image.prepladder.com/content/3VWGLMFcBFK1SPm4snGn1747129207.png", "https://image.prepladder.com/content/csS6lRr8OWIkTxcbgbWL1747129207.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old boy who presents with repetitive episodes of urinary tract infection. The mother reports that he urinates frequently but has a weak urinary flow and dribbling of urine. Upon examination, a palpable bladder is detected. What is the most sensitive investigation that can be employed to determine the underlying diagnosis?", "options": [{"label": "A", "text": "Ultrasonogram", "correct": false}, {"label": "B", "text": "Micturating cystourethrography", "correct": true}, {"label": "C", "text": "Urine routine examination", "correct": false}, {"label": "D", "text": "DMSA scan", "correct": false}], "correct_answer": "B. Micturating cystourethrography", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vesicoureteral <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> (VUR)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Retrograde flow of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> from the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> to ureters and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> at rest or during micturition</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Present in 30-35% of children with <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">febrile</span> UTI</li>\n<li>Conventionally considered a major risk factor for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"7d244db63c1692777196490682ecc8\">pyelonephritis</span> and <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> nephropathy</li>\n<li>Can cause <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> during pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Methods:</strong></p>\n<ul>\n<li><strong>Radionuclide MCU (more sensitive for detecting VUR)</strong></li>\n<li>Direct or <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> <span class=\"customMeta\" data-dictid=\"72cf96e6ab16927771970405c5066c\">radionuclide</span> cystography</li>\n<li>Regular radiologic <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> every 24-36 months for grades III-IV VUR</li>\n</ul>\n<p><strong>Additional Techniques:</strong></p>\n<ul>\n<li>Contrast-enhanced ultrasound</li>\n<li>MR urography</li>\n<li>Urinalysis and <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> cultures (if symptomatic)</li>\n</ul>\n<p><strong>Follow-up Monitoring:</strong></p>\n<ul>\n<li>Weight and <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> measurements</li>\n<li>Periodic radiologic cystogram</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prophylactic Antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medications and Dosages:</strong></p>\n<ul>\n<li>Amoxiciilin: 10-12.5 mg/kg/day</li>\n<li>Nitrofurantoin: 1-2 mg/kg/day</li>\n<li>Cephalexin: 10-12.5 mg/kg/day</li>\n<li>Cefadroxil: 5 mg/kg/day</li>\n</ul>\n<p><strong>Special Considerations:</strong></p>\n<ul>\n<li>Avoid cotrimoxazole in infants &lt;3 months, and those with G6PD deficiency</li>\n<li>Avoid <span class=\"customMeta\" data-dictid=\"5416c4dafd1692777193ae03602f5a\">nitrofurantoin</span> in &lt;3 months, G6PD deficiency, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> insufficiency</li>\n<li><strong>Cephalexin</strong> is the drug of choice in the<strong> first 3-6 months</strong> of life</li>\n<li>Cefadroxil is an alternative agent in early infancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>For Low <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">Grade</span> VUR (I-II):</strong></p>\n<ul>\n<li>With UTI: Consider <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> and Bladder-Bowel <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> management</li>\n<li>Without UTI: No therapy needed</li>\n</ul>\n<p><strong>For High <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">Grade</span> VUR (III-IV):</strong></p>\n<ul>\n<li>With BBD: <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">Antibiotic</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> until BBD resolves, manage BBD</li>\n<li>Without BBD: <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">Antibiotic</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> until age 2 and &gt;1-yr UTI-free</li>\n</ul>\n<p><strong>Additional Considerations:</strong></p>\n<ul>\n<li>Medical therapy based on the principle that VUR resolves over time</li>\n<li>Prophylactic antibiotics maintain <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and prevent <span class=\"customMeta\" data-dictid=\"210e94f8861692777201a0d6de4b0e\">UTI</span> while awaiting resolution</li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> indicated for breakthrough infections or parenchymal injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Guidelines</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Consider dietary <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> and medications</li>\n<li>Some patients require <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> retraining, <span class=\"customMeta\" data-dictid=\"9b4dbbb3321692777181e6fe172b88\">anticholinergic</span> medications</li>\n<li>Clean <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">catheterization</span> may be needed</li>\n<li>Liberal <span class=\"customMeta\" data-dictid=\"3d7596c31c1692777203ecf2ce7a17\">fluid intake</span> recommended</li>\n<li>Regular and complete <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> is important</li>\n<li>Avoid constipation</li>\n<li>Close follow-up for breakthrough UTI</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Outcomes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tends to resolve by 10 years of age</li>\n<li>Resolution rate 70-90% for grades I-III</li>\n<li>10-35% resolution for higher grades</li>\n<li>Better outcomes with: <strong>younger age, lower grades, <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> VUR</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a triage system, the patients with the highest priority and those who are deceased are identified by color coding.", "options": [{"label": "A", "text": "Black and red", "correct": false}, {"label": "B", "text": "Both black", "correct": false}, {"label": "C", "text": "Red and black", "correct": true}, {"label": "D", "text": "Both red", "correct": false}], "correct_answer": "C. Red and black", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/W7Xj5EabYvmM96NyxK3P1748156202.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55 year old male patient presented with complaints of dyspnea with congestive heart failure. The clinician wants to know whether it's HF with preserved EF or reduced EF. Which of the below investigation is used for calculation of ejection fraction?", "options": [{"label": "A", "text": "MUGA", "correct": true}, {"label": "B", "text": "SPECT using thallium", "correct": false}, {"label": "C", "text": "PET myocardial perfusion imaging", "correct": false}, {"label": "D", "text": "Sestamibi scan with pharmacological stress", "correct": false}], "correct_answer": "A. MUGA", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/m0OdpWD8xHzpmkbqMFWt1747129310.png"], "explanation": "<p>Correct Answer A- MUGA</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Scan types</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>For Myocardial <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Assess ischemia</li>\n<li><strong>Cold spot: </strong>decreased <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in ischemic areas.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Thallium scan (Commonly used) <strong>(Option B)</strong></li>\n<li>Tetrofosmin</li>\n<li>Sestamibi scan <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>For Myocardial Infarction </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Assess infarct</li>\n<li><strong>Hot spot</strong> in <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> area as <span class=\"customMeta\" data-dictid=\"53da8f40b5169277719620504e0cb9\">pyrophosphate</span> accumulates and is not metabolized.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>99m Tc - <span class=\"customMeta\" data-dictid=\"53da8f40b5169277719620504e0cb9\">Pyrophosphate</span> scan.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>For <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Function </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Evaluate <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> fraction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>MUGA</strong> (Multiple Gated Acquisition) scan (AKA nuclear ventriculography)\n\t\t\t\t<ul>\n<li>Radiolabeled RBCs are used</li>\n</ul>\n</li>\n<li>Most accurate for <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> function - <strong>Cardiac MRI</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>For Myocardial <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">Viability</span> </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Assess the <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> of myocardium</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>PETscan </strong>- Best investigation for myocardial viability. <strong>(Option C)</strong>\n<ul>\n<li><strong>Perfusion</strong> and<strong> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> mismatch</strong> are observed in the PET scan.</li>\n<li><strong>Perfusion Agents</strong>:N-13 <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> and Rubidium chloride.</li>\n<li><strong>Metabolism Agent</strong>:</li>\n<li>FDG-PET is used for <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> metabolism.\n\t\t\t\t\t<ul>\n<li>No FDG <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> indicates a <strong>normal heart</strong> or an<strong> infarct.</strong></li>\n<li>FDG <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> is present: In the <strong>Ischemic Myocardium</strong></li>\n</ul>\n</li>\n<li>FDG-PET is combined with <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for comprehensive assessment.\n\t\t\t\t\t<ul>\n<li>Uptake in PET with low <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> indicates <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (suggestive of <strong>hibernation</strong>).</li>\n<li>Irreversible <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> indicates the presence of <strong>scar tissue</strong>.</li>\n</ul>\n</li>\n<li><strong>Note:</strong> Hibernating <span class=\"customMeta\" data-dictid=\"c64e23ddb8169277719344010b3fc0\">myocardium</span> is ischemic but viable.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old man visited the Suraksha clinic due to an anorectal discharge. Which of the following kits, color-coded for specific purposes, is advised for the syndromic treatment of sexually transmitted infections (STIs)?", "options": [{"label": "A", "text": "Grey", "correct": true}, {"label": "B", "text": "Green", "correct": false}, {"label": "C", "text": "White", "correct": false}, {"label": "D", "text": "Blue", "correct": false}], "correct_answer": "A. Grey", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3NQrKbyf3epgXSN2fbl61748156281.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Suraksha Clinics: Integrating STI/RTI Treatment and HIV/AIDS Control</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Government STI/RTI clinics, branded as \"Suraksha Clinics,\" offer free standardized integrated STD and RTI treatment services at district-level and above healthcare facilities.</li>\n<li>Under National AIDS Control Program (NACP)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Referral Centers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>STD Clinics at district, block, and First Referral Unit (FRU) levels act as referral centers for specialized treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Counselling and <span class=\"customMeta\" data-dictid=\"672aab321d16927771840ecbc284dd\">Condom</span> Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Counselling services and high-quality condoms are provided to promote safer sexual practices.</li>\n<li>Utilizes the expertise of NGOs in providing counselling services at STD clinics.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Training and strengthening existing centers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Existing STD clinics in hospitals and medical colleges are strengthened with technical support, equipment,</li>\n<li>Training for medical staff to manage STDs/RTIs using a <span class=\"customMeta\" data-dictid=\"87356352bc169277719923fcc93329\">syndromic</span> approach.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pre-packed STI/RTI Color-Coded Kits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Free pre-packed kits provided to clinics, centrally procured and distributed through State AIDS Control Societies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Kit Colors and Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 1 (Grey)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Urethral discharge, <strong>anorectal discharge</strong>, and cervicitis<strong> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 2 (Green)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Vaginitis <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 3 (White) (Non-herpetic)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Genital ulcers <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 4 (Blue) (non-herpetic) in patient allergic to penicillin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Genital ulcers <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 5 (Red) (herpetic)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Genital ulcers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 6 (Yellow)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain (PID)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 7 (Black)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Inguinal bubo</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with severe dysmenorrhoea, dyspareunia, infertility, and a diagnosis of endometriosis was made. The patient was posted for laparoscopy, and at surgery, dense pelvic adhesions were seen with the bowel stuck to the fundus. Ovaries were cystic and stuck to each other. What is the next step of management for this patient?", "options": [{"label": "A", "text": "LUNA for chronic pelvic pain", "correct": false}, {"label": "B", "text": "Gestrinone to decrease the LH surge", "correct": false}, {"label": "C", "text": "Cystectomy and adhesiolysis", "correct": true}, {"label": "D", "text": "Hysterectomy and oophorectomy", "correct": false}], "correct_answer": "C. Cystectomy and adhesiolysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following images accurately represents the medical condition described in the given scenario?", "options": [{"label": "A", "text": "Diaphragmatic hernia", "correct": true}, {"label": "B", "text": "Intestinal obstruction", "correct": false}, {"label": "C", "text": "Pleural effusion", "correct": false}, {"label": "D", "text": "Pneumonia", "correct": false}], "correct_answer": "A. Diaphragmatic hernia", "question_images": ["https://image.prepladder.com/content/9KLSwZPumxHhyVTiA2ou1747129710.png"], "explanation_images": ["https://image.prepladder.com/content/XbxuC4jlZoUbbOUy4MX31747129747.png"], "explanation": "<p>Correct Answer A- &lt;span class=\"customMeta\" data-dictid=\"06ff18f51216927771867fe1461a04\"&gt;Diaphragmatic&lt;/span&gt; h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old female patient presents with primary amenorrhea. Upon examination, the absence of thelarche is noted, while her stature appears normal. Karyotyping reveals a 46XX genotype. Recommend a diagnostic procedure to aid in developing an appropriate treatment plan for the patient.", "options": [{"label": "A", "text": "Diagnostic laparoscopy", "correct": false}, {"label": "B", "text": "USG pelvis", "correct": false}, {"label": "C", "text": "LH, FSH levels", "correct": true}, {"label": "D", "text": "CT brain", "correct": false}], "correct_answer": "C. LH, FSH levels", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old child from a socioeconomically disadvantaged background has presented with fever, convulsions, and unusual behavior over the past two months, and has now become unresponsive to their parents for the past two days. On examination, the child exhibits neck stiffness, and their cerebrospinal fluid (CSF) analysis reveals an elevated number of lymphocytes, glucose levels of 30 mg%, and protein levels of 300 mg%. What is the diagnosis?", "options": [{"label": "A", "text": "Viral meningitis", "correct": false}, {"label": "B", "text": "Bacterial meningitis", "correct": false}, {"label": "C", "text": "Tubercular meningitis", "correct": true}, {"label": "D", "text": "Partially treated bacterial meningitis", "correct": false}], "correct_answer": "C. Tubercular meningitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sugar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gross physical appearance of CSF</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute bacterial meningitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;1000 PMN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Turbid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tubercular meningitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;100-1000 lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>++</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Straw-colored</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Viral meningitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>50-500 lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or turbid</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diseases are included in the scheme, which has the logo as given below?", "options": [{"label": "A", "text": "CVD, Diabetes, Bronchial asthma", "correct": false}, {"label": "B", "text": "Diabetes, Hypertension, Bronchial asthma", "correct": false}, {"label": "C", "text": "CVD, Cancer, Diabetes, Stroke", "correct": true}, {"label": "D", "text": "Bronchial asthma, Hypertension, CVD", "correct": false}], "correct_answer": "C. CVD, Cancer, Diabetes, Stroke", "question_images": ["https://image.prepladder.com/content/P5e2mrMSxxYPQtxtY5YP1747129546.png"], "explanation_images": [], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:158px\">\n<p style=\"text-align:center\"><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:605px\">\n<p style=\"text-align:center\"><strong>Initiatives</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:28px; vertical-align:top; width:158px\">\n<p><strong>New Initiatives under NPCDCS</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:28px; vertical-align:top; width:605px\">\n<ol>\n<li>Intervention for prevention and control of Rheumatic Heart Disease under NPCDCS and Rashtriya Bal Swasthya Karyakram (RBSK).</li>\n<li>Integration of AYUSH with NPCDCS.</li>\n<li>Integration of RNTCP with NPCDCS to articulate a national strategy for management of TB and diabetes comorbidities in India.</li>\n</ol>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:158px\">\n<p><strong>Cancer Component under NPCDCS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:605px\">\n<p>Cancer Services under NPCDCS:</p>\n<ul>\n<li>Providing common <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> services, basic surgery, chemotherapy, and <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> care for cancer patients at 100 district hospitals.</li>\n<li>Supporting each district with <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> drugs for 100 patients, establishing day-care <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> facilities, and providing facilities for laboratory investigations, including mammography.</li>\n<li>Offering home-based <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">palliative</span> care for chronic and progressive cancer patients in 100 districts.</li>\n<li>Designating State Cancer Institutes (SCIs) as <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> institutions for comprehensive cancer diagnosis, treatment, and care.</li>\n<li>Strengthening 45 centres as Tertiary Cancer Centres (TCCs) to deliver comprehensive cancer care services.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following scans does maximum radiation exposure occur?", "options": [{"label": "A", "text": "X-ray abdomen", "correct": false}, {"label": "B", "text": "Chest X ray", "correct": false}, {"label": "C", "text": "IV pyelography", "correct": false}, {"label": "D", "text": "CT", "correct": true}], "correct_answer": "D. CT", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DG1sjU3rsTT3XISrCXwx1748158843.png"], "explanation": "<p>Correct Answer D- CT\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the surgery for acute appendicitis in a 2-year-old child, the surgeon discovered a structure measuring 2 inches in length located 2 feet closer to the ileocecal junction. What is the most probable diagnosis in this case?", "options": [{"label": "A", "text": "Sarcoma", "correct": false}, {"label": "B", "text": "Appendicitis", "correct": false}, {"label": "C", "text": "Meckel's diverticulum", "correct": true}, {"label": "D", "text": "Zenker's diverticulum", "correct": false}], "correct_answer": "C. Meckel's diverticulum", "question_images": ["https://image.prepladder.com/content/gWmDM7YMKE5zfX6eiT1a1747130117.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:673px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Meckel Diverticulum:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Most common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> GI <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> (2-3% of infants) with <strong>incomplete <span class=\"customMeta\" data-dictid=\"e5922b669a169277719487f8bbabd3\">obliteration</span> of <span class=\"customMeta\" data-dictid=\"5c8603ec781692777194819e18f402\">omphalomesenteric</span> duct.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics (\"Rule of 2s\")</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>2% of population</li>\n<li>2 <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> from the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> valve</li>\n<li>2 inches long</li>\n<li>2 types of <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> tissue (gastric or pancreatic)<strong> </strong></li>\n<li>Often presents before age 2</li>\n<li>2 times more common in males</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painless rectal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (most common)</li>\n<li>Bowel obstruction</li>\n<li>Diverticulitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Meckel scan (technetium-99m pertechnetate)\n\t\t\t\t<ul>\n<li>Sensitivity: 85%</li>\n<li>Specificity: 95%</li>\n<li>Used to diagnose <strong>ectopic <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> mucosa</strong></li>\n</ul>\n</li>\n<li>Plain radiographs and <span class=\"customMeta\" data-dictid=\"55052c0f0616927771829c99eec183\">barium</span> studies are less useful</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intussusception, Volvulus and Perforation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The structure marked with arrowhead is?", "options": [{"label": "A", "text": "Esophagus", "correct": false}, {"label": "B", "text": "Pulmonary artery", "correct": false}, {"label": "C", "text": "Trachea", "correct": true}, {"label": "D", "text": "Left atrium", "correct": false}], "correct_answer": "C. Trachea", "question_images": ["https://image.prepladder.com/content/Os7vUGLNj6Y0FqSUxC4v1748158803.png"], "explanation_images": ["https://image.prepladder.com/content/dti1kV74I1xW2g3ksIdO1748158877.png"], "explanation": "<p>Correct Answer C- Trach\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with complaints with dyspnoea. The shown X-ray is suggestive of:-", "options": [{"label": "A", "text": "Consolidation", "correct": false}, {"label": "B", "text": "Exudative pleural effusion", "correct": true}, {"label": "C", "text": "Pneumothorax", "correct": false}, {"label": "D", "text": "Hydropneumothorax", "correct": false}], "correct_answer": "B. Exudative pleural effusion", "question_images": ["https://image.prepladder.com/content/Q93SGrxjbKc2t0oh5ZCv1747130576.png"], "explanation_images": ["https://image.prepladder.com/content/E0pngyI3T72gZzyysXXw1747130609.png", "https://image.prepladder.com/content/tR9FKryG1Fi1o15AAxjV1747130622.png", "https://image.prepladder.com/content/krDLNkc7kRmHXz6YkVX61747130644.png", "https://image.prepladder.com/content/gVABRDOtF7MUefAzAPeQ1747130661.png", "https://image.prepladder.com/content/pl9zO3h8mWNP8LTVLfDc1747130672.png", "https://image.prepladder.com/content/57zs9i3TxC1ETDfRXjif1748158954.png", "https://image.prepladder.com/content/2eREL3TgctvL3WKRQVed1747130700.png", "https://image.prepladder.com/content/zGHPri1M30mKtPad0Dxu1747130891.png"], "explanation": "<p>Correct Answer B- Exudative pleural effu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the sign:", "options": [{"label": "A", "text": "Seashore sign", "correct": true}, {"label": "B", "text": "Barcode sign", "correct": false}, {"label": "C", "text": "Stratosphere sign", "correct": false}, {"label": "D", "text": "Deep sulcus sign", "correct": false}], "correct_answer": "A. Seashore sign", "question_images": ["https://image.prepladder.com/content/3090LONxvs5KZm2lfM961747131044.png"], "explanation_images": ["https://image.prepladder.com/content/XP2wBunLq7Bd4fxqomYL1747131095.png", "https://image.prepladder.com/content/utUrx37obg5I1JPnAI7q1747131101.png", "https://image.prepladder.com/content/N3CMgF9Hm69vTG9TYNng1747131105.png", "https://image.prepladder.com/content/n5YJ68W09O2AySvbmmYX1747131118.png"], "explanation": "<p>Correct Answer A- Seashore sig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the minimum number of antenatal visits recommended by the World Health Organization (WHO)?", "options": [{"label": "A", "text": "4", "correct": false}, {"label": "B", "text": "8", "correct": true}, {"label": "C", "text": "6", "correct": false}, {"label": "D", "text": "3", "correct": false}], "correct_answer": "B. 8", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>WHO Recommendations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indian Recommendations (National Guidelines)</strong></p>\n<p>under Janani Suraksha Yojana (JSY)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimum Visits</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>8 visits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4 visits</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:352px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visit No.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visit 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 12 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visit 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At 20 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visit 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At 26 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visit 4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At 30 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visit 5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At 34 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visit 6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At 36 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visit 7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At 38 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visit 8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At 40 weeks</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visit No.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Components of Care</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visit 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Up to 12 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Register the pregnancy, initial screening (blood pressure, hemoglobin, blood grouping), and <span class=\"customMeta\" data-dictid=\"64dfe4fca51692777200a7ffbc44bb\">tetanus</span> vaccination.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visit 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>16–20 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monitor weight, hemoglobin, and provide counseling on <span class=\"customMeta\" data-dictid=\"05bef24e711692777193a154b462b4\">nutrition</span> and lifestyle; <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> for <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visit 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>24–28 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Screening for anemia, <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> monitoring, offer iron and <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> supplementation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visit 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>32–36 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focus on <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> monitoring (position and movements), <span class=\"customMeta\" data-dictid=\"64dfe4fca51692777200a7ffbc44bb\">tetanus</span> <span class=\"customMeta\" data-dictid=\"f23be6aa561692777201ca2e1aaa27\">vaccination</span> if needed, and provide education on labor and delivery.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a newborn who has a liver and small intestine protruding through the umbilicus, covered by membranes at birth?", "options": [{"label": "A", "text": "Omphalocele", "correct": true}, {"label": "B", "text": "Gastroschisis", "correct": false}, {"label": "C", "text": "Persistent vitellointestinal duct", "correct": false}, {"label": "D", "text": "Bochdalek hernia", "correct": false}], "correct_answer": "A. Omphalocele", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XLW8TNUfvnVRNpex0g9N1748154277.png", "https://image.prepladder.com/content/FiTyJnChXzqwyEstqRoV1748154312.png", "https://image.prepladder.com/content/iAaRLoRHnoNuy7At6MhS1748154319.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gastroschisis (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Omphalocele (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> where the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall fails to close, leading to <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> of intestinal loops into the <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> cavity.</p>\n<p>M/c in premature/SGA babies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> body wall <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> where portions of the <span class=\"customMeta\" data-dictid=\"8251cf3ec316927771925d519dd348\">midgut</span> fail to return to the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> after <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> herniation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location of defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right paraumbilical</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> is exposed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Present </strong>(if not ruptured).</p>\n<p>Sac is made of amnion, Wharton's <span class=\"customMeta\" data-dictid=\"88bc2baef31692777190f5b09925aa\">jelly</span> and peritoneum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Free intestinal loops.</strong></p>\n<p>(Liver is not usually herniated)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Firm mass including <strong>liver, intestine</strong> and/ other organs (like stomach, spleen)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Umbilical cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adjacent to the defect</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Attached to the sac</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated anomalies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated <span class=\"customMeta\" data-dictid=\"04f89c4775169277718128d3461838\">anatomic</span> defects are uncommon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated abnormalities are common and include:</p>\n<ul>\n<li>Neural tube defect</li>\n<li><strong>Cardiac abnormalities</strong></li>\n<li>Chromosomal defect</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Detection </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Identified through <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> ultrasound.</li>\n<li>Elevated alpha-fetoprotein (AFP) levels in <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> and <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated alpha-fetoprotein (AFP) concentrations in <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> and <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid, similar to gastroschisis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Affected <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops may be damaged due to exposure to <span class=\"customMeta\" data-dictid=\"16a98a214c16927771852d7f6c344e\">corrosive</span> <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid</strong>.</li>\n<li>Risk of <strong>volvulus</strong>, where the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> twists around itself, compromising blood supply.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Feeding difficulties</li>\n<li>Failure to thrive</li>\n<li>Inguinal hernias</li>\n<li>Gastroesophageal reflux</li>\n<li>Occasionally esophagitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Favorable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High <strong>mortality </strong>rates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Centers for Disease Control and Prevention\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Gastroschisis#/media/File:Gastroschisis-web.jpg\" data-tags=\"\" height=\"607\" src=\"https://image.prepladder.com/content/FiTyJnChXzqwyEstqRoV1748154312.png\" width=\"1010\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3604\" src=\"https://image.prepladder.com/content/iAaRLoRHnoNuy7At6MhS1748154319.png\" width=\"6571\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent techniques for cervical ripening belongs to the category of hygroscopic dilators?", "options": [{"label": "A", "text": "Intracervical dinoprostone gel", "correct": false}, {"label": "B", "text": "Intracervical laminaria tent", "correct": true}, {"label": "C", "text": "Foley catheter at internal of cervix", "correct": false}, {"label": "D", "text": "Misoprostol in posterior fornix", "correct": false}], "correct_answer": "B. Intracervical laminaria tent", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BfukmeY36wPXeAUVkfgO1748069181.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a patient who has chronic small bowel diarrhea, claims to have a wheat allergy, and exhibits villous atrophy on duodenal biopsy with tests positive for anti-endomysial antibodies and tissue transglutaminase (TTG) IgA antibodies?", "options": [{"label": "A", "text": "Cystic fibrosis", "correct": false}, {"label": "B", "text": "Whipple's disease", "correct": false}, {"label": "C", "text": "Tropical sprue", "correct": false}, {"label": "D", "text": "Celiac sprue", "correct": true}], "correct_answer": "D. Celiac sprue", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hbJGVXRtWRFJaupIt8ET1748154389.png", "https://image.prepladder.com/content/OXu4XZLBN31irLtHRe6o1748154400.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Celiac <span class=\"customMeta\" data-dictid=\"15ba4af6a9169277719905f80d2b20\">sprue</span> / <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">Celiac</span> disease / Gluten-sensitive enteropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diarrhoea, growth failure, and anaemia.</li>\n<li>Temporal association with the introduction of wheat products at weaning.</li>\n<li>Abdominal distension, vomiting, anorexia, <span class=\"customMeta\" data-dictid=\"c267cc6e5716927771818c84304bbe\">aphthous</span> stomatitis, and bloating.</li>\n<li>Rickets, osteoporosis, short stature, <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> atrophy, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy, and <span class=\"customMeta\" data-dictid=\"982688ae75169277719041afa70c42\">irritability</span> might be seen in some cases.</li>\n<li><strong>Dermatitis herpetiformis</strong> can be seen.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Reunala, Timo &amp; Salmi, Teea &amp; Hervonen, Kaisa &amp; Kaukinen, Katri &amp; Collin, Pekka. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Dermatitis-herpetiformis-Typical-scratched-papules-and-macules-on-the-elbows-A-and-on_fig1_325122702\" data-tags=\"\" height=\"438\" src=\"https://image.prepladder.com/content/hbJGVXRtWRFJaupIt8ET1748154389.png\" width=\"1000\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ESPGHAN (European Society for Pediatric Gastroenterology, Hepatology &amp; Nutrition) guidelines 2020 suggest that in all suspected cases (symptomatic, asymptomatic, and at-risk group), the first test should be total <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> IgA and IgAtTG.</p>\n<p> </p>\n<p><strong>Serology:</strong></p>\n<ul>\n<li><strong>Anti-TTG (Tissue Transglutaminase)</strong></li>\n<li>Anti EMA (Endomysial antibody)</li>\n<li>Anti-DGP (Deamidated <span class=\"customMeta\" data-dictid=\"21f6d7d8df1692777188deb1006c47\">gliadin</span> peptide)</li>\n</ul>\n<p> </p>\n<p><strong>Upper GI endoscopy:</strong></p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> may be normal or show the absence of folds or scalloped duodenal folds.</li>\n</ul>\n<p> </p>\n<p><strong>Histopathology:</strong></p>\n<ul>\n<li><strong>Villous atrophy/Flat villi</strong></li>\n<li>Crypt hyperplasia</li>\n<li>Intraepithelial <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> infiltration<strong>.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Celiac_disease_-_high_mag.jpg\" data-tags=\"\" height=\"3619\" src=\"https://image.prepladder.com/content/OXu4XZLBN31irLtHRe6o1748154400.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Treatment involves a <strong>gluten-free diet</strong> (avoid wheat, rye, barley and oats).</li>\n<li><strong>High-risk groups</strong> include <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">type 1</span> diabetes mellitus, Down syndrome, selective IgA deficiency, <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> disease, Turner syndrome, Williams syndrome, Addison’s disease, <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> liver disease and first-degree relatives of patients with <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> disease.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> association may be present with the introduction of wheat products at weaning.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Under which benefit in the ESI act do beneficiaries receive 70% of their wages for a duration of 3 months?", "options": [{"label": "A", "text": "Sickness benefit", "correct": true}, {"label": "B", "text": "Medical benefit", "correct": false}, {"label": "C", "text": "Maternity benefit", "correct": false}, {"label": "D", "text": "Dependent's benefit", "correct": false}], "correct_answer": "A. Sickness benefit", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:782px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Benefits of ESI (Employees State Insurance) Act</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medical Benefit <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Provides \"full medical care,\" including <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> <span class=\"customMeta\" data-dictid=\"1a8e8831bb1692777182ce2c8a751f\">at no</span> cost to insured individuals &amp; families in cases of sickness, employment injury, and maternity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sickness Benefit <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Provides <strong>70% </strong>of average daily wages in cash during medical leave for a maximum of 91 days within 365 days, as certified by the Insurance Medical Officer/Practitioner.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extended </strong>Sickness Benefit</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extended coverage for long-term diseases beyond 91 days; 34 diseases covered if employed for two years.</li>\n<li>Extended <span class=\"customMeta\" data-dictid=\"73c1caf8d11692777198b1248373d3\">sickness</span> benefit is paid at <strong>80%</strong> of the insured person's wages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Enhanced </strong>Sickness Benefit</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cash benefits (100% wages) for <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> procedures:\n\t\t\t\t<ul>\n<li>14 days for <span class=\"customMeta\" data-dictid=\"2a6989bad01692777201a73b82b799\">tubectomy</span> (women),</li>\n<li>7 days for <span class=\"customMeta\" data-dictid=\"8b8c53004d1692777201cf3df335f5\">vasectomy</span> (men).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maternity Benefit <strong>(Option C ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cash payments for childbirth, miscarriage, or pregnancy-related sickness:\n\t\t\t\t<ul>\n<li>26 weeks for childbirth,</li>\n<li>6 weeks for miscarriage, and</li>\n<li>40 days for pregnancy-related sickness.</li>\n</ul>\n</li>\n<li>Paid at 100% of the insured woman's average daily wages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disablement Benefit</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temporary Disablement Benefit (TDB):\n\t\t\t\t<ul>\n<li>90% of wages paid from day one for temporary employment injury, until recovery.</li>\n</ul>\n</li>\n<li>Permanent Disablement Benefit (PDB):\n\t\t\t\t<ul>\n<li>90% of wages paid monthly for life, based on certified loss of earning capacity.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dependent's Benefit <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependents receive 90% of the deceased's (due to employment injuries) wages as a shared pension, and they are eligible until age 18.</li>\n<li><strong>If the daughter marries before 18, the benefit is withdrawn. </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Funeral Expenses</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It offers a cash payment of up to<strong> Rs. 15,000 </strong>to cover funeral expenses upon the death of an insured individual.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rehabilitation</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Insured individuals and their families are entitled to continued medical treatment after permanent disablement or retirement.</li>\n<li>They have to pay a <span class=\"customMeta\" data-dictid=\"01cc201eb616927771937a9ae6c669\">nominal</span> fee of Rs.10 per month for this benefit.</li>\n<li>A rehabilitation <span class=\"customMeta\" data-dictid=\"f8330e788f16927771812e4f73b80c\">allowance</span> of Rs.15,000 granted.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unemployment allowance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>For eligible employees due to factory <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> or retrenchment: 50% of wage for up to two years.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "10-year-old girl presents to the OPD with a back deformity. What is the likely cause?", "options": [{"label": "A", "text": "Congenital", "correct": false}, {"label": "B", "text": "NF1", "correct": false}, {"label": "C", "text": "Idiopathic", "correct": true}, {"label": "D", "text": "Neuromuscular", "correct": false}], "correct_answer": "C. Idiopathic", "question_images": ["https://image.prepladder.com/content/Pk9ov9YPNq2ZCj6fxHMb1748159076.png"], "explanation_images": [], "explanation": "<p>Correct Answer C- Idiopath\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Zika virus is transmitted by:", "options": [{"label": "A", "text": "Aedes aegypti", "correct": true}, {"label": "B", "text": "Culex", "correct": false}, {"label": "C", "text": "Anopheles", "correct": false}, {"label": "D", "text": "Phlebotomus papatasii", "correct": false}], "correct_answer": "A. Aedes aegypti", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is incorrect concerning medical termination of pregnancy?", "options": [{"label": "A", "text": "Pregnancy resulting from rape", "correct": false}, {"label": "B", "text": "When the family is large", "correct": true}, {"label": "C", "text": "Baby with serious mental or physical abnormality", "correct": false}, {"label": "D", "text": "Failure of contraceptives", "correct": false}], "correct_answer": "B. When the family is large", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:487px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gestational Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Abortive method</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 7 weeks</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medical Abortion. (99% success rate if done before 7 weeks)</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 9 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 10 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medical Abortion</li>\n<li>Suction evacuation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 12 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Suction evacuation</li>\n<li>Dilatation and Curettage (D&amp;C)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>12-20 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilatation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20-24 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dilatation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E)</li>\n<li>Prostaglandin Induction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;24 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hysterotomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the required thickness of a lead apron used for radiation protection?", "options": [{"label": "A", "text": "1mm", "correct": false}, {"label": "B", "text": "2mm", "correct": false}, {"label": "C", "text": "0.5mm", "correct": true}, {"label": "D", "text": "1.5 mm", "correct": false}], "correct_answer": "C. 0.5mm", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>RADIATION DOSE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>BIOLOGICAL EFFECTS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;5 rad</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>No adverse effects</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>5-150 rad</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea, vomiting</li>\n<li>Mild haematological changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>150-1100 rad</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> failure</strong> (anaemia, infections, <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> tendency - might require <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> transplantation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>1100-2000 rad</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Gastrointestinal destruction</strong> in addition (death almost always occurs in a few weeks)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;2000 rad</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle and brain damage</strong> (death occurs in days)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male patient presented with a productive cough. He is a chronic smoker and alcoholic. CXR is shown below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Abscess", "correct": false}, {"label": "B", "text": "Consolidation", "correct": true}, {"label": "C", "text": "Cavity", "correct": false}, {"label": "D", "text": "Pleural effusion", "correct": false}], "correct_answer": "B. Consolidation", "question_images": ["https://image.prepladder.com/content/troIeuUibOjAtpyy2sXm1748159148.png"], "explanation_images": ["https://image.prepladder.com/content/DhAWvrD9wJHwTn2jBtLR1747132035.png", "https://image.prepladder.com/content/APhFlGPhBHR9HAltm2Qj1747132063.png"], "explanation": "<p>Correct Answer B- Consolidation</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:686px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>CXR Radiological Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Associated Diseases</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Consolidation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pneumonia, Lung abscess</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Infiltrates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pulmonary edema, ARDS</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Atelectasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Obstructive lung disease, Pneumothorax</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Blunting of the <span class=\"customMeta\" data-dictid=\"03b5b4a6ef1692777185c8ff0d80d2\">Costophrenic</span> Angle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pleural effusion, Empyema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Cavity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Tuberculosis, Lung abscess</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Nodule/mass</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lung cancer, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ground-glass opacities</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Interstitial lung diseases (e.g., <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> fibrosis, Pneumoconiosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Honeycombing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Idiopathic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis, End-stage <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> lung disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Air bronchograms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Consolidation, Alveolar processes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mediastinal shift</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pneumothorax, Large pleural effusion, Mediastinal mass</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old G3 P1L1 A1 at 37 weeks of gestation with a previous history of emergency caesarean section and dilatation and curettage presents to the ER with labor pains. During abdominal examination, it was difficult to palpate fetal parts. Per vaginal examination revealed a 5 cm dilated cervix, and her vitals were: BP-80/60 mmHg, RR – 20/min, HR – 106/min, SpO2 – 97% on room air. CTG showed a non-reassuring variable fetal heart rate pattern. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Amniotic fluid embolization", "correct": false}, {"label": "B", "text": "Placental abruption", "correct": true}, {"label": "C", "text": "Uterine rupture", "correct": false}, {"label": "D", "text": "Placenta previa", "correct": false}], "correct_answer": "B. Placental abruption", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/IfpKd5Crb64LGGbRpsSt1748069259.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Revealed </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Most common type, where the <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from the <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> is visible and exits through the vagina.</li>\n<li>This is often associated with <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Concealed </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bleeding is hidden behind the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> and is not visible externally.</li>\n<li>Blood collects within the uterus, causing increased pressure and pain without visible bleeding.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mixed </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Involves both concealed and revealed bleeding.</li>\n<li>There is both internal and external bleeding, with some blood exiting through the <span class=\"customMeta\" data-dictid=\"8537d8358c169277720162f2f6971b\">vagina</span> and some collecting behind the placenta.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:605px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Maternal findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fetal findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical features may be absent.</li>\n<li>The diagnosis is made after inspection of the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> following delivery.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding PV + <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain<br/>\n\t\t\t(Uterine <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> ±)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fetal <span class=\"customMeta\" data-dictid=\"3ca731b15316927771898437884f89\">heart sounds</span> are normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding PV + <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain<br/>\n\t\t\t(Uterine <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> always +)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fetal distress</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding PV + <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain (marked <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> tenderness) + Shock ± Coagulopathy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fetal death</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:635px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Placenta previa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Abruptio placentae</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nature of bleeding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless, causeless, and recurrent.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painful, often attributed to Pre-eclampsia or trauma, and continuous.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Character of blood</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding is always revealed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Revealed, concealed, or usually mixed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>General condition &amp; anaemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proportionate to visible blood loss.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Out of proportion to the visible blood loss in the concealed or mixed variety.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Features of eclampsia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not relevant.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present in one-third of the cases.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Abdominal examination</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Height of the uterus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proportionate height to the gestational age.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be disproportionately enlarged in concealed type.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The feel of the uterus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soft and relaxed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be tense, tender, and rigid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malpresentation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common (the head is high floating).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unrelated, the head may be engaged.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fetal heart sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually present.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually absent, especially in the concealed type.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>USG, MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placenta in the lower segment.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placenta in the upper segment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vaginal examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> is felt on the lower segment (not to be done in a suspected case).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> is not felt on the lower segment. Blood clots should not be confused with placenta.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a boarding school where students share the same canteen, one student experienced abdominal pain, jaundice, and fever. Subsequently, other students began showing similar symptoms. Which investigations should the local medical officer consider in order to arrive at a diagnosis?", "options": [{"label": "A", "text": "IgA for hepatitis A", "correct": false}, {"label": "B", "text": "IgM for hepatitis A", "correct": true}, {"label": "C", "text": "IgM for hepatitis B", "correct": false}, {"label": "D", "text": "IgG for hepatitis B", "correct": false}], "correct_answer": "B. IgM for hepatitis A", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/otqAqKL2qy5JM5GsxGVx1747132140.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A nurse got an accidental prick from a needle used for an HIV+ patient. Which single test would lead to a confirmatory diagnosis in her?", "options": [{"label": "A", "text": "p24 antigen", "correct": false}, {"label": "B", "text": "PCR", "correct": false}, {"label": "C", "text": "HIV ELISA", "correct": false}, {"label": "D", "text": "Western blot assay", "correct": true}], "correct_answer": "D. Western blot assay", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:714px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #272425; border-left:1px solid #272425; border-right:1px solid #272425; border-top:1px solid #272425\">\n<p><strong>LABORATORY DIAGNOSIS OF HIV INFECTION</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #272425; border-left:1px solid #272425; border-right:1px solid #272425; border-top:none\">\n<p><strong>Screening tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #272425; border-left:none; border-right:1px solid #272425; border-top:none\">\n<p>ELISA screens for HIV antibodies (most sensitive) <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #272425; border-left:1px solid #272425; border-right:1px solid #272425; border-top:none\">\n<p><strong>Confirmatory tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #272425; border-left:none; border-right:1px solid #272425; border-top:none\">\n<ul>\n<li>Western <span class=\"customMeta\" data-dictid=\"2bc990c16116927771830255971ff6\">blot</span> - A confirmatory test confirms specific antibodies against p24 and gp41 proteins. (highly specific) <strong>(Option D)</strong></li>\n<li>Confirmatory test for adults - qPCR for HIV1 <strong>(Option B ruled out)</strong></li>\n<li>Confirmatory tests of infants &lt; 1 year - HIV DNA RT-PCR</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #272425; border-left:1px solid #272425; border-right:1px solid #272425; border-top:none\">\n<p><strong>Virus Isolation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #272425; border-left:none; border-right:1px solid #272425; border-top:none\">\n<p>Direct virus testing is not standard; HIV isolation from cultured lymphocytes is costly and resource-intensive.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #272425; border-left:1px solid #272425; border-right:1px solid #272425; border-top:none\">\n<p><strong>CD4 <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">Lymphocyte</span> Count</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #272425; border-left:none; border-right:1px solid #272425; border-top:none\">\n<p>Most reliable predictor of HIV progression; absolute count indicates immune system health, with &lt;200 cells/µL signalling a high risk of AIDS-related infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #272425; border-left:1px solid #272425; border-right:1px solid #272425; border-top:none\">\n<p><strong>CD4 <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">Lymphocyte</span> Percentage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #272425; border-left:none; border-right:1px solid #272425; border-top:none\">\n<p>Independent indicator of disease progression; &lt;14% suggests a heightened risk of AIDS-related complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #272425; border-left:1px solid #272425; border-right:1px solid #272425; border-top:none\">\n<p><strong>HIV <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">Viral</span> Load Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #272425; border-left:none; border-right:1px solid #272425; border-top:none\">\n<p>Measure actively replicating HIV in blood; correlate with disease <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> and assess <span class=\"customMeta\" data-dictid=\"4019cd26841692777181fa4c0c5a6a\">antiretroviral</span> therapy effectiveness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #272425; border-left:1px solid #272425; border-right:1px solid #272425; border-top:none\">\n<p><strong>Other Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #272425; border-left:none; border-right:1px solid #272425; border-top:none\">\n<ul>\n<li>Beta-2 <span class=\"customMeta\" data-dictid=\"06477fc93b16927771922ca7cd0afd\">microglobulin</span> (B2M) levels and p24 <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> presence indicate immune <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> and <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> replication, aiding disease assessment.</li>\n<li>P24 <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> tests positive in the window period <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true regarding UTI in pregnancy?", "options": [{"label": "A", "text": "The prevalence of ASB is 50%", "correct": false}, {"label": "B", "text": "It is lower in people with sickle cell trait", "correct": false}, {"label": "C", "text": "The preferred antibiotic in pregnancy is amoxicillin", "correct": false}, {"label": "D", "text": "If ASB is not treated, 75% of them will develop symptomatic infection", "correct": true}], "correct_answer": "D. If ASB is not treated, 75% of them will develop symptomatic infection", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with fever and cough with expectoration. The chest X-ray has been shown below. What is the likely causative organism?", "options": [{"label": "A", "text": "Hemophilus influenza", "correct": false}, {"label": "B", "text": "Parainfluenza virus", "correct": false}, {"label": "C", "text": "Pneumococcus", "correct": true}, {"label": "D", "text": "S.aureus", "correct": false}], "correct_answer": "C. Pneumococcus", "question_images": ["https://image.prepladder.com/content/uOerwM8glmKsTBY4iwXc1748159338.png"], "explanation_images": [], "explanation": "<p>Correct Answer C- Pneumococcus</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Radiological Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Staphylococcal Pneumonia</strong> <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Air Bronchogram</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mycoplasma Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reticulonodular Markings</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Klebsiella Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bulging Fissure Sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Legionella Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral Multifocal Consolidation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pneumocystis carinii Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reticular Shadows and multiple cysts more often in the upper part of the lungs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lung Abscess</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Air-Fluid Level</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aspergilloma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fungal ball/ Monad sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allergic Bronchopulmonary Aspergillosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gloved-Finger Sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Invasive Aspergillosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Air-Crescent Sign/ <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">Halo</span> sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adenoid Hypertrophy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adenoid Enlargement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute Epiglottitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thumb Sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Croup (Parainfluenza) (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Steeple Sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mucormycosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reverse <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> sign/Bird nest sign/Atoll sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Haemophilus influenzae (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Patchy or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> consolidation, may have pleural effusion</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The blood pressure of 200 hypertensive patients is being compared after 3 months. One group of 100 patients received medical advice, while the other group of 100 patients were advised to make lifestyle changes. Which test of significance is used to compare the blood pressure in these two groups?", "options": [{"label": "A", "text": "ANOVA", "correct": false}, {"label": "B", "text": "Un-paired T test", "correct": true}, {"label": "C", "text": "Chi-square test", "correct": false}, {"label": "D", "text": "McNemar's test", "correct": false}], "correct_answer": "B. Un-paired T test", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p><strong>Parametric Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Paired Student's t-test</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Used to compare means (± SD) in paired data from the same group of individuals before and after an intervention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Unpaired Student's t-test <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Used to compare means (± SD) in two different groups of individuals. The<strong> Z-test is a <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> </strong>of the unpaired Student's t-test used when the sample size is &gt; 30.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>ANOVA <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Used to compare means (± SD) in more than two different groups of individuals.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Pearson correlation coefficient</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Measures the <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> association between two variables and can range from -1 (perfect negative correlation) to +1 (perfect positive correlation).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the rare and hazardous complication associated with Subacute Sclerosing Panencephalitis?", "options": [{"label": "A", "text": "Measles", "correct": true}, {"label": "B", "text": "Mumps", "correct": false}, {"label": "C", "text": "Rubella", "correct": false}, {"label": "D", "text": "Varicella", "correct": false}], "correct_answer": "A. Measles", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:535px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>MR (Measles-Rubella)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0.5 ml</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh or right upper arm (at the <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> of deltoid)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schedule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1st dose - 9 months; 2nd dose - 16-24 months</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What kit would you recommend for a 30-year-old woman who has been experiencing creamy discharge with a fishy odor for the past month, AMSEL's score of 3 out of 4 on the Whiff test, and positive amines in the secretion when tested with 10% KОН?", "options": [{"label": "A", "text": "Red kit", "correct": false}, {"label": "B", "text": "Blue kit", "correct": false}, {"label": "C", "text": "Green kit", "correct": true}, {"label": "D", "text": "Grey kit", "correct": false}], "correct_answer": "C. Green kit", "question_images": ["https://image.prepladder.com/content/xWUVMNqB8QZvUP7BC3xA1747132738.png"], "explanation_images": ["https://image.prepladder.com/content/Z0ceJ3EOBoJolekIw8F41748156386.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Suraksha Clinics: Integrating STI/RTI Treatment and HIV/AIDS Control</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Government STI/RTI clinics, branded as \"Suraksha Clinics,\" offer free standardized integrated STD and RTI treatment services at district-level and above healthcare facilities.</li>\n<li>Under National AIDS Control Program (NACP)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Referral Centers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>STD Clinics at district, block, and First Referral Unit (FRU) levels act as referral centers for specialized treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Counselling and <span class=\"customMeta\" data-dictid=\"672aab321d16927771840ecbc284dd\">Condom</span> Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Counselling services and high-quality condoms are provided to promote safer sexual practices.</li>\n<li>Utilizes the expertise of NGOs in providing counselling services at STD clinics.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Training and strengthening existing centers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Existing STD clinics in hospitals and medical colleges are strengthened with technical support, equipment,</li>\n<li>Training for medical staff to manage STDs/RTIs using a <span class=\"customMeta\" data-dictid=\"87356352bc169277719923fcc93329\">syndromic</span> approach.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pre-packed STI/RTI Color-Coded Kits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Free pre-packed kits provided to clinics, centrally procured and distributed through State AIDS Control Societies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Kit Colors and Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 1 (Grey) <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Urethral discharge, <strong>anorectal discharge</strong>, and cervicitis<strong> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 2 (Green) <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Vaginitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 3 (White) (Non-herpetic)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Genital ulcers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 4 (Blue) (non-herpetic) in patient allergic to <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Genital ulcers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 5 (Red) (herpetic) <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Genital ulcers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 6 (Yellow)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain (PID)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Kit 7 (Black)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Inguinal bubo</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Exclusive breastfeeding should be continued for a minimum of how many months?", "options": [{"label": "A", "text": "6 months", "correct": true}, {"label": "B", "text": "2 months", "correct": false}, {"label": "C", "text": "12 months", "correct": false}, {"label": "D", "text": "5 months", "correct": false}], "correct_answer": "A. 6 months", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman comes with chronic vulval itching and pain. On examination, there is a vulval lesion suspicious of vulval cancer. Which of the following lymph node/s should be considered for sentinel node biopsy to look for the metastatic spread?", "options": [{"label": "A", "text": "Pelvic lymph nodes", "correct": false}, {"label": "B", "text": "Cloquet node", "correct": false}, {"label": "C", "text": "Superficial inguinal lymph nodes", "correct": true}, {"label": "D", "text": "Deep inguinal lymph nodes", "correct": false}], "correct_answer": "C. Superficial inguinal lymph nodes", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Most common in elderly women, especially in the 6th and 7th decades, (50-70 years age group)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HPV infections, HSV infections, smoking, chronic immunosuppression, chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions (e.g., <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> sclerosis).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histological Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Squamous cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (SCC) is the most common type.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Labia majora: Most common site (60%).</li>\n<li>Clitoris: Second most common site (15%).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Exophytic (outward-growing) growth.</li>\n<li>Ulcerative lesions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pruritus (most common), often associated with an itch-scratch cycle.</li>\n<li>Swelling, lump, or ulcer.</li>\n<li>Cancer <span class=\"customMeta\" data-dictid=\"c566ff37d4169277718398ef8e80a9\">cachexia</span> (weight loss and muscle wasting).</li>\n<li>Cancer pain (late symptom).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primarily through the <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> system.</li>\n<li>Vulvar lymphatics cross midline, especially within 2 cm of the midline.</li>\n<li>Commonly involved <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes: Inguinofemoral.</li>\n<li>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement significantly impacts prognosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Excisional biopsy: Preferred for lesions &lt; 1 cm, for <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> assessment of invasion depth.</li>\n<li>Incisional biopsy: For lesions ≥ 1 cm.</li>\n<li>Wedge biopsy, Keyes punch biopsy, and <span class=\"customMeta\" data-dictid=\"f08132bdfb16927771986a66c5d7b6\">sentinel</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (to assess inguinofemoral <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vulvectomy: Partial or total, depending on disease stage.</li>\n<li>Inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> dissection: To evaluate disease spread.</li>\n<li>Sentinel <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (Superficial inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes): Determines stage and prognosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During her routine antenatal check-up, a 25-year-old woman's arterial blood gas analysis revealed an abnormality characterized by elevated pH and reduced carbon dioxide (CO2) levels in the blood. What type of arterial gas abnormality would likely be observed in this individual?", "options": [{"label": "A", "text": "Acute metabolic acidosis", "correct": false}, {"label": "B", "text": "Acute metabolic alkalosis", "correct": false}, {"label": "C", "text": "Chronic respiratory alkalosis", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. Chronic respiratory alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother of a 5-day-old baby presents with the complaint that her baby is “unable to latch on” for breastfeeding. She also says there is some leakage of milk at times, and on examination, there is bilateral tenderness and swelling. What is the most likely cause of this?", "options": [{"label": "A", "text": "Bacterial mastitis", "correct": false}, {"label": "B", "text": "Breast abscess", "correct": false}, {"label": "C", "text": "Lactational mastitis", "correct": false}, {"label": "D", "text": "Breast engorgement", "correct": true}], "correct_answer": "D. Breast engorgement", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient, who is in the 8th week of her pregnancy, came for medical termination of pregnancy (MTP). What would be the correct dosage of Misoprostol given through the mucosal route?", "options": [{"label": "A", "text": "200 mcg", "correct": false}, {"label": "B", "text": "600 mcg", "correct": false}, {"label": "C", "text": "400 mcg", "correct": false}, {"label": "D", "text": "800 mcg", "correct": true}], "correct_answer": "D. 800 mcg", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:487px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gestational Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Abortive method</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 7 weeks</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medical Abortion. (99% success rate if done before 7 weeks)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 9 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 10 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medical Abortion</li>\n<li>Suction evacuation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 12 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Suction evacuation</li>\n<li>Dilatation and Curettage (D&amp;C)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>12-20 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dilatation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20-24 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dilatation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E)</li>\n<li>Prostaglandin Induction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;24 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hysterotomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 14-year-old girl is presented by her mother due to concerns that the child has not experienced her first menstrual period. Upon examination, the presence of secondary sexual characteristics is observed, and ultrasound imaging reveals a normal uterus and ovaries. What would be the subsequent course of action in managing this case?", "options": [{"label": "A", "text": "Combined oral contraceptives", "correct": false}, {"label": "B", "text": "Karyotyping", "correct": false}, {"label": "C", "text": "Reassure mother and patient", "correct": true}, {"label": "D", "text": "LH, FSH level and TSH", "correct": false}], "correct_answer": "C. Reassure mother and patient", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypogonadotropic Hypogonadism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Constitutional delay</li>\n<li>Chronic illness, malnutrition</li>\n<li>Primary hypothyroidism</li>\n<li>Isolated <span class=\"customMeta\" data-dictid=\"514d28a1c21692777188703b64cfde\">gonadotropin</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (Kallman’s Syndrome)</li>\n<li>Intracranial lesions- Tumors (craniopharyngioma, <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> adenomas)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypergonadotropic Hypogonadism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gonadal <span class=\"customMeta\" data-dictid=\"2eb190da1c169277718620d9fd1b4a\">dysgenesis</span> (Turner’s Syndrome)</li>\n<li>Pure gonadal dysgenesis</li>\n<li>Ovarian failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eugonadism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anatomic causes (Mullerian agenesis, Imperforate hymen)</li>\n<li>Androgen <span class=\"customMeta\" data-dictid=\"f1fcf0370516927771902bff983613\">insensitivity</span> syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of learning is demonstrated when a doctor instructs an intern on proper technique for performing the knee reflex, emphasizing its significance in clinical practice?", "options": [{"label": "A", "text": "Cognitive learning", "correct": false}, {"label": "B", "text": "Psychomotor learning", "correct": true}, {"label": "C", "text": "Affective learning", "correct": false}, {"label": "D", "text": "Repeated learning", "correct": false}], "correct_answer": "B. Psychomotor learning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B) Psychomotor learning\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following laboratory findings will be observed in a 19-year-old female patient presenting with weakness, amenorrhea, fatigue, and a history of being constantly worried about weight gain, accompanied by poor appetite and a BMI of 15.8?", "options": [{"label": "A", "text": "Hypocholesterolaemia", "correct": false}, {"label": "B", "text": "Hyperthyroidism", "correct": true}, {"label": "C", "text": "Hypersecretion of corticotrophin-releasing hormone", "correct": false}, {"label": "D", "text": "Hyperglycaemia", "correct": false}], "correct_answer": "B. Hyperthyroidism", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organization is involved in intersectoral coordination in the integrated child development services (ICDS)?", "options": [{"label": "A", "text": "NHM", "correct": true}, {"label": "B", "text": "NACO", "correct": false}, {"label": "C", "text": "NLEP", "correct": false}, {"label": "D", "text": "UNDP", "correct": false}], "correct_answer": "A. NHM", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SdSQLcuYcUcRz2mFRhJH1747134001.jpeg", "https://image.prepladder.com/content/gz8a2Rb5gaLvZh3sQoW31748156841.png"], "explanation": "<p>Correct Option A) NHM </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:605px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Reduce Infant Mortality Rate to 25/1000 live births</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduce Maternal Mortality Rate to 1/1000 live births</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduce Total Fertility Rate to 2.1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduce annual <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> and mortality from TB by half.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduce <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of Leprosy to &lt;1/10000 population and <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> to <span class=\"customMeta\" data-dictid=\"116e588c7b1692777202c7f3040428\">zero</span> in all districts<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Annual <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> to &lt; 1/1000.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;1% <span class=\"customMeta\" data-dictid=\"1e300ef0e21692777192fbb44da080\">microfilaria</span> <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> in all districts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eliminate <span class=\"customMeta\" data-dictid=\"a6ac0e2bbf16927771905309bf8e7e\">kala-azar</span> by 2015</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the potential long-term consequences of this condition in a 25-year-old female with a previous history of chlamydia infection who currently presents with mild fever, non-specific lower abdominal pain, mild diffuse tenderness upon deep palpation in the lower abdomen, cervical motion tenderness, and mucopurulent discharge from the vagina?", "options": [{"label": "A", "text": "Infertility", "correct": true}, {"label": "B", "text": "Uterine cancer", "correct": false}, {"label": "C", "text": "Pelvic organ prolapse", "correct": false}, {"label": "D", "text": "Cervical cancer", "correct": false}], "correct_answer": "A. Infertility", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Infection ascends from the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> and <span class=\"customMeta\" data-dictid=\"2f1603da6716927771878d0cbdd372\">endometrium</span> to the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes and ovaries, causing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and scarring. Can lead to infertility, <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy, and chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute:</strong></p>\n<p>Neisseria gonorrhoeae, <span class=\"customMeta\" data-dictid=\"21e09b6e771692777184f66df5bf7a\">Chlamydia</span> trachomatis, E. coli, Mycoplasma genitalium, Anaerobes (Bacteroides species), Gardnerella vaginalis, Trichomonas vaginalis, Streptococci, Mycobacterium tuberculosis, Actinomyces israelii.</p>\n<p> </p>\n<p><strong>Chronic: </strong>Same as acute, with possible additional mixed infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Signs:</strong></p>\n<p>Fever, Purulent <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> discharge, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> motion tenderness, Adnexal tenderness, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> tenderness.</p>\n<p> </p>\n<p><strong>Symptoms:</strong></p>\n<p>Lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, Abnormal <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> discharge, Dyspareunia (pain during intercourse), Dysuria (pain during urination), Menstrual irregularities, Nausea and vomiting.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infertility: Due to <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> and damage to <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes.</li>\n<li>Ectopic Pregnancy</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> Pain</li>\n<li>Peritonitis</li>\n<li>Sepsis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated WBC, Elevated CRP, Elevated ESR.</p>\n<p>Ultrasound: Thickened, fluid-filled <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes and free <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fluid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Next Step in Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endocervical Swab: </strong>Detects key pathogens like <span class=\"customMeta\" data-dictid=\"21e09b6e771692777184f66df5bf7a\">Chlamydia</span> trachomatis and Neisseria gonorrhoeae to guide treatment and prevent complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First-line Therapy:</strong></p>\n<p>Ceftriaxone 250 mg IM single dose, or</p>\n<p>Cefoxitin 2g IM single dose + Probenecid 1g PO single dose, or</p>\n<p>Cefotaxime IV.</p>\n<p>Add Doxycycline 100 mg PO BD for 14 days, with or without Metronidazole 500 mg PO BD for 14 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Male Partner Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treat with Cefixime + Azithromycin (Grey kit in India) to prevent reinfection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Out-patient Therapy (India)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow kit: </strong>Ceftriaxone, Doxycycline, Metronidazole for <span class=\"customMeta\" data-dictid=\"87356352bc169277719923fcc93329\">syndromic</span> management.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the subsequent course of action for a 26-year-old woman who is not married and experiencing irregular menstrual cycles despite having a history of regular periods, with a normal pelvic examination?", "options": [{"label": "A", "text": "Transvaginal ultrasound", "correct": false}, {"label": "B", "text": "Reassure her that it’s normal to have delayed periods", "correct": false}, {"label": "C", "text": "Beta hCG estimation", "correct": true}, {"label": "D", "text": "Serum FSH and LH", "correct": false}], "correct_answer": "C. Beta hCG estimation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:609px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Serial beta-hCG Measurement</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal Intrauterine Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rising beta-hCG (doubling every 1.4–2 days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ectopic Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plateauing or declining beta-hCG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Threatened Abortion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable beta-hCG changes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Early Pregnancy Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Declining beta-hCG</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is seen in the OPD after her delivery, which was 5 days ago. She presents with smelly greenish vaginal discharge. What is the initial investigation for this patient?", "options": [{"label": "A", "text": "Complete blood count (CBC)", "correct": false}, {"label": "B", "text": "USG", "correct": false}, {"label": "C", "text": "Urine analysis", "correct": false}, {"label": "D", "text": "Per vagina examination", "correct": true}], "correct_answer": "D. Per vagina examination", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bacterial Vaginosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Candidiasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Trichomoniasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Overgrowth of Gardnerella vaginalis and others</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Candida <span class=\"customMeta\" data-dictid=\"ec6a29c167169277718195e3b531cf\">albicans</span> or other Candida species</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trichomonas vaginalis (protozoan)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Discharge appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thin, gray-white, homogeneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thick, white, \"cottage cheese-like\"</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yellow-green, frothy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Odor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fishy (especially post-coital or with KOH)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None or mild</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Foul-smelling</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vaginal pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 4.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤ 4.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 4.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Whiff Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive (fishy <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> with KOH)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May be positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clue cells, few lactobacilli</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyphae or pseudohyphae, spores</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motile trichomonads, many WBCs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often asymptomatic, may have <span class=\"customMeta\" data-dictid=\"8f179d376f16927771905338bc9387\">itching</span> or irritation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intense itching, burning, dyspareunia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Itching, burning, erythema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metronidazole or clindamycin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluconazole or <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> antifungals</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metronidazole or tinidazole</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As a senior resident in the OBG department, which of the following cases would you not consider uterine artery embolization as a treatment option?", "options": [{"label": "A", "text": "Patient with postpartum haemorrhage", "correct": false}, {"label": "B", "text": "Prior to the removal of placenta accreta in a multiparous woman", "correct": false}, {"label": "C", "text": "Patient diagnosed with calcified and pedunculated submucous fibroids", "correct": true}, {"label": "D", "text": "Multiparous woman with menorrhagia", "correct": false}], "correct_answer": "C. Patient diagnosed with calcified and pedunculated submucous fibroids", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bp6gzL0Qk9nk1uicZ9tg1748069318.png", "https://image.prepladder.com/content/Dkj0ToVXaaYsNjn9wBy51748069350.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:646px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>FIGO <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Fibroids.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Name</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Submucosal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pedunculated, Intracavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;50% <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">Intramural</span> and rest in cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥ 50% <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">Intramural</span> and a part in cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100% <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">intramural</span> but contacts endometrium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intramural</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramural</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subserosal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥ 50% <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">Intramural</span> and partly in serosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;50% <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">Intramural</span> and rest in serosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subserosal Pedunculated</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Others</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Other - Cervical, Parasitic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2-5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hybrid - Present both in the <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> (type 2) and in the <span class=\"customMeta\" data-dictid=\"8fc2f5e23316927771989ab10ac305\">serosa</span> (type 5)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organization is responsible for gathering and regularly publishing extensive surveys on morbidity, family planning, and vital events?", "options": [{"label": "A", "text": "AIIMS", "correct": false}, {"label": "B", "text": "National sample survey", "correct": true}, {"label": "C", "text": "Sample registration system", "correct": false}, {"label": "D", "text": "Central Bureau of Health", "correct": false}], "correct_answer": "B. National sample survey", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4yxGP5WVt9wQsPzsBnpp1747134595.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The full form of the Urban HEART programme is:", "options": [{"label": "A", "text": "Urban health equity assessment and response tool", "correct": true}, {"label": "B", "text": "Urban health evaluation assessment and response tool", "correct": false}, {"label": "C", "text": "Urban health equity assessment and response technique", "correct": false}, {"label": "D", "text": "Urban health evaluation assessment and response technique", "correct": false}], "correct_answer": "A. Urban health equity assessment and response tool", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VMhtuXa67Yvn6fbstsWB1748156710.png"], "explanation": "<p>Correct Option A) Urban health equ\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 45-year-old woman who is a mother of three, experiencing discomfort and a mass in her lower abdomen? During examination, her uterus appears uniformly enlarged and the adnexa is unaffected. An MRI reveals the presence of a cyst within the uterine muscle.", "options": [{"label": "A", "text": "Endometriosis", "correct": false}, {"label": "B", "text": "Adenomyosis", "correct": true}, {"label": "C", "text": "Leiomyoma", "correct": false}, {"label": "D", "text": "Endometrial hyperplasia", "correct": false}], "correct_answer": "B. Adenomyosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/91G7mhcV8LXixRNgs6PJ1747137479.png", "https://image.prepladder.com/content/sU8znbh8NbplR2GS3WPr1747137479.png", "https://image.prepladder.com/content/HnvMjeTCmjj7g0uyBIv31748069487.png", "https://image.prepladder.com/content/c5EEf0LKVFjHGfBhGb8y1748069461.png", "https://image.prepladder.com/content/pFLXgOr5AbQIpNWCJxuZ1748069473.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Presence of endometrial glands and <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> within the myometrium, leading to <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> enlargement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common in <span class=\"customMeta\" data-dictid=\"6970e591c01692777194fae32e526b\">parous</span> women over 40 years of age.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (AUB).</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain.</li>\n<li>Globally enlarged and <span class=\"customMeta\" data-dictid=\"7fb01b5ad51692777188c3cb1733f9\">globular</span> <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> (if diffuse).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Investigation:</strong> TVS with Color Doppler.</p>\n<p><strong>Key Signs on USG:</strong></p>\n<ul>\n<li>Shutter/Venetian Blind sign (echogenic striations).</li>\n<li>Central <span class=\"customMeta\" data-dictid=\"05493772261692777201c10c4ee537\">vascularity</span> on Doppler.</li>\n</ul>\n<p><strong>Diagnostic Criteria:</strong></p>\n<ul>\n<li>Asymmetrical <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> (posterior &gt; anterior).</li>\n<li>Heterogeneous myometrial echotexture.</li>\n<li>Hypoechoic myometrial cysts (honeycomb appearance).</li>\n<li>Striated projections from <span class=\"customMeta\" data-dictid=\"2f1603da6716927771878d0cbdd372\">endometrium</span> to myometrium.</li>\n<li>Poorly defined endometrial echo.</li>\n<li>J-Zone thickening ≥12 mm.</li>\n</ul>\n<p><strong>Secondary Investigation: MRI (if USG is i</strong><strong>nconclusive).</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ryan Thibodeau\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/venetian-blind-appearance-uterus\" data-tags=\"\" height=\"603\" src=\"https://image.prepladder.com/content/91G7mhcV8LXixRNgs6PJ1747137479.png\" width=\"679\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Agostinho, L., Cruz, R., Guerra, A., Barata, M.J., &amp; Setubal, A.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Adenomyosis-and-MRI%3A-What-you-need-to-know-and-be-Agostinho-Cruz/544cac1aa0a69aa25c8584e6eca82620c3e254bc/figure/4\" data-tags=\"\" height=\"688\" src=\"https://image.prepladder.com/content/sU8znbh8NbplR2GS3WPr1747137479.png\" width=\"609\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Thickened junctional zone (&gt;12 mm).</li>\n<li>High-intensity myometrial <span class=\"customMeta\" data-dictid=\"e2071f8f891692777203982b3fa0f5\">foci</span> on T2-weighted images.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Myometrial <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> by endometrial glands and stroma.</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"KGH\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Uterine_adenomyosis_(1).JPG\" data-tags=\"\" height=\"3417\" src=\"https://image.prepladder.com/content/HnvMjeTCmjj7g0uyBIv31748069487.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Combined OCPs and progestin-only regimens (for <span class=\"customMeta\" data-dictid=\"6fab9041ff1692777186e2eea4c0b2\">dysmenorrhea</span> and menorrhagia).</li>\n<li>NSAIDs (for pain and menorrhagia).</li>\n<li>LNG-IUS (for menorrhagia).</li>\n<li>GnRH agonists (for <span class=\"customMeta\" data-dictid=\"790585287b169277719995a5fe1e1a\">subfertility</span> or pre-surgical symptom relief).</li>\n<li>Danazol (for <span class=\"customMeta\" data-dictid=\"a342b2f59f16927771929cc4b94551\">menorrhagia</span> and pain).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conservative:</strong></p>\n<ul>\n<li>Adenomyomectomy (risk of recurrence).</li>\n<li>Uterine mass reduction (laparotomy/laparoscopy).</li>\n<li>Uterine <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> (UAE).</li>\n</ul>\n<p><strong>Definitive: </strong>Total hysterectomy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following regions is free from rabies?", "options": [{"label": "A", "text": "Sikkim", "correct": false}, {"label": "B", "text": "Kerala", "correct": false}, {"label": "C", "text": "Lakshadweep", "correct": true}, {"label": "D", "text": "Jammu and Kashmir", "correct": false}], "correct_answer": "C. Lakshadweep", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C) Lakshadweep </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Agent factor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Zoonotic disease with a 100% fatality rate</li>\n<li>Lyssavirus type 1\n\t\t\t\t<ul>\n<li>Bullet-shaped RNA virus (Rhabdoviridae family).</li>\n</ul>\n</li>\n<li>Two Types of Viruses:\n\t\t\t\t<ul>\n<li>Street virus:\n\t\t\t\t\t<ul>\n<li>Cause natural infection (Rabies)</li>\n<li>Variable <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> period (7 days-months)</li>\n</ul>\n</li>\n<li>Fixed virus:\n\t\t\t\t\t<ul>\n<li>Fixed <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> period (5-7 days)</li>\n<li>For vaccine production.</li>\n<li>It does not demonstrate Negri bodies.</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Host factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Occupation\n\t\t\t\t<ul>\n<li>Dog handlers</li>\n<li>Forest workers</li>\n<li>Veterinarians.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmission</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incubation period: 2-8 weeks</li>\n<li>Animal bite: Dog, Cat, Monkey or Wild animal (all need vaccination)</li>\n<li>Licks on abraded skin are considered as the route of transmission.</li>\n<li>Rodent bites don't require vaccination.</li>\n<li>Human bite is a very dangerous bite (no documented cases yet)</li>\n<li>In India:\n\t\t\t\t<ul>\n<li>Urban <span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\">Rabies</span> is very common.</li>\n<li>Rabies is not found around water-bounded areas (Lakshadweep and Andaman and Nicobar Islands)<strong> (Option C)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old G2P1L1 presents with abdominal pain, bleeding per vaginum in labor, and loss of fetal movements. She occasionally smokes but does not consume alcohol or recreational drugs. On examination, her pulse rate is 80 bpm, BP is 150/90 mmHg, and her abdomen is tense on palpation. What is the probable diagnosis?", "options": [{"label": "A", "text": "Abruptio placenta", "correct": true}, {"label": "B", "text": "Placenta previa", "correct": false}, {"label": "C", "text": "Hydramnios", "correct": false}, {"label": "D", "text": "Preterm labor", "correct": false}], "correct_answer": "A. Abruptio placenta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/q0ZxYMJp877B1m8rUkwR1748069529.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Revealed </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Most common type, where the <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from the <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> is visible and exits through the vagina.</li>\n<li>This is often associated with <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Concealed </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bleeding is hidden behind the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> and is not visible externally.</li>\n<li>Blood collects within the uterus, causing increased pressure and pain without visible bleeding.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mixed </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Involves both concealed and revealed bleeding.</li>\n<li>There is both internal and external bleeding, with some blood exiting through the <span class=\"customMeta\" data-dictid=\"8537d8358c169277720162f2f6971b\">vagina</span> and some collecting behind the placenta.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:605px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Maternal findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fetal findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical features may be absent.</li>\n<li>The diagnosis is made after inspection of the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> following delivery.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding PV + <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain<br/>\n\t\t\t(Uterine <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> ±)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fetal <span class=\"customMeta\" data-dictid=\"3ca731b15316927771898437884f89\">heart sounds</span> are normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding PV + <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain<br/>\n\t\t\t(Uterine <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> always +)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fetal distress</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding PV + <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain (marked <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> tenderness) + Shock ± Coagulopathy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fetal death</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:635px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Placenta previa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Abruptio placentae</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nature of bleeding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Painless, </strong>causeless, and recurrent.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Painful</strong>, often attributed to Pre-eclampsia or trauma, and continuous.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Character of blood</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding is always revealed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Revealed, concealed, or usually mixed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>General condition &amp; anaemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Proportionate </strong>to visible blood loss.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Out of proportion</strong> to the visible blood loss in the concealed or mixed variety.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Features of eclampsia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not relevant.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present in one-third of the cases.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Abdominal examination</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Height of the uterus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proportionate height to the gestational age.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be disproportionately enlarged in concealed type.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The feel of the uterus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soft and relaxed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be tense, tender, and rigid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malpresentation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common (the head is high floating).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unrelated, the head may be engaged.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fetal heart sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually present.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually absent, especially in the concealed type.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>USG, MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placenta in the lower segment.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placenta in the upper segment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vaginal examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> is felt on the lower segment (not to be done in a suspected case).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> is not felt on the lower segment. Blood clots should not be confused with placenta.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How should a patient be managed if a 30-year-old woman, using an intrauterine contraceptive device (IUCD) for contraception, presents to the emergency department after experiencing two episodes of painless vaginal bleeding following 8 weeks of missed periods? She also complains of dizziness, and her blood pressure is 80/50 mmHg, with a pulse rate of 138 beats per minute. A urine pregnancy test is positive.", "options": [{"label": "A", "text": "IV fluids followed by oral methotrexate", "correct": false}, {"label": "B", "text": "Immediate laparotomy", "correct": false}, {"label": "C", "text": "Stabilizing the patient followed by suction evacuation", "correct": true}, {"label": "D", "text": "Dilatation and curettage", "correct": false}], "correct_answer": "C. Stabilizing the patient followed by suction evacuation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman who has never given birth and is undergoing hormone replacement therapy (HRT) presents with abdominal pain. On examination, a non-painful palpable mass is detected in the right adnexa. Following further investigation, she undergoes laparotomy, and her ovaries are observed as described. What is the probable diagnosis?", "options": [{"label": "A", "text": "Nodular carcinoma of ovary", "correct": false}, {"label": "B", "text": "Chocolate cyst of ovary", "correct": false}, {"label": "C", "text": "Ovarian fibroid", "correct": false}, {"label": "D", "text": "Ovarian carcinoma", "correct": true}], "correct_answer": "D. Ovarian carcinoma", "question_images": ["https://image.prepladder.com/content/xuJrcumnMr1zJk6lyPiu1748069625.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the possible cause for the increased bleeding in a G2P1L1 woman who had a previous cesarean section due to fetal distress and now has an uneventful vaginal birth after cesarean section (VBAC) but an incomplete removal of the placenta, with the cord snapping on traction?", "options": [{"label": "A", "text": "Abruptio placenta", "correct": false}, {"label": "B", "text": "Placenta previa", "correct": false}, {"label": "C", "text": "Uterine rupture", "correct": false}, {"label": "D", "text": "Placenta percreta", "correct": true}], "correct_answer": "D. Placenta percreta", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Placenta Accreta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Placenta Increta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Placenta Percreta</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> to myometrium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Invades into the myometrium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Invades through the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall to adjacent organs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Depth of Invasion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limited to <span class=\"customMeta\" data-dictid=\"46cc90d0e216927771936d8239e379\">myometrium</span> surface.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Partial invasion of myometrium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complete invasion through <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Previous <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">cesarean</span> delivery, <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> previa, <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> surgery.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Same as accreta.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Same as accreta, higher risk with multiple cesareans.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Postpartum hemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Massive hemorrhage, adjacent organ involvement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ultrasound, MRI if needed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ultrasound, MRI for depth assessment.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ultrasound, MRI showing invasion into adjacent organs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Planned cesarean, <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> if needed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cesarean, likely hysterectomy.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cesarean <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> to prevent complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe hemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Massive hemorrhage, organ injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good with early diagnosis.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> expertise.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality risk.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 29-year-old female complains of foul-smelling vaginal discharge. A Giemsa stained smear of the discharge is shown below. Which of the following is not seen in this condition?", "options": [{"label": "A", "text": "Strawberry cervix", "correct": false}, {"label": "B", "text": "Curdy white discharge", "correct": true}, {"label": "C", "text": "Burning micturition", "correct": false}, {"label": "D", "text": "Vulval pruritus", "correct": false}], "correct_answer": "B. Curdy white discharge", "question_images": ["https://image.prepladder.com/content/gWv2MqsbbGxxpjeYwEVr1747138813.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bacterial Vaginosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Candidiasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Trichomoniasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Overgrowth of Gardnerella vaginalis and others</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Candida <span class=\"customMeta\" data-dictid=\"ec6a29c167169277718195e3b531cf\">albicans</span> or other Candida species</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trichomonas vaginalis (protozoan)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Discharge appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thin, gray-white, homogeneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thick, white, \"cottage cheese-like\"</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yellow-green, frothy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Odor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fishy (especially post-coital or with KOH)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None or mild</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Foul-smelling</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vaginal pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 4.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤ 4.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 4.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Whiff Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive (fishy <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> with KOH)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May be positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clue cells, few lactobacilli</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyphae or pseudohyphae, spores</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motile trichomonads, many WBCs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often asymptomatic, may have <span class=\"customMeta\" data-dictid=\"8f179d376f16927771905338bc9387\">itching</span> or irritation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intense itching, burning, dyspareunia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Itching, burning, erythema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metronidazole or clindamycin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluconazole or <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> antifungals</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metronidazole or tinidazole</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female, married for the past 5 years, presents with complaints of inability to conceive despite regular intercourse. Physical examination is unremarkable. Semen analysis of the husband revealed no abnormalities. Hysterosalpingography reveals the following picture. The anomaly shown in the image below falls under which category of the American Fertility Society classification of Müllerian duct anomalies?", "options": [{"label": "A", "text": "Class IV", "correct": false}, {"label": "B", "text": "Class III", "correct": false}, {"label": "C", "text": "Class II", "correct": true}, {"label": "D", "text": "Class I", "correct": false}], "correct_answer": "C. Class II", "question_images": ["https://image.prepladder.com/content/QC1u5BhzNApFAJ8fLpyu1747138924.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:772px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Müllerian <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> Anomaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class I</strong></p>\n<p> </p>\n<p><strong>Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome</strong></p>\n<p> </p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Complete or partial absence of the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> and upper two-thirds of the vagina.</li>\n<li>Ovaries are normal.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primary amenorrhea.</li>\n<li>Absence of menstruation.</li>\n<li>Normal secondary sexual characteristics.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pelvic ultrasound.</li>\n<li>MRI.</li>\n<li>Karyotyping.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vaginal reconstruction.</li>\n<li>Assisted <span class=\"customMeta\" data-dictid=\"7a47c14dc91692777197a27e7aa854\">reproduction</span> for <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">fertility</span> (gestational surrogacy or <span class=\"customMeta\" data-dictid=\"c6c40c102d1692777194a23b2674c4\">oocyte</span> donation).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class II </strong></p>\n<p><strong>Unicornuate Uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Uterus is smaller and only one side develops.</li>\n<li>Can have a <span class=\"customMeta\" data-dictid=\"552c5ff93a16927771977cf35eac28\">rudimentary</span> horn.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dysmenorrhea.</li>\n<li>Infertility.</li>\n<li>Recurrent miscarriage.</li>\n<li>Ectopic pregnancy.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hysterosalpingography (HSG).</li>\n<li>MRI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgical removal of <span class=\"customMeta\" data-dictid=\"552c5ff93a16927771977cf35eac28\">rudimentary</span> horn.</li>\n<li>Fertility management.</li>\n<li>Cesarean delivery in case of pregnancy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class III</strong></p>\n<p><strong>Bicornuate Uterus</strong></p>\n<p> </p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Uterus has two horns.</li>\n<li>Often with a deep <span class=\"customMeta\" data-dictid=\"cdb5523e491692777190f8bc3775ff\">indentation</span> in the upper part.</li>\n<li>Single cervix.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Menstrual irregularities.</li>\n<li>Recurrent pregnancy loss.</li>\n<li>Preterm labor.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HSG.</li>\n<li>MRI.</li>\n<li>Laparoscopy.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> (metroplasty) in some cases.</li>\n<li>Supportive care for pregnancy management.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class IV</strong></p>\n<p><strong>Septate Uterus</strong></p>\n<p> </p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Normally shaped <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> but with a <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> or <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> dividing the cavity.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recurrent miscarriage.</li>\n<li>Infertility.</li>\n<li>Preterm labor.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HSG.</li>\n<li>MRI.</li>\n<li>Sonohysterogram.</li>\n<li>Laparoscopy.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> (hysteroscopic septoplasty).</li>\n<li>Fertility treatments if needed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class V</strong></p>\n<p><strong>Arcuate Uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild <span class=\"customMeta\" data-dictid=\"cdb5523e491692777190f8bc3775ff\">indentation</span> of the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> with a normal external <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contour.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often asymptomatic.</li>\n<li>May have <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> miscarriage.</li>\n<li>Preterm birth.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HSG.</li>\n<li>MRI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Typically no treatment required.</li>\n<li>Management of complications like <span class=\"customMeta\" data-dictid=\"423516578d1692777192412d27cc61\">miscarriage</span> may be necessary.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class VI </strong></p>\n<p><strong>Didelphys Uterus</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Complete non-fusion of the Müllerian ducts.</li>\n<li>Two separate <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> cavities and cervices.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vaginal septum.</li>\n<li>Recurrent miscarriage.</li>\n<li>Preterm labor.</li>\n<li>Infertility.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HSG.</li>\n<li>MRI.</li>\n<li>Laparoscopy.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> if needed.</li>\n<li>Assisted <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> techniques (ART) for infertility.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following chart shows the hormonal variations in the menstrual cycle. Identify the true statement:", "options": [{"label": "A", "text": "White Line represents estrogen", "correct": false}, {"label": "B", "text": "White Line represents FSH hormone", "correct": true}, {"label": "C", "text": "White Line represents LH hormone", "correct": false}, {"label": "D", "text": "White Line represents progesterone", "correct": false}], "correct_answer": "B. White Line represents FSH hormone", "question_images": ["https://image.prepladder.com/content/7GUtSIhE67n5kNEpZwJs1748069725.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:745px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hormone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Triggering Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Peak Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Role</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luteinizing Hormone (LH)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior pituitary</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surge in GnRH from hypothalamus, feedback from estrogen/progesterone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Just before ovulation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Triggers ovulation, supports <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> luteum formation, stimulates <span class=\"customMeta\" data-dictid=\"183d374ac91692777196c63c850299\">progesterone</span> secretion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Estrogen (Estradiol)</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Granulosa cells of ovarian follicles</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulated by FSH and LH, increases with <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> growth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Just before <span class=\"customMeta\" data-dictid=\"264a9eb50d1692777194427a13247b\">ovulation</span> (mid-cycle)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates <span class=\"customMeta\" data-dictid=\"b0c3f6b8901692777203d0446fe1f4\">follicle</span> growth, thickens endometrial lining, regulates FSH and LH through feedback mechanisms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Progesterone</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corpus luteum (post-ovulation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LH surge, transformation of <span class=\"customMeta\" data-dictid=\"b0c3f6b8901692777203d0446fe1f4\">follicle</span> to <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> luteum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Post-ovulation, during <span class=\"customMeta\" data-dictid=\"165a6f47ef1692777191a1162aa3cd\">luteal</span> phase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintains <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> lining for implantation, inhibits ovulation, supports pregnancy if <span class=\"customMeta\" data-dictid=\"2a8e411e2116927772022dd4b365bc\">fertilization</span> occurs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Follicle-Stimulating Hormone (FSH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior pituitary</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GnRH from hypothalamus, modulated by <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> feedback</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Just before ovulation, during <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> phase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates <span class=\"customMeta\" data-dictid=\"b0c3f6b8901692777203d0446fe1f4\">follicle</span> growth and <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> production to support <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> development and <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the image:", "options": [{"label": "A", "text": "Tuberculoid leprosy", "correct": false}, {"label": "B", "text": "Leishmaniasis", "correct": false}, {"label": "C", "text": "Borderline tuberculoid leprosy", "correct": false}, {"label": "D", "text": "Lepromatous leprosy", "correct": true}], "correct_answer": "D. Lepromatous leprosy", "question_images": ["https://image.prepladder.com/content/kBLFVhddAZpmR5wFFjhg1747137913.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:557px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lepromatous Leprosy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low host resistance, abundant <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> in lesions, widespread lesions, higher transmission likelihood <strong>(Option D)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tuberculoid Leprosy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High resistance, limited well-defined skin lesions, minimal <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> in the lesions<strong> (Option A ruled out). </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dimorphous (Borderline)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Characteristics of both <span class=\"customMeta\" data-dictid=\"2b635d48ce1692777191e4be9f89d6\">lepromatous</span> and <span class=\"customMeta\" data-dictid=\"49badd9dce169277720199215b5069\">tuberculoid</span> forms, potential to shift between the two <strong>(Option C ruled out).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Indeterminate Leprosy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early, unstable stage, may resolve spontaneously or progress to other forms.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Riya was found to have a height of more than the 95th percentile for her age and an arm-span to height ratio of more than 1.05. On further examination, she had flat feet, mild scoliosis, and long slender fingers. An image of her showing characteristic signs is provided below. What is the most common ocular complication expected in this child?", "options": [{"label": "A", "text": "Hypertensive retinopathy", "correct": false}, {"label": "B", "text": "Rosette cataract", "correct": false}, {"label": "C", "text": "Retinitis pigmentosa", "correct": false}, {"label": "D", "text": "Subluxation of lens", "correct": true}], "correct_answer": "D. Subluxation of lens", "question_images": ["https://image.prepladder.com/content/EFIXGlti3TgDBVTz97IS1747199425.png"], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\"&gt;Subluxation&lt;/span&gt; of lens</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Skeletal abnormalities:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Tall stature</li>\n<li>Arachnodactyly</li>\n<li>Chest wall abnormalities like <span class=\"customMeta\" data-dictid=\"05b4df8d1f1692777195b4acd00e4e\">pectus</span> excavatum/Pectus carinatum</li>\n<li>Thumb sign( On folding thumb, it will protrude beyond the <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> border of palm) or wrist sign is positive</li>\n<li>Increased joint laxity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CVS abnormalities:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Aortic root dilation</li>\n<li>Mitral insufficiencies</li>\n<li>Arrhythmias</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eye abnormalities:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ectopia lentis or <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> of the lens of the eye <strong>(Option D)</strong></li>\n<li>Blindness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulmonary involvement: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increased risk of pneumothorax</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is considered the most reliable tonometer in the medical field?", "options": [{"label": "A", "text": "Schiotz", "correct": false}, {"label": "B", "text": "Goldmann applanation tonometer", "correct": true}, {"label": "C", "text": "Tonopen", "correct": false}, {"label": "D", "text": "Pascal dynamic contour", "correct": false}], "correct_answer": "B. Goldmann applanation tonometer", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Rr7wPKKodBm48LrWc7g11747199734.png", "https://image.prepladder.com/content/dqyKe7dVtAIpBDQh6hXX1747199764.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the main underlying factor responsible for regular astigmatism when studying the optics of a patient?", "options": [{"label": "A", "text": "Abnormal curvature of the cornea", "correct": true}, {"label": "B", "text": "Excessive eye rubbing", "correct": false}, {"label": "C", "text": "Prolonged exposure to bright light", "correct": false}, {"label": "D", "text": "Vitamin A deficiency", "correct": false}], "correct_answer": "A. Abnormal curvature of the cornea", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/L7UVwFLATO8W4CcAgEqS1747200091.png", "https://image.prepladder.com/content/1yZ6KUyDjoL3Z0K7e1MF1747200096.png", "https://image.prepladder.com/content/AcJ0ycvU8YrANZN0TceA1747200102.png", "https://image.prepladder.com/content/3MvWISMBvRGrSsPUbMp51747200125.png"], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\"&gt;Abnormal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\"&gt;curvature&lt;/span&gt; of the cornea</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>With-the-Rule (WTR) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The vertical <span class=\"customMeta\" data-dictid=\"d2266722801692777192382c2b5902\">meridian</span> has greater <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> than the <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> meridian.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Against-the-Rule (ATR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> <span class=\"customMeta\" data-dictid=\"d2266722801692777192382c2b5902\">meridian</span> is more curved than the vertical meridian.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oblique Astigmatism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Principal meridians are at <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> angles (e.g., 45° and 135°), still perpendicular to each other.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bi-oblique Astigmatism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Principal meridians are not perpendicular to each other (e.g., 30° and 100°).</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Simple Astigmatism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>One <span class=\"customMeta\" data-dictid=\"d2266722801692777192382c2b5902\">meridian</span> focuses on the retina; the other focuses in front (simple myopic) or behind (simple hypermetropic).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Compound Astigmatism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both meridians focus light either in front (compound myopic) or behind (compound hypermetropic) the retina.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mixed Astigmatism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>One <span class=\"customMeta\" data-dictid=\"d2266722801692777192382c2b5902\">meridian</span> focuses in front of the <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> (myopic), and the other behind (hypermetropic).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about the instrument shown in the image given below is false?", "options": [{"label": "A", "text": "Used to measure the curvature of the cornea", "correct": false}, {"label": "B", "text": "Assess corneal astigmatism.", "correct": false}, {"label": "C", "text": "Depends on Purkinje image I.", "correct": false}, {"label": "D", "text": "Measures intraocular pressure.", "correct": true}], "correct_answer": "D. Measures intraocular pressure.", "question_images": ["https://image.prepladder.com/content/HBuOIA7YU1syzeFzQ5pt1748070203.png"], "explanation_images": ["https://image.prepladder.com/content/FcCOrEpQJqdRT40CwT7H1747200439.png"], "explanation": "<p>Correct Answer D - Measures &lt;span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\"&gt;intraocular&lt;/span&gt; pressure.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred initial treatment for a 4-year-old boy who initially had facial swelling but now has experienced total body swelling involving the face, abdomen, scrotum, and feet, and has a urinalysis showing 4+ protein and a urine protein: creatinine ratio of 3?", "options": [{"label": "A", "text": "Prednisolone", "correct": true}, {"label": "B", "text": "Cyclophosphamide", "correct": false}, {"label": "C", "text": "Levamisole", "correct": false}, {"label": "D", "text": "Cyclosporine", "correct": false}], "correct_answer": "A. Prednisolone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Prednisolone&lt;br/&gt;\n&lt;br/&gt;\nExplanation: </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Duration of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Glucocorticoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Potency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Effects/Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Short (8-12 hrs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hydrocortisone</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Low</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Physiological replacement therapy, <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, anti-inflammatory</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Intermediate (12-36 hrs)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cortisone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Anti-inflammatory, rheumatic disorders</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Prednisone</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Intermediate</p>\n<p> </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Anti-inflammatory, immunosuppressive, rheumatic disorders, asthma, <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> diseases</p>\n<p>Minimal change disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Prednisolone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Intermediate to Long</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Methylprednisolone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Intermediate to High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Anti-inflammatory, immunosuppressive, severe <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions, multiple sclerosis.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Long </strong></p>\n<p><strong>(36-72 hrs)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Dexamethasone</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>High</p>\n<p> </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Anti-inflammatory, immunosuppressive, severe <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions, cerebral edema.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Betamethasone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Fludrocortisone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Mineralocorticoid activity, <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, salt-wasting disorders.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe a disease that is typically not found in a country but is brought in from abroad, as seen in the case of a 25-year-old male who was diagnosed with the condition upon arrival at an Indian airport, leading to quarantine?", "options": [{"label": "A", "text": "Endemic", "correct": false}, {"label": "B", "text": "Epidemic", "correct": false}, {"label": "C", "text": "Zoonotic", "correct": false}, {"label": "D", "text": "Exotic", "correct": true}], "correct_answer": "D. Exotic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D) Exotic</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Term</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemic (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Occurrence of disease clearly in <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> of normal <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> (Mean + 2SD or &gt;80% expected frequency).</li>\n<li>Occurrence of even a single case of a previously eliminated disease.</li>\n<li>Occurrence of a single case of an exotic disease.<strong> (Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seasonal <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> outbreaks during winter months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endemic (Option A ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Constant presence of a disease within a specific population.</li>\n<li>Epidemiologically <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> cases in terms of time, place, or person.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malaria in Africa, TB in India</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pandemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Global spread of a disease.</li>\n<li>Defined as an epidemic in a large population.</li>\n<li>Requires crossing 2 continents and 2 WHO-specific regions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HIV/AIDS, COVID-19.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sporadic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>They occur randomly and unpredictably, without any discernible pattern in time, location, or individual.</li>\n<li>There's no epidemiological link between the cases.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tetanus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Installation and usage of sanitary latrines by general public constitutes which level of prevention:", "options": [{"label": "A", "text": "Health promotion", "correct": true}, {"label": "B", "text": "Specific protection", "correct": false}, {"label": "C", "text": "Early diagnosis and treatment", "correct": false}, {"label": "D", "text": "Disability limitation and rehabilitation", "correct": false}], "correct_answer": "A. Health promotion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Level of Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Goals </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primordial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To prevent the <strong>establishment of risk factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lifestyle modification</li>\n<li>Health promotion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Interventions to <strong>prevent the onset of disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vaccinations</li>\n<li>Health education</li>\n<li>Family planning</li>\n<li>Use of <span class=\"customMeta\" data-dictid=\"8fad75f63f1692777192f93996c6ab\">mosquito</span> nets</li>\n<li><strong>Pre-placement examinatio</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> and prompt treatment</strong> of disease to prevent complications<strong> (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Screening tests (e.g., mammograms, PAP smears)</li>\n<li>Self-examinations</li>\n<li>Health camps with screening DOTS for TB; ART for HIV; MDT for leprosy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tertiary </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Interventions to <strong>manage and reduce complications</strong> of existing disease to prevent disability or death <strong> (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rehabilitation</li>\n<li>Physical therapy</li>\n<li>Chronic disease management programs</li>\n<li>Reconstructive surgery</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A study conducted on 46 mothers who delivered deformed babies showed that 41 were found to have thalidomide during their early pregnancy; what kind of study is being done here?", "options": [{"label": "A", "text": "Prospective cohort study", "correct": false}, {"label": "B", "text": "Retrospective cohort study", "correct": false}, {"label": "C", "text": "Case-control study", "correct": true}, {"label": "D", "text": "Descriptive study", "correct": false}], "correct_answer": "C. Case-control study", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C) &lt;span class=\"customMeta\" data-dictid=\"1c939e27aa1692777184a86f1932bd\"&gt;Case-control study&lt;/span&gt; </p>\n<p><strong>References:</strong></p>\n<ul><li>↳ Observational studies</li><li>↳ Observational studies</li><li>↳ Observational studies</li><li>↳ Observational studies</li><li>↳ Analytical studies Case-control/case reference. (Option C) Ecological/correlational. Cross-sectional/prevalence. Cohort/follow-up. (Options A &amp; B ruled out)</li><li>↳ Analytical studies</li><li>↳ Analytical studies</li><li>↳ Case-control/case reference. (Option C) Ecological/correlational. Cross-sectional/prevalence. Cohort/follow-up. (Options A &amp; B ruled out)</li><li>↳ Case-control/case reference. (Option C) Ecological/correlational. Cross-sectional/prevalence. Cohort/follow-up. (Options A &amp; B ruled out)</li><li>↳ Case-control/case reference. (Option C)</li><li>↳ (Option C)</li><li>↳ Ecological/correlational.</li><li>↳ Cross-sectional/prevalence.</li><li>↳ Cohort/follow-up. (Options A &amp; B ruled out)</li><li>↳ (Options A &amp; B ruled out)</li><li>↳ Descriptive studies (Option D ruled out)</li><li>↳ Descriptive studies (Option D ruled out)</li><li>↳ Descriptive studies (Option D ruled out)</li><li>↳ (Option D ruled out)</li><li>↳ Experimental/observational studies</li><li>↳ Experimental/observational studies</li><li>↳ Experimental/observational studies</li><li>↳ Experimental/observational studies</li><li>↳ Community trials/community intervention trials.</li><li>↳ Community trials/community intervention trials.</li><li>↳ Community trials/community intervention trials.</li><li>↳ Field trials.</li><li>↳ Field trials.</li><li>↳ Field trials.</li><li>↳ Non-randomised trials Uncontrolled trials. Natural experiments. Before and after comparison studies.</li><li>↳ Non-randomised trials</li><li>↳ Non-randomised trials</li><li>↳ Uncontrolled trials. Natural experiments. Before and after comparison studies.</li><li>↳ Uncontrolled trials. Natural experiments. Before and after comparison studies.</li><li>↳ Uncontrolled trials.</li><li>↳ Natural experiments.</li><li>↳ Before and after comparison studies.</li><li>↳ Randomised controlled trials Trial of aetiological agents. Risk factor trials. Clinical trials. Preventive trials. Cessation experiments. Evaluation of health services.</li><li>↳ Randomised controlled trials</li><li>↳ Randomised controlled trials</li><li>↳ Trial of aetiological agents. Risk factor trials. Clinical trials. Preventive trials. Cessation experiments. Evaluation of health services.</li><li>↳ Trial of aetiological agents. Risk factor trials. Clinical trials. Preventive trials. Cessation experiments. Evaluation of health services.</li><li>↳ Trial of aetiological agents.</li><li>↳ Risk factor trials.</li><li>↳ Clinical trials.</li><li>↳ Preventive trials.</li><li>↳ Cessation experiments.</li><li>↳ Evaluation of health services.</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Observational studies</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Analytical studies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Case-control/case reference. <strong>(Option C)</strong></li>\n<li>Ecological/correlational.</li>\n<li>Cross-sectional/prevalence.</li>\n<li>Cohort/follow-up. <strong>(Options A &amp; B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Descriptive studies <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Experimental/observational studies</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Community trials/community intervention trials.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Field trials.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-randomised trials</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Uncontrolled trials.</li>\n<li>Natural experiments.</li>\n<li>Before and after comparison studies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Randomised controlled trials</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trial of aetiological agents.</li>\n<li>Risk factor trials.</li>\n<li>Clinical trials.</li>\n<li>Preventive trials.</li>\n<li>Cessation experiments.</li>\n<li>Evaluation of health services.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please recognize the logo displayed in the provided image", "options": [{"label": "A", "text": "International red cross", "correct": false}, {"label": "B", "text": "Suraksha Clinic", "correct": true}, {"label": "C", "text": "National AIDS control programme", "correct": false}, {"label": "D", "text": "Family planning campaign", "correct": false}], "correct_answer": "B. Suraksha Clinic", "question_images": ["https://image.prepladder.com/content/H4RkKoDoUUnrpVZ0g3jH1748156482.png"], "explanation_images": ["https://image.prepladder.com/content/G0HRawrbltmI2mbjrLF11748156494.png"], "explanation": "<p>Correct Option B) Suraksha C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 306 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Preoperative assessment of oral cavity for endotracheal intubation in an adult is done by:", "options": [{"label": "A", "text": "Mallampatti score", "correct": true}, {"label": "B", "text": "Conmack lehane", "correct": false}, {"label": "C", "text": "ASA grading", "correct": false}, {"label": "D", "text": "AHA grading", "correct": false}], "correct_answer": "A. Mallampatti score", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2qyARP113sIFfujIynZV1715663849.png"], "explanation": "<p>Correct Option A: M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following Anaesthesia agent is hepatotoxic:", "options": [{"label": "A", "text": "Sevoflurane", "correct": false}, {"label": "B", "text": "Isoflurane", "correct": false}, {"label": "C", "text": "Halothane", "correct": true}, {"label": "D", "text": "Procaine", "correct": false}], "correct_answer": "C. Halothane", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Haloth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Anaesthesia given to dog:", "options": [{"label": "A", "text": "Ketamine", "correct": false}, {"label": "B", "text": "Medetomidine hydrochloride", "correct": false}, {"label": "C", "text": "Midazolam", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is used for hypotensive anesthesia?", "options": [{"label": "A", "text": "Isoflurane", "correct": false}, {"label": "B", "text": "Nitroglycerin", "correct": false}, {"label": "C", "text": "Both 1 &amp;amp; 2", "correct": true}, {"label": "D", "text": "Dantrolene", "correct": false}], "correct_answer": "C. Both 1 &amp; 2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Both 1 and 2\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the shortest acting local anesthetic?", "options": [{"label": "A", "text": "Procaine", "correct": false}, {"label": "B", "text": "Cocaine", "correct": false}, {"label": "C", "text": "Dibucaine", "correct": false}, {"label": "D", "text": "Chloroprocaine", "correct": true}], "correct_answer": "D. Chloroprocaine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective approach for verifying the accuracy of intubation during laryngoscopy?", "options": [{"label": "A", "text": "Capnography", "correct": true}, {"label": "B", "text": "Air entry on auscultation", "correct": false}, {"label": "C", "text": "Ultrasonography", "correct": false}, {"label": "D", "text": "Chest movement", "correct": false}], "correct_answer": "A. Capnography", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/a479AfWVCYCHroIO7A041715663890.png"], "explanation": "<p>Correct Option A - Capnograph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition shown in the image below:", "options": [{"label": "A", "text": "Impetigo", "correct": true}, {"label": "B", "text": "Chickenpox", "correct": false}, {"label": "C", "text": "Herpes Simplex", "correct": false}, {"label": "D", "text": "Molluscum contagiosum", "correct": false}], "correct_answer": "A. Impetigo", "question_images": ["https://image.prepladder.com/content/VAyCiuGLgfQu7b9x3GiL1747742237.png"], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Characteristic</strong></p>\n</td>\n<td>\n<p><strong>Impetigo</strong></p>\n</td>\n<td>\n<p><strong>Chickenpox</strong></p>\n</td>\n<td>\n<p><strong>Herpes Simplex</strong></p>\n</td>\n<td>\n<p><strong>Molluscum Contagiosum</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Causative Agent</p>\n</td>\n<td>\n<p>Staphylococcus aureus or Streptococcus pyogenes</p>\n</td>\n<td>\n<p>Varicella-zoster virus</p>\n</td>\n<td>\n<p>Herpes simplex virus (HSV)</p>\n</td>\n<td>\n<p>Molluscum contagiosum virus (MCV)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Transmission</p>\n</td>\n<td>\n<p>Direct contact with infected skin or objects</p>\n</td>\n<td>\n<p>Airborne <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> droplets</p>\n</td>\n<td>\n<p>Direct contact with infected skin or fluids</p>\n</td>\n<td>\n<p>Direct contact with infected skin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lesion Appearance</p>\n</td>\n<td>\n<p>Small, red sores that <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> and <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> yellowish-brown crusts</p>\n</td>\n<td>\n<p>Small, itchy blisters that evolve into fluid-filled vesicles</p>\n</td>\n<td>\n<p>Painful blisters or sores, often with a cluster or grouped pattern</p>\n</td>\n<td>\n<p>Small, flesh-colored or pinkish bumps with a central dimple</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Distribution of Lesions</p>\n</td>\n<td>\n<p>Often found around the mouth, nose, and extremities</p>\n</td>\n<td>\n<p>Widespread distribution throughout the body</p>\n</td>\n<td>\n<p>Localized to the affected area (e.g., lips, mouth, genitals)</p>\n</td>\n<td>\n<p>Can occur on any part of the body</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Treatment</p>\n</td>\n<td>\n<p>Topical antibiotics, oral antibiotics for severe cases</p>\n</td>\n<td>\n<p>Supportive care, <span class=\"customMeta\" data-dictid=\"0961725e7716927771811b32dec45d\">antiviral</span> medications (in severe cases)</p>\n</td>\n<td>\n<p>Antiviral medications (topical or oral)</p>\n</td>\n<td>\n<p>Cryotherapy, <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> treatments</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are these lines called?", "options": [{"label": "A", "text": "Lymphatic development", "correct": false}, {"label": "B", "text": "Dermatomes", "correct": false}, {"label": "C", "text": "Blaschko lines", "correct": true}, {"label": "D", "text": "Vascular development", "correct": false}], "correct_answer": "C. Blaschko lines", "question_images": ["https://image.prepladder.com/content/8iuweXNoWa52aVlRaOYp1691561188.png"], "explanation_images": [], "explanation": "<p>Correct option C\n<table>\n<thead>\n<tr>\n<th><strong>Aspect</strong></th>\n<th><strong>Description</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Blaschko Lines</strong></td>\n<td>Imaginary lines on the skin that represent the developmental pathways of cells during embryogenesis.</td>\n</tr>\n<tr>\n<td><strong>Pattern</strong></td>\n<td>V-shaped or S-shaped patterns that follow distinct routes across the body.</td>\n</tr>\n<tr>\n<td><strong>Nature</strong></td>\n<td>Not visible under normal circumstances; only apparent when skin conditions cause specific patterns.</td>\n</tr>\n<tr>\n<td><strong>Etiology</strong></td>\n<td>Genetic mosaicism, with a mix of cells having different genetic mutations during embryonic development.</td>\n</tr>\n<tr>\n<td><strong>Visibility</strong></td>\n<td>Blaschko lines are often revealed when skin disorders or conditions follow these patterns.</td>\n</tr>\n<tr>\n<td><strong>Examples</strong></td>\n<td>Some skin conditions showing Blaschko line patterns include <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> nevi, <span class=\"customMeta\" data-dictid=\"45d1f54a631692777195670b446c7e\">pigmentary</span> mosaicism, and certain genetic syndromes.</td>\n</tr>\n<tr>\n<td><strong>Notable Cases</strong></td>\n<td>Hypomelanosis of Ito, <span class=\"customMeta\" data-dictid=\"e140688f6e16927771903db5d43939\">Incontinentia</span> Pigmenti, <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">Linear</span> <span class=\"customMeta\" data-dictid=\"0f0be4ebf11692777201b3aaf5e6fc\">Verrucous</span> <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">Epidermal</span> Nevus.</td>\n</tr>\n<tr>\n<td><strong>Diagnosis</strong></td>\n<td>Blaschko lines are not a medical diagnosis; they are a developmental concept used to explain certain skin patterns.</td>\n</tr>\n<tr>\n<td><strong>Clinical Implications</strong></td>\n<td>Understanding <span class=\"customMeta\" data-dictid=\"c3797b874916927771838d13ff2d14\">Blaschko lines</span> can help dermatologists diagnose and <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> genetic skin conditions.</td>\n</tr>\n<tr>\n<td><strong>Therapeutic Considerations</strong></td>\n<td>Knowledge of Blaschko line patterns can assist in planning <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> interventions or treatments for specific skin conditions.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following manifestations is absent in individuals with congenital syphilis?", "options": [{"label": "A", "text": "Higoumenakis sign", "correct": false}, {"label": "B", "text": "Hutchinson teeth", "correct": false}, {"label": "C", "text": "Genital ulcers", "correct": true}, {"label": "D", "text": "Buneo's Triad", "correct": false}], "correct_answer": "C. Genital ulcers", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Genital u\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the treatment used for vitiligo among the options listed below?", "options": [{"label": "A", "text": "Retinoids", "correct": false}, {"label": "B", "text": "Systemic steroids", "correct": false}, {"label": "C", "text": "Psoralen PUVA", "correct": true}, {"label": "D", "text": "Nd-YAG laser", "correct": false}], "correct_answer": "C. Psoralen PUVA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C</p>\n<p><strong>References:</strong></p>\n<ul><li>↳ Vitiligo is a skin condition characterized by the loss of pigmentation in certain areas, resulting in white patches on the skin. Various treatment modalities are available for vitiligo, and the choice depends on factors such as the extent of the condition and patient preferences. Psoralen PUVA (Psoralen plus Ultraviolet A) therapy is a commonly used treatment option. Psoralen is a medication that sensitizes the skin to UVA light, and PUVA involves the combination of psoralen ingestion or topical application followed by exposure to UVA light. This treatment helps stimulate repigmentation of the white patches in vitiligo.</li><li>↳ Incorrect options:</li><li>↳ Incorrect options:</li><li>↳ Option A: Retinoids are a class of medications derived from vitamin A and are used in various dermatological conditions but are not a primary treatment for vitiligo.</li><li>↳ Option A:</li><li>↳ Option B: Systemic steroids may be used in some cases of vitiligo, but they are not the mainstay of treatment.</li><li>↳ Option B:</li><li>↳ Option D: Nd-YAG laser is a type of laser used in dermatology for various purposes but is not the primary treatment for vitiligo.</li><li>↳ Option D:</li></u\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p style=\"text-align: center;\"><strong>TREATMENT OF VITILIGO</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Topical Corticosteroids</p>\n</td>\n<td>\n<p>These are creams or ointments containing corticosteroids that are applied to the depigmented areas. They help to suppress the <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> and promote repigmentation.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Topical <span class=\"customMeta\" data-dictid=\"746f157681169277718323a004b1d4\">Calcineurin</span> Inhibitors</p>\n</td>\n<td>\n<p>These medications, such as <span class=\"customMeta\" data-dictid=\"c156680d2216927772004a7846ad8e\">tacrolimus</span> and pimecrolimus, modulate the <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> and can be applied topically to the affected areas to promote repigmentation.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Psoralen plus <span class=\"customMeta\" data-dictid=\"84608ab7f91692777201521a0fdc0b\">Ultraviolet</span> A (PUVA)</p>\n</td>\n<td>\n<p>This treatment involves the use of psoralen, a medication that sensitizes the skin to <span class=\"customMeta\" data-dictid=\"11183d98e116927772017e77696a88\">UVA</span> light, followed by exposure to <span class=\"customMeta\" data-dictid=\"11183d98e116927772017e77696a88\">UVA</span> light. It stimulates <span class=\"customMeta\" data-dictid=\"fcde1de1141692777197e8813c85c1\">repigmentation</span> and is usually done in combination with oral or <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> <span class=\"customMeta\" data-dictid=\"c99213afd4169277719659563ed8c3\">psoralen</span> application.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Narrowband <span class=\"customMeta\" data-dictid=\"84608ab7f91692777201521a0fdc0b\">Ultraviolet</span> B (NB-UVB)</p>\n</td>\n<td>\n<p>Narrowband <span class=\"customMeta\" data-dictid=\"5eb25d8b3d1692777201d9a92c7dde\">UVB</span> light treatment involves exposure to a specific <span class=\"customMeta\" data-dictid=\"ef914bdb201692777202c455236ca8\">wavelength</span> of <span class=\"customMeta\" data-dictid=\"5eb25d8b3d1692777201d9a92c7dde\">UVB</span> light. It stimulates <span class=\"customMeta\" data-dictid=\"6c5489238a1692777192a4dddfd694\">melanocyte</span> activity and promotes repigmentation. It is often performed in sessions, typically two to three times per week.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Excimer Laser</p>\n</td>\n<td>\n<p>Excimer laser treatment delivers targeted <span class=\"customMeta\" data-dictid=\"5eb25d8b3d1692777201d9a92c7dde\">UVB</span> light to the affected areas. It is more precise and requires fewer treatment sessions compared to traditional phototherapy.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Surgical Techniques</p>\n</td>\n<td>\n<p>Surgical options include punch grafting, <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> <span class=\"customMeta\" data-dictid=\"495ed15ced1692777183595fc14e52\">blister</span> grafting, split-thickness skin grafting, and <span class=\"customMeta\" data-dictid=\"6c5489238a1692777192a4dddfd694\">melanocyte</span> transplantation. These procedures involve transferring healthy skin cells or tissue to the depigmented areas to promote repigmentation. They are typically considered for stable <span class=\"customMeta\" data-dictid=\"1d57ae1fc0169277720240b02df182\">vitiligo</span> and limited areas of involvement.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Depigmentation</p>\n</td>\n<td>\n<p>In cases of extensive <span class=\"customMeta\" data-dictid=\"1d57ae1fc0169277720240b02df182\">vitiligo</span> where <span class=\"customMeta\" data-dictid=\"fcde1de1141692777197e8813c85c1\">repigmentation</span> is not feasible, <span class=\"customMeta\" data-dictid=\"fa15f2737616927771864ea2681ae1\">depigmentation</span> can be an option. This involves removing the remaining <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> from unaffected areas to achieve a uniform appearance.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Supportive Measures</p>\n</td>\n<td>\n<p>Supportive measures may include the use of <span class=\"customMeta\" data-dictid=\"ca37aeaa751692777199b48f4231c6\">sunscreen</span> to protect the depigmented areas from sunburn, camouflage makeup to conceal the patches, and counseling or support groups to address psychological and social aspects of living with vitiligo.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Tzancksmear as shown in the image shows:", "options": [{"label": "A", "text": "Acanthosis", "correct": false}, {"label": "B", "text": "Acantholytic cells", "correct": true}, {"label": "C", "text": "Smudge cells", "correct": false}, {"label": "D", "text": "Anaplasia", "correct": false}], "correct_answer": "B. Acantholytic cells", "question_images": ["https://image.prepladder.com/content/YK66HkkqTbMOappTF1i91714027698.PNG"], "explanation_images": [], "explanation": "<p>Correct option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gastric lavage, commonly known as stomach pumping or gastric irrigation, is a procedure performed to remove the contents of the stomach. It has been widely used since the early 19th century as a standard method to eliminate toxins from the stomach. This procedure is typically employed for individuals who have consumed poison or overdosed on substances like ethanol. Additionally, it may be performed prior to surgery to empty the digestive tract. In which of the following situations is gastric lavage not recommended?", "options": [{"label": "A", "text": "Organo-Phosphosphate poisoning", "correct": false}, {"label": "B", "text": "Hydrocarbons", "correct": true}, {"label": "C", "text": "Ethanol poisoning", "correct": false}, {"label": "D", "text": "PCM toxicity", "correct": false}], "correct_answer": "B. Hydrocarbons", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"55164fe9f9169277718979ac034040\"&gt;Hydrocarbon&lt;/span&gt; poisoning\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which confirmatory test is utilized by forensic experts to establish the presence of a bloodstain at a crime scene ?", "options": [{"label": "A", "text": "Spectroscopic test", "correct": true}, {"label": "B", "text": "Kastle meyer test", "correct": false}, {"label": "C", "text": "Benzidine test", "correct": false}, {"label": "D", "text": "Orthotoluidine test", "correct": false}], "correct_answer": "A. Spectroscopic test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - S\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tests for bloodstain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Principle/Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kastle-Meyer Test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phenolphthalein test for the presence of hemoglobin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Simple and sensitive test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can yield <span class=\"customMeta\" data-dictid=\"b0151941a0169277720265b58da84e\">false-positive</span> results</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benzidine Test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benzidine reacts with <span class=\"customMeta\" data-dictid=\"d4fff554a316927771885dc8700abe\">heme</span> to produce a blue color</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specific for detecting blood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benzidine is a known carcinogen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leucomalachite Green</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oxidation of leucomalachite green by hemoglobin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensitive and specific for blood</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Toxicity concerns</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Microscopic Analysis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Examination of bloodstains under a microscope</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can provide detailed information</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires specialized equipment and training</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DNA Analysis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identification of blood using DNA profiling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly accurate and reliable identification</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires laboratory facilities and expertise</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old girl was rescued from a village in Bihar where she had been sold off by her father for Rs. 25000 to a 45-year-old man . On examination, she was found to be 12 weeks pregnant . She was granted permission to abort the pregnancy, taking into consideration the age of the girl and the circumstances of her pregnancy . A doctor who will be eligible to perform the abortion for this girl should have performed at least how many MTP prior to this?", "options": [{"label": "A", "text": "10", "correct": false}, {"label": "B", "text": "15", "correct": false}, {"label": "C", "text": "25", "correct": true}, {"label": "D", "text": "35", "correct": false}], "correct_answer": "C. 25", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 25: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "From the dense vegetation near the highway, the police have found the remains of a burnt body. The location was discovered with the help of a sniffer dog, as they were tracing a 25-year-old IT worker who had gone missing the night before. To determine the identity of the victim, the team needs to gather a suitable sample. Which type of tissue from a charred body is most effective for identification purposes?", "options": [{"label": "A", "text": "Hair", "correct": false}, {"label": "B", "text": "Bone", "correct": false}, {"label": "C", "text": "Teeth", "correct": true}, {"label": "D", "text": "Blood", "correct": false}], "correct_answer": "C. Teeth", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Teeth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Death registration in India done within?", "options": [{"label": "A", "text": "21 days", "correct": true}, {"label": "B", "text": "28 days", "correct": false}, {"label": "C", "text": "30 days", "correct": false}, {"label": "D", "text": "40 days", "correct": false}], "correct_answer": "A. 21 days", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 2\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most reliable criteria among Gustafson's criteria for age estimation is ?", "options": [{"label": "A", "text": "Root resorption", "correct": false}, {"label": "B", "text": "Paradentosis", "correct": false}, {"label": "C", "text": "Translucency of root", "correct": true}, {"label": "D", "text": "Attrition", "correct": false}], "correct_answer": "C. Translucency of root", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Translu\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Criteria</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Score </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Attrition</p>\n</td>\n<td>\n<p style=\"text-align: center;\">0-3</p>\n</td>\n<td>\n<p>Evaluation of wear and tear of tooth surface.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Periodontal <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">Ligament</span> Retractions</p>\n</td>\n<td>\n<p style=\"text-align: center;\">0-3</p>\n</td>\n<td>\n<p>Assessment of <span class=\"customMeta\" data-dictid=\"09980563461692777188b0de904031\">gum</span> line recession.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Secondary <span class=\"customMeta\" data-dictid=\"681c1265fd1692777185a6df7e02ca\">Dentin</span> Formations</p>\n</td>\n<td>\n<p style=\"text-align: center;\">0-3</p>\n</td>\n<td>\n<p>Examination of additional <span class=\"customMeta\" data-dictid=\"681c1265fd1692777185a6df7e02ca\">dentin</span> layers in the <span class=\"customMeta\" data-dictid=\"5b7b8d266716927771968316ee113b\">pulp</span> chamber.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Root Translucency</p>\n</td>\n<td>\n<p style=\"text-align: center;\">0-3</p>\n</td>\n<td>\n<p>Analysis of increased transparency of the tooth root.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Root Resorption</p>\n</td>\n<td>\n<p style=\"text-align: center;\">0-3</p>\n</td>\n<td>\n<p>Evaluation of loss of tooth root structure.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came in with an unidentified fungal infection. Upon microscopic examination, spherical fungi with brown coloration and septate hyphae were observed. Possible condition can be inferred from the presence of brown colored bodies on tissue biopsy.", "options": [{"label": "A", "text": "Histoplasmosis", "correct": false}, {"label": "B", "text": "Chromoblastomycosis", "correct": true}, {"label": "C", "text": "Coccidioidomycosis", "correct": false}, {"label": "D", "text": "Candida albicans", "correct": false}], "correct_answer": "B. Chromoblastomycosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Bacillus Anthrax is:", "options": [{"label": "A", "text": "Gram positive cocci in cluster", "correct": false}, {"label": "B", "text": "Gram positive rods with square ends", "correct": true}, {"label": "C", "text": "Gram-positive cocci in chains", "correct": false}, {"label": "D", "text": "Gram negative cocci in cluster", "correct": false}], "correct_answer": "B. Gram positive rods with square ends", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3IES9I9ELnYHC7mxrpvp1712812961.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"c72cd5f69316927771883c73649d86\"&gt;Gram-positive&lt;/span&gt; rods with squ\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about Corona virus is incorrect?", "options": [{"label": "A", "text": "ssRNA genome", "correct": false}, {"label": "B", "text": "Icosahedral capsid", "correct": true}, {"label": "C", "text": "Host cell entry occurs by attachment of viral spike", "correct": false}, {"label": "D", "text": "Human corona virus 229 E is alpha type", "correct": false}], "correct_answer": "B. Icosahedral capsid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Icosahedral C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "DNA transfer in bacteria via phage is?", "options": [{"label": "A", "text": "Conjugation", "correct": false}, {"label": "B", "text": "Transduction", "correct": true}, {"label": "C", "text": "Transformation", "correct": false}, {"label": "D", "text": "Translation", "correct": false}], "correct_answer": "B. Transduction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xijgBxRj0MpDN2cphYyT1712742521.png"], "explanation": "<p>Correct Option B - Transdu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sporulation occurs in this phase of bacterial growth curve:", "options": [{"label": "A", "text": "Stationary phase", "correct": true}, {"label": "B", "text": "Lag phase", "correct": false}, {"label": "C", "text": "Log phase", "correct": false}, {"label": "D", "text": "Decline phase", "correct": false}], "correct_answer": "A. Stationary phase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/75Yun8CZ3EJdbwTHpGbN1712813074.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"9cf5375557169277719946c3651430\"&gt;Stationary&lt;/span&gt; Phase:</p>\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p><strong>Lag Phase</strong></p>\n</td>\n<td>\n<p><strong>Log Phase</strong></p>\n</td>\n<td>\n<p><strong>Stationary Phase</strong></p>\n</td>\n<td>\n<p><strong>Dead Phase</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>No increase in the number of bacteria</li>\n<li>Cell adaptation</li>\n<li>Increase in size, enzymes and metabolite</li>\n<li>The maximum size of bacteria is seen in end of the <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> phase</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Cell division</li>\n<li>Smaller in size</li>\n<li>Maximum <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> activity</li>\n<li>More <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> to antibiotics</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Some bacteria remain <span class=\"customMeta\" data-dictid=\"915ca56f53169277720296a38e3e8e\">viable</span> and some are dead</li>\n<li>Bacterial growth ceases due to <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> of nutrients</li>\n<li>Mnemonic STAB (STAT from stationary)\n\t\t\t\t<ul>\n<li>S in sporulation</li>\n<li>T in <span class=\"customMeta\" data-dictid=\"f7e90c7acc169277718783c542e52c\">Exo</span> <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">Toxin</span> production</li>\n<li>A in <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> production</li>\n<li>B in <span class=\"customMeta\" data-dictid=\"83d3c331361692777182da5eff7fea\">Bacteriocin</span> production</li>\n</ul>\n</li>\n<li>Antibiotic production happens in this phase</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Decline phase</li>\n<li>Cell death or involution</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p><strong>Lag Phase</strong></p>\n</td>\n<td>\n<p><strong>Log Phase</strong></p>\n</td>\n<td>\n<p><strong>Stationary Phase</strong></p>\n</td>\n<td>\n<p><strong>Dead Phase</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>No increase in the number of bacteria</li>\n<li>Cell adaptation</li>\n<li>Increase in size, enzymes and metabolite</li>\n<li>The maximum size of bacteria is seen in end of the <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> phase</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Cell division</li>\n<li>Smaller in size</li>\n<li>Maximum <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> activity</li>\n<li>More <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> to antibiotics</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Some bacteria remain <span class=\"customMeta\" data-dictid=\"915ca56f53169277720296a38e3e8e\">viable</span> and some are dead</li>\n<li>Bacterial growth ceases due to <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> of nutrients</li>\n<li>Mnemonic STAB (STAT from stationary)\n\t\t\t\t<ul>\n<li>S in sporulation</li>\n<li>T in <span class=\"customMeta\" data-dictid=\"f7e90c7acc169277718783c542e52c\">Exo</span> <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">Toxin</span> production</li>\n<li>A in <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> production</li>\n<li>B in <span class=\"customMeta\" data-dictid=\"83d3c331361692777182da5eff7fea\">Bacteriocin</span> production</li>\n</ul>\n</li>\n<li>Antibiotic production happens in this phase</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Decline phase</li>\n<li>Cell death or involution</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man is accompanied by his wife to the Neurology OPD. His wife expressed concern about her husband's condition and they were directed to this facility by a local doctor. According to the doctor's note, the patient is unable to repeat spoken words, but can comprehend them and respond appropriately by nodding. The patient also experiences difficulty in naming people and writing. The doctor referred the patient to a specialized facility for a CT brain scan. As the intern on duty, you would inform the Chief Medical Officer (CMO) that this condition could be indicative of a brain lesion in which specific area?", "options": [{"label": "A", "text": "Arcuate fasciculus", "correct": true}, {"label": "B", "text": "Anterior commissure", "correct": false}, {"label": "C", "text": "Corpus callosum", "correct": false}, {"label": "D", "text": "Fornix", "correct": false}], "correct_answer": "A. Arcuate fasciculus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"734bdc6ddd1692777182e15cb76ca5\"&gt;Arcuate&lt;/span&gt; fasciculu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are common causes of granuloma formation?", "options": [{"label": "A", "text": "Mycobacterial infections", "correct": true}, {"label": "B", "text": "Viral infection", "correct": false}, {"label": "C", "text": "Actinomycosis", "correct": false}, {"label": "D", "text": "Allergic reactions", "correct": false}], "correct_answer": "A. Mycobacterial infections", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n<table>\n<thead>\n<tr>\n<th><strong>Aspect</strong></th>\n<th><strong>Description</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Definition</strong></td>\n<td>- A <span class=\"customMeta\" data-dictid=\"2334b7498b1692777188fa8b2eee36\">granuloma</span> is a localized, organized collection of immune cells, typically formed in response to persistent, indigestible, or challenging substances that the immune system cannot eliminate.</td>\n</tr>\n<tr>\n<td><strong>Types of Granulomas</strong></td>\n<td>- <strong>Infectious Granulomas:</strong> Result from chronic infections by certain bacteria (e.g., <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> tuberculosis), fungi, or parasites. - <strong>Non-Infectious Granulomas:</strong> Can be caused by non-infectious factors, including foreign bodies, immune disorders, or unknown etiologies (e.g., sarcoidosis).</td>\n</tr>\n<tr>\n<td><strong>Cellular Composition</strong></td>\n<td>- <strong>Macrophages:</strong> Play a central role in <span class=\"customMeta\" data-dictid=\"2334b7498b1692777188fa8b2eee36\">granuloma</span> formation by engulfing and presenting antigens. - <strong>T lymphocytes:</strong> Participate in the <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> and regulation of <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> inflammation. - <strong>Giant Cells:</strong> <span class=\"customMeta\" data-dictid=\"aa085932ce1692777193be7e5198bf\">Multinucleated</span> cells formed by the <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of macrophages, often seen in the center of granulomas.</td>\n</tr>\n<tr>\n<td><strong>Histological Appearance</strong></td>\n<td>- Granulomas have a characteristic appearance under a microscope, featuring a central area of altered macrophages surrounded by lymphocytes and fibrosis. - The center may contain <span class=\"customMeta\" data-dictid=\"99368d5fef1692777183ea405bed67\">caseous</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> in certain <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> granulomas.</td>\n</tr>\n<tr>\n<td><strong>Common Causes</strong></td>\n<td>- <strong>Infectious Causes:</strong> <span class=\"customMeta\" data-dictid=\"46f768d2e41692777193d69cbc7eec\">Mycobacteria</span> (e.g., <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> tuberculosis), <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> (e.g., Histoplasma), parasites (e.g., Schistosoma). - <strong>Non-Infectious Causes:</strong> Foreign bodies (e.g., sutures, talc), immune disorders (e.g., sarcoidosis).</td>\n</tr>\n<tr>\n<td><strong>Clinical Significance</strong></td>\n<td>- Granulomas can be protective, isolating and containing the source of infection or irritation. - In certain cases, granulomas may contribute to tissue damage and dysfunction, especially if they are numerous or affect vital organs.</td>\n</tr>\n<tr>\n<td><strong>Diagnostic Methods</strong></td>\n<td>- <strong>Microscopy:</strong> <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">Histological</span> examination of tissue samples, such as biopsies, to identify the characteristic <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> arrangement of granulomas. - <strong>Imaging:</strong> Radiological studies, such as <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> or CT scans, may reveal the presence of granulomas in affected organs.</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td>- Treatment depends on the underlying cause. In <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> granulomas, <span class=\"customMeta\" data-dictid=\"78d28b340916927771810a3fffeb0a\">antimicrobial</span> therapy is often necessary. - Non-infectious granulomas may require anti-inflammatory medications or treatment of the underlying condition.</td>\n</tr>\n<tr>\n<td><strong>Complications</strong></td>\n<td>- Granulomas can lead to <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and scarring, affecting the normal structure and function of organs. - Complications may arise if granulomas are numerous, large, or located in critical areas.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "HUS in children is caused by:", "options": [{"label": "A", "text": "E. coli 0157: H7", "correct": true}, {"label": "B", "text": "Malaria", "correct": false}, {"label": "C", "text": "Parvovirus B19", "correct": false}, {"label": "D", "text": "Bartonella henselae", "correct": false}], "correct_answer": "A. E. coli 0157: H7", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - E. &lt;span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\"&gt;coli&lt;/span&gt; 0157\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which pathway provides afferent fibers to the mammillary body, a structure located beneath the brain's surface?", "options": [{"label": "A", "text": "Corpus callosum", "correct": false}, {"label": "B", "text": "Thalamus", "correct": false}, {"label": "C", "text": "Pituitary gland", "correct": false}, {"label": "D", "text": "Fornix", "correct": true}], "correct_answer": "D. Fornix", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d9rCWNDEwoeXKS4QMIXT1715064639.png"], "explanation": "<p>Correct Option D - F\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Deficiency of which complement system increases the risk of N. meningitidis infection?", "options": [{"label": "A", "text": "C1-C4 deficiency", "correct": false}, {"label": "B", "text": "C5-C9 deficiency", "correct": true}, {"label": "C", "text": "C3 deficiency", "correct": false}, {"label": "D", "text": "C2 deficiency", "correct": false}], "correct_answer": "B. C5-C9 deficiency", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - C5-C9\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p style=\"text-align:center\"><strong>Complement protein deficiencies </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p><strong>Complement deficiencies </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p><strong>Pathway(s) involved </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p><strong>Disease/pathology </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>C1, C2, C3, C4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>C1, C2, C4 – classical pathway</p>\n<p>C3 – common deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus (SLE), <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> and <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">pyogenic</span> infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Properdin, Factor D</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Alternative pathway</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Neisseria and <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">pyogenic</span> infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Membrane attack complex (C5-C9)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Common deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Disseminated <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> infection</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what level does the duct of the parotid gland, a paired salivary gland producing serous secretions, open?", "options": [{"label": "A", "text": "First mandibular molar", "correct": false}, {"label": "B", "text": "Second mandibular molar", "correct": false}, {"label": "C", "text": "First maxillary pre molar", "correct": false}, {"label": "D", "text": "Second maxillary molar", "correct": true}], "correct_answer": "D. Second maxillary molar", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salivary Gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duct</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Opening in Mouth</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Parotid Gland</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stensen's Duct</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Opposite the second maxillary molar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Submandibular Gland</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wharton's Duct</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At the base of the <span class=\"customMeta\" data-dictid=\"f7c3ba6f1c1692777191e58e8571b0\">lingual</span> frenulum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sublingual Gland</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bartholin's Duct</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple openings along the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> fold and floor of the mouth</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minor Salivary Glands</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple small ducts</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Throughout the oral cavity, including lips, cheeks, palate, and tongue</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent options triggers the classical complement cascade?", "options": [{"label": "A", "text": "C1", "correct": false}, {"label": "B", "text": "C3 Convertase", "correct": false}, {"label": "C", "text": "lgA", "correct": false}, {"label": "D", "text": "Ag - Ab complex", "correct": true}], "correct_answer": "D. Ag - Ab complex", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Ag - &lt;span class=\"customMeta\" data-dictid=\"c087dfa48f1692777180b90ca2237f\"&gt;Ab&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle is responsible for causing trismus due to spasm?", "options": [{"label": "A", "text": "Buccinator", "correct": false}, {"label": "B", "text": "Lateral pterygoid", "correct": false}, {"label": "C", "text": "Medial pterygoid", "correct": true}, {"label": "D", "text": "Mentalis", "correct": false}], "correct_answer": "C. Medial pterygoid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\"&gt;Medial&lt;/span&gt; pteryg\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insertion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Lesion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Buccinator</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alveolar processes of <span class=\"customMeta\" data-dictid=\"84514257721692777192f1748073bd\">maxilla</span> and mandible, orbicularis oris muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compresses cheeks during chewing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesion may result in difficulty in retaining food in mouth</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral pterygoid</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Condyle of mandible</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protrusion of jaw, side-to-side movement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysfunction may contribute to <span class=\"customMeta\" data-dictid=\"66f9c028981692777200c9ce0cd63f\">temporomandibular</span> joint (TMJ) disorders, leading to jaw pain and limited jaw movement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial pterygoid</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial surface of mandible</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevation of jaw, side-to-side movement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spasm or <span class=\"customMeta\" data-dictid=\"b0cbb1769e1692777189fd5a90d39a\">hypertonicity</span> can cause <span class=\"customMeta\" data-dictid=\"60defa6790169277720059582a2772\">trismus</span> (difficulty in opening the mouth fully)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mentalis</p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chin</p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Raises and protrudes lower lip, wrinkles the chin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesion may result in weakness or <span class=\"customMeta\" data-dictid=\"0bead1317716927771827dc3e80706\">asymmetry</span> of the <span class=\"customMeta\" data-dictid=\"534123d47916927771914a66769a37\">lower lip</span> and chin, affecting <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expressions</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following virus is from Herpes virus family ?", "options": [{"label": "A", "text": "Rubella", "correct": false}, {"label": "B", "text": "Measles", "correct": false}, {"label": "C", "text": "Rabies", "correct": false}, {"label": "D", "text": "EBV", "correct": true}], "correct_answer": "D. EBV", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - EBV:</p>\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p><strong>Type</strong></p>\n</td>\n<td>\n<p><strong>Virus</strong></p>\n</td>\n<td>\n<p><strong>Associated Diseases</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV1</strong></p>\n</td>\n<td>\n<p>Herpes Simplex Virus 1</p>\n</td>\n<td>\n<p>Oral <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">herpes</span> (cold sores), <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> herpes, and encephalitis.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV2</strong></p>\n</td>\n<td>\n<p>Herpes Simplex Virus 2</p>\n</td>\n<td>\n<p>Genital herpes.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV3</strong></p>\n</td>\n<td>\n<p>Herpes <span class=\"customMeta\" data-dictid=\"03350c16f71692777202dbca70976e\">Zoster</span> Virus</p>\n</td>\n<td>\n<p>Chickenpox and shingles.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV4</strong></p>\n</td>\n<td>\n<p>Epstein–Barr virus</p>\n</td>\n<td>\n<p>Infectious mononucleosis, Burkitt's lymphoma, <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> carcinoma.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV5</strong></p>\n</td>\n<td>\n<p>Cytomegalovirus (largest member)</p>\n</td>\n<td>\n<p>Congenital infections, mononucleosis, organ transplant complications.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV6</strong></p>\n</td>\n<td>\n<p>Human <span class=\"customMeta\" data-dictid=\"c68a8d1fc016927771880d99a69e9f\">Herpesvirus</span> 6</p>\n</td>\n<td>\n<p>Roseola infantum, <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">febrile</span> illness</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV7</strong></p>\n</td>\n<td>\n<p>Human <span class=\"customMeta\" data-dictid=\"c68a8d1fc016927771880d99a69e9f\">Herpesvirus</span> 7</p>\n</td>\n<td>\n<p>Febrile illness and a few cases of <span class=\"customMeta\" data-dictid=\"23e8c9aa00169277719722d6ea90d0\">roseola</span> infantum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV8</strong></p>\n</td>\n<td>\n<p>Human <span class=\"customMeta\" data-dictid=\"c68a8d1fc016927771880d99a69e9f\">Herpesvirus</span> 8</p>\n</td>\n<td>\n<p>Kaposi's sarcoma</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p><strong>HHV1</strong></p>\n</td>\n<td>\n<p>Herpes Simplex Virus 1</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV2</strong></p>\n</td>\n<td>\n<p>Herpes Simplex Virus 2</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV3</strong></p>\n</td>\n<td>\n<p>Herpes <span class=\"customMeta\" data-dictid=\"03350c16f71692777202dbca70976e\">Zoster</span> Virus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV4</strong></p>\n</td>\n<td>\n<p>Epstein–Barr virus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV5</strong></p>\n</td>\n<td>\n<p>Cytomegalovirus (largest member)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV6</strong></p>\n</td>\n<td>\n<p>Human <span class=\"customMeta\" data-dictid=\"c68a8d1fc016927771880d99a69e9f\">Herpesvirus</span> 6</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV7</strong></p>\n</td>\n<td>\n<p>Human <span class=\"customMeta\" data-dictid=\"c68a8d1fc016927771880d99a69e9f\">Herpesvirus</span> 7</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HHV8</strong></p>\n</td>\n<td>\n<p>Human <span class=\"customMeta\" data-dictid=\"c68a8d1fc016927771880d99a69e9f\">Herpesvirus</span> 8</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which division of the facial nerve innervates the muscles located in the lower lip?", "options": [{"label": "A", "text": "Temporal", "correct": false}, {"label": "B", "text": "Cervical", "correct": false}, {"label": "C", "text": "Buccal", "correct": false}, {"label": "D", "text": "Mandibular", "correct": true}], "correct_answer": "D. Mandibular", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:573px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Facial Nerve Branch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supply</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporal Branch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frontalis muscle (forehead), orbicularis <span class=\"customMeta\" data-dictid=\"7860833ed41692777194b7b9b531f7\">oculi</span> (temporal part)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Zygomatic Branch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Orbicularis <span class=\"customMeta\" data-dictid=\"7860833ed41692777194b7b9b531f7\">oculi</span> (zygomatic part)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Buccal Branch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Buccinator muscle, orbicularis oris (lateral part)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marginal Mandibular Branch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscles of the <span class=\"customMeta\" data-dictid=\"534123d47916927771914a66769a37\">lower lip</span> (depressor labii inferioris, mentalis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cervical Branch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Platysma muscle</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mark the false statement regarding testing of covid 19:", "options": [{"label": "A", "text": "Most predominant method of diagnosis of Covid 19 is RT-PCR", "correct": false}, {"label": "B", "text": "First line screening assay: N gene assay", "correct": true}, {"label": "C", "text": "Confirmatory assay: RdRp gene assay", "correct": false}, {"label": "D", "text": "Peripheral ground glass opacities on CT are frequently observed.", "correct": false}], "correct_answer": "B. First line screening assay: N gene assay", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - First Line Screening Assay: N Gene A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Neurocysticercosis is caused by?", "options": [{"label": "A", "text": "Cysticercus bovis", "correct": false}, {"label": "B", "text": "Taenia saginata asiatica", "correct": false}, {"label": "C", "text": "Cysticercus cellulose", "correct": true}, {"label": "D", "text": "Taenia saginata", "correct": false}], "correct_answer": "C. Cysticercus cellulose", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Cysticercus Cellu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female comes to the outpatient department complaining of fever, cough, muscle pain and headache . On taking occupational history, she reveals working for a centrally airconditioned corporate company . The doctor sent a sputum sample for culture sensitivity. The microbiologist used buffered charcoal yeast extract to culture the suspected organism. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Legionnaire disease", "correct": true}, {"label": "B", "text": "Brucellosis", "correct": false}, {"label": "C", "text": "Pneumonia caused by Haemophilus", "correct": false}, {"label": "D", "text": "Acute gastroenteritis", "correct": false}], "correct_answer": "A. Legionnaire disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Legionnaire D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When should you perform Widal test in a case of typhoid?", "options": [{"label": "A", "text": "1st week", "correct": false}, {"label": "B", "text": "2nd week", "correct": true}, {"label": "C", "text": "3rd week", "correct": false}, {"label": "D", "text": "4th week", "correct": false}], "correct_answer": "B. 2nd week", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 2nd week: </p>\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Week of Infection</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Test performed</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Week 1</p>\n</td>\n<td>\n<p>Blood culture</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Week 2</p>\n</td>\n<td>\n<p>Antibody test (Widal)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Week 3</p>\n</td>\n<td>\n<p>Stool culture</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Week 4</p>\n</td>\n<td>\n<p>Urine culture</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Week of <span class=\"customMeta\" data-dictid=\"361c327ab81692777198a1cd507e57\">Salmonella</span> typhi Infection</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Test performed</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Week 1</p>\n</td>\n<td>\n<p>Blood culture</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Week 2</p>\n</td>\n<td>\n<p>Antibody test (Widal)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Week 3</p>\n</td>\n<td>\n<p>Stool culture</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Week 4</p>\n</td>\n<td>\n<p>Urine culture</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman at 26 weeks of gestation gets an ultrasound done for fetal well-being and is diagnosed with hydrops fetalis . Which of the following fetal infections could have led to this condition?", "options": [{"label": "A", "text": "Ebstein barr virus", "correct": false}, {"label": "B", "text": "Human papilloma virus", "correct": false}, {"label": "C", "text": "Parvovirus B19", "correct": true}, {"label": "D", "text": "Influenza Virus", "correct": false}], "correct_answer": "C. Parvovirus B19", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old female patient visits the outpatient department (OPD) with a complaint of a mass descending through the vaginal opening. Upon examination, it is determined to be a second-degree uterovaginal prolapse. The patient does not have any chronic illnesses and does not smoke or consume alcohol. She has previously undergone two vaginal deliveries, one 8 years ago and the other 10 years ago with Episiotomy. The doctor proceeds to gather a detailed obstetric history pertaining to these two deliveries. Which of the following factors in the patient's history is unlikely to have contributed to her current condition?", "options": [{"label": "A", "text": "Precipitate labor", "correct": false}, {"label": "B", "text": "Prolonged second stage", "correct": false}, {"label": "C", "text": "Premature bearing down", "correct": false}, {"label": "D", "text": "Episiotomy", "correct": true}], "correct_answer": "D. Episiotomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: E\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the conservative approach used to treat pelvic organ prolapse?", "options": [{"label": "A", "text": "Perineorrhaphy", "correct": false}, {"label": "B", "text": "Shirodkar Procedure", "correct": false}, {"label": "C", "text": "Pessary", "correct": true}, {"label": "D", "text": "Le Fort Repair", "correct": false}], "correct_answer": "C. Pessary", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C-What is the conservative approach used to treat &lt;span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\"&gt;pelvic&lt;/span&gt; organ prolapse?\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cut off point for 50 gram glucose challenge test at 1 hour mg%?", "options": [{"label": "A", "text": "100", "correct": false}, {"label": "B", "text": "140", "correct": true}, {"label": "C", "text": "180", "correct": false}, {"label": "D", "text": "200", "correct": false}], "correct_answer": "B. 140", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "28 year old lady (G2 P1) who does not want to conceive after abortion, which is the preferred mode of contraception?", "options": [{"label": "A", "text": "OCP", "correct": false}, {"label": "B", "text": "IUD", "correct": true}, {"label": "C", "text": "Barrier", "correct": false}, {"label": "D", "text": "Implant", "correct": false}], "correct_answer": "B. IUD", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B-IUD\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 year old primigravida female delivers a full term baby. However she choses to formula feed her newborn . After how much duration can she start using combined oral contraceptives for avoiding a pregnancy?", "options": [{"label": "A", "text": "2 weeks", "correct": false}, {"label": "B", "text": "6 weeks", "correct": true}, {"label": "C", "text": "12 weeks", "correct": false}, {"label": "D", "text": "Immediately after delivery", "correct": false}], "correct_answer": "B. 6 weeks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 43-year-old female patient visits the doctor with concerns about her irregular menstrual periods and experiencing bleeding after sexual intercourse for the past 2 months. The patient comes from a low socio-economic background and has 4 children. She uses an intrauterine contraceptive device (IUCD) for birth control. Additionally, the patient has a long history of smoking and has been diagnosed with hypertension for the past 5 years. The patient's vital signs are stable, and the physical examination does not reveal any significant findings. Further investigations indicate a positive test for type 16 human papillomavirus (HPV) and a biopsy confirms the presence of cervical cancer in its early stage. Which of the following factors from her medical history does not contribute to her current condition?", "options": [{"label": "A", "text": "HPV 16, smoking", "correct": false}, {"label": "B", "text": "Hypertension and IUCD use", "correct": true}, {"label": "C", "text": "Multiparity and low socio-economic status", "correct": false}, {"label": "D", "text": "Multiparity and smoking", "correct": false}], "correct_answer": "B. Hypertension and IUCD use", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B-Hypertension and IUCD u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The calculation of the EDD (Expected Date of Delivery) is determined by?", "options": [{"label": "A", "text": "Young's rule", "correct": false}, {"label": "B", "text": "Naegele's formula", "correct": true}, {"label": "C", "text": "Cardiff Formula", "correct": false}, {"label": "D", "text": "Hadlock Formula", "correct": false}], "correct_answer": "B. Naegele's formula", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Method</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Naegele's Rule</p>\n</td>\n<td>\n<p>EDD = Date of Last <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">Menstrual</span> Period (LMP) + 1 year - 3 months + 7 days</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ultrasound Dating</p>\n</td>\n<td>\n<p>Determining EDD based on <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> measurements obtained through ultrasound, typically in the first <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> or early second trimester.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Crown-Rump Length (CRL)</p>\n</td>\n<td>\n<p>EDD is estimated by measuring the length of the <span class=\"customMeta\" data-dictid=\"421fecf0e21692777202704942ac48\">fetus</span> from <span class=\"customMeta\" data-dictid=\"7c11c2cc6a1692777185bfb953fa72\">crown</span> (top of the head) to <span class=\"customMeta\" data-dictid=\"f42b1a63fb1692777197b752d084d6\">rump</span> (bottom) in early pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Biparietal <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">Diameter</span> (BPD)</p>\n</td>\n<td>\n<p>EDD is estimated by measuring the <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> between the two sides of the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head in mid-pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Symphysis-Fundal Height (SFH)</p>\n</td>\n<td>\n<p>EDD is estimated by measuring the distance between the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> <span class=\"customMeta\" data-dictid=\"48b6a0a5fb1692777199da12372b14\">symphysis</span> (the bone in the pelvis) and the top of the uterus.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ballard Score</p>\n</td>\n<td>\n<p>EDD is estimated by assessing the physical characteristics of the <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> to determine gestational age.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Assisted <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">Reproductive</span> Technology (ART) EDD</p>\n</td>\n<td>\n<p>EDD is determined based on the date of <span class=\"customMeta\" data-dictid=\"30bf2366951692777187735fffe4b4\">embryo</span> transfer or <span class=\"customMeta\" data-dictid=\"b1c5c7438a16927771901f358b0bfd\">insemination</span> during assisted <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> techniques.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Electronic <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">Fetal</span> Monitoring (EFM)</p>\n</td>\n<td>\n<p>EDD is estimated based on <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heart rate patterns recorded during electronic monitoring in labor.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of twinning is observed if a zygote undergoes division within 3 days of fertilization?", "options": [{"label": "A", "text": "Monochorionic, Monoamniotic", "correct": false}, {"label": "B", "text": "Monochorionic, Diamniotic", "correct": false}, {"label": "C", "text": "Diamniotic, Dichorionic", "correct": true}, {"label": "D", "text": "Dichorionic, Monoamniotic", "correct": false}], "correct_answer": "C. Diamniotic, Dichorionic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of Twins</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>MCMA Twins</p>\n</td>\n<td>\n<p>Also known as Monochorionic-Monoamniotic twins.</p>\n</td>\n<td>\n<ul>\n<li>Develop from a single fertilized egg (zygote) that does not fully separate, resulting in a shared <span class=\"customMeta\" data-dictid=\"167c22e3951692777184a6ad73e1a4\">chorion</span> (placental membrane) and <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> sac.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td> </td>\n<td>\n<ul>\n<li>Have the highest risk among all twin types for complications such as cord entanglement, compression, and twin-to-twin <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> syndrome (TTTS), where there is an uneven <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> between the twins through shared blood vessels in the placenta.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>MCDA Twins</p>\n</td>\n<td>\n<p>Also known as Monochorionic-Diamniotic twins.</p>\n</td>\n<td>\n<ul>\n<li>Develop from a single fertilized egg that partially separates, resulting in a shared <span class=\"customMeta\" data-dictid=\"167c22e3951692777184a6ad73e1a4\">chorion</span> (placental membrane) but separate <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> sacs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td> </td>\n<td>\n<ul>\n<li>Share the same placenta, which can lead to complications such as TTTS and selective <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> growth restriction (sIUGR), where one twin is significantly smaller than the other due to uneven blood flow.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>DCDA Twins</p>\n</td>\n<td>\n<p>Also known as Dichorionic-Diamniotic twins.</p>\n</td>\n<td>\n<ul>\n<li>Develop from two separate fertilized eggs (zygotes) that implant in the uterus, resulting in separate chorions (placental membranes) and separate <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> sacs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td> </td>\n<td>\n<ul>\n<li>Have their own individual placentas, reducing the risk of complications compared to <span class=\"customMeta\" data-dictid=\"36a0e5ef371692777192bd11b1b9bf\">monochorionic</span> twins.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td> </td>\n<td>\n<ul>\n<li>Can be either <span class=\"customMeta\" data-dictid=\"f1024f59d11692777186dbab3925cf\">dizygotic</span> (fraternal) or <span class=\"customMeta\" data-dictid=\"e7afab7b981692777192aca13178fa\">monozygotic</span> (identical) twins, depending on whether each egg was fertilized by a separate <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> or if a single fertilized egg split into two embryos, respectively.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>DMDA Twins</p>\n</td>\n<td>\n<p>Also known as Dizygotic-Diamniotic twins.</p>\n</td>\n<td>\n<ul>\n<li>Develop from two separate fertilized eggs (zygotes) that implant in the uterus, resulting in separate chorions (placental membranes) and separate <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> sacs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td> </td>\n<td>\n<ul>\n<li>Are <span class=\"customMeta\" data-dictid=\"f1024f59d11692777186dbab3925cf\">dizygotic</span> (fraternal) twins, meaning each twin has a unique set of genetic material and can be of different sexes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td> </td>\n<td>\n<ul>\n<li>Have their own individual placentas, reducing the risk of complications compared to <span class=\"customMeta\" data-dictid=\"36a0e5ef371692777192bd11b1b9bf\">monochorionic</span> twins.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the chromosomal pattern in complete mole?", "options": [{"label": "A", "text": "46 XY both maternal origin", "correct": false}, {"label": "B", "text": "46 XX both maternal origin", "correct": false}, {"label": "C", "text": "46 XX both paternal origin", "correct": true}, {"label": "D", "text": "46 YY both paternal origin", "correct": false}], "correct_answer": "C. 46 XX both paternal origin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C-46 XX both paternal orig\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete Mole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incomplete Mole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chromosomal Makeup</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Completely paternal chromosomes (46, XX or 46, XY).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal chromosomal makeup, often <span class=\"customMeta\" data-dictid=\"e2ea7e265716927772007f42ede4c0\">triploid</span> (69, XXX, 69, XXY, etc.).</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of failed medical management, which part of the fallopian tube is most likely to experience the earliest rupture of an ectopic sac?", "options": [{"label": "A", "text": "Interstitial", "correct": false}, {"label": "B", "text": "Isthmus", "correct": true}, {"label": "C", "text": "Ampulla", "correct": false}, {"label": "D", "text": "Infundibulum", "correct": false}], "correct_answer": "B. Isthmus", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Medical Management Options</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Methotrexate</p>\n</td>\n<td>\n<p>Methotrexate is a medication that stops the growth of rapidly dividing cells, including the developing embryo. It is administered as a single or multiple doses, either intramuscularly or directly into the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy under <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> guidance. Regular monitoring of <span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\">hCG</span> levels and follow-up is required.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Expectant Management</p>\n</td>\n<td>\n<p>Also known as \"watchful waiting,\" expectant management involves monitoring the patient's condition and allowing the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy to resolve naturally without intervention. This approach is suitable for cases with low <span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\">hCG</span> levels, no symptoms of rupture, and stable clinical condition. Regular monitoring and follow-up visits are necessary.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Combination Therapy</p>\n</td>\n<td>\n<p>Combination therapy involves administering both <span class=\"customMeta\" data-dictid=\"a98f8182f116927771927e607ba8c8\">methotrexate</span> and a medication called mifepristone. <span class=\"customMeta\" data-dictid=\"f9a7fe348e16927771921ce2ada3b2\">Mifepristone</span> acts by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> <span class=\"customMeta\" data-dictid=\"183d374ac91692777196c63c850299\">progesterone</span> receptors, further inhibiting the growth of the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy. This approach may be considered in certain cases, but its use is less common compared to <span class=\"customMeta\" data-dictid=\"a98f8182f116927771927e607ba8c8\">methotrexate</span> alone.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Repeated Doses of Methotrexate</p>\n</td>\n<td>\n<p>In some cases, multiple doses of <span class=\"customMeta\" data-dictid=\"a98f8182f116927771927e607ba8c8\">methotrexate</span> may be required if the <span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\">hCG</span> levels do not decrease adequately following the initial dose. Repeat doses are typically given at specified intervals, and monitoring of <span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\">hCG</span> levels and clinical symptoms is essential.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Surgical Intervention</p>\n</td>\n<td>\n<p>In certain situations, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention may be necessary, especially if medical management fails, the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy ruptures, or there are signs of significant <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> or <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> instability. <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> options include <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> <span class=\"customMeta\" data-dictid=\"61fda112f41692777198f6f3b8535f\">salpingostomy</span> or salpingectomy, which involve removing the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy or the affected <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient who is a 32-year-old female, experiencing her first pregnancy at full term, and has a previously diagnosed fibroid uterus, an elective cesarean section is being planned due to the baby being in a breech presentation. The patient expresses her desire to have the fibroid removed during the surgery. However, she has been informed about the potential drawbacks of undergoing myomectomy. Which of the following conditions is a reason to consider removing the fibroid in this patient?", "options": [{"label": "A", "text": "Pedunculated subserosal", "correct": true}, {"label": "B", "text": "In the broad ligament", "correct": false}, {"label": "C", "text": "Posterior in location", "correct": false}, {"label": "D", "text": "Small in size", "correct": false}], "correct_answer": "A. Pedunculated subserosal", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After 28 weeks of POG what is the primary source of amniotic fluid secretion ?", "options": [{"label": "A", "text": "Fetal skin", "correct": false}, {"label": "B", "text": "Fetal urine", "correct": true}, {"label": "C", "text": "Placental cell membrane", "correct": false}, {"label": "D", "text": "Plasma", "correct": false}], "correct_answer": "B. Fetal urine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent infections is frequently associated with infertility?", "options": [{"label": "A", "text": "Chlamydia", "correct": true}, {"label": "B", "text": "Trichomoniasis", "correct": false}, {"label": "C", "text": "Candidiasis", "correct": false}, {"label": "D", "text": "Bacterial vaginosis", "correct": false}], "correct_answer": "A. Chlamydia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A-Ch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What initial tests should be recommended to this couple, a 29-year-old woman who has been unable to conceive for 3 years, and her husband, who have been married for 4 years, live together, and are sexually active without using contraception? The woman's menstrual cycle occurs at regular 28-day intervals, and her husband is a professional cyclist.", "options": [{"label": "A", "text": "Semen analysis, CXR, Mantoux test", "correct": false}, {"label": "B", "text": "Semen analysis, Tubal patency test, Ovulation test", "correct": true}, {"label": "C", "text": "Ovulation, tubal patency, Mantoux test", "correct": false}, {"label": "D", "text": "Testicular biopsy, USG, Sperm penetration test", "correct": false}], "correct_answer": "B. Semen analysis, Tubal patency test, Ovulation test", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A G4P2 female presented with history of two abortions at 16 weeks and 20 weeks POG . Which of the following could be the most likely reason for these abortions?", "options": [{"label": "A", "text": "Chromosomal abnormality", "correct": false}, {"label": "B", "text": "Cervical incompetence", "correct": true}, {"label": "C", "text": "Placenta previa", "correct": false}, {"label": "D", "text": "Thyroid abnormality", "correct": false}], "correct_answer": "B. Cervical incompetence", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about endometriosis?", "options": [{"label": "A", "text": "Presence of endometrial gland in deep myometrium", "correct": false}, {"label": "B", "text": "Presence of endometrium at ectopic locations", "correct": true}, {"label": "C", "text": "Treated preferably with hysterectomy", "correct": false}, {"label": "D", "text": "Seen in multiparous women", "correct": false}], "correct_answer": "B. Presence of endometrium at ectopic locations", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rare sites</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ovaries</li>\n<li>Pelvic peritoneum</li>\n<li>Pouch of Douglas</li>\n<li>Uterosacral ligaments</li>\n<li>Rectovaginal septum</li>\n<li>Sigmoid colon</li>\n<li>Appendix</li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n<li>Fallopian tubes</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Umbilicus</li>\n<li>Abdominal scar</li>\n<li>Lungs</li>\n<li>Pleura</li>\n<li>Ureter</li>\n<li>Kidney</li>\n<li>Nasal mucosa</li>\n<li>Episiotomy scar</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable cause of infertility in a 29-year-old female who has a history of abdominal pain, dyspareunia, dysmenorrhea, and menorrhagia?", "options": [{"label": "A", "text": "Adenomyomatosis", "correct": false}, {"label": "B", "text": "Endometriosis", "correct": true}, {"label": "C", "text": "Myomas", "correct": false}, {"label": "D", "text": "Cervicitis", "correct": false}], "correct_answer": "B. Endometriosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32 year old pregnant woman presents with 36 weeks of gestation with complaints of pain abdomen and decreased fetal movements . On examination PR: 96/min, BP = 156/100 mm Hg, FHR = 128 bpm. On per-vagina examination there is altered blood seen and cervix is soft 1 cm dilated. What is the preferred management?", "options": [{"label": "A", "text": "Tocolytics", "correct": false}, {"label": "B", "text": "Induce labour", "correct": false}, {"label": "C", "text": "Immediate LSCS", "correct": true}, {"label": "D", "text": "Wait and watch", "correct": false}], "correct_answer": "C. Immediate LSCS", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable reason for a 30-year-old woman visiting a clinician due to abundant facial hair and hair growth on her upper back, arms, and thighs?", "options": [{"label": "A", "text": "Drug-induced", "correct": false}, {"label": "B", "text": "PCOS", "correct": true}, {"label": "C", "text": "Endometriosis", "correct": false}, {"label": "D", "text": "Adenomyosis", "correct": false}], "correct_answer": "B. PCOS", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B-PCOS\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the correct statement about the condition of a 52-year-old woman who visits a physician complaining of experiencing warm spells followed by excessive sweating, and has not had menstrual periods for the past 3 years?", "options": [{"label": "A", "text": "Increased FSH, increased estrogen", "correct": false}, {"label": "B", "text": "Decreased FSH, decreased estrogen", "correct": false}, {"label": "C", "text": "Decreased FSH, increased estrogen", "correct": false}, {"label": "D", "text": "Increased FSH, decreased estrogen", "correct": true}], "correct_answer": "D. Increased FSH, decreased estrogen", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primigravida presents at 9 weeks of amenorrhea with a positive pregnancy test. She complains of nausea and vomiting which gets better by evening. The doctor advices her folic acid and dietary modifications to help with her vomiting. He explains that the cause of such presentation is a hormone. The source of this hormone is?", "options": [{"label": "A", "text": "Yolk sac", "correct": false}, {"label": "B", "text": "Fetal Liver", "correct": false}, {"label": "C", "text": "Syncytiotrophoblast", "correct": true}, {"label": "D", "text": "Umbilical cord", "correct": false}], "correct_answer": "C. Syncytiotrophoblast", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Physiological Changes in Pregnancy</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cardiovascular System</p>\n</td>\n<td>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"b9b690b70c16927771833aae799b33\">blood volume</span> and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Elevated heart rate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Slight increase in blood pressure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Respiratory System</p>\n</td>\n<td>\n<ul>\n<li>Increased oxygen demand</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Altered lung capacity and function</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gastrointestinal System</p>\n</td>\n<td>\n<ul>\n<li>Hormonal changes affect <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> and absorption</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Slowed <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> motility</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Increased water <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> in the colon</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Elevated risk of <span class=\"customMeta\" data-dictid=\"281b8ef3701692777185aa34365916\">constipation</span> and hemorrhoids</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Renal System</p>\n</td>\n<td>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> size and blood flow</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Enhanced <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> rate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> production and frequency</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Potential water and <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> imbalances</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Musculoskeletal System</p>\n</td>\n<td>\n<ul>\n<li>Relaxation of ligaments and joints</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Shift in center of gravity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> lordosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Potential postural changes and discomfort</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Endocrine System</p>\n</td>\n<td>\n<ul>\n<li>Hormonal changes to support pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Increased levels of <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> and progesterone</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Maternal adaptations for <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> growth and development</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Integumentary System</p>\n</td>\n<td>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the skin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Potential changes in skin pigmentation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Stretching of the skin and development of stretch marks</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Changes in hair and nail growth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Immune System</p>\n</td>\n<td>\n<ul>\n<li>Altered <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> and tolerance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> to certain infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<ul>\n<li>Protection of the developing fetus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "True about pterygium:", "options": [{"label": "A", "text": "Inflammation of cornea", "correct": false}, {"label": "B", "text": "Fatty deposition of sclera", "correct": false}, {"label": "C", "text": "Conjunctival invasion making a flap over cornea", "correct": true}, {"label": "D", "text": "Dead epithelial debris accumulation", "correct": false}], "correct_answer": "C. Conjunctival invasion making a flap over cornea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - Conjunctival invasion making a &lt;span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\"&gt;flap&lt;/span&gt; ov\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For laser iridotomy which laser is used?", "options": [{"label": "A", "text": "Argon laser", "correct": false}, {"label": "B", "text": "Nd YAG laser", "correct": true}, {"label": "C", "text": "Excimer laser", "correct": false}, {"label": "D", "text": "Co2 Laser", "correct": false}], "correct_answer": "B. Nd YAG laser", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of laser</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Wavelength</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Effects produced</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Clinical applications</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Argon</p>\n</td>\n<td>\n<p>488 (Blue)</p>\n<p>514 (Green)</p>\n</td>\n<td>\n<p>Photocoagulation</p>\n</td>\n<td>\n<ul>\n<li>Iridoplasty</li>\n<li>Trabeculoplasty</li>\n<li>Pupillomydriasis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Krypton</p>\n</td>\n<td>\n<p>647</p>\n</td>\n<td>\n<p>Photocoagulation</p>\n</td>\n<td>\n<ul>\n<li>Retinal photocoagulation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Diode</p>\n</td>\n<td>\n<p>810</p>\n</td>\n<td>\n<p>Photocoagulation</p>\n</td>\n<td>\n<ul>\n<li>Retinal photocoagulation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>FD-YAG</p>\n</td>\n<td>\n<p>577 (Green)</p>\n</td>\n<td>\n<p>Photocoagulation</p>\n</td>\n<td>\n<ul>\n<li>Retinal photocoagulation</li>\n<li>Cyclophotocoagulation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>ND-YAG</p>\n</td>\n<td>\n<p>1064 (near infrared)</p>\n</td>\n<td>\n<p>Photo disruption</p>\n</td>\n<td>\n<ul>\n<li>Posterior capsulotomy</li>\n<li>Iridotomy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Excimer</p>\n</td>\n<td>\n<p>193 (Ultraviolet)</p>\n</td>\n<td>\n<p>Photoablation</p>\n</td>\n<td>\n<ul>\n<li>LASIK</li>\n<li>LASEK</li>\n<li>Photo-refractive <span class=\"customMeta\" data-dictid=\"8a6b591d1d16927771900a3c620d92\">keratectomy</span> (PRK)</li>\n<li>Photo-therapeutic <span class=\"customMeta\" data-dictid=\"8a6b591d1d16927771900a3c620d92\">keratectomy</span> (PTK)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Femtosecond</p>\n</td>\n<td>\n<p>1053 (Near-infrared)</p>\n</td>\n<td>\n<p>Photo disruption</p>\n</td>\n<td>\n<ul>\n<li>Femtosecond laser-assisted <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> surgery and <span class=\"customMeta\" data-dictid=\"95dc7047f41692777191f225afb261\">lamellar</span> and full-thickness corneal transplant</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In Dacryocystorhinostomy (DCR), the point of opening of the lacrimal sac is into:", "options": [{"label": "A", "text": "Inferior meatus", "correct": false}, {"label": "B", "text": "Middle meatus", "correct": true}, {"label": "C", "text": "Supreme meatus", "correct": false}, {"label": "D", "text": "Superior meatus", "correct": false}], "correct_answer": "B. Middle meatus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Middle meatu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn is hypermetropic by", "options": [{"label": "A", "text": "+ 2.5 D", "correct": true}, {"label": "B", "text": "+ 5 D", "correct": false}, {"label": "C", "text": "+ 10 D", "correct": false}, {"label": "D", "text": "+ 1 D", "correct": false}], "correct_answer": "A. + 2.5 D", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the origin of corneal endothelium ?", "options": [{"label": "A", "text": "Neuroectoderm", "correct": false}, {"label": "B", "text": "Neural crest cells", "correct": true}, {"label": "C", "text": "Mesoderm", "correct": false}, {"label": "D", "text": "Surface ectoderm", "correct": false}], "correct_answer": "B. Neural crest cells", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\"&gt;Neural&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"48528974ed1692777185cd29753db5\"&gt;crest&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is true regarding retinoscopy using a plane mirror?", "options": [{"label": "A", "text": "In hypermetropia the red glow moves in opposite direction", "correct": false}, {"label": "B", "text": "In myopia the red glow moves in same direction", "correct": false}, {"label": "C", "text": "In emmetropia the red glow moves in opposite direction", "correct": false}, {"label": "D", "text": "Done at 1 meter away from patient", "correct": true}], "correct_answer": "D. Done at 1 meter away from patient", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Rosette cataract is seen after?", "options": [{"label": "A", "text": "Blunt trauma to eye", "correct": true}, {"label": "B", "text": "Copper foreign body in eye", "correct": false}, {"label": "C", "text": "Penetrating injury to eye", "correct": false}, {"label": "D", "text": "Infection", "correct": false}], "correct_answer": "A. Blunt trauma to eye", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Blunt trau\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is true regarding a patient who has a history of falling on a symmetrical surface and presents with enophthalmos, diplopia on upward gaze, and loss of sensitivity over the cheek?", "options": [{"label": "A", "text": "Maxillary fracture", "correct": false}, {"label": "B", "text": "It is a blow out fracture", "correct": true}, {"label": "C", "text": "Zygomatic bone is most likely injured", "correct": false}, {"label": "D", "text": "Frontal bone fracture", "correct": false}], "correct_answer": "B. It is a blow out fracture", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - It is a blow out fractu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Blow out fracture can be due to?", "options": [{"label": "A", "text": "Tennis ball injury", "correct": true}, {"label": "B", "text": "Chisel and hammer injury", "correct": false}, {"label": "C", "text": "Sudden fall", "correct": false}, {"label": "D", "text": "Penetrating injury by knife", "correct": false}], "correct_answer": "A. Tennis ball injury", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Tennis ball inju\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which eye condition is commonly associated with sarcoidosis ?", "options": [{"label": "A", "text": "Cataract", "correct": false}, {"label": "B", "text": "Ectopia lentis", "correct": false}, {"label": "C", "text": "Anterior uveitis", "correct": true}, {"label": "D", "text": "Glaucoma", "correct": false}], "correct_answer": "C. Anterior uveitis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "To confirm the diagnosis, what additional investigation should be conducted for a child exhibiting symptoms of night blindness and delayed dark adaptation?", "options": [{"label": "A", "text": "Dark adaptometry", "correct": false}, {"label": "B", "text": "ERG", "correct": true}, {"label": "C", "text": "EOG", "correct": false}, {"label": "D", "text": "Retinoscopy", "correct": false}], "correct_answer": "B. ERG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - ERG\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Blount Disease results from the involvement of", "options": [{"label": "A", "text": "Proximal tibia", "correct": true}, {"label": "B", "text": "Distal tibia", "correct": false}, {"label": "C", "text": "Proximal femur", "correct": false}, {"label": "D", "text": "Distal femur", "correct": false}], "correct_answer": "A. Proximal tibia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Proximal T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which joints are affected in a condition where the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints are involved, while the metacarpophalangeal (MCP) joints and wrist are spared?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": true}, {"label": "B", "text": "Rheumatoid arthritis", "correct": false}, {"label": "C", "text": "Psoriasis", "correct": false}, {"label": "D", "text": "Hyperparathyroidism", "correct": false}], "correct_answer": "A. Osteoarthritis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Osteoarth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the medical condition of a tennis player who is able to repeatedly and independently reduce a shoulder dislocation?", "options": [{"label": "A", "text": "Acute shoulder dislocation", "correct": false}, {"label": "B", "text": "Recurrent shoulder dislocation", "correct": true}, {"label": "C", "text": "Inferior shoulder dislocation", "correct": false}, {"label": "D", "text": "Fracture upper end humerus", "correct": false}], "correct_answer": "B. Recurrent shoulder dislocation", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of Shoulder Dislocation</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anterior Dislocation</p>\n</td>\n<td>\n<p>The humeral head (upper arm bone) is displaced in front of the shoulder joint. <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> is the most common type, accounting for about 95% of all shoulder dislocations.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Posterior Dislocation</p>\n</td>\n<td>\n<p>The humeral head is displaced behind the shoulder joint. <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> is less common and often associated with high-energy trauma or seizures.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inferior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">Dislocation</span> (Luxatio Erecta)</p>\n</td>\n<td>\n<p>The humeral head is displaced downward below the shoulder joint, causing an unusual appearance where the arm is locked in an abducted position. It is a rare <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of shoulder dislocation.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Superior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">Dislocation</span> (Reverse Shoulder Dislocation)</p>\n</td>\n<td>\n<p>The humeral head is displaced upward above the shoulder joint, usually caused by a combination of forceful muscle contractions and a fall onto an outstretched hand. Superior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> is also rare.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Multidirectional <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">Instability</span> (MDI)</p>\n</td>\n<td>\n<p>MDI is a condition characterized by recurrent, <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> shoulder dislocations in multiple directions. It is often associated with shoulder <span class=\"customMeta\" data-dictid=\"6f158cd2c11692777191fbc6ef31ac\">laxity</span> and may require specialized treatment approaches.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Subluxation</p>\n</td>\n<td>\n<p>Subluxation refers to partial or incomplete dislocation, where the humeral head briefly slips out of the joint but returns to its normal position without requiring external intervention. It can cause pain and instability.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 year old man when presented with a gradual progressive swelling , was diagnosed with Adamantinoma. Which of the following bone is typically affected by this tumor?", "options": [{"label": "A", "text": "Radius", "correct": false}, {"label": "B", "text": "Humerus", "correct": false}, {"label": "C", "text": "Femur", "correct": false}, {"label": "D", "text": "Tibia", "correct": true}], "correct_answer": "D. Tibia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old woman comes to the emergency department after a road traffic accident. She was a non-restrained passenger in a car. She has pain in her neck and difficulty in neck movements. She has no associated neurological deficits. A neck collar is applied to protect the spinal cord. An X-ray of the neck is shown in the image below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hangman fracture", "correct": true}, {"label": "B", "text": "Jefferson's fracture", "correct": false}, {"label": "C", "text": "Clay shoveler fracture", "correct": false}, {"label": "D", "text": "Sciwora", "correct": false}], "correct_answer": "A. Hangman fracture", "question_images": ["https://image.prepladder.com/content/kXzG1LcPTb9786LDQaj01713874262.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Hangman Fractu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Albers Schonberg disease is:", "options": [{"label": "A", "text": "Paget", "correct": false}, {"label": "B", "text": "Osteogenesis imperfecta", "correct": false}, {"label": "C", "text": "Osteoporosis", "correct": false}, {"label": "D", "text": "Osteopetrosis", "correct": true}], "correct_answer": "D. Osteopetrosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 year old Volleyball player presents to your OPD with injury to thumb ,along with pain, swelling, and tenderness at the base of thumb. On examination the thumb is in the position of abduction. Which of the following is the diagnosis of the presenting condition?", "options": [{"label": "A", "text": "Game keepers thumb", "correct": true}, {"label": "B", "text": "Bowler's thumb", "correct": false}, {"label": "C", "text": "Kaplan injury", "correct": false}, {"label": "D", "text": "Mallet finger", "correct": false}], "correct_answer": "A. Game keepers thumb", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Game Keepers Thu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following fracture?", "options": [{"label": "A", "text": "Colles Fracture", "correct": false}, {"label": "B", "text": "Monteggia Fracture", "correct": true}, {"label": "C", "text": "Barton's Fracture", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Monteggia Fracture", "question_images": ["https://image.prepladder.com/content/Fq3unid4WmRilPLxBecu1713874332.png"], "explanation_images": ["https://image.prepladder.com/content/4b25O3dV08uYsM59CuAv1700128690.png", "https://image.prepladder.com/content/U3BLeFsm7KRyBdNCUqb81700128834.png"], "explanation": "<p>Correct Option B - Monteggia Fractu\n<table>\n<tbody>\n<tr>\n<td><strong>Definition</strong></td>\n<td>Monteggia <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> is a type of <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> involving a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> or middle third of the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> with <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head. It was first described by Giovanni Battista Monteggia.</td>\n</tr>\n<tr>\n<td><strong>Anatomy Involved</strong></td>\n<td>Fracture of the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> (usually the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> or middle third). - <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">Dislocation</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head.</td>\n</tr>\n<tr>\n<td><strong>Mechanism of Injury</strong></td>\n<td>Typically results from a direct blow to the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> or a fall on an outstretched hand. - Force is transmitted along the forearm, causing the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> and <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head dislocation.</td>\n</tr>\n<tr>\n<td><strong>Clinical Presentation</strong></td>\n<td><strong>Deformity:</strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the fractured <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> may be visible.- <strong>Pain:</strong> <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">Localized</span> pain at the site of the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> and dislocation. - <strong>Limited Range of Motion:</strong> Restricted <span class=\"customMeta\" data-dictid=\"d3daf86e63169277719936e262ff26\">supination</span> and <span class=\"customMeta\" data-dictid=\"189ee8a22a1692777196b04278555f\">pronation</span> of the forearm.</td>\n</tr>\n<tr>\n<td><strong>Classification</strong></td>\n<td><strong>Bado Classification:</strong> Classifies Monteggia Fractures based on the direction of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> and associated <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> pattern (Types I-IV).</td>\n</tr>\n<tr>\n<td><strong>Diagnostic Imaging</strong></td>\n<td>X-rays of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> and the dislocated <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head. - CT scans may be used for more detailed assessment.</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td><strong>Closed Reduction:</strong> Attempted for certain cases with early presentation and minimal displacement. - <strong>Open Reduction and Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">Fixation</span> (ORIF):</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention may be required for more complex fractures or cases not amenable to closed reduction.</td>\n</tr>\n<tr>\n<td><strong>Complications</strong></td>\n<td><strong>Malunion:</strong> Improper <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> of the fractured bones. - <strong>Nonunion:</strong> Failure of the fractured bones to heal. - <strong>Radial Nerve Injury:</strong> Possible nerve injury associated with the fracture.</td>\n</tr>\n<tr>\n<td><strong>Rehabilitation</strong></td>\n<td>Initiated post-surgery or after <span class=\"customMeta\" data-dictid=\"da014870171692777184980beab405\">closed reduction</span> to restore <span class=\"customMeta\" data-dictid=\"069cba94231692777197b41e753795\">range of motion</span> and strength. - Physical therapy is often a crucial component.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 79 yrs old lady had a fall in the bathroom, the following X-rays were taken in order to make a diagnosis . Which of the following is treatment of this condition?", "options": [{"label": "A", "text": "Hemiarthroplasty", "correct": true}, {"label": "B", "text": "Hip spica", "correct": false}, {"label": "C", "text": "Total Hip Replacement", "correct": false}, {"label": "D", "text": "Nailing", "correct": false}], "correct_answer": "A. Hemiarthroplasty", "question_images": ["https://image.prepladder.com/content/H9stkGvqCzIcl5EvY1OV1695620895.png", "https://image.prepladder.com/content/ZgdEdMpEZM3VMq1vPXGT1700226697.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Hemiarth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents to the orthopedic OPD with a limp and limb shortening . His X-ray is given below, What is the diagnosis?", "options": [{"label": "A", "text": "Perthes", "correct": false}, {"label": "B", "text": "SCFE", "correct": false}, {"label": "C", "text": "DDH", "correct": true}, {"label": "D", "text": "Fracture neck of femur", "correct": false}], "correct_answer": "C. DDH", "question_images": ["https://image.prepladder.com/content/58zrNUjYxwMptccR6pYf1695620955.png", "https://image.prepladder.com/content/hJFyEL82yu095NtjLQSP1695620967.png"], "explanation_images": [], "explanation": "<p>Correct Option C - DDH\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Condition</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Developmental <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">Dysplasia</span> of the Hip (DDH)</p>\n</td>\n<td>\n<p>Abnormal development of the <span class=\"customMeta\" data-dictid=\"c28d031bd31692777189aa73411316\">hip joint</span> causing <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> or dislocation. It can result in a shortened leg and a limp.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Legg-Calvé-Perthes Disease</p>\n</td>\n<td>\n<p>Avascular <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head, leading to <span class=\"customMeta\" data-dictid=\"c28d031bd31692777189aa73411316\">hip joint</span> damage, limp, and leg length discrepancy.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Slipped Capital <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">Femoral</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">Epiphysis</span> (SCFE)</p>\n</td>\n<td>\n<p>Displacement of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head from the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck, leading to a <span class=\"customMeta\" data-dictid=\"9fcdd5799c1692777191a2f2f38d56\">limp</span> and limb shortening. More common in adolescents.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Septic Arthritis</p>\n</td>\n<td>\n<p>Infection of the joint, causing pain, swelling, decreased range of motion, and limping.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Juvenile <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">Idiopathic</span> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (JIA)</p>\n</td>\n<td>\n<p>Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the joints, including the hip joint, resulting in pain, stiffness, and limping.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Osteomyelitis</p>\n</td>\n<td>\n<p>Infection of the bone, which can lead to limping, <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pain, swelling, and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Periosteal Reaction</p>\n</td>\n<td>\n<p>A response of the <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> to various conditions, such as trauma or infection, causing pain, swelling, and sometimes limb shortening.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Leg Length Discrepancy</p>\n</td>\n<td>\n<p>A difference in leg length, which can result from various causes, including <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies or previous fractures.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Fractures</p>\n</td>\n<td>\n<p>Fractures of the hip, femur, or other bones can cause limping and limb shortening.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Ectopia lentis is seen in?", "options": [{"label": "A", "text": "Homocystinuria", "correct": true}, {"label": "B", "text": "Refsum's disease", "correct": false}, {"label": "C", "text": "Wilson's disease", "correct": false}, {"label": "D", "text": "Sarcoidosis", "correct": false}], "correct_answer": "A. Homocystinuria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A -Homocystinu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most characteristic feature of diabetic nephropathy, which is shown below, is?", "options": [{"label": "A", "text": "Kimmelstiel Wilson nodules", "correct": true}, {"label": "B", "text": "Armanni Ebstein change", "correct": false}, {"label": "C", "text": "Aschoff nodule", "correct": false}, {"label": "D", "text": "Anitschkow cell", "correct": false}], "correct_answer": "A. Kimmelstiel Wilson nodules", "question_images": ["https://image.prepladder.com/content/FYFcYlnwhsfzNCql3rRW1713769281.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Kimmelstiel Wilson Nodu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Stellate granuloma is found in:", "options": [{"label": "A", "text": "Cat scratch disease", "correct": true}, {"label": "B", "text": "Leprosy", "correct": false}, {"label": "C", "text": "Coccidomycosis", "correct": false}, {"label": "D", "text": "Histoplasmosis", "correct": false}], "correct_answer": "A. Cat scratch disease", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Xenograft is:", "options": [{"label": "A", "text": "Graft across species", "correct": true}, {"label": "B", "text": "Graft from same species", "correct": false}, {"label": "C", "text": "Graft from same individual", "correct": false}, {"label": "D", "text": "Graft from same organ", "correct": false}], "correct_answer": "A. Graft across species", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\"&gt;Graft&lt;/span&gt; across species:</p>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Graft types</strong></td>\n<td style=\"text-align:center\"><strong>Description</strong></td>\n<td style=\"text-align:center\"><strong>Examples</strong></td>\n</tr>\n<tr>\n<td>Autograft</td>\n<td>Transfer of tissue from one site to another in the same individual</td>\n<td>Skin grafts from one site to another on the same individual</td>\n</tr>\n<tr>\n<td>Allograft</td>\n<td>Transfer of tissue between genetically non-identical individuals of the same species</td>\n<td>Kidney transplant from a living or deceased donor</td>\n</tr>\n<tr>\n<td>Isograft</td>\n<td>Transfer of tissue between genetically identical individuals (e.g., identical twins)</td>\n<td>Organ transplant between <span class=\"customMeta\" data-dictid=\"e7afab7b981692777192aca13178fa\">monozygotic</span> twins</td>\n</tr>\n<tr>\n<td>Xenograft</td>\n<td>Transfer of tissue between different species</td>\n<td>Pig <span class=\"customMeta\" data-dictid=\"efba33a3fd1692777189906f884236\">heart valve</span> transplant in a human</td>\n</tr>\n</tbody>\n\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td><strong>Graft types</strong></td>\n<td><strong>Description</strong></td>\n<td><strong>Examples</strong></td>\n</tr>\n<tr>\n<td>Autograft</td>\n<td>Transfer of tissue from one site to another in the same individual</td>\n<td>Skin grafts from one site to another on the same individual</td>\n</tr>\n<tr>\n<td>Allograft</td>\n<td>Transfer of tissue between genetically non-identical individuals of the same species</td>\n<td>Kidney transplant from a living or deceased donor</td>\n</tr>\n<tr>\n<td>Isograft</td>\n<td>Transfer of tissue between genetically identical individuals (e.g., identical twins)</td>\n<td>Organ transplant between <span class=\"customMeta\" data-dictid=\"e7afab7b981692777192aca13178fa\">monozygotic</span> twins</td>\n</tr>\n<tr>\n<td>Xenograft</td>\n<td>Transfer of tissue between different species</td>\n<td>Pig <span class=\"customMeta\" data-dictid=\"efba33a3fd1692777189906f884236\">heart valve</span> transplant in a human</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most abundant glycoprotein in basement membranes?", "options": [{"label": "A", "text": "Fibronectin", "correct": false}, {"label": "B", "text": "Laminin", "correct": true}, {"label": "C", "text": "Integrin", "correct": false}, {"label": "D", "text": "Syndecan", "correct": false}], "correct_answer": "B. Laminin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about anaplasia?", "options": [{"label": "A", "text": "Loss of cohesion between cells", "correct": false}, {"label": "B", "text": "Loss of differentiation", "correct": true}, {"label": "C", "text": "Change of epithelium type", "correct": false}, {"label": "D", "text": "Benign and fully reversible", "correct": false}], "correct_answer": "B. Loss of differentiation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HAV5tgfo4mYTpcyoGQrh1749369197.mp3", "video": ""}, {"text": "Which of the following histopathological findings is not seen 12 hours after an ischemic injury to the heart?", "options": [{"label": "A", "text": "Karyorrhexis of myocytes", "correct": false}, {"label": "B", "text": "Neocapillary invasion of myocytes", "correct": false}, {"label": "C", "text": "Hyper-eosinophilia of myocytes", "correct": true}, {"label": "D", "text": "Coagulation necrosis of myocytes", "correct": false}], "correct_answer": "C. Hyper-eosinophilia of myocytes", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kTTl3QpVM5uGgf3CWU9d1712146077.png", "https://image.prepladder.com/content/i56IuCsxDNmRNd8XpiQO1712145973.png"], "explanation": "<p>Correct Option C - Hyper-eosinoph\n<table>\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Timings of death</strong></td>\n<td style=\"text-align:center\"><strong>Gross morphology</strong></td>\n<td style=\"text-align:center\"><strong>Light <span class=\"customMeta\" data-dictid=\"51df8cdfc91692777192aa76f4de51\">microscopy</span> </strong></td>\n<td style=\"text-align:center\"><strong>Electron microscopy</strong></td>\n</tr>\n<tr>\n<td>Reversible cell injury (20 to 40 minutes)</td>\n<td style=\"text-align:center\">-</td>\n<td style=\"text-align:center\">-</td>\n<td>\n<ul>\n<li>Relaxation of myofibrils</li>\n<li>Mitochondrial swelling</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Irreversible cell injury (30 minutes to 4 hours)</p>\n</td>\n<td style=\"text-align:center\">-</td>\n<td>\n<ul>\n<li>Vacuolation of cells</li>\n<li>Waviness of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> fibres</li>\n</ul>\n<p><img src=\"https://image.prepladder.com/content/kTTl3QpVM5uGgf3CWU9d1712146077.png\"/></p>\n</td>\n<td>\n<ul>\n<li>Amorphous densities (calcium in mitochondria)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>4 to 12 hours</td>\n<td>Occasional dark mottling</td>\n<td>Coagulative necrosis</td>\n<td style=\"text-align:center\">-</td>\n</tr>\n<tr>\n<td>12 to 24 hours</td>\n<td>Dark mottling</td>\n<td>\n<ul>\n<li>Coagulative necrosis</li>\n<li>Neutrophils</li>\n<li>Contraction band necrosis</li>\n</ul>\n</td>\n<td> </td>\n</tr>\n<tr>\n<td>1 to 3 days</td>\n<td>-</td>\n<td>Neutrophils (acute inflammation)</td>\n<td>-</td>\n</tr>\n<tr>\n<td>3 to 7 days</td>\n<td style=\"text-align:center\">-</td>\n<td>Macrophages (chronic inflammation)</td>\n<td style=\"text-align:center\">-</td>\n</tr>\n<tr>\n<td>7 to 10 days</td>\n<td style=\"text-align:center\">-</td>\n<td>\n<p>Early <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue</p>\n<p><img src=\"https://image.prepladder.com/content/i56IuCsxDNmRNd8XpiQO1712145973.png\"/></p>\n</td>\n<td style=\"text-align:center\">-</td>\n</tr>\n<tr>\n<td>10 to 14 days</td>\n<td style=\"text-align:center\">-</td>\n<td>\n<ul>\n<li>Granulation tissue</li>\n<li>Early collagen</li>\n</ul>\n</td>\n<td style=\"text-align:center\">-</td>\n</tr>\n<tr>\n<td>2 weeks to 2 months</td>\n<td style=\"text-align:center\">-</td>\n<td>High collagen</td>\n<td style=\"text-align:center\">-</td>\n</tr>\n<tr>\n<td>&gt;2 months</td>\n<td style=\"text-align:center\">-</td>\n<td>Scar formation</td>\n<td style=\"text-align:center\">-</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the type of cell in the body that has the ability to give rise to the highest number of other cells?", "options": [{"label": "A", "text": "Totipotent", "correct": true}, {"label": "B", "text": "Multipotent", "correct": false}, {"label": "C", "text": "Pluripotent", "correct": false}, {"label": "D", "text": "Lineage stem cells", "correct": false}], "correct_answer": "A. Totipotent", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diseases has an X-linked recessive pattern of inheritance?", "options": [{"label": "A", "text": "Hurler syndrome", "correct": false}, {"label": "B", "text": "Thalassemia", "correct": false}, {"label": "C", "text": "Hereditary spherocytosis", "correct": false}, {"label": "D", "text": "G6PD deficiency", "correct": true}], "correct_answer": "D. G6PD deficiency", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"96985248371692777188cfb38ca861\"&gt;G6PD&lt;/span&gt; D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3L9kOuLRWfnKtYqy1dY51748415368.mp3", "video": ""}, {"text": "With which pattern of disease inheritance is consanguinity associated?", "options": [{"label": "A", "text": "Autosomal recessive", "correct": true}, {"label": "B", "text": "Autosomal dominant", "correct": false}, {"label": "C", "text": "X-linked recessive", "correct": false}, {"label": "D", "text": "X-linked dominant", "correct": false}], "correct_answer": "A. Autosomal recessive", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yoiQXPA0H4T86YudPiP31713266416.png"], "explanation": "<p>Correct Option A - Autosomal Recessiv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1mhiPqE16epkTizOyzFj1748415732.mp3", "video": ""}, {"text": "In the context of Goodpasture syndrome, which organ is affected?", "options": [{"label": "A", "text": "Liver", "correct": false}, {"label": "B", "text": "Adrenals", "correct": false}, {"label": "C", "text": "Kidney", "correct": true}, {"label": "D", "text": "Brain", "correct": false}], "correct_answer": "C. Kidney", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism for healing in the case of a 57-year-old male with a gradually developing swelling over the scalp region, pus discharge, and pain?", "options": [{"label": "A", "text": "Granuloma formation", "correct": false}, {"label": "B", "text": "Scab formation", "correct": false}, {"label": "C", "text": "Granulation tissue", "correct": true}, {"label": "D", "text": "Neovascularization", "correct": false}], "correct_answer": "C. Granulation tissue", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 47-year-old male active smoker with a known case of bronchial asthma now presents with difficulty breathing, with the breath sounds being audible externally. Which of the following is not a feature you will expect to find in this patient?", "options": [{"label": "A", "text": "Thickening of bronchial wall", "correct": false}, {"label": "B", "text": "Increase in number of airway goblet cells", "correct": false}, {"label": "C", "text": "Fibroblastic foci", "correct": true}, {"label": "D", "text": "Sub-basement membrane fibrosis", "correct": false}], "correct_answer": "C. Fibroblastic foci", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"99d12f6d811692777202e87cc63267\"&gt;Fibroblastic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a type-2 hypersensitivity reaction?", "options": [{"label": "A", "text": "Chronic kidney rejection", "correct": false}, {"label": "B", "text": "Autoimmune hemolytic anaemia", "correct": true}, {"label": "C", "text": "Arthus reaction", "correct": false}, {"label": "D", "text": "Mantoux test", "correct": false}], "correct_answer": "B. Autoimmune hemolytic anaemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\"&gt;Autoimmune&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\"&gt;hemolytic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Acute graft rejection occurs within?", "options": [{"label": "A", "text": "Seconds to minutes", "correct": false}, {"label": "B", "text": "Days to weeks", "correct": false}, {"label": "C", "text": "Weeks to months", "correct": true}, {"label": "D", "text": "Months to years", "correct": false}], "correct_answer": "C. Weeks to months", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vDTxvxd344wn9KgkGsPT1698301883.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In iron deficiency anemia, all of the following are reduced , except :", "options": [{"label": "A", "text": "Total iron binding capacity", "correct": true}, {"label": "B", "text": "Percentage saturation of transferrin", "correct": false}, {"label": "C", "text": "Hemoglobin level", "correct": false}, {"label": "D", "text": "Serum ferritin", "correct": false}], "correct_answer": "A. Total iron binding capacity", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Total iron binding capacity:</p>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"text-align:center\"><strong>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia</strong></td>\n</tr>\n<tr>\n<td>Serum iron</td>\n<td style=\"text-align:center\">↓</td>\n</tr>\n<tr>\n<td>Total iron binding capacity</td>\n<td style=\"text-align:center\">↑</td>\n</tr>\n<tr>\n<td>Transferrin saturation</td>\n<td style=\"text-align:center\">↓</td>\n</tr>\n<tr>\n<td>Serum ferritin</td>\n<td style=\"text-align:center\">↓</td>\n</tr>\n<tr>\n<td>Soluble <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> receptor</td>\n<td style=\"text-align:center\">↑</td>\n</tr>\n<tr>\n<td>Serum <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> protoporphyrin</td>\n<td style=\"text-align:center\">↑</td>\n</tr>\n</tbody>\n\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"text-align:center\"><strong>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia</strong></td>\n</tr>\n<tr>\n<td>Serum iron</td>\n<td style=\"text-align:center\">↓</td>\n</tr>\n<tr>\n<td>Total iron binding capacity</td>\n<td style=\"text-align:center\">↑</td>\n</tr>\n<tr>\n<td>Transferrin saturation</td>\n<td style=\"text-align:center\">↓</td>\n</tr>\n<tr>\n<td>Serum ferritin</td>\n<td style=\"text-align:center\">↓</td>\n</tr>\n<tr>\n<td>Soluble <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> receptor</td>\n<td style=\"text-align:center\">↑</td>\n</tr>\n<tr>\n<td>Serum <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> protoporphyrin</td>\n<td style=\"text-align:center\">↑</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male comes to the outdoor patient department with complaints of episodic headaches, palpitations, and sweating . On physical examination, his chest shows pectus excavatum and a high extremities-to-body ratio . Growth is seen on her tongue, and a mass on the left flank is also palpated. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "MEN 1", "correct": false}, {"label": "B", "text": "MEN 2A", "correct": false}, {"label": "C", "text": "MEN 2B", "correct": true}, {"label": "D", "text": "Neurofibromatosis type 2", "correct": false}], "correct_answer": "C. MEN 2B", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\"&gt;MEN&lt;/span&gt; 2B\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>MEN 1</strong></td>\n<td><strong>MEN 2A</strong></td>\n<td><strong>MEN 2B</strong></td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Mode of inheritance</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Autosomal dominant inheritance</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Autosomal dominant inheritance</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Autosomal dominant inheritance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Associated gene mutations</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>MEN1 gene mutation</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>RET gene mutation</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>RET gene mutation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Endocrine tumors</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Parathyroid adenoma</li>\n<li>Pancreatic <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> tumors</li>\n<li>Pituitary tumors</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</li>\n<li>Pheochromocytoma</li>\n<li>Parathyroid hyperplasia</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</li>\n<li>Pheochromocytoma</li>\n<li>Marfanoid habitus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pheochromocytoma produces all, except:", "options": [{"label": "A", "text": "Nor-epinephrine", "correct": false}, {"label": "B", "text": "Secretin", "correct": true}, {"label": "C", "text": "Vasoactive intestinal polypeptide", "correct": false}, {"label": "D", "text": "Somatostatin", "correct": false}], "correct_answer": "B. Secretin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Urea cycle occurs in which part of the cell?", "options": [{"label": "A", "text": "Mitochondria", "correct": false}, {"label": "B", "text": "Cytoplasm", "correct": false}, {"label": "C", "text": "Both", "correct": true}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "C. Both", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a start codon?", "options": [{"label": "A", "text": "UAA", "correct": false}, {"label": "B", "text": "UAG", "correct": false}, {"label": "C", "text": "UGA", "correct": false}, {"label": "D", "text": "AUG", "correct": true}], "correct_answer": "D. AUG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Codon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amino Acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AUG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Methionine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Start codon, initiates translation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>UAA, UAG, UGA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stop codons, signal the end of translation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>UGG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tryptophan</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Encodes the <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid tryptophan</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>UUA, UUG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leucine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Encode the <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid leucine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>UUU, UUC</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phenylalanine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Encode the <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid phenylalanine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GGC, GGA, GGG, GGU</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glycine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Encode the <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid glycine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CUC, CUU, CUA, CUG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leucine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Encode the <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid leucine</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Melanin is synthesized from which of the following?", "options": [{"label": "A", "text": "Tyrosine", "correct": true}, {"label": "B", "text": "Tryptophan", "correct": false}, {"label": "C", "text": "Phenyl alanine", "correct": false}, {"label": "D", "text": "Threonine", "correct": false}], "correct_answer": "A. Tyrosine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following aids in the process of wound healing?", "options": [{"label": "A", "text": "Keratan sulfate", "correct": false}, {"label": "B", "text": "Dermatan sulfate", "correct": false}, {"label": "C", "text": "Hyaluronic acid", "correct": true}, {"label": "D", "text": "Chondroitin sulfate", "correct": false}], "correct_answer": "C. Hyaluronic acid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does NOT inhibit oxidative phosphorylation?", "options": [{"label": "A", "text": "CO", "correct": false}, {"label": "B", "text": "Antimycin A", "correct": false}, {"label": "C", "text": "Malonate", "correct": false}, {"label": "D", "text": "Thermogenin", "correct": true}], "correct_answer": "D. Thermogenin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the role of zinc in the treatment of diarrhea?", "options": [{"label": "A", "text": "Reduces the risk, duration and severity of diarrheal episodes", "correct": false}, {"label": "B", "text": "Enhances immune response", "correct": false}, {"label": "C", "text": "Regulates intestinal transport &amp;amp; absorption of water and electrolytes", "correct": false}, {"label": "D", "text": "All", "correct": true}], "correct_answer": "D. All", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the optimal approach for treating a patient who is hemodynamically stable, has a broad QRS complex on their ECG, and is experiencing antidromic tachycardia?", "options": [{"label": "A", "text": "Oral verapamil", "correct": false}, {"label": "B", "text": "Oral Beta-blocker", "correct": false}, {"label": "C", "text": "Cardioversion", "correct": false}, {"label": "D", "text": "Intravenous Procainamide", "correct": true}], "correct_answer": "D. Intravenous Procainamide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an incorrect procedure when dealing with W.P.W?", "options": [{"label": "A", "text": "Treadmill test", "correct": true}, {"label": "B", "text": "Electrophysiological studies", "correct": false}, {"label": "C", "text": "Oral beta blocker", "correct": false}, {"label": "D", "text": "Procainamide", "correct": false}], "correct_answer": "A. Treadmill test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the following conditions is rescue percutaneous coronary intervention (PCI) performed?", "options": [{"label": "A", "text": "Persistent chest pain with ST elevation &amp;gt; 60 min after thrombolysis", "correct": false}, {"label": "B", "text": "Persistent chest pain with ST elevation &amp;gt; 30 min after thrombolysis", "correct": false}, {"label": "C", "text": "Persistent chest persistent chest pain with ST elevation &amp;gt; 90 min after thrombolysis", "correct": true}, {"label": "D", "text": "Pain with ST elevation for &amp;gt; 120 min after thrombolysis", "correct": false}], "correct_answer": "C. Persistent chest persistent chest pain with ST elevation &gt; 90 min after thrombolysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is cardio protective?", "options": [{"label": "A", "text": "HDL", "correct": true}, {"label": "B", "text": "LDL", "correct": false}, {"label": "C", "text": "IDL", "correct": false}, {"label": "D", "text": "VLDL", "correct": false}], "correct_answer": "A. HDL", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the effects on the fetus when Indomethacin is used in the uterus during the third trimester?", "options": [{"label": "A", "text": "Patent ductus arteriosus", "correct": false}, {"label": "B", "text": "Early closure of ductus arteriosus", "correct": true}, {"label": "C", "text": "Ventricular septal defect", "correct": false}, {"label": "D", "text": "Atrial septal defect", "correct": false}], "correct_answer": "B. Early closure of ductus arteriosus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Teratogenic Drug</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Effects on Fetus</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Thalidomide</p>\n</td>\n<td>\n<p>Limb abnormalities (e.g., phocomelia)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Isotretinoin</p>\n</td>\n<td>\n<p>Craniofacial abnormalities, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> defects</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Warfarin</p>\n</td>\n<td>\n<p>Central nervous system abnormalities</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>ACE inhibitors</p>\n</td>\n<td>\n<p>Renal damage, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> growth restriction</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Methotrexate</p>\n</td>\n<td>\n<p>Neural tube defects, limb abnormalities</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Valproic acid</p>\n</td>\n<td>\n<p>Neural tube defects, cognitive impairments</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lithium</p>\n</td>\n<td>\n<p>Cardiac malformations, developmental delays</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Carbamazepine</p>\n</td>\n<td>\n<p>Neural tube defects, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> abnormalities</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Misoprostol</p>\n</td>\n<td>\n<p>Uterine abnormalities, limb defects</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Alcohol</p>\n</td>\n<td>\n<p>Fetal alcohol syndrome, developmental delays</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Continuous murmur is heard in?", "options": [{"label": "A", "text": "Patent ductus arteriosus", "correct": true}, {"label": "B", "text": "VSD", "correct": false}, {"label": "C", "text": "ASD", "correct": false}, {"label": "D", "text": "Tetralogy of Fallout", "correct": false}], "correct_answer": "A. Patent ductus arteriosus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: Patent &lt;span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\"&gt;ductus&lt;/span&gt; arteriosus (PDA)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the reason behind the stability of adenosine receptors, which is attributed to the formation of numerous disulfide bonds between?", "options": [{"label": "A", "text": "Cysteine", "correct": true}, {"label": "B", "text": "Methionine", "correct": false}, {"label": "C", "text": "Arginine", "correct": false}, {"label": "D", "text": "Alanine", "correct": false}], "correct_answer": "A. Cysteine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common immediate complication following a splenectomy?", "options": [{"label": "A", "text": "Hemorrhage", "correct": true}, {"label": "B", "text": "Fistula", "correct": false}, {"label": "C", "text": "Bleeding from gastric mucosa", "correct": false}, {"label": "D", "text": "Pancreatitis", "correct": false}], "correct_answer": "A. Hemorrhage", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Hemorrhag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Steps of PCR in sequence are?", "options": [{"label": "A", "text": "Extend DNA, anneal primers, Denture DNA", "correct": false}, {"label": "B", "text": "Anneal primers, extend DNA, Denature DNA", "correct": false}, {"label": "C", "text": "Denature DNA, anneal primers, Extends DNA", "correct": true}, {"label": "D", "text": "Denature DNA, Extend DNA, Anneal primers", "correct": false}], "correct_answer": "C. Denature DNA, anneal primers, Extends DNA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In fever of unknown origin, blood sample should be drawn how many times?", "options": [{"label": "A", "text": "2", "correct": false}, {"label": "B", "text": "3", "correct": true}, {"label": "C", "text": "4", "correct": false}, {"label": "D", "text": "5", "correct": false}], "correct_answer": "B. 3", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following has low glycemic index?", "options": [{"label": "A", "text": "Easily digestible", "correct": false}, {"label": "B", "text": "Increases plasma glucose", "correct": false}, {"label": "C", "text": "Has slower absorption", "correct": true}, {"label": "D", "text": "Increase glycogen deposits", "correct": false}], "correct_answer": "C. Has slower absorption", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - H\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Food Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Glycemic Index (GI)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White Bread</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>70</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Brown Rice</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>50</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Watermelon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>72</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sweet Potato</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>70</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oatmeal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>55</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White Potato</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>85</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carrots</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>35</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Apples</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>39</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bananas</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>62</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chickpeas</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>33</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Whole Wheat Bread</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>69</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lentils</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>29</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oranges</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>40</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Milk (whole)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>27</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pineapple</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>59</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In what situations is surgery contraindicated for patients with Ulcerative Colitis?", "options": [{"label": "A", "text": "Crohn’s disease", "correct": true}, {"label": "B", "text": "Dysplasia", "correct": false}, {"label": "C", "text": "Toxic megacolon", "correct": false}, {"label": "D", "text": "Colonic bleeding", "correct": false}], "correct_answer": "A. Crohn’s disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Crohn’\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mainstay of treatment of glue ear?", "options": [{"label": "A", "text": "Radical Mastoidectomy", "correct": false}, {"label": "B", "text": "Myringotomy + aeration to middle ear", "correct": true}, {"label": "C", "text": "Temporal bone resection", "correct": false}, {"label": "D", "text": "Tonsillectomy &amp;amp; adenoidectomy", "correct": false}], "correct_answer": "B. Myringotomy + aeration to middle ear", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"43046dc2c016927771930d2538e6d6\"&gt;Myringotomy&lt;/span&gt; + &lt;span class=\"customMeta\" data-dictid=\"ec8505f749169277718070157610a9\"&gt;aeration&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please match the appropriate answers related to cardiac abnormalities and their corresponding syndromes. 1) Noonan syndrome (A) PDA 2) Downs syndrome (B) Bicuspid aortic valve 3) Turner syndrome (C) Endocardial cushion defects 4) Congenital Rubella Syndrome (D) Pulmonary stenosis", "options": [{"label": "A", "text": "1-(A), 2-(B), 3-(C), 4-(D)", "correct": false}, {"label": "B", "text": "1-(D), 2-(C), 3-(B), 4-(A)", "correct": true}, {"label": "C", "text": "1-(D), 2-(B), 3-(C), 4-(A)", "correct": false}, {"label": "D", "text": "1-(A), 2-(C), 3-(B), 4-(D)", "correct": false}], "correct_answer": "B. 1-(D), 2-(C), 3-(B), 4-(A)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B- 1-(D), 2-(C), 3-(B), 4-(A):</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital syndromes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac abnormalities</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Noonan syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulmonary stenosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Down syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocardial <span class=\"customMeta\" data-dictid=\"f4ac509de71692777185c1d0700a8b\">cushion</span> defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Turner syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bicuspid aortic valve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PDA</strong></p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital syndromes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiac abnormalities</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Noonan syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary stenosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> is a narrowing of the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> valve, leading to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> from the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> to the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Down syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endocardial <span class=\"customMeta\" data-dictid=\"f4ac509de71692777185c1d0700a8b\">cushion</span> defects</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endocardial <span class=\"customMeta\" data-dictid=\"f4ac509de71692777185c1d0700a8b\">cushion</span> defects involve abnormalities in the formation of the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> and valves of the heart, leading to a common <span class=\"customMeta\" data-dictid=\"d77b211e3a1692777182121ece27fc\">atrioventricular</span> <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> defect</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Turner syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bicuspid aortic valve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"9461b5b89b16927771839fb979168f\">bicuspid</span> <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> is a <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> where the <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> has two leaflets instead of the normal three.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PDA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PDA is a condition where a <span class=\"customMeta\" data-dictid=\"72c06d2cc71692777183b1cbaf5bae\">blood vessel</span> called the <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus, which connects the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> to the <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> during <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development, remains open after birth</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options accurately describes the development of cancer in patients with ulcerative colitis?", "options": [{"label": "A", "text": "Bad prognosis if it involved only rectum", "correct": false}, {"label": "B", "text": "Good prognosis if it involves only rectum and is low grade", "correct": false}, {"label": "C", "text": "2% chance of malignancy if present for 10 years", "correct": true}, {"label": "D", "text": "Young age onset has low chances as compared to old age onset", "correct": false}], "correct_answer": "C. 2% chance of malignancy if present for 10 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 2% chance of &lt;span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\"&gt;malignancy&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis of a patient who has a two-day history of fever, with a neck swelling and displacement of one tonsil towards the midline upon examination?", "options": [{"label": "A", "text": "Quinsy", "correct": false}, {"label": "B", "text": "Parapharyngeal abscess", "correct": true}, {"label": "C", "text": "Retropharyngeal abscess", "correct": false}, {"label": "D", "text": "Tonsillitis", "correct": false}], "correct_answer": "B. Parapharyngeal abscess", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Condition</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Common Symptoms</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Quinsy (Peritonsillar Abscess)</p>\n</td>\n<td>\n<p>Collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> between the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> and surrounding tissues</p>\n</td>\n<td>\n<p>Severe throat pain, difficulty swallowing, \"hot potato\" voice</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Parapharyngeal Abscess</p>\n</td>\n<td>\n<p>Infection in the space behind the <span class=\"customMeta\" data-dictid=\"2f64b606f6169277720080acdb1d3d\">tonsil</span> and next to the pharynx</p>\n</td>\n<td>\n<p>Neck swelling, <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of tonsil, possible difficulty swallowing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Retropharyngeal Abscess</p>\n</td>\n<td>\n<p>Infection in the space behind the <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">pharynx</span> and in front of the <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> vertebrae</p>\n</td>\n<td>\n<p>Neck pain, difficulty swallowing, stiff neck</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tonsillitis</p>\n</td>\n<td>\n<p>Inflammation of the tonsils</p>\n</td>\n<td>\n<p>Sore throat, difficulty swallowing, fever</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient with necrotizing fascitis was admitted to the ER. The patient was tachycardic and hypotensive. He was treated for septic shock. Which of the following is the characteristic feature of refractory septic shock?", "options": [{"label": "A", "text": "Shock persisting &amp;gt; 1 hour after IVF administration", "correct": false}, {"label": "B", "text": "Shock persisting &amp;gt; 1 hour after IVF administration and high dose vasopressors", "correct": true}, {"label": "C", "text": "Shock that is refractory to medical treatment", "correct": false}, {"label": "D", "text": "Shock that does not improve despite treatment for 24 hours", "correct": false}], "correct_answer": "B. Shock persisting &gt; 1 hour after IVF administration and high dose vasopressors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Shock persisting &amp;gt; 1 hour after &lt;span class=\"customMeta\" data-dictid=\"cf23a56e0916927771903ba7e75f72\"&gt;IVF&lt;/span&gt; administration and high-dose v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Continuous murmur is heard in:", "options": [{"label": "A", "text": "Patent ductus arteriosus", "correct": true}, {"label": "B", "text": "Ventricular septal defect", "correct": false}, {"label": "C", "text": "Atrial septal defect", "correct": false}, {"label": "D", "text": "Tetralogy of fallot", "correct": false}], "correct_answer": "A. Patent ductus arteriosus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Patent &lt;span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\"&gt;ductus&lt;/span&gt; arteriosu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed symptom of nasopharyngeal carcinoma?", "options": [{"label": "A", "text": "Airway obstruction", "correct": false}, {"label": "B", "text": "Headache", "correct": false}, {"label": "C", "text": "Neck swelling", "correct": true}, {"label": "D", "text": "Epistaxis", "correct": false}], "correct_answer": "C. Neck swelling", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Neck swelling\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the waist to hip ratio that is associated with an increased risk of heart disease?", "options": [{"label": "A", "text": "&amp;gt; 0.80 in males", "correct": false}, {"label": "B", "text": "&amp;gt; 0.80 in females", "correct": false}, {"label": "C", "text": "&amp;gt; 0.85 in males", "correct": false}, {"label": "D", "text": "&amp;gt; 0.85 in females", "correct": true}], "correct_answer": "D. &gt; 0.85 in females", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>NYHA Class</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Class I</p>\n</td>\n<td>\n<p>No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or shortness of breath.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Class II</p>\n</td>\n<td>\n<p>Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or shortness of breath.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Class III</p>\n</td>\n<td>\n<p>Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or shortness of breath.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Class IV</p>\n</td>\n<td>\n<p>Unable to carry on any physical activity without discomfort. Symptoms of <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> are present at rest, and any physical activity worsens them.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Menke's disease is a metabolic defect in the process of:", "options": [{"label": "A", "text": "Zinc", "correct": false}, {"label": "B", "text": "Copper", "correct": true}, {"label": "C", "text": "Selenium", "correct": false}, {"label": "D", "text": "Iron", "correct": false}], "correct_answer": "B. Copper", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Picket fence fever is a feature of which of the following in", "options": [{"label": "A", "text": "Lateral sinus thrombophlebitis", "correct": true}, {"label": "B", "text": "Quincy", "correct": false}, {"label": "C", "text": "Laryngitis sicca", "correct": false}, {"label": "D", "text": "Croup", "correct": false}], "correct_answer": "A. Lateral sinus thrombophlebitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\"&gt;Lateral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\"&gt;sinus&lt;/span&gt; thromboph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pellagra like rash is seen in:", "options": [{"label": "A", "text": "Gaucher disease", "correct": false}, {"label": "B", "text": "Alkaptonuria", "correct": false}, {"label": "C", "text": "Hartnup disease", "correct": true}, {"label": "D", "text": "Phenylketonuria", "correct": false}], "correct_answer": "C. Hartnup disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C: Hartnu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the treatment for neutropenia following chemotherapy?", "options": [{"label": "A", "text": "Leucovorin", "correct": false}, {"label": "B", "text": "Filgastrim", "correct": true}, {"label": "C", "text": "Ondansetron", "correct": false}, {"label": "D", "text": "Darbepoetin", "correct": false}], "correct_answer": "B. Filgastrim", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Filg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Why is cold water not used for syringing?", "options": [{"label": "A", "text": "Cold water leads to wax impaction", "correct": false}, {"label": "B", "text": "Cold water leads to foreign body impaction", "correct": false}, {"label": "C", "text": "Can cause tympanic membrane rupture", "correct": false}, {"label": "D", "text": "It causes vertigo by caloric stimulation", "correct": true}], "correct_answer": "D. It causes vertigo by caloric stimulation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - It causes &lt;span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\"&gt;vertigo&lt;/span&gt; by &lt;span class=\"customMeta\" data-dictid=\"39156a37b21692777183372a301aa8\"&gt;caloric&lt;/span&gt; stimu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pediatric patient arrives at the hospital complaining of several abnormal fractures, and the X-ray shows the image shown below. The blood tests indicate low levels of phosphorus and calcium, normal levels of Vitamin D, and increased levels of PTH. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Osteopetrosis", "correct": true}, {"label": "B", "text": "Osteomalacia", "correct": false}, {"label": "C", "text": "Osteosclerosis", "correct": false}, {"label": "D", "text": "Histiocytosis X", "correct": false}], "correct_answer": "A. Osteopetrosis", "question_images": ["https://image.prepladder.com/content/QQwfkQwUF2Ig8ddmbCxM1691478751.png"], "explanation_images": [], "explanation": "<p>Correct option A - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old, male with hypertension develops sudden onset weakness on the right side of the face &amp;amp; arm. His attender recalls history of headache, blurred vision in the patient which leads to the suspicion of increased ICP. Which is the most common cranial nerve involved in raised ICP?", "options": [{"label": "A", "text": "Abducens nerve", "correct": true}, {"label": "B", "text": "Facial nerve", "correct": false}, {"label": "C", "text": "Trigeminal nerve", "correct": false}, {"label": "D", "text": "Facial nerve", "correct": false}], "correct_answer": "A. Abducens nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"493415137f1692777180adce8b5447\"&gt;Abducens&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a manifestation of congenital syphilis ?", "options": [{"label": "A", "text": "Gumma", "correct": true}, {"label": "B", "text": "Hutchinson's teeth", "correct": false}, {"label": "C", "text": "Olympian brow", "correct": false}, {"label": "D", "text": "Interstitial keratitis", "correct": false}], "correct_answer": "A. Gumma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7MUV5sNSq32hWdEhh1R01714039109.jpeg"], "explanation": "<p>Correct Option A - Gu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "From the first pharyngeal arch, which muscle originates among the options provided?", "options": [{"label": "A", "text": "Stapedius muscle", "correct": false}, {"label": "B", "text": "Anterior belly of digastric muscle", "correct": true}, {"label": "C", "text": "Posterior belly of digastric muscle", "correct": false}, {"label": "D", "text": "Stylopharyngeus", "correct": false}], "correct_answer": "B. Anterior belly of digastric muscle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B- Anterior belly of &lt;span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\"&gt;digastric&lt;/span&gt; mu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pharyngeal Arch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structures Derived</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First Pharyngeal Arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscles of <span class=\"customMeta\" data-dictid=\"7beec9567a1692777191ec123e0989\">Mastication</span> (Masseter, Temporalis, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Pterygoids)</li>\n<li>Anterior Belly of <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">Digastric</span> Muscle</li>\n<li>Mylohyoid Muscle</li>\n<li>Tensor Tympani Muscle</li>\n<li>Tensor Veli Palatini Muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Second Pharyngeal Arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> Expression</li>\n<li>Stylohyoid Muscle</li>\n<li>Posterior Belly of <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">Digastric</span> Muscle</li>\n<li>Stapedius Muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Third Pharyngeal Arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stylopharyngeus Muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fourth and Sixth Pharyngeal Arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscles of the <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">Pharynx</span> (except Stylopharyngeus)</li>\n<li>Muscles of the Larynx</li>\n<li>Cricothyroid Muscle</li>\n<li>Levator Veli Palatini Muscle</li>\n<li>Constrictors of the <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">Pharynx</span> (Superior, Middle, and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Constrictors)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Rinku devi, a 26 years old female, labourer by occupation presented to you with complains of pain abdomen, nausea and restlessness since 4 hours . She gives h/o 2 episodes of hematuria. USG showed a 3×3 cm stone in Right renal pelvis . There is no evidence of hydronephrosis . Which of following is the best procedure for management of this patient?", "options": [{"label": "A", "text": "ESWL", "correct": false}, {"label": "B", "text": "PCNL", "correct": true}, {"label": "C", "text": "Antegrade Pyeloplasty", "correct": false}, {"label": "D", "text": "Retrograde pyeloplasty", "correct": false}], "correct_answer": "B. PCNL", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - PCNL\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which chromosome is affected in Hunter disease, leading to an abnormality?", "options": [{"label": "A", "text": "X chromosome", "correct": true}, {"label": "B", "text": "Y chromosome", "correct": false}, {"label": "C", "text": "Chromosome 21", "correct": false}, {"label": "D", "text": "Chromosome 22", "correct": false}], "correct_answer": "A. X chromosome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - X ch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does a dip at 4000Hz indicate in pure tone audiometry?", "options": [{"label": "A", "text": "Otosclerosis", "correct": false}, {"label": "B", "text": "Meniere's disease", "correct": false}, {"label": "C", "text": "Noise induced hearing loss", "correct": true}, {"label": "D", "text": "Age related hearing loss", "correct": false}], "correct_answer": "C. Noise induced hearing loss", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Noise &lt;span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\"&gt;induced&lt;/span&gt; hearing\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A new vaccine which was launched in 2018 in Thailand with the name CYD-TDV . In which of the following condition it is used?", "options": [{"label": "A", "text": "Dengue", "correct": true}, {"label": "B", "text": "Malaria", "correct": false}, {"label": "C", "text": "Yellow fever", "correct": false}, {"label": "D", "text": "Japanese encephalitis", "correct": false}], "correct_answer": "A. Dengue", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Dengu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Intellectual disability is seen in:", "options": [{"label": "A", "text": "Phenylketonuria", "correct": true}, {"label": "B", "text": "Alkaptonuria", "correct": false}, {"label": "C", "text": "Albinism", "correct": false}, {"label": "D", "text": "Von Gierke disease", "correct": false}], "correct_answer": "A. Phenylketonuria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Phenylketonu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle is responsible for the spasm causing trismus in parapharyngeal abscess?", "options": [{"label": "A", "text": "Medial pterygoid", "correct": true}, {"label": "B", "text": "Lateral pterygoid", "correct": false}, {"label": "C", "text": "Masseter", "correct": false}, {"label": "D", "text": "Temporalis", "correct": false}], "correct_answer": "A. Medial pterygoid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male who had a history of domestic animal bite has come for a follow-up post 90 days after receiving rabies post-exposure prophylaxis. Now what will you use for rapid diagnosis of rabies in this case?", "options": [{"label": "A", "text": "Skin biopsy with fluorescent antibody testing", "correct": true}, {"label": "B", "text": "Rabies virus specific antibodies", "correct": false}, {"label": "C", "text": "Inoculation in mice", "correct": false}, {"label": "D", "text": "Corneal impression smear", "correct": false}], "correct_answer": "A. Skin biopsy with fluorescent antibody testing", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Skin &lt;span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\"&gt;Biopsy&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"df068e6efc16927772029693b5023e\"&gt;Fluorescent&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\"&gt;Antibody&lt;/span&gt; Testing\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In parotid gland surgery, which of the subsequent structures serves as a reference point for the facial nerve?", "options": [{"label": "A", "text": "Tragal pointer", "correct": true}, {"label": "B", "text": "Posterior border of mylohyoid", "correct": false}, {"label": "C", "text": "Tip of helix", "correct": false}, {"label": "D", "text": "Styloid process", "correct": false}], "correct_answer": "A. Tragal pointer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"473c9d41411692777200a97f44dd69\"&gt;Tragal&lt;/span&g\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Facial Nerve</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Landmark in <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">Parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">Gland</span> Surgery</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Facial Nerve</p>\n</td>\n<td>\n<p>- Emerges from <span class=\"customMeta\" data-dictid=\"10a9865a511692777199f3007e4f54\">stylomastoid</span> <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> - Courses through the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> gland</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Landmark 1</p>\n</td>\n<td>\n<p>Tragal <span class=\"customMeta\" data-dictid=\"12f1ba6f0f16927771964563dc0c2d\">pointer</span> (small <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> at the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> margin of the <span class=\"customMeta\" data-dictid=\"e8a77282b816927772006578f87e08\">tragus</span> of the ear)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Landmark 2</p>\n</td>\n<td>\n<p>Retromandibular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> (used to locate the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve branches)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Landmark 3</p>\n</td>\n<td>\n<p>Anterior border of the <span class=\"customMeta\" data-dictid=\"ebf38dd1b416927771994e550b0d1e\">sternocleidomastoid</span> muscle (used to guide the <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Landmark 4</p>\n</td>\n<td>\n<p>Transverse <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (crosses the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and aids in identifying the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a 10-year-old child who is brought to the clinic with developmental delay and extrapyramidal symptoms and is found to have a lens dislocation towards the inferonasal area during further examination?", "options": [{"label": "A", "text": "Marfan syndrome", "correct": false}, {"label": "B", "text": "Homocystinuria", "correct": true}, {"label": "C", "text": "Alkaptonuria", "correct": false}, {"label": "D", "text": "Wilson disease", "correct": false}], "correct_answer": "B. Homocystinuria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Homocystinu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most likely diagnosis in case of continuous watery discharge from the nose following a trauma?", "options": [{"label": "A", "text": "CSF otorrhea", "correct": false}, {"label": "B", "text": "Common colds", "correct": false}, {"label": "C", "text": "CSF rhinorrhea", "correct": true}, {"label": "D", "text": "Anterior epistaxis", "correct": false}], "correct_answer": "C. CSF rhinorrhea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\"&gt;CSF&lt;/span&gt; rhinorrh\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Option</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated with Continuous Watery <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">Discharge</span> from Nose after Trauma?</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A. <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> otorrhea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leakage of <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid from the ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B. Common colds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Viral infection causing <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and runny nose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C. <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> rhinorrhea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leakage of <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid from the nose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>D. <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> epistaxis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nosebleeds from the front part of the nose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">No</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Common neurological tumour in NF-2?", "options": [{"label": "A", "text": "Vestibular Schwannoma", "correct": true}, {"label": "B", "text": "Optic glioma", "correct": false}, {"label": "C", "text": "Café-Au-Lait macules", "correct": false}, {"label": "D", "text": "Neurofibrosarcoma", "correct": false}], "correct_answer": "A. Vestibular Schwannoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Vestibular Sch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the potential diagnosis for a 6-year-old child who exhibits hepatosplenomegaly, generalized lymphadenopathy, fever, and develops a rash following the administration of ampicillin ?", "options": [{"label": "A", "text": "Infectious mononucleosis", "correct": true}, {"label": "B", "text": "Scarlet fever", "correct": false}, {"label": "C", "text": "Kawasaki disease", "correct": false}, {"label": "D", "text": "HIV infection", "correct": false}], "correct_answer": "A. Infectious mononucleosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\"&gt;Infectious&lt;/span&gt; mononu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended method for preventing meningococcal meningitis during pregnancy?", "options": [{"label": "A", "text": "Ceftriaxone", "correct": true}, {"label": "B", "text": "Rifampicin", "correct": false}, {"label": "C", "text": "Ciprofloxacin", "correct": false}, {"label": "D", "text": "Penicillin G", "correct": false}], "correct_answer": "A. Ceftriaxone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the subsequent options does not represent a premalignant lesion or condition?", "options": [{"label": "A", "text": "Chronic hypertrophic candidiasis", "correct": true}, {"label": "B", "text": "Oral submucosal fibrosis", "correct": false}, {"label": "C", "text": "Lichen planus", "correct": false}, {"label": "D", "text": "Leukoplakia", "correct": false}], "correct_answer": "A. Chronic hypertrophic candidiasis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Premalignant Lesion/Condition</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Associated Risk of Cancer</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Chronic hypertrophic candidiasis</p>\n</td>\n<td>\n<p>Fungal infection caused by <span class=\"customMeta\" data-dictid=\"f54d5c5cf11692777183318f259e5f\">Candida</span> species</p>\n</td>\n<td>\n<p>Not considered premalignant</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oral <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> fibrosis</p>\n</td>\n<td>\n<p>Chronic condition with <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> bands in the oral cavity</p>\n</td>\n<td>\n<p>Increased risk of oral <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lichen planus</p>\n</td>\n<td>\n<p>Autoimmune condition affecting skin and oral mucosa</p>\n</td>\n<td>\n<p>Associated with increased risk of oral <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in some cases</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Leukoplakia</p>\n</td>\n<td>\n<p>White or gray patches on <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes, including oral mucosa</p>\n</td>\n<td>\n<p>Considered a <span class=\"customMeta\" data-dictid=\"feb5b6aaeb16927771964c9d7c801c\">premalignant</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with potential for oral cancer development</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "AFP is a tumour marker for which of the following?", "options": [{"label": "A", "text": "Hepatocellular carcinoma", "correct": true}, {"label": "B", "text": "Renal cell carcinoma", "correct": false}, {"label": "C", "text": "Oncocytoma", "correct": false}, {"label": "D", "text": "Chordoma", "correct": false}], "correct_answer": "A. Hepatocellular carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Hepatocellu\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Carcinoma/Cancer</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Associated Tumor Marker</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hepatocellular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (HCC)</p>\n</td>\n<td>\n<p>Alpha-fetoprotein (AFP)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Colorectal carcinoma</p>\n</td>\n<td>\n<p>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (CEA)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pancreatic carcinoma</p>\n</td>\n<td>\n<p>Carbohydrate <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> 19-9 (CA 19-9)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ovarian carcinoma</p>\n</td>\n<td>\n<p>Cancer <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> 125 (CA 125)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Breast carcinoma</p>\n</td>\n<td>\n<p>Estrogen <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> (ER), <span class=\"customMeta\" data-dictid=\"183d374ac91692777196c63c850299\">Progesterone</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> (PR), Human <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> growth factor <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> 2 (HER2/neu)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Prostate carcinoma</p>\n</td>\n<td>\n<p>Prostate-specific <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (PSA)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lung carcinoma</p>\n</td>\n<td>\n<p>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (CEA), <span class=\"customMeta\" data-dictid=\"bc3875332b1692777185e2c8163a73\">Cytokeratin</span> 19 fragment (CYFRA 21-1), Neuron-specific <span class=\"customMeta\" data-dictid=\"92417be2b316927771877be984d041\">enolase</span> (NSE)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Testicular carcinoma</p>\n</td>\n<td>\n<p>Alpha-fetoprotein (AFP), Human <span class=\"customMeta\" data-dictid=\"6d72527c991692777184af095c6f14\">chorionic gonadotropin</span> (hCG), <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> (LDH)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Thyroid carcinoma</p>\n</td>\n<td>\n<p>Thyroglobulin, Calcitonin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Bladder carcinoma</p>\n</td>\n<td>\n<p>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (CEA), <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> tumor <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (BTA), Nuclear <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> protein 22 (NMP22)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Neuroendocrine tumors</p>\n</td>\n<td>\n<p>Chromogranin A, Synaptophysin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following muscles is not innervated by the hypoglossal nerve?", "options": [{"label": "A", "text": "Palatoglossus", "correct": true}, {"label": "B", "text": "Styloglossus", "correct": false}, {"label": "C", "text": "Genioglossus", "correct": false}, {"label": "D", "text": "Hyoglossus", "correct": false}], "correct_answer": "A. Palatoglossus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Muscle</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Nerve Supply</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Genioglossus</p>\n</td>\n<td>\n<p>Hypoglossal nerve (CN XII)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hyoglossus</p>\n</td>\n<td>\n<p>Hypoglossal nerve (CN XII)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Styloglossus</p>\n</td>\n<td>\n<p>Hypoglossal nerve (CN XII)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Palatoglossus</p>\n</td>\n<td>\n<p>Vagus nerve (CN X)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In an eye camp, doctors try to make people aware of the causes of blindness. Vitamin A is the leading cause of preventable childhood blindness. A parent brings her 18-month-old child to the doctor for a routine eye check-up. The doctor notices a thinned-out cornea, and from old records, it was seen that the child also has iron-deficiency anemia. If the weight of the child is 10kg, what should be the dose of vitamin A to be given in this case if the doctor marks it as keratomalacia?", "options": [{"label": "A", "text": "50,000 IU", "correct": false}, {"label": "B", "text": "1,00,000 IU", "correct": false}, {"label": "C", "text": "2,00,000 IU", "correct": true}, {"label": "D", "text": "5,00,000 IU", "correct": false}], "correct_answer": "C. 2,00,000 IU", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C: 2,00,000 IU\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>&lt; 6 months</strong></td>\n<td><strong>6 months - 1 year</strong></td>\n<td><strong>&gt; 1 year</strong></td>\n</tr>\n<tr>\n<td><strong>Day 0</strong></td>\n<td>50,000 IU</td>\n<td>1,00,000 IU</td>\n<td>2,00,000 IU</td>\n</tr>\n<tr>\n<td><strong>Day 1</strong></td>\n<td>50,000 IU</td>\n<td>1,00,000 IU</td>\n<td>2,00,000 IU</td>\n</tr>\n<tr>\n<td><strong>Day 2</strong></td>\n<td>50,000 IU</td>\n<td>1,00,000 IU</td>\n<td>2,00,000 IU</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is considered a post-hepatic cause of portal hypertension?", "options": [{"label": "A", "text": "Budd Chiari syndrome", "correct": true}, {"label": "B", "text": "Banti disease", "correct": false}, {"label": "C", "text": "Portal vein thrombosis", "correct": false}, {"label": "D", "text": "Schistosomiasis", "correct": false}], "correct_answer": "A. Budd Chiari syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Budd Ch\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pre-Hepatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hepatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Post-Hepatic</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Portal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Splenic <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Banti syndrome (massive splenomegaly)\n\t\t\t\t<ul>\n<li>Idiopathic and more common in Japan</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pre-sinusoidal\n\t\t\t\t<ul>\n<li>Schistosomiasis</li>\n</ul>\n</li>\n<li>Sinusoidal\n\t\t\t\t<ul>\n<li>Cirrhosis</li>\n</ul>\n</li>\n<li>Post sinusoidal\n\t\t\t\t<ul>\n<li>Veno <span class=\"customMeta\" data-dictid=\"3cd09dcb0e1692777194e41a18d184\">occlusive</span> disease</li>\n<li>Radiation, <span class=\"customMeta\" data-dictid=\"040570886616927771884f5b87b36c\">Herbal</span> tea</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Budd Chiari Syndrome</li>\n<li>Inferior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> webs</li>\n<li>Restrictive cardio myopathy</li>\n<li>Constrictive <span class=\"customMeta\" data-dictid=\"607e653eef1692777195e56becea2c\">pericarditis</span> (compliance will reduced)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes a patient who is unable to smell coffee but can smell ammonia after experiencing head trauma?", "options": [{"label": "A", "text": "Ammonia is used for testing olfactory nerve", "correct": false}, {"label": "B", "text": "The olfaction system is not damaged", "correct": false}, {"label": "C", "text": "Ammonia irritates trigeminal nerve", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. Ammonia irritates trigeminal nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Ammonia irritates the &lt;span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\"&gt;trigeminal&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended preventive dosage of Oseltamivir for infants ?", "options": [{"label": "A", "text": "1 mg/kg/day", "correct": false}, {"label": "B", "text": "3 mg/kg/day", "correct": true}, {"label": "C", "text": "5 mg/kg/day", "correct": false}, {"label": "D", "text": "7 mg/kg/day", "correct": false}], "correct_answer": "B. 3 mg/kg/day", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 3 mg/kg\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dose</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infants</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3mg/kg/dose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>˂ 15 kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30 mg/dose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-23 kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>45 mg/dose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>24-40 kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>60 mg/dose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;40 kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>75 mg/dose</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pheochromocytoma is associated in production of all of the below except.", "options": [{"label": "A", "text": "Epinephrine", "correct": false}, {"label": "B", "text": "Norepinephrine", "correct": false}, {"label": "C", "text": "Cortisol", "correct": true}, {"label": "D", "text": "Dopamine", "correct": false}], "correct_answer": "C. Cortisol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle among the options provided functions as an accessory muscle in the process of mastication?", "options": [{"label": "A", "text": "Buccinator", "correct": true}, {"label": "B", "text": "Masseter", "correct": false}, {"label": "C", "text": "Medial pterygoid", "correct": false}, {"label": "D", "text": "Lateral pterygoid", "correct": false}], "correct_answer": "A. Buccinator", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Muscle</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Actions</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Buccinator</p>\n</td>\n<td>\n<p>Compresses cheeks, assists in chewing and swallowing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Palatoglossus</p>\n</td>\n<td>\n<p>Elevates the back of the tongue, assists in swallowing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mylohyoid</p>\n</td>\n<td>\n<p>Elevates the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone and floor of the mouth, assists in swallowing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anterior belly of the digastric</p>\n</td>\n<td>\n<p>Depresses the mandible, elevates the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cut off for diagnosis of Priapism is ?", "options": [{"label": "A", "text": "1 hour", "correct": false}, {"label": "B", "text": "2 hours", "correct": false}, {"label": "C", "text": "3 hours", "correct": false}, {"label": "D", "text": "4 hours", "correct": true}], "correct_answer": "D. 4 hours", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 4 hou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A term neonate was born to a G2P1 mother, and initial measures were done by your senior resident, and he asked you a question: A newborn loses maximum heat from?", "options": [{"label": "A", "text": "Head", "correct": true}, {"label": "B", "text": "Abdomen", "correct": false}, {"label": "C", "text": "Palms and soles", "correct": false}, {"label": "D", "text": "Neck", "correct": false}], "correct_answer": "A. Head", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Glucose is reabsorbed in which part?", "options": [{"label": "A", "text": "Proximal convoluted tubule", "correct": true}, {"label": "B", "text": "Proximal straight tubule", "correct": false}, {"label": "C", "text": "Collecting duct", "correct": false}, {"label": "D", "text": "Distal convoluted tubule", "correct": false}], "correct_answer": "A. Proximal convoluted tubule", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\"&gt;Proximal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\"&gt;convoluted&lt;/span&gt; tubule:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tubular Segment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glucose <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">Reabsorption</span> (%)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Luminal <span class=\"customMeta\" data-dictid=\"850b296dd316927772005b651f6e87\">Transporter</span> (Lumen to cytoplasm)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Basolateral <span class=\"customMeta\" data-dictid=\"850b296dd316927772005b651f6e87\">Transporter</span> (Cytoplasm to blood)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">Convoluted</span> Tubules (PCT)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>90%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SGLT <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">type II</span> (Secondary active Transporter)</p>\n<ul>\n<li>1 molecule of sodium and 1 molecule of <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> from the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> to the cell.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GLUT-2 (Facilitated <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> transporter)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal Straight Tubules (PST)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SGLT <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> (Secondary active Transporter)</p>\n<ul>\n<li>2 molecules of sodium and 1 molecule of <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> from the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> to the cell.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GLUT-1 (Facilitated <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> transporter)</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate next step in the evaluation of a 6-year-old patient who has been experiencing fever for the past 3 days and complains of pain in the right upper abdomen , and upon examination, tenderness is observed in the right upper quadrant ?", "options": [{"label": "A", "text": "USG", "correct": true}, {"label": "B", "text": "Serology", "correct": false}, {"label": "C", "text": "LFT", "correct": false}, {"label": "D", "text": "CT abdomen", "correct": false}], "correct_answer": "A. USG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - USG (Ultrasonography)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended daily dose of iodine for a child?", "options": [{"label": "A", "text": "120-200 μg", "correct": false}, {"label": "B", "text": "90-120 μg", "correct": true}, {"label": "C", "text": "30-60 μg", "correct": false}, {"label": "D", "text": "500 μg", "correct": false}], "correct_answer": "B. 90-120 μg", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B: 90-120 μg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following symptoms is absent in Horner syndrome?", "options": [{"label": "A", "text": "Mydriasis", "correct": true}, {"label": "B", "text": "Ptosis", "correct": false}, {"label": "C", "text": "Anhidrosis", "correct": false}, {"label": "D", "text": "Enophthalmos", "correct": false}], "correct_answer": "A. Mydriasis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female comes to the OPD for well-care visits. The patient is completely well and eats a balanced diet . She never smokes or drinks alcohol and has no significant past medical history . On examination, her vitals are normal. The patient tells the physician that next week she will go on a trip to an island and is worried about motion sickness . Which of the following drugs may be considered first-line therapy for this patient's prophylaxis of motion sickness?", "options": [{"label": "A", "text": "Promethazine", "correct": true}, {"label": "B", "text": "Ondansetron", "correct": false}, {"label": "C", "text": "Metoclopramide", "correct": false}, {"label": "D", "text": "Domperidone", "correct": false}], "correct_answer": "A. Promethazine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Prometh\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Anti-Emetic</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Conditions </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Promethazine</strong></p>\n</td>\n<td>\n<p>Motion sickness, <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (PONV), chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (CINV), vertigo</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Ondansetron</strong></p>\n</td>\n<td>\n<p>Chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (CINV), <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (PONV), radiation-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting, gastroenteritis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Metoclopramide</strong></p>\n</td>\n<td>\n<p>Gastroparesis, chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (CINV), <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (PONV), <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease (GERD)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Domperidone</strong></p>\n</td>\n<td>\n<p>Gastroparesis, <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (PONV), GERD</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Prochlorperazine</strong></p>\n</td>\n<td>\n<p>Chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (CINV), <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (PONV), vertigo, migraine-associated <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Dimenhydrinate</strong></p>\n</td>\n<td>\n<p>Motion sickness, vertigo, <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> disorders</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Scopolamine</strong></p>\n</td>\n<td>\n<p>Motion sickness, <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (PONV)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Aprepitant</strong></p>\n</td>\n<td>\n<p>Chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (CINV)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Dexamethasone</strong></p>\n</td>\n<td>\n<p>Chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (CINV), <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (PONV), <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> severe <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not correct about Defibrillation?", "options": [{"label": "A", "text": "Only be used by a trained person", "correct": false}, {"label": "B", "text": "Decrease in success rate with delay in initiation", "correct": false}, {"label": "C", "text": "Improve prognosis", "correct": false}, {"label": "D", "text": "1 minute gap between 2 shocks", "correct": true}], "correct_answer": "D. 1 minute gap between 2 shocks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Exenatide, a recently introduced medication, is employed for the treatment of diabetes mellitus. The drug's mode of action is characterized by:", "options": [{"label": "A", "text": "Inhibition of DPP- 4", "correct": false}, {"label": "B", "text": "Release of insulin via acting as agonist of GLP-1 receptors", "correct": true}, {"label": "C", "text": "Inhibiting intestinal absorption of carbohydrates", "correct": false}, {"label": "D", "text": "Stimulation of PPAR-gamma", "correct": false}], "correct_answer": "B. Release of insulin via acting as agonist of GLP-1 receptors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the compound that prostaglandin, indicated for multiple conditions, is derived from?", "options": [{"label": "A", "text": "Stearic acid", "correct": false}, {"label": "B", "text": "Arachidonic acid", "correct": true}, {"label": "C", "text": "Linoleic acid", "correct": false}, {"label": "D", "text": "Linolenic acid", "correct": false}], "correct_answer": "B. Arachidonic acid", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug should not be administered to a pregnant woman?", "options": [{"label": "A", "text": "Erythromycin", "correct": false}, {"label": "B", "text": "Amoxicillin", "correct": false}, {"label": "C", "text": "Ceftriaxone", "correct": false}, {"label": "D", "text": "Streptomycin", "correct": true}], "correct_answer": "D. Streptomycin", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Drug</strong></p>\n</td>\n<td>\n<p><strong>Contraindication/Considerations during Pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Accutane (Isotretinoin)</p>\n</td>\n<td>\n<p>Known to cause severe birth defects and should be avoided</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>ACE inhibitors</p>\n</td>\n<td>They can cause serious <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> complications, including <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> dysplasia, oligohydramnios, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypoplasia, and even <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> death</td>\n</tr>\n<tr>\n<td>\n<p>Angiotensin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> blockers (ARBs)</p>\n</td>\n<td>\n<p>S/E include <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> dysfunction, oligohydramnios, and skeletal abnormalities</p>\n<p>They are particularly risky during the second and third trimesters.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Warfarin</p>\n</td>\n<td>\n<p>Can cross the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> and cause <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and abnormalities</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Methotrexate</p>\n</td>\n<td>\n<p>Teratogenic and should be avoided</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tetracyclines</p>\n</td>\n<td>\n<p>Can affect <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> bone and <span class=\"customMeta\" data-dictid=\"17dfb015d2169277720023db8fe9e5\">teeth</span> development and should be avoided</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>NSAIDs</p>\n</td>\n<td>\n<p>May increase the risk of complications during pregnancy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Paroxetine (SSRI)</p>\n</td>\n<td>\n<p>Increased risk of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heart defects</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Valproic acid</p>\n</td>\n<td>\n<p>Increased risk of birth defects, developmental delays, and more</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Thalidomide</p>\n</td>\n<td>\n<p>Known to cause severe birth defects and should be avoided</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mediastinal surface of the right lung is related to? A. The Azygos vein B. The Right Lymphatic Duct C. The Aorta D. The Trachea", "options": [{"label": "A", "text": "A only", "correct": true}, {"label": "B", "text": "B &amp;amp; D only", "correct": false}, {"label": "C", "text": "C only", "correct": false}, {"label": "D", "text": "A &amp;amp; D only", "correct": false}], "correct_answer": "A. A only", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Landmark</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Azygos Vein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Major <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> that drains blood from the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> wall into the superior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> cava.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Right <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">Lymphatic</span> Duct</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphatic vessel that drains <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> from the upper right <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aorta</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The largest <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> in the body that carries oxygenated blood from the heart to the <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> circulation. While it is located in the mediastinum, it is positioned more towards the left side rather than the <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> surface of the right lung.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trachea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tube-like structure that connects the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (voice box) to the bronchi. It runs down the midline of the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> cavity, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to the <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> surface of both lungs. While it is located near the <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> surface of the right lung, it is not directly related to it.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sternum is attached to scapula via?", "options": [{"label": "A", "text": "Manubrium", "correct": false}, {"label": "B", "text": "Clavicle", "correct": true}, {"label": "C", "text": "First rib", "correct": false}, {"label": "D", "text": "Second rib", "correct": false}], "correct_answer": "B. Clavicle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of methyl dopa?", "options": [{"label": "A", "text": "Blockade of beta adrenergic receptors", "correct": false}, {"label": "B", "text": "Agonism of beta 2 receptors", "correct": false}, {"label": "C", "text": "Agonism of alpha 2 receptors", "correct": true}, {"label": "D", "text": "Blockade of alpha 2 receptors", "correct": false}], "correct_answer": "C. Agonism of alpha 2 receptors", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Retraction of the scapula is primarily done by?", "options": [{"label": "A", "text": "Serratus anterior", "correct": false}, {"label": "B", "text": "Trapezius", "correct": true}, {"label": "C", "text": "Subscapularis", "correct": false}, {"label": "D", "text": "Supraspinatus", "correct": false}], "correct_answer": "B. Trapezius", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trapezius</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scapular <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> (pulls the <span class=\"customMeta\" data-dictid=\"153f2ea4be16927771981ce5d9171f\">scapula</span> backward)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sternocleidomastoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexes the neck, rotates and tilts the head</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pectoralis major</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adducts the arm, medially rotates the arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deltoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abducts the arm (raises the arm away from the body)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serratus anterior</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protracts the <span class=\"customMeta\" data-dictid=\"153f2ea4be16927771981ce5d9171f\">scapula</span> (pulls the <span class=\"customMeta\" data-dictid=\"153f2ea4be16927771981ce5d9171f\">scapula</span> forward)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rhomboids (major and minor)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scapular retraction, downward <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of the scapula</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old male child is brought to the ophthalmology clinic by his mother with complaints of blurring of vision for one week. The patient further explains that he only has blurring of the far vision and has no problem in his near vision. The patient gives a history of no other abnormalities. For a detailed examination of the eye, the doctor uses a short-acting topical medication which also has a cycloplegic effect. Which of the following drug was used by the doctor in this case?", "options": [{"label": "A", "text": "Atropine oral", "correct": false}, {"label": "B", "text": "Atropine eye ointment", "correct": false}, {"label": "C", "text": "Tropicamide eye drops", "correct": true}, {"label": "D", "text": "Phenylephrine eye drops", "correct": false}], "correct_answer": "C. Tropicamide eye drops", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - T\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Cycloplegic Drug</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Duration of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Tropicamide</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Short-acting (3-6 hours)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Cyclopentolate</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Intermediate-acting (6-24 hours)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Homatropine</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Intermediate-acting (6-24 hours)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Atropine</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Long-acting (up to 7 days)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Scopolamine</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Long-acting (up to 7 days)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of scapular winging?", "options": [{"label": "A", "text": "Trapezius", "correct": false}, {"label": "B", "text": "Serratus anterior", "correct": true}, {"label": "C", "text": "Latissimus dorsi", "correct": false}, {"label": "D", "text": "Pectroralis major", "correct": false}], "correct_answer": "B. Serratus anterior", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked bony process?", "options": [{"label": "A", "text": "Capitulum", "correct": false}, {"label": "B", "text": "Olecranon", "correct": false}, {"label": "C", "text": "Trochlea", "correct": false}, {"label": "D", "text": "Radial head", "correct": true}], "correct_answer": "D. Radial head", "question_images": ["https://image.prepladder.com/content/IUlvgxT7dCf0Jp1ylV261724829884.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\"&gt;Radial&lt;/span&gt; h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During embryological development, the midgut undergoes rotation. In a 6-month-old infant presenting with bilious emesis, it is discovered that the cecum is fixed in the right upper quadrant due to peritoneal bands, leading to a diagnosis of intestinal malrotation. Which of the following statements accurately describes the midgut rotation during embryological development?", "options": [{"label": "A", "text": "270-degree clockwise", "correct": false}, {"label": "B", "text": "270-degree anticlockwise", "correct": true}, {"label": "C", "text": "360-degree clockwise", "correct": false}, {"label": "D", "text": "360-degree anticlockwise", "correct": false}], "correct_answer": "B. 270-degree anticlockwise", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In relation to the anatomy of vasa brevia, a senior surgeon asks a first-year surgery resident a question that suggests vasa brevia is another term for which artery runs through the gastrosplenic ligament. This scenario is based on a research article published about the branches and course of vasa brevia.", "options": [{"label": "A", "text": "Long gastric arteries", "correct": false}, {"label": "B", "text": "Short gastric arteries", "correct": true}, {"label": "C", "text": "Iliea vasa recta", "correct": false}, {"label": "D", "text": "Jejunal vasa recta", "correct": false}], "correct_answer": "B. Short gastric arteries", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked artery originating from celiac trunk territory?", "options": [{"label": "A", "text": "Splenic artery", "correct": false}, {"label": "B", "text": "Gastroepiploic Artery", "correct": true}, {"label": "C", "text": "Gastroduodenal Artery", "correct": false}, {"label": "D", "text": "Left gastric artery", "correct": false}], "correct_answer": "B. Gastroepiploic Artery", "question_images": ["https://image.prepladder.com/content/GK9KswjQrOSV42xqxlmO1694693293.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following ligaments is another name for the lienorenal ligament derived from the peritoneum, where the tail of the pancreas is located in a healthy adult female?", "options": [{"label": "A", "text": "Hapato-gastric", "correct": false}, {"label": "B", "text": "Hepato-duodenal", "correct": false}, {"label": "C", "text": "Gastro-splenic", "correct": false}, {"label": "D", "text": "Spleno-renal", "correct": true}], "correct_answer": "D. Spleno-renal", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Developmental Process</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Week 4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Formation of the pancreatic buds: Two pancreatic buds, the <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> pancreatic buds, arise from the <span class=\"customMeta\" data-dictid=\"c64a46d2cc169277720303d0143935\">foregut</span> endoderm.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Week 5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rotation and <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the buds: The <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> rotates to the right, causing the <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> pancreatic <span class=\"customMeta\" data-dictid=\"fbaff1edd216927771835557d40049\">bud</span> to move posteriorly and to the right. Eventually, the <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> buds <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> a single pancreas.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Week 6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiation of the pancreatic tissue: The <span class=\"customMeta\" data-dictid=\"2fd92bbb11169277719474e970be5d\">pancreatic buds</span> <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> into the <span class=\"customMeta\" data-dictid=\"938890efd616927771870f4a611546\">exocrine</span> and <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> components of the pancreas. The <span class=\"customMeta\" data-dictid=\"938890efd616927771870f4a611546\">exocrine</span> tissue develops into <span class=\"customMeta\" data-dictid=\"ddae3800d31692777180746a2d0590\">acinar</span> cells and ductal cells, while the <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> tissue forms clusters of cells called islets of Langerhans, which will produce hormones.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Week 8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maturation and functional development: The <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> continues to develop and mature, with the <span class=\"customMeta\" data-dictid=\"938890efd616927771870f4a611546\">exocrine</span> cells producing <span class=\"customMeta\" data-dictid=\"a32cad4dbc169277718669cfb165a5\">digestive</span> enzymes and the <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> cells producing <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> and other hormones.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Week 10 onwards</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Further growth and refinement: The <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> continues to grow and <span class=\"customMeta\" data-dictid=\"428b0fa6f316927771970a5763c505\">refine</span> its structure and function throughout <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development and into <span class=\"customMeta\" data-dictid=\"ba016f80c31692777196b151e95b8f\">postnatal</span> life.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Bleeding vessel in hemorrhoids is?", "options": [{"label": "A", "text": "Superior rectal artery", "correct": false}, {"label": "B", "text": "Superior rectal vein", "correct": true}, {"label": "C", "text": "Middle rectal artery", "correct": false}, {"label": "D", "text": "Middle rectal vein", "correct": false}], "correct_answer": "B. Superior rectal vein", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Foot eversion is caused by?", "options": [{"label": "A", "text": "Extensor digitorum", "correct": false}, {"label": "B", "text": "Peroneus longus", "correct": true}, {"label": "C", "text": "Tibialis anterior", "correct": false}, {"label": "D", "text": "Tibialis posterior", "correct": false}], "correct_answer": "B. Peroneus longus", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Insertion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Innervation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gastrocnemius</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calcaneus (via Achilles tendon)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibial nerve (S1-S2)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plantarflexion of the foot, assists <span class=\"customMeta\" data-dictid=\"9025b2cfe9169277719002ab4a9a5e\">in knee</span> flexion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soleus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calcaneus (via Achilles tendon)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibial nerve (S1-S2)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plantarflexion of the foot, stabilizes the ankle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibialis anterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"5cd19952761692777185af9b7666f0\">cuneiform</span> and first metatarsal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dorsiflexion of the foot, <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> of the foot</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extensor digitorum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Middle and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"27cd397275169277719513776c38c8\">phalanges</span> of toes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extension of the toes, <span class=\"customMeta\" data-dictid=\"5c4883591b16927771863aa94323f0\">dorsiflexion</span> of the foot</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flexor digitorum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Middle and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"27cd397275169277719513776c38c8\">phalanges</span> of toes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibial nerve (S2-S3)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flexion of the toes, plantarflexion of the foot</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peroneus longus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> cuneiform</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eversion of the foot, plantarflexion of the foot</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peroneus brevis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fifth metatarsal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eversion of the foot, plantarflexion of the foot</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibialis posterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Navicular, cuneiforms, and metatarsals</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibial nerve (L4-L5)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inversion of the foot, plantarflexion of the foot</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle is supplied by the both tibial and common peroneal nerve?", "options": [{"label": "A", "text": "Gracilis", "correct": false}, {"label": "B", "text": "Biceps femoris", "correct": true}, {"label": "C", "text": "Adductor longus", "correct": false}, {"label": "D", "text": "Adductor magnus", "correct": false}], "correct_answer": "B. Biceps femoris", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Innervation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibialis anterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extensor digitorum longus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extensor hallucis longus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fibularis (Peroneus) tertius</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fibularis (Peroneus) brevis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fibularis (Peroneus) longus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gastrocnemius</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibial nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soleus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibial nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flexor digitorum longus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibial nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flexor hallucis longus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibial nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibialis posterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibial nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abductor hallucis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flexor digitorum brevis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Quadratus plantae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abductor <span class=\"customMeta\" data-dictid=\"71a5caf62116927771863da6f46ba3\">digiti</span> minimi</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lumbricals</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Interossei</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> nerve</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pilocarpine produces:", "options": [{"label": "A", "text": "Active miosis", "correct": true}, {"label": "B", "text": "Active mydriasis", "correct": false}, {"label": "C", "text": "Passive miosis", "correct": false}, {"label": "D", "text": "Passive mydriasis", "correct": false}], "correct_answer": "A. Active miosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Activ\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug directly inhibits clotting factor Xa among the options provided?", "options": [{"label": "A", "text": "Apixaban", "correct": true}, {"label": "B", "text": "Argatroban", "correct": false}, {"label": "C", "text": "Fondaparinux", "correct": false}, {"label": "D", "text": "Aspirin", "correct": false}], "correct_answer": "A. Apixaban", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug from the options provided is known as a protein synthesis inhibitor?", "options": [{"label": "A", "text": "Linezolide", "correct": true}, {"label": "B", "text": "Nevirapine", "correct": false}, {"label": "C", "text": "Indinavir", "correct": false}, {"label": "D", "text": "Ceftriazone", "correct": false}], "correct_answer": "A. Linezolide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - L\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Class of Antibiotic</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Mechanism of Action (MOA)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Penicillins</p>\n</td>\n<td>\n<p>Inhibit bacterial <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to penicillin-binding proteins (PBPs)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cephalosporins</p>\n</td>\n<td>\n<p>Inhibit bacterial <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to PBPs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Carbapenems</p>\n</td>\n<td>\n<p>Inhibit bacterial <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to PBPs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Monobactams</p>\n</td>\n<td>\n<p>Inhibit bacterial <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to PBP3 in <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">Gram-negative</span> bacteria</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Aminoglycosides</p>\n</td>\n<td>\n<p>Inhibit bacterial protein <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to the 30S ribosomal subunit</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tetracyclines</p>\n</td>\n<td>\n<p>Inhibit bacterial protein <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to the 30S ribosomal subunit</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Macrolides</p>\n</td>\n<td>\n<p>Inhibit bacterial protein <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to the 50S ribosomal subunit</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Clindamycin</p>\n</td>\n<td>\n<p>Inhibit bacterial protein <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to the 50S ribosomal subunit</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Quinolones</p>\n</td>\n<td>\n<p>Inhibit bacterial DNA <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by inhibiting <span class=\"customMeta\" data-dictid=\"27e761fe21169277718664069a016d\">DNA gyrase</span> and <span class=\"customMeta\" data-dictid=\"f3fc0b88991692777200b39f3208ec\">topoisomerase</span> IV</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sulfonamides</p>\n</td>\n<td>\n<p>Inhibit bacterial <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by acting as competitive inhibitors of dihydropteroate synthase</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Trimethoprim</p>\n</td>\n<td>\n<p>Inhibit bacterial <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by inhibiting <span class=\"customMeta\" data-dictid=\"0f9fe95f081692777186e5071229c6\">dihydrofolate</span> reductase</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Glycopeptides/Vancomycin</p>\n</td>\n<td>\n<p>Inhibit bacterial <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to the <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> D-alanine-D-alanine moieties of <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> precursors</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oxazolidinones</p>\n</td>\n<td>\n<p>Inhibit bacterial protein <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to the 23S <span class=\"customMeta\" data-dictid=\"ff37e741eb1692777197a5d617b479\">ribosomal RNA</span> of the 50S subunit</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lipopeptides/Daptomycin</p>\n</td>\n<td>\n<p>Disrupt bacterial cell <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> integrity and cause depolarization</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Polymyxins</p>\n</td>\n<td>\n<p>Disrupt bacterial cell <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> integrity and cause leakage of <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> contents</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rifampin</p>\n</td>\n<td>\n<p>Inhibit bacterial <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to bacterial <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> polymerase</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred medication for preventing meningococcal meningitis in a pregnant woman following exposure to a confirmed case?", "options": [{"label": "A", "text": "Ciprofloxacin", "correct": false}, {"label": "B", "text": "Ceftriaxone", "correct": true}, {"label": "C", "text": "Cefalexin", "correct": false}, {"label": "D", "text": "Rifabutin", "correct": false}], "correct_answer": "B. Ceftriaxone", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Antibiotic</strong></p>\n</td>\n<td>\n<p><strong>Dosage</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ceftriaxone</p>\n</td>\n<td>\n<p>250 mg <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">intramuscular</span> (IM) or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> (IV) once</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cefotaxime</p>\n</td>\n<td>\n<p>1 g <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">intramuscular</span> (IM) or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> (IV) once</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Penicillin G</p>\n</td>\n<td>\n<p>2 million units <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">intramuscular</span> (IM) once</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Azithromycin</p>\n</td>\n<td>\n<p>1 g orally once</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rifampin</p>\n</td>\n<td>\n<p>600 mg orally twice daily for 2 days</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Purpose of adding zinc to insulin in commercial preparations for treatment of diabetes mellitus is:", "options": [{"label": "A", "text": "To make it long acting", "correct": true}, {"label": "B", "text": "To make it short acting", "correct": false}, {"label": "C", "text": "To make is fast acting", "correct": false}, {"label": "D", "text": "Addition of zinc make the insulin effective orally", "correct": false}], "correct_answer": "A. To make it long acting", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - To make it long acting: \n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Insulin Type</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Onset of Action</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Peak Action</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Duration of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Rapid-acting insulin</p>\n</td>\n<td>\n<p style=\"text-align: center;\">15 minutes to 30 minutes</p>\n</td>\n<td>\n<p style=\"text-align: center;\">1 hour to 2 hours</p>\n</td>\n<td>\n<p style=\"text-align: center;\">3 hours to 5 hours</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Short-acting insulin</p>\n</td>\n<td>\n<p style=\"text-align: center;\">30 minutes to 1 hour</p>\n</td>\n<td>\n<p style=\"text-align: center;\">2 hours to 4 hours</p>\n</td>\n<td>\n<p style=\"text-align: center;\">5 hours to 8 hours</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Intermediate-acting insulin</p>\n</td>\n<td>\n<p style=\"text-align: center;\">1 hour to 2 hours</p>\n</td>\n<td>\n<p style=\"text-align: center;\">4 hours to 12 hours</p>\n</td>\n<td>\n<p style=\"text-align: center;\">12 hours to 18 hours</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Long-acting insulin</p>\n</td>\n<td>\n<p style=\"text-align: center;\">1 hour to 2 hours</p>\n</td>\n<td>\n<p style=\"text-align: center;\">No pronounced peak</p>\n</td>\n<td>\n<p style=\"text-align: center;\">24 hours to 36 hours</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Ultra-long-acting insulin</p>\n</td>\n<td>\n<p style=\"text-align: center;\">1 hour to 2 hours</p>\n</td>\n<td>\n<p style=\"text-align: center;\">No pronounced peak</p>\n</td>\n<td>\n<p style=\"text-align: center;\">More than 42 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the surgery of a 40-year-old patient, anesthesia is administered along with other agents to enhance the effects of anesthesia and minimize any negative consequences. Which of the options below refers to the muscle relaxant with the shortest duration of action and is commonly used for rapid sequence induction?", "options": [{"label": "A", "text": "Tubocurarine", "correct": false}, {"label": "B", "text": "Succinylcholine", "correct": true}, {"label": "C", "text": "Pancuronium", "correct": false}, {"label": "D", "text": "Atracurium", "correct": false}], "correct_answer": "B. Succinylcholine", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Agent</strong></p>\n</td>\n<td>\n<p><strong>Purpose</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Benzodiazepines</p>\n</td>\n<td>\n<p>Provide <span class=\"customMeta\" data-dictid=\"b81cee1b5f16927771987099f651a0\">sedation</span> and anxiolysis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Opioids</p>\n</td>\n<td>\n<p>Provide <span class=\"customMeta\" data-dictid=\"66ccee483016927771810c2c295d74\">analgesia</span> and reduce <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> pain</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Propofol</p>\n</td>\n<td>\n<p>Induce and maintain anesthesia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inhalational agents</p>\n</td>\n<td>\n<p>Maintain general <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> during surgery</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Neuromuscular blockers</p>\n</td>\n<td>\n<p>Facilitate muscle <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> during surgery</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Antiemetics</p>\n</td>\n<td>\n<p>Prevent or treat <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anticholinergics</p>\n</td>\n<td>\n<p>Prevent <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> and reduce <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> secretions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Local anesthetics</p>\n</td>\n<td>\n<p>Provide regional <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> or <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain control</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Corticosteroids</p>\n</td>\n<td>\n<p>Reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and prevent allergic reactions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nonsteroidal anti-inflammatory drugs (NSAIDs)</p>\n</td>\n<td>\n<p>Provide <span class=\"customMeta\" data-dictid=\"66ccee483016927771810c2c295d74\">analgesia</span> and reduce inflammation</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which medication is known to induce orthostatic (postural) hypotension and may lead to potentially severe blood pressure drops when patients transition from sitting or lying down to a standing position, potentially causing dizziness, lightheadedness, or even fainting?", "options": [{"label": "A", "text": "Metformin", "correct": false}, {"label": "B", "text": "Prazosin", "correct": true}, {"label": "C", "text": "Acarbose", "correct": false}, {"label": "D", "text": "Nor-adrenaline", "correct": false}], "correct_answer": "B. Prazosin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - P\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Drug Class</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Alpha-1 <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> blockers</p>\n</td>\n<td>\n<p>Prazosin, Terazosin, Doxazosin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Alpha-2 <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> agonists</p>\n</td>\n<td>\n<p>Clonidine, Methyldopa</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Calcium channel blockers</p>\n</td>\n<td>\n<p>Amlodipine, Nifedipine, Verapamil</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>ACE inhibitors</p>\n</td>\n<td>\n<p>Lisinopril, Enalapril, Ramipril</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Angiotensin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> blockers</p>\n</td>\n<td>\n<p>Losartan, Valsartan, Irbesartan</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Diuretics</p>\n</td>\n<td>\n<p>Hydrochlorothiazide, Furosemide</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Antidepressants</p>\n</td>\n<td>\n<p>Tricyclic antidepressants (e.g., Amitriptyline), Selective <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> <span class=\"customMeta\" data-dictid=\"42c441fad11692777197258f322307\">reuptake</span> inhibitors (SSRIs)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Antipsychotics</p>\n</td>\n<td>\n<p>Haloperidol, Risperidone, Quetiapine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sedative-hypnotics</p>\n</td>\n<td>\n<p>Benzodiazepines (e.g., Diazepam), Z-drugs (e.g., Zolpidem)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Opioids</p>\n</td>\n<td>\n<p>Morphine, Oxycodone, Codeine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anti-Parkinson's agents</p>\n</td>\n<td>\n<p>Levodopa, <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">Dopamine</span> agonists (e.g., Pramipexole)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nonsteroidal anti-inflammatory drugs (NSAIDs)</p>\n</td>\n<td>\n<p>Ibuprofen, Naproxen</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Antihistamines</p>\n</td>\n<td>\n<p>Diphenhydramine, Chlorpheniramine</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended medication for treating a 23-year-old female who is experiencing burning pain while urinating and has been diagnosed with a co-infection of chlamydia and gonococcus?", "options": [{"label": "A", "text": "Azithromycin", "correct": true}, {"label": "B", "text": "Ceftriaxone", "correct": false}, {"label": "C", "text": "Fluconazole", "correct": false}, {"label": "D", "text": "Clindamycin", "correct": false}], "correct_answer": "A. Azithromycin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug can be administered in the next cycle of chemotherapy to prevent neutropenia in a patient who has received anti-cancer therapy?", "options": [{"label": "A", "text": "Filgrastim", "correct": true}, {"label": "B", "text": "Prednisolone", "correct": false}, {"label": "C", "text": "Vitamin B12", "correct": false}, {"label": "D", "text": "Folic acid", "correct": false}], "correct_answer": "A. Filgrastim", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Drug</strong></p>\n</td>\n<td>\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td>\n<p><strong>Example</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Filgrastim</p>\n</td>\n<td>\n<p>Stimulates <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">neutrophil</span> production</p>\n</td>\n<td>\n<p>Granix, Neupogen</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pegfilgrastim</p>\n</td>\n<td>\n<p>Long-acting <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of filgrastim</p>\n</td>\n<td>\n<p>Neulasta</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sargramostim</p>\n</td>\n<td>\n<p>Stimulates <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">neutrophil</span> production and other immune cells</p>\n</td>\n<td>\n<p>Leukine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lenograstim</p>\n</td>\n<td>\n<p>Stimulates <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">neutrophil</span> production</p>\n</td>\n<td>\n<p>Granocyte, Myelostim</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tbo-filgrastim</p>\n</td>\n<td>\n<p>Stimulates <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">neutrophil</span> production</p>\n</td>\n<td>\n<p>Granix</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old presents with complaints of chest and difficulty in swallowing. Based on the findings in the below image, what is the likely diagnosis?", "options": [{"label": "A", "text": "Achalasia cardia", "correct": false}, {"label": "B", "text": "Diffuse oesophageal spasm", "correct": true}, {"label": "C", "text": "Carcinoma Oesophagus spasm", "correct": false}, {"label": "D", "text": "Schatzki's Ring", "correct": false}], "correct_answer": "B. Diffuse oesophageal spasm", "question_images": ["https://image.prepladder.com/content/KKuHKyc65VDvcDWucoyD1688374084.png"], "explanation_images": ["https://image.prepladder.com/content/SsLKPfMgq0luLoeLimLY1714110938.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\"&gt;Diffuse&lt;/span&gt; oesophag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following actions is not typically performed in cases of Carcinoma of the Oesophagus?", "options": [{"label": "A", "text": "Biopsy", "correct": false}, {"label": "B", "text": "pH-metry", "correct": true}, {"label": "C", "text": "CT chest", "correct": false}, {"label": "D", "text": "PET scan", "correct": false}], "correct_answer": "B. pH-metry", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following features are true about Allergic Broncho Pulmonary Aspergillosis? Distal bronchiectasis Serum precipitins to Aspergillus Increased lgE Levels Seen in asthmatics", "options": [{"label": "A", "text": "1,2,3 only", "correct": false}, {"label": "B", "text": "2,3,4 only", "correct": true}, {"label": "C", "text": "1,3,4 only", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "B. 2,3,4 only", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 2,3,4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate description of marble Schonberg disease?", "options": [{"label": "A", "text": "Osteopetrosis", "correct": true}, {"label": "B", "text": "Osteomalacia", "correct": false}, {"label": "C", "text": "Osteosclerosis", "correct": false}, {"label": "D", "text": "Osteonecrosis", "correct": false}], "correct_answer": "A. Osteopetrosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Why is COVID-19 a major global concern despite influenza spreading faster than COVID-19?", "options": [{"label": "A", "text": "Median incubation period is more in influenza", "correct": false}, {"label": "B", "text": "Reproductive number for COVID-19 is 2-2.5", "correct": true}, {"label": "C", "text": "Serial interval is 5-6 days in influenza", "correct": false}, {"label": "D", "text": "Reproductive number for Influenza is higher", "correct": false}], "correct_answer": "B. Reproductive number for COVID-19 is 2-2.5", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\"&gt;Reproductive&lt;/span&gt; number for &lt;span class=\"customMeta\" data-dictid=\"2d364aeaf7169277718529fa58f6ea\"&gt;COVID-19&lt;/span&gt; is 2-2.5\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was brought to the OPD with complains of Mental retardation, mousy odur and hypopigmentation. What is the likely diagnosis?", "options": [{"label": "A", "text": "Phenylketonuria", "correct": true}, {"label": "B", "text": "Alkaptonuria", "correct": false}, {"label": "C", "text": "Albinism", "correct": false}, {"label": "D", "text": "MSUD", "correct": false}], "correct_answer": "A. Phenylketonuria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Phenylketonu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 43-year-old patient comes to the OPD with complains tingling sensation in the hands and feet. Reversible dementia is seen in?", "options": [{"label": "A", "text": "SACD", "correct": true}, {"label": "B", "text": "AD", "correct": false}, {"label": "C", "text": "CJD", "correct": false}, {"label": "D", "text": "Pick's disease", "correct": false}], "correct_answer": "A. SACD", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - SACD\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statements below is NOT accurate regarding Parkinson's disease?", "options": [{"label": "A", "text": "Manganese can cause secondary Parkinsonism", "correct": false}, {"label": "B", "text": "Usage of Carbidopa leads to on and off phenomenon", "correct": true}, {"label": "C", "text": "Slight tremor in the hand or foot followed by jaw", "correct": false}, {"label": "D", "text": "Cog wheel rigidity or lead pipe rigidity is seen", "correct": false}], "correct_answer": "B. Usage of Carbidopa leads to on and off phenomenon", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Usage of &lt;span class=\"customMeta\" data-dictid=\"fdef17b2781692777183c601c1c5eb\"&gt;Carbidopa&lt;/span&gt; leads to on and off ph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient being discussed has come in for medical evaluation following an injury to the chest. During the examination, the presence of crepitus is detected. Based on these findings, what is the likely clinical diagnosis?", "options": [{"label": "A", "text": "Subcutaneous emphysema", "correct": true}, {"label": "B", "text": "Gas gangrene", "correct": false}, {"label": "C", "text": "Acute tubular necrosis", "correct": false}, {"label": "D", "text": "Hyperbaric decompression sickness", "correct": false}], "correct_answer": "A. Subcutaneous emphysema", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Subcutaneous emph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old was brought to the emergency with complians of severe abdominal pain with tenderness, fever with chills, and tachycardia. What is the most likely diagnosis for the image displayed?", "options": [{"label": "A", "text": "Pneumoperitoneum", "correct": true}, {"label": "B", "text": "Pneumothorax", "correct": false}, {"label": "C", "text": "Eventration of diaphragm", "correct": false}, {"label": "D", "text": "Pneumomediastinum", "correct": false}], "correct_answer": "A. Pneumoperitoneum", "question_images": ["https://image.prepladder.com/content/YHhrxnoPM2oVu5pjxYQL1688378653.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Pneumoperitoneu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology/Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Consolidation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pneumonia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ground glass opacity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Interstitial lung disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cavity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lung abscess, tuberculosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pleural effusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pleural fluid accumulation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atelectasis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collapse of lung tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nodule/mass</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lung cancer, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Air bronchogram</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Consolidation, lung infiltrates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiomegaly</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged heart</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flattened diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>COPD (Chronic obstructive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Honeycomb pattern</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mediastinal shift</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mass, tumor, pneumothorax</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rib fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chest trauma, trauma-related injury</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mark the true statements? 1. MEN 2B is also known as Sipple syndrome 2. MEN 1 is also known as Wermer syndrome 3. MEN 2B is characterized by the presence of Marfanoid Habitus. 4. MEN 4 is a/w CDKN1B", "options": [{"label": "A", "text": "1 and 2 are true", "correct": false}, {"label": "B", "text": "3 and 4 are true", "correct": false}, {"label": "C", "text": "1, 2 and 4 are true", "correct": false}, {"label": "D", "text": "2, 3 and 4 are true", "correct": true}], "correct_answer": "D. 2, 3 and 4 are true", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 3 and 4 are tru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options has the lowest concentration in intracellular fluid (ICF)compared to extracellular fluid ?", "options": [{"label": "A", "text": "Calcium", "correct": true}, {"label": "B", "text": "Magnesium", "correct": false}, {"label": "C", "text": "Potassium", "correct": false}, {"label": "D", "text": "Protein", "correct": false}], "correct_answer": "A. Calcium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Calciu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extracellular Fluid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intracellular Fluid</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Na<sup>+</sup></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>142 mEq/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>K<sup>+</sup></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 mEq/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>140 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ca<sup>2+</sup></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.4 mEq/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.0001 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mg<sup>2+</sup></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.2 mEq/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>58 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cl<sup>-</sup></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>103 mEq/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 mEq</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HCO<sub>3</sub></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>24 mEq/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phosphates</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 mEq/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>75 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SO<sub>4</sub></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 mEq/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glucose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>90 mg/dl</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0 to 20 mg/dl</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amino acids</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30 mg/dl</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>200 mg/dl</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>pH</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7.4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7.0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proteins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 gm/dl (5mEq/L)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>16 gm/dl (40 mEq/L)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In good pasture syndrome , which organ is involved apart from lung?", "options": [{"label": "A", "text": "Kidney", "correct": true}, {"label": "B", "text": "Liver", "correct": false}, {"label": "C", "text": "Spleen", "correct": false}, {"label": "D", "text": "Heart", "correct": false}], "correct_answer": "A. Kidney", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - K\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the opposition to passive stretching?", "options": [{"label": "A", "text": "Tone", "correct": false}, {"label": "B", "text": "Spasticity", "correct": true}, {"label": "C", "text": "Rigidity", "correct": false}, {"label": "D", "text": "Paratonia", "correct": false}], "correct_answer": "B. Spasticity", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Tone</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Spasticity</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Rigidity</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Paratonia</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Definition</strong></p>\n</td>\n<td>\n<p>Refers to the tension or resistance in a muscle at rest.</p>\n</td>\n<td>\n<p>Increased muscle tone characterized by velocity-dependent resistance to <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> movement.</p>\n</td>\n<td>\n<p>Increased resistance to <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> movement independent of velocity.</p>\n</td>\n<td>\n<p>Impaired ability to modulate muscle tone, leading to variable resistance to <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> movement.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Underlying Causes</strong></p>\n</td>\n<td>\n<p>Can be influenced by factors such as muscle strength, neurological conditions, and psychological factors.</p>\n</td>\n<td>\n<p>Commonly associated with upper <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">motor neuron</span> lesions, such as stroke, cerebral palsy, or multiple sclerosis.</p>\n</td>\n<td>\n<p>Often seen in conditions like Parkinson's disease, where there is a <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</p>\n</td>\n<td>\n<p>Typically observed in individuals with <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> or certain neurological conditions.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Characteristics</strong></p>\n</td>\n<td>\n<p>Can be increased (hypertonic) or decreased (hypotonic) depending on the condition.</p>\n</td>\n<td>\n<p>Characterized by a velocity-dependent increase in muscle tone, meaning the resistance to <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> movement increases with higher speed or sudden stretching.</p>\n</td>\n<td>\n<p>Characterized by a constant, uniform increase in muscle tone regardless of the speed or force applied during <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> movement.</p>\n</td>\n<td>\n<p>Characterized by variable resistance to <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> movement, fluctuating between increased and decreased muscle tone.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Associated Symptoms</strong></p>\n</td>\n<td>\n<p>Can be accompanied by weakness, stiffness, or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> postures.</p>\n</td>\n<td>\n<p>May include muscle spasms, exaggerated reflexes, <span class=\"customMeta\" data-dictid=\"9d3cc5b04f16927771848eaf4788a0\">clonus</span> (rhythmic contractions), and associated functional impairments.</p>\n</td>\n<td>\n<p>Often associated with a \"cogwheel\" or \"lead-pipe\" rigidity, where movements are jerky or exhibit a ratcheting sensation.</p>\n</td>\n<td>\n<p>Associated with an inability to relax or <span class=\"customMeta\" data-dictid=\"8459151fee1692777197d1ac765aa0\">resistive</span> behavior during <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> movement testing.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Management</strong></p>\n</td>\n<td>\n<p>Treatment may focus on addressing underlying causes, physical therapy, stretching exercises, and <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> techniques.</p>\n</td>\n<td>\n<p>Treatment approaches may include physical therapy, medications (such as muscle relaxants or <span class=\"customMeta\" data-dictid=\"3cb8b8422c16927771836b57b4c79e\">botulinum toxin</span> injections), and modalities like <span class=\"customMeta\" data-dictid=\"4f5917b20816927771990a45367450\">splinting</span> or orthotics.</p>\n</td>\n<td>\n<p>Management strategies may involve medications <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia, deep brain stimulation, and physical therapy.</p>\n</td>\n<td>\n<p>Management includes promoting <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> techniques, using clear and simple instructions, and modifying the environment to minimize resistance during <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> movement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Enterokinase is an activator of?", "options": [{"label": "A", "text": "Trypsinogen", "correct": true}, {"label": "B", "text": "Trypsin", "correct": false}, {"label": "C", "text": "Chymotrypsin", "correct": false}, {"label": "D", "text": "Antitrypsin", "correct": false}], "correct_answer": "A. Trypsinogen", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Enzyme</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Activation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pepsinogen</p>\n</td>\n<td>\n<p>Activated by the <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> environment (low pH) in the stomach to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> pepsin. <span class=\"customMeta\" data-dictid=\"ba6a4968271692777195adb7c5c8f0\">Pepsinogen</span> is initially secreted as an inactive <span class=\"customMeta\" data-dictid=\"ae13cdc5c3169277719683e9f6bda5\">precursor</span> and is activated by the presence of <span class=\"customMeta\" data-dictid=\"c6cd3307e0169277718936624365e5\">hydrochloric acid</span> (HCl).</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gastric lipase</p>\n</td>\n<td>\n<p>Activated by the <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> environment (low pH) in the stomach. The low pH in the stomach aids in the <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> lipase, allowing it to break down dietary fats.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gelatinase</p>\n</td>\n<td>\n<p>Activated by the <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> environment (low pH) in the stomach. Gelatinase, also known as collagenase, is an <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> that helps in the <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> of collagen-rich <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chymosin (rennin)</p>\n</td>\n<td>\n<p>Activated by the presence of acid and partially digested proteins (such as casein) in the stomach. <span class=\"customMeta\" data-dictid=\"d7e2316cf6169277718483c713a1ba\">Chymosin</span> plays a role in the <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> of milk proteins in infants and young animals.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gastric amylase</p>\n</td>\n<td>\n<p>Activated by the <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> environment (low pH) in the stomach. <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> <span class=\"customMeta\" data-dictid=\"ee24d3aa0016927771810af81a9cf3\">amylase</span> helps in the initial <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of starches and carbohydrates into simpler sugars.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Intrinsic factor</p>\n</td>\n<td>\n<p>Not activated by an enzyme. <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">Intrinsic</span> factor is a <span class=\"customMeta\" data-dictid=\"6c9fa3a73216927771888299c86e08\">glycoprotein</span> secreted by <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> cells in the stomach and is involved in the <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of vitamin B12 in the small intestine. It facilitates the binding of vitamin B12 and its <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> by specific receptors in the ileum.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a component of child pugh classification?", "options": [{"label": "A", "text": "SGOT", "correct": true}, {"label": "B", "text": "Bilirubin", "correct": false}, {"label": "C", "text": "Albumin", "correct": false}, {"label": "D", "text": "Prothrombin time", "correct": false}], "correct_answer": "A. SGOT", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - SGOT\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the connecting structure between Broca's area and Wernicke's area?", "options": [{"label": "A", "text": "Arcuate fasciculus", "correct": true}, {"label": "B", "text": "Anterior commissure", "correct": false}, {"label": "C", "text": "Corpus callosum", "correct": false}, {"label": "D", "text": "Fornix", "correct": false}], "correct_answer": "A. Arcuate fasciculus", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Brain Area</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Function</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Interconnections</strong></p>\n</td>\n<td> </td>\n</tr>\n<tr>\n<td rowspan=\"3\">\n<p>Broca's Area</p>\n</td>\n<td rowspan=\"3\">\n<p>Involved in speech production and language processing</p>\n</td>\n<td rowspan=\"3\">\n<p>- Connected to Wernicke's area via the <span class=\"customMeta\" data-dictid=\"734bdc6ddd1692777182e15cb76ca5\">arcuate</span> fasciculus</p>\n<p>- Interconnects with motor <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> and other regions involved in speech</p>\n<p>- Receives input from <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> and visual association areas</p>\n</td>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td rowspan=\"3\">\n<p>Wernicke's Area</p>\n</td>\n<td rowspan=\"3\">\n<p>Involved in language comprehension and interpretation</p>\n</td>\n<td rowspan=\"3\">\n<p>- Connected to Broca's area via the <span class=\"customMeta\" data-dictid=\"734bdc6ddd1692777182e15cb76ca5\">arcuate</span> fasciculus</p>\n<p>- Interconnects with <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> and visual association areas</p>\n<p>- Receives input from the <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> <span class=\"customMeta\" data-dictid=\"231fafb8e116927771888a0efe57f1\">gyrus</span> and other language-related areas</p>\n</td>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td rowspan=\"3\">\n<p>Angular Gyrus</p>\n</td>\n<td rowspan=\"3\">\n<p>Involved in language processing and reading</p>\n</td>\n<td rowspan=\"3\">\n<p>- Connected to Wernicke's area and visual association areas</p>\n<p>- Interconnects with Broca's area and other language-related regions</p>\n<p>- Receives input from the visual <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> and other language-related areas</p>\n</td>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td rowspan=\"3\">\n<p>Primary Auditory</p>\n<p>Cortex</p>\n</td>\n<td rowspan=\"3\">\n<p>Processes <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> information</p>\n</td>\n<td rowspan=\"3\">\n<p>- Connected to Wernicke's area and other language-related regions</p>\n<p>- Interconnects with Broca's area and other language-related regions</p>\n<p>- Receives input from the <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> system</p>\n</td>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td rowspan=\"3\">\n<p>Visual Association</p>\n<p>Cortex</p>\n</td>\n<td rowspan=\"3\">\n<p>Processes visual information</p>\n</td>\n<td rowspan=\"3\">\n<p>- Connected to Wernicke's area, <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> gyrus, and other language areas</p>\n<p>- Interconnects with Broca's area and other language-related regions</p>\n<p>- Receives input from the visual system</p>\n</td>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n<tr>\n<td> </td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fulminant diabetes mellitus is seen in?", "options": [{"label": "A", "text": "Diabetic ketoacidosis", "correct": false}, {"label": "B", "text": "Coxsackie B virus", "correct": true}, {"label": "C", "text": "Non ketonic hyperosmolar coma", "correct": false}, {"label": "D", "text": "Autoimmune pancreatis", "correct": false}], "correct_answer": "B. Coxsackie B virus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a calcium-binding protein?", "options": [{"label": "A", "text": "Calbindin", "correct": false}, {"label": "B", "text": "Calmodulin", "correct": false}, {"label": "C", "text": "Troponin", "correct": false}, {"label": "D", "text": "Clathrin", "correct": true}], "correct_answer": "D. Clathrin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Clath\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a 6-year-old patient who presents with a mild fever persisting for 7 days , enlarged cervical lymph nodes, and a palpable spleen tip, and subsequently develops a widespread rash after administration of ampicillin?", "options": [{"label": "A", "text": "Infectious mononucleosis", "correct": true}, {"label": "B", "text": "Scarlet fever", "correct": false}, {"label": "C", "text": "Kawasaki", "correct": false}, {"label": "D", "text": "Hodgkin's lymphoma", "correct": false}], "correct_answer": "A. Infectious mononucleosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Infectious mononu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Histamine is secreted by?", "options": [{"label": "A", "text": "Enterochromaffin cell", "correct": true}, {"label": "B", "text": "Parietal cell", "correct": false}, {"label": "C", "text": "Oxyntic cell", "correct": false}, {"label": "D", "text": "Chief cell", "correct": false}], "correct_answer": "A. Enterochromaffin cell", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"6c13e383a01692777187ae85e093b6\"&gt;Enterochromaffin&lt;/span&g\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Substance Secreted</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Parietal cells</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hydrochloric acid (HCl)</li>\n<li>Intrinsic factor</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chief cells</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pepsinogen</li>\n<li>Gastric lipase</li>\n<li>Gastric amylase</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>G cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gastrin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>D cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Somatostatin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Enterochromaffin cells</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Histamine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mucous cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucus</li>\n<li>Bicarbonate</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate statement regarding rheumatoid nodules?", "options": [{"label": "A", "text": "Tender, located on extensor surface and seen with arthritis", "correct": false}, {"label": "B", "text": "Non tender, located on extensor surface and seen with arthritis", "correct": true}, {"label": "C", "text": "Non tender, located on flexor surface and seen with arthritis", "correct": false}, {"label": "D", "text": "Tender, located on flexor surface and seen with arthritis", "correct": false}], "correct_answer": "B. Non tender, located on extensor surface and seen with arthritis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Non tender, located on &lt;span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\"&gt;extensor&lt;/span&gt; surface and seen with arth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Reward centre in the brain is?", "options": [{"label": "A", "text": "Amygdala", "correct": false}, {"label": "B", "text": "Thalamus", "correct": false}, {"label": "C", "text": "Hippocampus", "correct": false}, {"label": "D", "text": "Ventral tegmental area", "correct": true}], "correct_answer": "D. Ventral tegmental area", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Brain Center</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Respective Area(s)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Motor Cortex</p>\n</td>\n<td>\n<p>Frontal lobe</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sensory Cortex</p>\n</td>\n<td>\n<p>Parietal lobe</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Visual Cortex</p>\n</td>\n<td>\n<p>Occipital lobe</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Auditory Cortex</p>\n</td>\n<td>\n<p>Temporal lobe</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Broca's Area</p>\n</td>\n<td>\n<p>Frontal <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> (typically in the left hemisphere)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Wernicke's Area</p>\n</td>\n<td>\n<p>Temporal <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> (typically in the left hemisphere)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Prefrontal Cortex</p>\n</td>\n<td>\n<p>Frontal lobe</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Somatosensory Cortex</p>\n</td>\n<td>\n<p>Parietal lobe</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hippocampus</p>\n</td>\n<td>\n<p>Medial <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> lobe</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Amygdala</p>\n</td>\n<td>\n<p>Temporal lobe</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the purpose of using the Modified Duke Criteria in diagnosing?", "options": [{"label": "A", "text": "Infective endarteritis", "correct": false}, {"label": "B", "text": "Infectious mononucleosis", "correct": false}, {"label": "C", "text": "Inflammatory myopathy", "correct": false}, {"label": "D", "text": "Infective endocarditis", "correct": true}], "correct_answer": "D. Infective endocarditis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D</p>\n<table>\n<thead>\n<tr>\n<th>Major Criteria</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Positive Blood Culture</td>\n<td>- Typical organisms isolated from 2 separate blood cultures. - Persistently positive blood cultures, with typical organisms isolated from cultures done &gt; 12 hours apart. - <span class=\"customMeta\" data-dictid=\"c9ed7c1a9f1692777185cc193f7ec1\">Coxiella</span> infection (Q fever) demonstrated by a single positive <span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\">blood culture</span> with Phase I <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> <span class=\"customMeta\" data-dictid=\"6c8421504e1692777200e552c3b421\">titre</span> &gt; 1:800.</td>\n</tr>\n<tr>\n<td>Echocardiographic Evidence</td>\n<td>- Evidence of <span class=\"customMeta\" data-dictid=\"a55b16a09b169277720184a41c82c4\">vegetation</span> or oscillating <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> mass on echocardiography. - <span class=\"customMeta\" data-dictid=\"8ba00f15d31692777200f1c6d2cbae\">Transesophageal</span> <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> (TEE) is preferred over <span class=\"customMeta\" data-dictid=\"d2f68167161692777200f27aa61366\">transthoracic</span> <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> (TTE). - New valvular <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> or partial <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> of <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> valve.</td>\n</tr>\n<tr>\n<td>New Onset <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">Murmur</span> in Patient with Pre-existing Heart Lesion</td>\n<td>- Development of a new <span class=\"customMeta\" data-dictid=\"882af9bf8116927771898d62bf73d6\">heart murmur</span> in a patient with pre-existing heart disease.</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th>Minor Modified Criteria</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Predisposition</td>\n<td>- Presence of pre-existing heart disease or history of <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> drug usage.</td>\n</tr>\n<tr>\n<td>Fever &gt; 38°C</td>\n<td>- Fever with temperature exceeding 38°C.</td>\n</tr>\n<tr>\n<td>Vascular Phenomenon</td>\n<td>- Major <span class=\"customMeta\" data-dictid=\"acd7af7f74169277718736b038fb02\">embolic</span> phenomenon. - <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">Septic</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infarction. - <span class=\"customMeta\" data-dictid=\"39f702525516927771939b0791cac7\">Mycotic</span> aneurysm. - <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">Intracranial</span> hemorrhage. - Janeway lesions (palm, soles).</td>\n</tr>\n<tr>\n<td>Immunological Phenomenon (Mnemonic – ROG)</td>\n<td>- Roth spots. - <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> factor positivity. - Osler nodes (tip of fingers). - Glomerulonephritis.</td>\n</tr>\n<tr>\n<td>Microbiological Evidence</td>\n<td>- Positive <span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\">blood culture</span> not meeting major criteria. - Moderate-high clinical suspicion warrants <span class=\"customMeta\" data-dictid=\"8ba00f15d31692777200f1c6d2cbae\">transesophageal</span> <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> (TEE), while low suspicion warrants <span class=\"customMeta\" data-dictid=\"d2f68167161692777200f27aa61366\">transthoracic</span> <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> (TTE). - Additional <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> modalities include SHOT metagenomics, FDG PET-CT, and multi-slice CT angiography.</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Glucose is absorbed by?", "options": [{"label": "A", "text": "Upper part of proximal tubule", "correct": true}, {"label": "B", "text": "Ascending limb of LOH", "correct": false}, {"label": "C", "text": "Cortical Collecting duct", "correct": false}, {"label": "D", "text": "Medullary collecting duct", "correct": false}], "correct_answer": "A. Upper part of proximal tubule", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Upper part of &lt;span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\"&gt;proximal&lt;/span&gt; tubule:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tubular Segment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glucose <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">Reabsorption</span> (%)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Luminal Transporter(Lumen to cytoplasm)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Basolateral <span class=\"customMeta\" data-dictid=\"850b296dd316927772005b651f6e87\">Transporter</span> (Cytoplasm to blood)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">Convoluted</span> Tubules (PCT)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>90%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SGLT <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">type II</span> (Secondary active Transporter)</p>\n<ul>\n<li>1 molecule of sodium and 1 molecule of <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> from the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> to the cell.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GLUT-2 (Facilitated <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> transporter)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal Straight Tubules (PST)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SGLT <span class=\"customMeta\" data-dictid=\"946a9a6be11692777201eb269e8327\">type I</span> (Secondary active Transporter)</p>\n<ul>\n<li>2 molecules of sodium and 1 molecule of <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> from the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> to the cell.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GLUT-1 (Facilitated <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> transporter)</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following indicators may be observed when using a small-sized blood pressure cuff?", "options": [{"label": "A", "text": "False elevation of BP", "correct": true}, {"label": "B", "text": "Falsely low value of BP", "correct": false}, {"label": "C", "text": "Cancels the effects of calcified arteries", "correct": false}, {"label": "D", "text": "Increases trans arm impendance", "correct": false}], "correct_answer": "A. False elevation of BP", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: False &lt;span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\"&gt;elevation&lt;/span&gt; of BP\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which medication could be the cause of recurrent falls in an elderly male patient?", "options": [{"label": "A", "text": "Prazocin", "correct": true}, {"label": "B", "text": "Metformin", "correct": false}, {"label": "C", "text": "Acarbose", "correct": false}, {"label": "D", "text": "Thiazide", "correct": false}], "correct_answer": "A. Prazocin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the duration for which sperm stays in the epididymis?", "options": [{"label": "A", "text": "24hours", "correct": false}, {"label": "B", "text": "48 hours", "correct": false}, {"label": "C", "text": "20 days", "correct": true}, {"label": "D", "text": "96hours", "correct": false}], "correct_answer": "C. 20 days", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td><strong>Definition</strong></td>\n<td>Spermatogenesis is the process of <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> cell development, involving <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> and maturation.</td>\n</tr>\n<tr>\n<td><strong>Location</strong></td>\n<td>Occurs in the <span class=\"customMeta\" data-dictid=\"1406286c02169277719897928fb9f1\">seminiferous</span> tubules of the testes.</td>\n</tr>\n<tr>\n<td><strong>Stages</strong></td>\n<td>1. <span class=\"customMeta\" data-dictid=\"af3fa45f87169277719914e0dbaf14\">Spermatogonia</span> 2. Primary Spermatocytes 3. Secondary Spermatocytes 4. Spermatids</td>\n</tr>\n<tr>\n<td><strong>Hormonal Regulation</strong></td>\n<td>Stimulated by gonadotropins (Luteinizing Hormone - LH and Follicle-Stimulating Hormone - FSH).</td>\n</tr>\n<tr>\n<td><strong>Meiosis</strong></td>\n<td>Spermatogenesis involves two rounds of meiotic division: <span class=\"customMeta\" data-dictid=\"5e3732fcf416927771923ad13f4d16\">Meiosis</span> I and <span class=\"customMeta\" data-dictid=\"5e3732fcf416927771923ad13f4d16\">Meiosis</span> II.</td>\n</tr>\n<tr>\n<td><strong>Duration</strong></td>\n<td>Takes approximately 64-72 days from spermatogonial division to <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> release.</td>\n</tr>\n<tr>\n<td><strong>Mitotic Division</strong></td>\n<td>Spermatogonia (stem cells) divide mitotically to produce more <span class=\"customMeta\" data-dictid=\"af3fa45f87169277719914e0dbaf14\">spermatogonia</span> and primary spermatocytes.</td>\n</tr>\n<tr>\n<td><strong>Meiotic Divisions</strong></td>\n<td>Primary spermatocytes undergo <span class=\"customMeta\" data-dictid=\"5e3732fcf416927771923ad13f4d16\">Meiosis</span> I to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> secondary spermatocytes, which undergo <span class=\"customMeta\" data-dictid=\"5e3732fcf416927771923ad13f4d16\">Meiosis</span> II.</td>\n</tr>\n<tr>\n<td><strong>Transformation</strong></td>\n<td>Spermatids are formed after <span class=\"customMeta\" data-dictid=\"5e3732fcf416927771923ad13f4d16\">Meiosis</span> II, which <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> into <span class=\"customMeta\" data-dictid=\"b8de2260ef1692777199037ce4faf5\">spermatozoa</span> through spermiogenesis.</td>\n</tr>\n<tr>\n<td><strong>Spermiogenesis</strong></td>\n<td>Process of transforming round spermatids into elongated, <span class=\"customMeta\" data-dictid=\"27cf09e9d316927771928763e99e0d\">motile</span> <span class=\"customMeta\" data-dictid=\"b8de2260ef1692777199037ce4faf5\">spermatozoa</span> with distinct morphology.</td>\n</tr>\n<tr>\n<td><strong>Sertoli Cells</strong></td>\n<td>Sertoli cells in the <span class=\"customMeta\" data-dictid=\"1406286c02169277719897928fb9f1\">seminiferous</span> tubules provide support, nourishment, and protection for developing sperm.</td>\n</tr>\n<tr>\n<td><strong>Spermiation</strong></td>\n<td>The release of <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> <span class=\"customMeta\" data-dictid=\"b8de2260ef1692777199037ce4faf5\">spermatozoa</span> from the Sertoli cells into the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> of the <span class=\"customMeta\" data-dictid=\"1406286c02169277719897928fb9f1\">seminiferous</span> tubules.</td>\n</tr>\n<tr>\n<td><strong>Sperm Maturation</strong></td>\n<td>After spermiation, <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> undergo further <span class=\"customMeta\" data-dictid=\"76948f718016927771924774ade7e9\">maturation</span> in the epididymis, acquiring <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> and fertility.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What mediates Inverse stretch reflex?", "options": [{"label": "A", "text": "Golgi tendon", "correct": true}, {"label": "B", "text": "Muscle spindle", "correct": false}, {"label": "C", "text": "Unmyelinated C fibres", "correct": false}, {"label": "D", "text": "Dorsal Column", "correct": false}], "correct_answer": "A. Golgi tendon", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of Stretch Reflex</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Mediator</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Monosynaptic</p>\n</td>\n<td>\n<p>Muscle <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> neuron</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Polysynaptic</p>\n</td>\n<td>\n<p>Muscle spindle, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> neuron, and interneuron</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Reciprocal Inhibition</p>\n</td>\n<td>\n<p>Muscle spindle, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> neuron, and <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> interneuron</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Golgi <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">Tendon</span> Reflex</p>\n</td>\n<td>\n<p>Golgi <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> organ and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> neuron</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Flexor Withdrawal Reflex</p>\n</td>\n<td>\n<p>Cutaneous receptors, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> neuron, and interneurons</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following organelle has DNA?", "options": [{"label": "A", "text": "Mitochondria", "correct": true}, {"label": "B", "text": "Golgi complex", "correct": false}, {"label": "C", "text": "SER", "correct": false}, {"label": "D", "text": "RER", "correct": false}], "correct_answer": "A. Mitochondria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A-Mitoch\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Organelle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presence of DNA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presence of RNA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nucleus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chloroplasts</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoplasmic Reticulum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Golgi Apparatus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ribosomes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lysosomes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peroxisomes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are Glucogenic hormones except?", "options": [{"label": "A", "text": "ADH", "correct": true}, {"label": "B", "text": "Glucagon", "correct": false}, {"label": "C", "text": "Thyroxine", "correct": false}, {"label": "D", "text": "Glucocorticoids", "correct": false}], "correct_answer": "A. ADH", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the consistent amplitude of action potential when the stimulus is delivered at an intensity above the threshold ?", "options": [{"label": "A", "text": "All or none law", "correct": true}, {"label": "B", "text": "Local potential", "correct": false}, {"label": "C", "text": "Absolute refractory period", "correct": false}, {"label": "D", "text": "Relative refractory period", "correct": false}], "correct_answer": "A. All or none law", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"b5c051aedf16927771818e206f4417\"&gt;All or none&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What specific region of the thalamus is associated with the regulation of motor control?", "options": [{"label": "A", "text": "Ventrolateral thalamus", "correct": true}, {"label": "B", "text": "Ventral posteromedial", "correct": false}, {"label": "C", "text": "Ventral posterolateral", "correct": false}, {"label": "D", "text": "Superior and inferior colliculi", "correct": false}], "correct_answer": "A. Ventrolateral thalamus", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Thalamic Nucleus</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ventral <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">Posterolateral</span> (VPL)</p>\n</td>\n<td>\n<p>Relays <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> information from the body to the primary <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> cortex</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ventral <span class=\"customMeta\" data-dictid=\"b1b0b6b9c716927771966dfdac754d\">Posteromedial</span> (VPM)</p>\n</td>\n<td>\n<p>Relays <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> information from the face to the primary <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> cortex</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lateral <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">Geniculate</span> (LGN)</p>\n</td>\n<td>\n<p>Relays visual information from the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> tracts to the primary visual cortex</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Medial <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">Geniculate</span> (MGN)</p>\n</td>\n<td>\n<p>Relays <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> information from the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"1bbc05a9c216927771844ff032232d\">colliculus</span> to the primary <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> cortex</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ventral <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> (VA)</p>\n</td>\n<td>\n<p>Contributes to <span class=\"customMeta\" data-dictid=\"098b60fa37169277719232147d5fb7\">motor control</span> by receiving input from the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ventral <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> (VL)</p>\n</td>\n<td>\n<p>Contributes to <span class=\"customMeta\" data-dictid=\"098b60fa37169277719232147d5fb7\">motor control</span> by receiving input from the cerebellum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anterior (AN)</p>\n</td>\n<td>\n<p>Involved in memory, emotion, and regulation of the <span class=\"customMeta\" data-dictid=\"fae243395d16927771917dbd1992e9\">limbic</span> system</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Intralaminar Nuclei</p>\n</td>\n<td>\n<p>Involved in arousal, attention, and <span class=\"customMeta\" data-dictid=\"6c0c4e41b31692777192be0fbfce62\">modulation</span> of pain perception</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which test is utilized for the diagnosis of DIC among the following options?", "options": [{"label": "A", "text": "Fibrin degradation products", "correct": false}, {"label": "B", "text": "Activation partial thromboplastin time", "correct": false}, {"label": "C", "text": "Prothrombin time", "correct": false}, {"label": "D", "text": "Dimer assay", "correct": true}], "correct_answer": "D. Dimer assay", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"15131f1b0a1692777186cd434919ce\"&gt;Dimer&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Active form of Vitamin D3 is?", "options": [{"label": "A", "text": "Calcitriol", "correct": true}, {"label": "B", "text": "Calciferol", "correct": false}, {"label": "C", "text": "Calcidiol", "correct": false}, {"label": "D", "text": "Ergocalciferol", "correct": false}], "correct_answer": "A. Calcitriol", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Vitamin</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Active Form/Product</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin A</p>\n</td>\n<td>\n<p>Retinol, Retinal, Retinoic Acid</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin B1</p>\n</td>\n<td>\n<p>Thiamine <span class=\"customMeta\" data-dictid=\"53da8f40b5169277719620504e0cb9\">Pyrophosphate</span> (TPP)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin B2</p>\n</td>\n<td>\n<p>Flavin <span class=\"customMeta\" data-dictid=\"701cef29c216927771801e7d1a7c0f\">Adenine</span> <span class=\"customMeta\" data-dictid=\"419082b5c61692777186e04b66aafb\">Dinucleotide</span> (FAD)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin B3</p>\n</td>\n<td>\n<p>Nicotinamide <span class=\"customMeta\" data-dictid=\"701cef29c216927771801e7d1a7c0f\">Adenine</span> <span class=\"customMeta\" data-dictid=\"419082b5c61692777186e04b66aafb\">Dinucleotide</span> (NAD), <span class=\"customMeta\" data-dictid=\"5eb9769383169277719347453a36cc\">Nicotinamide</span> <span class=\"customMeta\" data-dictid=\"701cef29c216927771801e7d1a7c0f\">Adenine</span> <span class=\"customMeta\" data-dictid=\"419082b5c61692777186e04b66aafb\">Dinucleotide</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> (NADP)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin B5</p>\n</td>\n<td>\n<p>Coenzyme A (CoA)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin B6</p>\n</td>\n<td>\n<p>Pyridoxal <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> (PLP)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin B7</p>\n</td>\n<td>\n<p>Biotin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin B9</p>\n</td>\n<td>\n<p>Folic Acid (Folate)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin B12</p>\n</td>\n<td>\n<p>Methylcobalamin, Cyanocobalamin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin C</p>\n</td>\n<td>\n<p>Ascorbic Acid</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin D</p>\n</td>\n<td>\n<p>Calcitriol</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin E</p>\n</td>\n<td>\n<p>Alpha-Tocopherol</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin K</p>\n</td>\n<td>\n<p>Phylloquinone (K1), <span class=\"customMeta\" data-dictid=\"bd6808e6c816927771927330b198fc\">Menaquinone</span> (K2)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the clinical diagnosis for a patient who experiences sudden and severe respiratory distress after undergoing internal jugular vein catheterization?", "options": [{"label": "A", "text": "Pneumothorax", "correct": true}, {"label": "B", "text": "Sepsis", "correct": false}, {"label": "C", "text": "ARDS", "correct": false}, {"label": "D", "text": "Infective endarteritis", "correct": false}], "correct_answer": "A. Pneumothorax", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Pneumoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which hormone binds to tyrosine kinase receptors and has 4 subunits and 2 units for receptor binding?", "options": [{"label": "A", "text": "Insulin", "correct": true}, {"label": "B", "text": "Glucagon", "correct": false}, {"label": "C", "text": "T3", "correct": false}, {"label": "D", "text": "ADH", "correct": false}], "correct_answer": "A. Insulin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As an intern in the neurology ward of the Department of Internal Medicine, you encounter a 48-year-old female patient who has been admitted due to muscle weakness. After conducting investigations and examinations, it is found that her nerve conduction shows a decremental response , but she displays signs of flaccidity. Based on these findings, what possible diagnosis would you consider?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": true}, {"label": "B", "text": "GBS", "correct": false}, {"label": "C", "text": "Transverse myelitis", "correct": false}, {"label": "D", "text": "Traumatic neuritis", "correct": false}], "correct_answer": "A. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\"&gt;Myasthenia&lt;/span&gt; grav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What happens to urine after passing the thin descending loop of Henle ?", "options": [{"label": "A", "text": "Hypotonic", "correct": false}, {"label": "B", "text": "Normal", "correct": false}, {"label": "C", "text": "Hypertonic", "correct": true}, {"label": "D", "text": "Remains unchanged", "correct": false}], "correct_answer": "C. Hypertonic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - H\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephron segment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tonicity/Osmolality of <span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\">Luminal</span> Content Relative to plasma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Filtration (Glomerulus)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isotonic (same as <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolality)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal Tubule</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isotonic (the <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of <span class=\"customMeta\" data-dictid=\"6fe354b91616927771982cc53f71fc\">solute</span> is proportional to the <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of water; thus, the <span class=\"customMeta\" data-dictid=\"4e17dff110169277720097f083b99b\">tonicity</span> of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> will be the same as that of plasma)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Descending <span class=\"customMeta\" data-dictid=\"65b254877916927772008696d46c79\">Thin Segment</span> (DTS)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertonic (water reabsorption, no <span class=\"customMeta\" data-dictid=\"6fe354b91616927771982cc53f71fc\">solute</span> reabsorption)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thick <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> Limb (TAL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isotonic (Solute reabsorption, no water reabsorption)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">Tubule</span> (DCT)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypotonic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collecting <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> (CD) – Presence of a crucial hormone, <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> in the blood, determines whether there will be increased <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> or not.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>With <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> more <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of water: Hypertonic</li>\n<li>Without <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> water <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> is nil: More <span class=\"customMeta\" data-dictid=\"6c1412e72916927771893d06180642\">hypotonic</span> (collecting <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> absorbs little sodium)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What conditions are associated with Type 2 hypersensitivity reactions?", "options": [{"label": "A", "text": "Hyper acute kidney rejection", "correct": false}, {"label": "B", "text": "Blood transfusion reaction", "correct": true}, {"label": "C", "text": "Arthus reaction", "correct": false}, {"label": "D", "text": "Pathergy phenomenon", "correct": false}], "correct_answer": "B. Blood transfusion reaction", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe increased pain in response to a minor stimulus?", "options": [{"label": "A", "text": "Hypersensitivity", "correct": false}, {"label": "B", "text": "Causalgia", "correct": false}, {"label": "C", "text": "Hyperalgesia", "correct": true}, {"label": "D", "text": "Allodynia", "correct": false}], "correct_answer": "C. Hyperalgesia", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Stimulus</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mechanical stimulus</p>\n</td>\n<td>\n<p>Physical pressure or trauma to tissues or organs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Thermal stimulus</p>\n</td>\n<td>\n<p>Heat or cold applied to the body</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chemical stimulus</p>\n</td>\n<td>\n<p>Exposure to irritants or <span class=\"customMeta\" data-dictid=\"16a98a214c16927771852d7f6c344e\">corrosive</span> substances</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Electrical stimulus</p>\n</td>\n<td>\n<p>Electric shocks or currents</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inflammatory stimulus</p>\n</td>\n<td>\n<p>Inflammation of tissues or organs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ischemic stimulus</p>\n</td>\n<td>\n<p>Lack of blood supply to tissues or organs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nociceptive stimulus</p>\n</td>\n<td>\n<p>Activation of specialized pain receptors (nociceptors) by harmful or potentially damaging stimuli</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Neuropathic stimulus</p>\n</td>\n<td>\n<p>Damage or <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> of the nervous system, resulting in <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> pain perception</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a management approach used for a violent patient in psychiatry?", "options": [{"label": "A", "text": "BZD", "correct": false}, {"label": "B", "text": "CBT", "correct": true}, {"label": "C", "text": "ECT", "correct": false}, {"label": "D", "text": "Haloperidol", "correct": false}], "correct_answer": "B. CBT", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which test is the most sensitive for diagnosing Organophosphate poisoning among the following options?", "options": [{"label": "A", "text": "Plasma acetylcholinesterase", "correct": true}, {"label": "B", "text": "Organophosphate level in blood", "correct": false}, {"label": "C", "text": "Organophosphate level in plasma", "correct": false}, {"label": "D", "text": "RBC transaminase levels", "correct": false}], "correct_answer": "A. Plasma acetylcholinesterase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\"&gt;Plasma&lt;/span&gt; acetylcholinesterase: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following has the least chance of developing malignancy?", "options": [{"label": "A", "text": "Chronic hyperplastic candidiasis", "correct": false}, {"label": "B", "text": "Oral submucosal fibrosis", "correct": false}, {"label": "C", "text": "Oral lichen planus", "correct": true}, {"label": "D", "text": "Leukoplakia", "correct": false}], "correct_answer": "C. Oral lichen planus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JkHpfLhBlvPa2lmDZke81714112028.png"], "explanation": "<p>Correct Option C - Oral &lt;span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\"&gt;lichen&lt;/span&gt; planu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Double depression is:-", "options": [{"label": "A", "text": "Major depressive disorder from 2 years", "correct": false}, {"label": "B", "text": "Depression with OCD", "correct": false}, {"label": "C", "text": "Depression with dysthymia", "correct": true}, {"label": "D", "text": "Depression with anxiety attack", "correct": false}], "correct_answer": "C. Depression with dysthymia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Depression with dysth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Extensor Reflex on pinching gastrocnemius muscle is called?", "options": [{"label": "A", "text": "Gower Sign", "correct": false}, {"label": "B", "text": "Homan Sign", "correct": false}, {"label": "C", "text": "Oppenheim Sign", "correct": false}, {"label": "D", "text": "Gordon Sign", "correct": true}], "correct_answer": "D. Gordon Sign", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Gordon Sig\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Sign</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Associated Condition</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gower Sign</p>\n</td>\n<td>\n<p>Duchenne <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> dystrophy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Homan Sign</p>\n</td>\n<td>\n<p>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> (DVT)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oppenheim Sign</p>\n</td>\n<td>\n<p>Upper <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">motor neuron</span> dysfunction</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gordon Sign</p>\n</td>\n<td>\n<p>Hypertrophy of calf muscles due to muscle weakness</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the psychiatric disorder most frequently observed in patients with medical or surgical conditions?", "options": [{"label": "A", "text": "Depression", "correct": false}, {"label": "B", "text": "Schizophrenia", "correct": false}, {"label": "C", "text": "Delirium", "correct": true}, {"label": "D", "text": "Dementia", "correct": false}], "correct_answer": "C. Delirium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Deliriu\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Psychiatric Illness</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Delirium</p>\n</td>\n<td>\n<p>Acute and fluctuating <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> of consciousness and cognitive function often seen in the context of medical illness, surgery, or medication use. It requires prompt evaluation and treatment.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Depression</p>\n</td>\n<td>\n<p>Mood disorder characterized by persistent feelings of sadness, loss of interest or pleasure, changes in <span class=\"customMeta\" data-dictid=\"d4a253810c1692777181f708ba3dc6\">appetite</span> or sleep patterns, and other symptoms. It can coexist with medical or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> conditions.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anxiety</p>\n</td>\n<td>\n<p>A group of disorders characterized by excessive worry, fear, and apprehension. It can occur in response to medical conditions or as a pre-existing condition in medico-surgical patients.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Substance Use Disorders</p>\n</td>\n<td>\n<p>Conditions characterized by the problematic use of substances, such as alcohol, drugs, or medications. These disorders can be present in medico-surgical patients, either pre-existing or as a result of medical treatments or conditions.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Adjustment Disorders</p>\n</td>\n<td>\n<p>Emotional and behavioral reactions to identifiable stressors, such as a medical diagnosis, surgery, or <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> events. These reactions may cause <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> and interfere with daily functioning.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Psychotic Disorders</p>\n</td>\n<td>\n<p>Conditions characterized by <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> thoughts, perceptions, and behavior, such as <span class=\"customMeta\" data-dictid=\"d844b672a616927771988fee71197b\">schizophrenia</span> or brief <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> episodes. They can occur in medico-surgical patients, either pre-existing or as a result of medical conditions or treatments.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cognitive Disorders</p>\n</td>\n<td>\n<p>Conditions characterized by a decline in cognitive abilities, including memory, thinking, and problem-solving. Examples include <span class=\"customMeta\" data-dictid=\"41cc5ad93c169277718553c6b948a3\">dementia</span> or delirium, which can be seen in medico-surgical patients.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sleep Disorders</p>\n</td>\n<td>\n<p>Conditions characterized by disruptions in sleep patterns, such as <span class=\"customMeta\" data-dictid=\"04b9e17b411692777190d32aceafae\">insomnia</span> or sleep apnea. These disorders can be present in medico-surgical patients, either pre-existing or as a result of medical conditions or treatments.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the pathology in the shown CT:", "options": [{"label": "A", "text": "Intraventricular bleed", "correct": false}, {"label": "B", "text": "Massive Epidural hemorrhage", "correct": true}, {"label": "C", "text": "Subdural hemorrhage", "correct": false}, {"label": "D", "text": "Subarachnoid hemorrhage", "correct": false}], "correct_answer": "B. Massive Epidural hemorrhage", "question_images": ["https://image.prepladder.com/content/PqaVkz6ACBfZPSaDerwX1691479391.png"], "explanation_images": [], "explanation": "<p>Correct Option B\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Type of Brain Hemorrhage</strong></p>\n</td>\n<td>\n<p><strong>Appearance on CT Scan</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Epidural Hemorrhage</p>\n</td>\n<td>\n<p>Convex, lens-shaped collection of blood located between the skull and the <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> mater. Appears hyperdense.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Subdural Hemorrhage</p>\n</td>\n<td>\n<p>Crescent-shaped collection of blood between the <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> <span class=\"customMeta\" data-dictid=\"aaae314d6f1692777191e3350c8ade\">mater</span> and the brain. Appears hyperdense.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Subarachnoid Hemorrhage</p>\n</td>\n<td>\n<p>Diffuse or <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> areas of high-density blood within the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Intracerebral Hemorrhage</p>\n</td>\n<td>\n<p>Irregular-shaped areas of high-density blood within the brain tissue.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Intraventricular Hemorrhage</p>\n</td>\n<td>\n<p>Hyperdense areas of blood accumulation within the brain's ventricles.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Traumatic <span class=\"customMeta\" data-dictid=\"a479c9f4081692777187a3308ccd27\">Extradural</span> Hemorrhage</p>\n</td>\n<td>\n<p>Collection of blood between the skull and the <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> <span class=\"customMeta\" data-dictid=\"aaae314d6f1692777191e3350c8ade\">mater</span> caused by trauma. Appears hyperdense.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hypertensive <span class=\"customMeta\" data-dictid=\"c7f167b8df1692777190bcd90fe428\">Intracerebral</span> Hemorrhage</p>\n</td>\n<td>\n<p>Areas of high-density blood within the brain tissue, often in deep structures like the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Aneurysmal <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">Subarachnoid</span> Hemorrhage</p>\n</td>\n<td>\n<p>Diffuse or <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> areas of high-density blood within the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space, typically associated with the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of an <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> aneurysm.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not considered a negative symptom of schizophrenia?", "options": [{"label": "A", "text": "Over activity", "correct": true}, {"label": "B", "text": "Anhedonia", "correct": false}, {"label": "C", "text": "Alogia", "correct": false}, {"label": "D", "text": "Apathy", "correct": false}], "correct_answer": "A. Over activity", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Positive Symptoms</strong></p>\n</td>\n<td>\n<p>Positive symptoms are additional experiences or behaviors that are not typically present in individuals without schizophrenia. They include:</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hallucinations</p>\n</td>\n<td>\n<p>Sensory perceptions without any external stimulus. Common types include <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> hallucinations (e.g., hearing voices), but hallucinations can also occur in other modalities such as visual, tactile, olfactory, or gustatory.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Delusions</p>\n</td>\n<td>\n<p>False beliefs that persist despite evidence to the contrary. Examples include <span class=\"customMeta\" data-dictid=\"39a55021ff16927771946d220fe0db\">paranoid</span> delusions (believing others are plotting against them) or <span class=\"customMeta\" data-dictid=\"2bf49be62516927771886ca6913e3e\">grandiose</span> delusions (believing one has exceptional abilities or status).</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Disorganized Thinking</p>\n</td>\n<td>\n<p>Disorganized thought processes, <span class=\"customMeta\" data-dictid=\"014b1a7b931692777197f57251720d\">reflected</span> in disorganized speech and difficulty in organizing thoughts or connecting ideas logically.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Grossly Disorganized Behavior</p>\n</td>\n<td>\n<p>Disorganized or bizarre behaviors, such as unusual body movements, unpredictable agitation, or inappropriate emotional responses.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Negative Symptoms</strong></p>\n</td>\n<td>\n<p>Negative symptoms are deficits or reductions in normal emotional, cognitive, or behavioral functioning. They include:</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Apathy</p>\n</td>\n<td>\n<p>Lack of interest, motivation, or enthusiasm in activities or goals. Individuals may experience <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> drive or find it difficult to initiate and sustain activities.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Blunted Affect</p>\n</td>\n<td>\n<p>Reduced or minimal emotional expression or responsiveness. Individuals may appear emotionally \"flat\" or unresponsive to social cues or events.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Avolition</p>\n</td>\n<td>\n<p>Decreased motivation or ability to engage in purposeful activities. It can manifest as a lack of initiative, difficulty setting goals, or general lack of drive.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Social Withdrawal</p>\n</td>\n<td>\n<p>Withdrawal from social interactions and a <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> desire to engage in social relationships. Individuals may isolate themselves or have a decreased interest in socializing.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anhedonia</p>\n</td>\n<td>\n<p>Loss of interest or pleasure in previously enjoyable activities. Individuals may have difficulty experiencing joy or finding satisfaction in things they used to find pleasurable.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently encountered acute organic mental disorder?", "options": [{"label": "A", "text": "Delirium", "correct": true}, {"label": "B", "text": "Dementia", "correct": false}, {"label": "C", "text": "Amnesia", "correct": false}, {"label": "D", "text": "Anxiety disorder", "correct": false}], "correct_answer": "A. Delirium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the sign?", "options": [{"label": "A", "text": "Claw sign", "correct": false}, {"label": "B", "text": "Target sign", "correct": true}, {"label": "C", "text": "Coffee bean sign", "correct": false}, {"label": "D", "text": "Lead pipe sign", "correct": false}], "correct_answer": "B. Target sign", "question_images": ["https://image.prepladder.com/content/HePk6xOgM9zC7O43Q4Pq1698755076.png"], "explanation_images": ["https://image.prepladder.com/content/W2VDOgDkfTd55etKd31O1698755143.png", "https://image.prepladder.com/content/HKWEahgNcPwOYNVVp4ur1698755218.png", "https://image.prepladder.com/content/zrsquAkvZRAKoMvFnrKz1698755258.png", "https://image.prepladder.com/content/W14MYZ1oD5OvrwQiZLCy1698755368.png"], "explanation": "<p>Correct Option B: \n<table>\n<tbody>\n<tr>\n<td><strong>Definition</strong></td>\n<td>Intussusception is a medical condition in which one portion of the <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> (typically the small intestine) invaginates or telescopes into another segment of the intestine. This can lead to <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood flow, and potential tissue damage. It is most common in infants and young children.</td>\n</tr>\n<tr>\n<td><strong>Prevalence</strong></td>\n<td>Intussusception is relatively common in children, with a peak <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> between 3 months and 6 years of age. It is rare in adults but can occur.</td>\n</tr>\n<tr>\n<td><strong>Causes</strong></td>\n<td>The exact cause is often unknown, but it may be <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by infections, changes in <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> tissue in the intestine, or sometimes a structural lead point such as a <span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\">polyp</span> or tumor.</td>\n</tr>\n<tr>\n<td><strong>Symptoms</strong></td>\n<td>- <strong>Children:</strong> Sudden, severe <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, drawing knees to the chest, vomiting, and \"currant jelly\" <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> (blood and <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> in the stool). - <strong>Adults:</strong> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain, nausea, and vomiting.</td>\n</tr>\n<tr>\n<td><strong>Diagnosis</strong></td>\n<td>- Clinical evaluation based on symptoms and physical examination.- <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> studies, such as <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> X-rays, can confirm the diagnosis by showing the classic \"target sign.\"</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td>- <strong>Enema (Air or Barium):</strong> Often the first-line treatment. It can both diagnose and treat <span class=\"customMeta\" data-dictid=\"ecba80da7b1692777190a1ae56e0a7\">intussusception</span> by pushing the telescoped segment back into its normal position.- <strong>Surgery:</strong> If <span class=\"customMeta\" data-dictid=\"981cb55fe1169277718759ac720c5d\">enema</span> is unsuccessful or if complications like <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> occur, surgery may be necessary to correct the problem.</td>\n</tr>\n<tr>\n<td><strong>Prognosis</strong></td>\n<td>The <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> is generally good, especially when diagnosed and treated promptly. Delayed diagnosis or treatment can lead to complications, such as <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> or perforation.</td>\n</tr>\n<tr>\n<td><strong>Complications</strong></td>\n<td>- <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> perforation- Infection in the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cavity- Peritonitis- <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">Scar</span> tissue (adhesions) after surgery</td>\n</tr>\n<tr>\n<td><strong>Key Points</strong></td>\n<td>- <span class=\"customMeta\" data-dictid=\"ecba80da7b1692777190a1ae56e0a7\">Intussusception</span> is a common cause of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in children.- Diagnosis is typically based on clinical symptoms and <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies.- Early treatment is important to prevent complications.- In adults, <span class=\"customMeta\" data-dictid=\"ecba80da7b1692777190a1ae56e0a7\">intussusception</span> is often associated with a <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> lead point and may require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent investigations operate based on the same principle?", "options": [{"label": "A", "text": "CT and MRI", "correct": false}, {"label": "B", "text": "CT and X-ray", "correct": true}, {"label": "C", "text": "USG and HIDA Scan", "correct": false}, {"label": "D", "text": "MRI and PET Scan", "correct": false}], "correct_answer": "B. CT and X-ray", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Radiological Investigation</strong></p>\n</td>\n<td>\n<p><strong>Principle</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>X-ray</p>\n</td>\n<td>\n<p>Ionizing radiation is passed through the body, and the resulting image is captured on a detector.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Computed <span class=\"customMeta\" data-dictid=\"8d4f2a375b1692777200f41db641bc\">Tomography</span> (CT)</p>\n</td>\n<td>\n<p>X-ray beams <span class=\"customMeta\" data-dictid=\"ed17327223169277719753b0e5d6b4\">rotate</span> around the body, and multiple cross-sectional images are generated and reconstructed by a computer.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRI)</p>\n</td>\n<td>\n<p>Powerful magnetic fields and radio waves are used to create detailed images of the body's structures based on the behavior of <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> atoms in the body.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ultrasound (USG)</p>\n</td>\n<td>\n<p>High-frequency sound waves are emitted and their reflections are used to create <span class=\"customMeta\" data-dictid=\"9ddd195e9a1692777197bb3f135c2e\">real-time</span> images of the internal organs.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Positron Emission <span class=\"customMeta\" data-dictid=\"8d4f2a375b1692777200f41db641bc\">Tomography</span> (PET)</p>\n</td>\n<td>\n<p>A <span class=\"customMeta\" data-dictid=\"f391426a781692777197a16039bb5e\">radioactive</span> <span class=\"customMeta\" data-dictid=\"887a04d130169277720091d7c1eeea\">tracer</span> is <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> into the body, and its distribution and <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> are detected to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> of organs and tissues.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Single-Photon Emission <span class=\"customMeta\" data-dictid=\"44b07c254816927771855a12777513\">Computed Tomography</span> (SPECT)</p>\n</td>\n<td>\n<p>A <span class=\"customMeta\" data-dictid=\"f391426a781692777197a16039bb5e\">radioactive</span> <span class=\"customMeta\" data-dictid=\"887a04d130169277720091d7c1eeea\">tracer</span> is <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> into the body, and the emitted <span class=\"customMeta\" data-dictid=\"49be0416121692777188dc8944b7bc\">gamma</span> rays are detected to create three-dimensional images.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mammography</p>\n</td>\n<td>\n<p>Low-dose <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> are used to image the breast tissue, primarily for breast cancer screening and diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Fluoroscopy</p>\n</td>\n<td>\n<p>Continuous <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> beams are used to create <span class=\"customMeta\" data-dictid=\"9ddd195e9a1692777197bb3f135c2e\">real-time</span> moving images of the internal structures, such as the <span class=\"customMeta\" data-dictid=\"a32cad4dbc169277718669cfb165a5\">digestive</span> or <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> systems.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Bone Densitometry</p>\n</td>\n<td>\n<p>X-rays or <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> are used to measure the density of bones, helping diagnose <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> and assess <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> risk.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Investigation of choice for GERD:", "options": [{"label": "A", "text": "USG", "correct": false}, {"label": "B", "text": "HIDA", "correct": false}, {"label": "C", "text": "Manometry", "correct": false}, {"label": "D", "text": "24 hour pH monitoring", "correct": true}], "correct_answer": "D. 24 hour pH monitoring", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Adhesion of platelets is the main function of von-willebrand factor. Which of the following is true for von-willebrand disease?", "options": [{"label": "A", "text": "Normal partial thromboplastin time", "correct": false}, {"label": "B", "text": "Decreased platelets", "correct": false}, {"label": "C", "text": "Normal prothrombin time", "correct": true}, {"label": "D", "text": "Normal bleeding time", "correct": false}], "correct_answer": "C. Normal prothrombin time", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Normal &lt;span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\"&gt;prothrombin&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the pathology present in the provided X-ray image.", "options": [{"label": "A", "text": "Pneumothorax", "correct": false}, {"label": "B", "text": "Pneumoperitoneum", "correct": true}, {"label": "C", "text": "Hydrothorax", "correct": false}, {"label": "D", "text": "Normal X-ray", "correct": false}], "correct_answer": "B. Pneumoperitoneum", "question_images": ["https://image.prepladder.com/content/4ulqiVTlkftdLqc3pGsf1688386205.png"], "explanation_images": [], "explanation": "<p>Correct Option B\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Pneumatic Condition</strong></p>\n</td>\n<td>\n<p><strong>X-ray Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pneumothorax</p>\n</td>\n<td>\n<p>- Visible lung collapse with absent lung markings at the periphery</p>\n<p>- Deep <span class=\"customMeta\" data-dictid=\"2a56f52a921692777199df43853eba\">sulcus</span> sign (deep <span class=\"customMeta\" data-dictid=\"03b5b4a6ef1692777185c8ff0d80d2\">costophrenic</span> angle)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pneumoperitoneum</p>\n</td>\n<td>\n<p>- Presence of free air under the diaphragm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pneumomediastinum</p>\n</td>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">Radiolucent</span> streaks outlining the mediastinum</p>\n<p>- Presence of air in the mediastinum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pneumopericardium</p>\n</td>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">Radiolucent</span> outline around the heart</p>\n<p>- Presence of air within the <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> sac</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pulmonary <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">Interstitial</span> Emphysema</p>\n</td>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">Diffuse</span> air-filled lucencies throughout the lung fields</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Subcutaneous Emphysema</p>\n</td>\n<td>\n<p>- Air dissecting through the soft tissues</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pneumocephalus</p>\n</td>\n<td>\n<p>- Air within the <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> cavity</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pneumoperitoneum</p>\n</td>\n<td>\n<p>- Presence of free air under the diaphragm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pneumatosis Intestinalis</p>\n</td>\n<td>\n<p>- Air within the walls of the intestines</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pneumobilia</p>\n</td>\n<td>\n<p>- Presence of air within the <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> system</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mosquito having spotted wings is?", "options": [{"label": "A", "text": "Anopheles", "correct": true}, {"label": "B", "text": "Culex", "correct": false}, {"label": "C", "text": "Aedes", "correct": false}, {"label": "D", "text": "Mansonia", "correct": false}], "correct_answer": "A. Anopheles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/c63UveFKbiTXQ7Saq9Yl1713771781.png"], "explanation": "\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td>\n<p>Identification</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Sits at an angle of 450.</p>\n</li>\n<li>\n<p>Head is downwards - resting in an inclined position.</p>\n</li>\n<li>\n<p>Has spotted wings</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Breeding</p>\n</td>\n<td>\n<ul>\n<li>Anopheles breed in clean <span class=\"customMeta\" data-dictid=\"00e90b2b491692777199a0547a1945\">stagnant</span> water (Also called sophisticated mosquitoes).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Eggs</p>\n</td>\n<td>\n<ul>\n<li>Eggs are laid singly.</li>\n<li>Eggs are boat-shaped with <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> floats.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Larvae</p>\n</td>\n<td>\n<ul>\n<li>Larva doesn't have a <span class=\"customMeta\" data-dictid=\"9d59eae3ce16927771982e99e0035f\">siphon</span> tube - no breathing. Rests <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the surface of the water.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Flight range</p>\n</td>\n<td>\n<ul>\n<li>2 to 3 km.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Yaws is caused by:", "options": [{"label": "A", "text": "T. Pertunae", "correct": true}, {"label": "B", "text": "T. endemicum", "correct": false}, {"label": "C", "text": "T. Carateum", "correct": false}, {"label": "D", "text": "Hemophilus", "correct": false}], "correct_answer": "A. T. Pertunae", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - T. Pertu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40 yr old man comes with a history of retrosternal chest pain and dysphagia, Barium meal was done given below. What is the classical pattern of dysphagia found in this condition?", "options": [{"label": "A", "text": "More for liquids &amp;gt;&amp;gt; solids", "correct": true}, {"label": "B", "text": "Progressive Dysphagia for liquids = solids", "correct": false}, {"label": "C", "text": "Progressive dysphagia more for solids &amp;gt;&amp;gt; liquids", "correct": false}, {"label": "D", "text": "Intermittent dysphagia for solids = liquids", "correct": false}], "correct_answer": "A. More for liquids &gt;&gt; solids", "question_images": ["https://image.prepladder.com/content/gyf55uGT1rYtlwkBdJFa1691480387.png"], "explanation_images": [], "explanation": "<p>Correct Option A\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Radiological Findings</strong></p>\n</td>\n<td>\n<p><strong>ACHLASIA CARDIA</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Esophageal Dilatation</p>\n</td>\n<td>\n<p>Enlarged <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> due to functional <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> at the lower <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> (LES)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Bird's <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">Beak</span> Appearance</p>\n</td>\n<td>\n<p>Distal smooth, short segment tapering resembling a bird's beak, seen on <span class=\"customMeta\" data-dictid=\"55052c0f0616927771829c99eec183\">barium</span> swallow study</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lack of Peristalsis</p>\n</td>\n<td>\n<p>Absence of normal peristaltic contractions in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> body</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Residual Contrast Material</p>\n</td>\n<td>\n<p>Incomplete <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> of contrast material from the <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> into the stomach</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pseudo-Diverticula Formation</p>\n</td>\n<td>\n<p>Outpouchings or <span class=\"customMeta\" data-dictid=\"c9f59a135316927771862d79e1f59b\">diverticula</span> may <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> in the dilated esophagus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Narrowing of LES</p>\n</td>\n<td>\n<p>Narrowing or <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> opening of the lower <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> sphincter</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rhythmic Contractions</p>\n</td>\n<td>\n<p>Simultaneous, rhythmic contractions of the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> body, resulting in a \"corkscrew\" appearance</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which subtype of human papilloma virus has maximum chances of causing carcinoma cervix?", "options": [{"label": "A", "text": "HPV 16 &amp;amp; 18", "correct": true}, {"label": "B", "text": "HPV 6 &amp;amp; 11", "correct": false}, {"label": "C", "text": "HPV 31 &amp;amp; 32", "correct": false}, {"label": "D", "text": "HPV 1 &amp;amp; 2", "correct": false}], "correct_answer": "A. HPV 16 &amp; 18", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\"&gt;HPV&lt;/span&gt; 16 &\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>HPV Serotype</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>HPV 1, 2, 3 (Low risk)</p>\n</td>\n<td>\n<p>Plantar wart/Verruca and <span class=\"customMeta\" data-dictid=\"4e27c55ae5169277720209638fd5c0\">Filiform</span> wart</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>HPV 5, 8 (High risk)</p>\n</td>\n<td>\n<p>Tree man syndrome/Epiderodysplasia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>HPV 6, 11 (Low risk)</p>\n</td>\n<td>\n<p>Laryngeal <span class=\"customMeta\" data-dictid=\"e6a08d4d3e16927771948b8b25fc77\">papillomatosis</span> and <span class=\"customMeta\" data-dictid=\"2ed8a5f8f2169277718404b6d69c6c\">Condyloma</span> acuminatum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>HPV 16, 18, 31, 33, 35 (High risk)</p>\n</td>\n<td>\n<p>Squamous cell carcinoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Size of uterus (in inch):", "options": [{"label": "A", "text": "4x2x1", "correct": false}, {"label": "B", "text": "3x2x1", "correct": true}, {"label": "C", "text": "4x3x1", "correct": false}, {"label": "D", "text": "5x4x2", "correct": false}], "correct_answer": "B. 3x2x1", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Stage of Sexual Maturity</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Uterus Size</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Prepubertal</p>\n</td>\n<td>\n<p>Small (less than 3 cm in length)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Puberty</p>\n</td>\n<td>\n<p>Begins to enlarge, approximately 6-8 cm in length</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Reproductive Age</p>\n</td>\n<td>\n<p>Varies throughout the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle:</p>\n<ul>\n<li>Early <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> phase: 6-8 cm in length</li>\n<li>Ovulation: 8-10 cm in length</li>\n<li>Late <span class=\"customMeta\" data-dictid=\"165a6f47ef1692777191a1162aa3cd\">luteal</span> phase: 6-8 cm in length</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Perimenopause</p>\n</td>\n<td>\n<p>Starts to decrease in size</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Postmenopause</p>\n</td>\n<td>\n<p>Smaller and atrophic (less than 6 cm in length)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common immediate complication of splenectomy:", "options": [{"label": "A", "text": "Hemorrhage", "correct": true}, {"label": "B", "text": "Fistula", "correct": false}, {"label": "C", "text": "Bleeding from gastric mucosa", "correct": false}, {"label": "D", "text": "Pancreatitis", "correct": false}], "correct_answer": "A. Hemorrhage", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Hemorrhag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pearl index is used to calculate which of the following?", "options": [{"label": "A", "text": "Accidental pregnancies", "correct": true}, {"label": "B", "text": "Population", "correct": false}, {"label": "C", "text": "Fertility rate", "correct": false}, {"label": "D", "text": "Abortions", "correct": false}], "correct_answer": "A. Accidental pregnancies", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child is brought with a high fever with rigors for 5 days with pain in the right hypochondrium . On examination, the patient is anicteric, and tenderness is noted in the right upper quadrant. What is the best investigation for this case?", "options": [{"label": "A", "text": "USG", "correct": false}, {"label": "B", "text": "Serology", "correct": true}, {"label": "C", "text": "SGOT/LFT", "correct": false}, {"label": "D", "text": "CECT", "correct": false}], "correct_answer": "B. Serology", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Serolog\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Comment on the diagnosis of this 60 years of man:", "options": [{"label": "A", "text": "Basal cell carcinoma", "correct": false}, {"label": "B", "text": "Plunging Ranula", "correct": false}, {"label": "C", "text": "Epulis", "correct": false}, {"label": "D", "text": "SCC of lip", "correct": true}], "correct_answer": "D. SCC of lip", "question_images": ["https://image.prepladder.com/content/ZIsTuNulygWzH82Bw6ge1714022708.png"], "explanation_images": [], "explanation": "<p>Correct Option D - SCC\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the first postmortem change that occurs in a dead body ?", "options": [{"label": "A", "text": "Maggot formation", "correct": false}, {"label": "B", "text": "Putrefaction", "correct": false}, {"label": "C", "text": "Greenish discoloration of right iliac fossa", "correct": true}, {"label": "D", "text": "Mummification", "correct": false}], "correct_answer": "C. Greenish discoloration of right iliac fossa", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective treatment approach for anal canal carcinoma?", "options": [{"label": "A", "text": "Chemoradiation", "correct": true}, {"label": "B", "text": "Surgery", "correct": false}, {"label": "C", "text": "Radiation Therapy", "correct": false}, {"label": "D", "text": "Chemotherapy", "correct": false}], "correct_answer": "A. Chemoradiation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the population served by a single Primary Health Center (PHC) in the plains?", "options": [{"label": "A", "text": "3000", "correct": false}, {"label": "B", "text": "5000", "correct": false}, {"label": "C", "text": "20000", "correct": false}, {"label": "D", "text": "30000", "correct": true}], "correct_answer": "D. 30000", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 30000: \n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sub-center </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PHC </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CHC </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Population </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>1/5,000 in plain areas </li>\n<li>1/3,000 population in hilly areas </li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>1/30,000 in plain areas </li>\n<li>1/20,000 in hilly areas </li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>1/1,20,000 in plain area s</li>\n<li>1/80,000 in hilly areas </li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Level of health care </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secondary or first referral level </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Responsibility for maintenance </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Central government </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>State government </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>State government</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Number of villages supervised </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 villages </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>29 villages </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>158 villages </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Number of beds </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type B-2 beds </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old female presented to the OPD with complaints of abdominal pain, diarrhea, and weight loss. On further evaluation, the patient was found to have multiple strictures of small bowel with interspersed areas of normal mucosa in between . Which of the following is false regarding the given condition?", "options": [{"label": "A", "text": "No recurrence after surgery", "correct": true}, {"label": "B", "text": "Aphthous ulcer", "correct": false}, {"label": "C", "text": "Skip lesions", "correct": false}, {"label": "D", "text": "Fistula formation", "correct": false}], "correct_answer": "A. No recurrence after surgery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - No &lt;span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\"&gt;recurrence&lt;/span&gt; after surg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the CD4 cut off for initiating Antiretroviral Therapy (ART) in the treatment of AIDS?", "options": [{"label": "A", "text": "200", "correct": false}, {"label": "B", "text": "350", "correct": false}, {"label": "C", "text": "500", "correct": false}, {"label": "D", "text": "No cut-off", "correct": true}], "correct_answer": "D. No cut-off", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - No cu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Normal Waist to hip-ratio in male is:", "options": [{"label": "A", "text": "&amp;gt;0.8 in males", "correct": false}, {"label": "B", "text": "&amp;gt;0.85 in females", "correct": false}, {"label": "C", "text": "&amp;gt;0.90 males", "correct": false}, {"label": "D", "text": "&amp;lt;0.90 males", "correct": true}], "correct_answer": "D. &lt;0.90 males", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common subtype of Rodent ulcer is :", "options": [{"label": "A", "text": "Superficial", "correct": false}, {"label": "B", "text": "Cystic", "correct": false}, {"label": "C", "text": "Nodular", "correct": true}, {"label": "D", "text": "Pigmented", "correct": false}], "correct_answer": "C. Nodular", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Nodu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of these is the best for management of a 3 cm stone in renal pelvis without evidence of hydronephrosis ?", "options": [{"label": "A", "text": "ESWL", "correct": false}, {"label": "B", "text": "PCNL", "correct": true}, {"label": "C", "text": "Antegrae pyeloplasty", "correct": false}, {"label": "D", "text": "Retrograde pyeloplasty", "correct": false}], "correct_answer": "B. PCNL", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - PCNL\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How can the diagnosis of Rabies be quickly made in a living dog that is displaying symptoms of the disease?", "options": [{"label": "A", "text": "Fluorescent antibody test", "correct": true}, {"label": "B", "text": "Corneal impression", "correct": false}, {"label": "C", "text": "Inoculation in mouse", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Fluorescent antibody test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Fluorescent &lt;span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\"&gt;antibody&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the following conditions is AFP a tumor marker?", "options": [{"label": "A", "text": "HCC", "correct": true}, {"label": "B", "text": "RCC", "correct": false}, {"label": "C", "text": "Oncocytoma", "correct": false}, {"label": "D", "text": "Chordoma", "correct": false}], "correct_answer": "A. HCC", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - HCC\n<table border=\"1\" style=\"width:692px\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Antigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Associated Cancers</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>CEA</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<ul>\n<li>Colorectal carcinoma</li>\n<li>Pancreatic carcinoma</li>\n<li>Gastric carcinoma</li>\n<li>Lung carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>PSA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p>Prostate carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>AFP</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<ul>\n<li>Hepatocellular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (HCC)</li>\n<li>Germ cell tumors (e.g., testicular cancer)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>CA125</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p>Ovarian carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>CA 199</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<ul>\n<li>Pancreatic carcinoma</li>\n<li>Colorectal carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>hCG</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<ul>\n<li>Germ cell tumors (e.g., testicular and ovarian cancer)</li>\n<li>Choriocarcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>153</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p>Breast carcinoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a germ cell tumor not typically observed in males ?", "options": [{"label": "A", "text": "Choriocarcinoma", "correct": false}, {"label": "B", "text": "Seminoma", "correct": false}, {"label": "C", "text": "Sertoli cell tumour", "correct": true}, {"label": "D", "text": "Teratoma", "correct": false}], "correct_answer": "C. Sertoli cell tumour", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"ac8c26ed99169277719897b57e48b8\"&gt;Sertoli cell&lt;/span&gt; tu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following locations is the dye injected for Sentinel Lymph Node Biopsy ?", "options": [{"label": "A", "text": "Axilla", "correct": false}, {"label": "B", "text": "Tail of spence", "correct": false}, {"label": "C", "text": "Nipple", "correct": false}, {"label": "D", "text": "Areola", "correct": true}], "correct_answer": "D. Areola", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate portrayal of Paget's disease of the breast?", "options": [{"label": "A", "text": "Eczema of skin of nipple", "correct": true}, {"label": "B", "text": "The most common presentation is bilateral..", "correct": false}, {"label": "C", "text": "Mastitis carcinomatosis", "correct": false}, {"label": "D", "text": "Atrophic scirrhous carcinoma", "correct": false}], "correct_answer": "A. Eczema of skin of nipple", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6oUKASrqKmbBk9kTgqLB1714481840.png"], "explanation": "<p>Correct Option A - Eczema of skin of nipple: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male came to the OPD with complaints of a painful erection without sexual drive . The patient also gives a history of taking antipsychotic medication. The cut-off duration for diagnosis of Priapism is:", "options": [{"label": "A", "text": "1 hour", "correct": false}, {"label": "B", "text": "2 hours", "correct": false}, {"label": "C", "text": "3 hours", "correct": false}, {"label": "D", "text": "4 hours", "correct": true}], "correct_answer": "D. 4 hours", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 4 hou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 43-year-old female presents to the clinic with a complaint of recurrent right upper quadrant pain complaint. They exacerbate, especially after eating. An ultrasound of the abdomen is performed, which comes out to be non-conclusive. Which of the following procedures is indicated in the image below?", "options": [{"label": "A", "text": "Percutaneous transhepatic cholangiogram", "correct": false}, {"label": "B", "text": "T-tube cholangiogram", "correct": false}, {"label": "C", "text": "Endoscopic retrograde cholangiopancreatography (ERCP)", "correct": true}, {"label": "D", "text": "Hepatobiliary iminodiacetic acid (HIDA) scan", "correct": false}], "correct_answer": "C. Endoscopic retrograde cholangiopancreatography (ERCP)", "question_images": ["https://image.prepladder.com/content/MS8ezue4EMgROUyBSeac1714386511.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Endoscopic &lt;span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\"&gt;retrograde&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"81439c0f9716927771841fe69eb19e\"&gt;cholangiopancreatography&lt;/span&gt; (ERCP)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the urgent indication for performing laparotomy in a 30-year-old man who presents with right iliac fossa pain lasting for four days , as depicted in the provided USG image?", "options": [{"label": "A", "text": "Rising pulse rate", "correct": false}, {"label": "B", "text": "Increasing abdominal pain", "correct": false}, {"label": "C", "text": "Increase in the size of mass", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": ["https://image.prepladder.com/content/KTKFgQdueEAaUCinRNp11713856913.png"], "explanation_images": [], "explanation": "<p>Correct Option D - All of the abov\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Bell clapper testis predisposes to:", "options": [{"label": "A", "text": "Torsion testis", "correct": true}, {"label": "B", "text": "Varicocele", "correct": false}, {"label": "C", "text": "Cancer of testis", "correct": false}, {"label": "D", "text": "Hydrocele", "correct": false}], "correct_answer": "A. Torsion testis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed complication in a 29-year-old man who visits the outpatient department due to pain, heaviness, and swelling in his right leg? The patient has been dealing with varicose veins since he was 12 years old. After undergoing below-knee stripping of the long saphenous vein, both the symptoms and visible varicose veins disappeared.", "options": [{"label": "A", "text": "Hemorrhage", "correct": false}, {"label": "B", "text": "Thromboembolism", "correct": false}, {"label": "C", "text": "Neuralgia", "correct": true}, {"label": "D", "text": "Infection", "correct": false}], "correct_answer": "C. Neuralgia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Neuralg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common benign breast tumour :", "options": [{"label": "A", "text": "Fibroadenoma", "correct": true}, {"label": "B", "text": "Fibroadenosis", "correct": false}, {"label": "C", "text": "DCIS", "correct": false}, {"label": "D", "text": "Phyllodes tumour", "correct": false}], "correct_answer": "A. Fibroadenoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - F\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sebaceous cyst is not seen in:", "options": [{"label": "A", "text": "Back", "correct": false}, {"label": "B", "text": "Soles", "correct": true}, {"label": "C", "text": "Scalp", "correct": false}, {"label": "D", "text": "Scrotum", "correct": false}], "correct_answer": "B. Soles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent options does not constitute a Hospital-Acquired infection?", "options": [{"label": "A", "text": "Surgical site infection", "correct": false}, {"label": "B", "text": "STD", "correct": true}, {"label": "C", "text": "UTI", "correct": false}, {"label": "D", "text": "Pneumonia", "correct": false}], "correct_answer": "B. STD", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - STD\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Amount of blood loss in class III circulatory failure/Haemorrhagic shock ?", "options": [{"label": "A", "text": "&amp;lt; 15%", "correct": false}, {"label": "B", "text": "15-30%", "correct": false}, {"label": "C", "text": "30-40%", "correct": true}, {"label": "D", "text": "&amp;gt;40%", "correct": false}], "correct_answer": "C. 30-40%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 30-40%: \n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Parameter</strong></td>\n<td style=\"text-align:center\"><strong>Class I</strong></td>\n<td style=\"text-align:center\"><strong>Class II</strong></td>\n<td style=\"text-align:center\"><strong>Class III</strong></td>\n<td style=\"text-align:center\"><strong>Class IV</strong></td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Blood loss (%)</td>\n<td style=\"text-align:center\">0-15%</td>\n<td style=\"text-align:center\">15-30%</td>\n<td style=\"text-align:center\">30-40%</td>\n<td style=\"text-align:center\">&gt; 40%</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">CNS</td>\n<td style=\"text-align:center\">Slightly anxious</td>\n<td style=\"text-align:center\">Mildly anxious</td>\n<td style=\"text-align:center\">Anxious or confused</td>\n<td style=\"text-align:center\">Confused or lethargic</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Pulse (Beats/min)</td>\n<td style=\"text-align:center\">&lt; 100/min</td>\n<td style=\"text-align:center\">&gt; 100/min</td>\n<td style=\"text-align:center\">&gt; 120/min</td>\n<td style=\"text-align:center\">&gt; 140/min</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Blood pressure</td>\n<td style=\"text-align:center\">Normal</td>\n<td style=\"text-align:center\">Normal</td>\n<td style=\"text-align:center\">Decreased</td>\n<td style=\"text-align:center\">Decreased</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Pulse pressure</td>\n<td style=\"text-align:center\">Normal</td>\n<td style=\"text-align:center\">Decreased</td>\n<td style=\"text-align:center\">Decreased</td>\n<td style=\"text-align:center\">Decreased</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Respiratory Rate</td>\n<td style=\"text-align:center\">14-20/min</td>\n<td style=\"text-align:center\">20-30/min</td>\n<td style=\"text-align:center\">30-40/min</td>\n<td style=\"text-align:center\">&gt; 35/min</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Urine (mL/hr)</td>\n<td style=\"text-align:center\">&gt; 30</td>\n<td style=\"text-align:center\">20-30</td>\n<td style=\"text-align:center\">5-15</td>\n<td style=\"text-align:center\">Negligible/Nil</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Fluid</td>\n<td style=\"text-align:center\">Crystalloid</td>\n<td style=\"text-align:center\">Crystalloid</td>\n<td style=\"text-align:center\">Crystalloid + Blood</td>\n<td style=\"text-align:center\">Crystalloid + Blood</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Base deficit</td>\n<td style=\"text-align:center\">0 to 2 mEq/L</td>\n<td style=\"text-align:center\">2 to 6 mEq/L</td>\n<td style=\"text-align:center\">6 to 10 mEq/L</td>\n<td style=\"text-align:center\">10 mEq/L or less</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Provide your opinion on the diagnosis based on a radiographic image displayed of a 65-year-old male experiencing acute abdominal pain.", "options": [{"label": "A", "text": "Ileocolic intussusception", "correct": false}, {"label": "B", "text": "Sigmoid volvulus", "correct": false}, {"label": "C", "text": "Toxic megacolon", "correct": false}, {"label": "D", "text": "Colocolic intussusception", "correct": true}], "correct_answer": "D. Colocolic intussusception", "question_images": ["https://image.prepladder.com/content/uw031wA6f0vYg87hYUFT1714481869.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Colocolic intussu\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Pathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Free air under the diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Air is visualized under the diaphragm, indicating air escaping into the peritoneal cavity.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perforation of a <span class=\"customMeta\" data-dictid=\"d837e66d6a1692777202dc9564a29a\">viscus</span> (e.g., <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> or duodenal ulcer)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thumbprinting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thickened mucosal folds with a \"thumbprint\" appearance.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ischemic colitis, <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> inflammation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corkscrew appearance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tortuous and dilated appearance of the esophagus.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diffuse <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> spasm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Double bubble sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two air-filled bubbles are seen in the abdomen, representing dilated stomach and duodenum.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Duodenal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> or <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> in infants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thumb sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enlarged <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> with a thumb-like appearance.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epiglottitis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not included in the breast triple assessment?", "options": [{"label": "A", "text": "Clinical examination", "correct": false}, {"label": "B", "text": "Axillary sampling", "correct": true}, {"label": "C", "text": "USG", "correct": false}, {"label": "D", "text": "FNAC and biopsy", "correct": false}], "correct_answer": "B. Axillary sampling", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Axillary sampling\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the lesion shown below?", "options": [{"label": "A", "text": "Wet gangrene", "correct": true}, {"label": "B", "text": "Dry gengrene", "correct": false}, {"label": "C", "text": "Frost bite", "correct": false}, {"label": "D", "text": "Ainhum", "correct": false}], "correct_answer": "A. Wet gangrene", "question_images": ["https://image.prepladder.com/content/Qwn8HpfclM8wl1lS49nj1713857061.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Wet gangrene: \n<table border=\"1\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\"> </td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Dry Gangrene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Wet Gangrene</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Ischemic <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of tissue due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood supply</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Necrosis of tissue with bacterial infection and excessive moisture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> (arterial insufficiency)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Infection (usually polymicrobial) in ischemic tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Dry, shriveled, and blackened tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Swollen, discolored (black, green, or brown), and moist tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Temperature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Cold to touch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Warm to touch</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Painless</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Can be painful</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Line of demarcation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Clear line between affected and healthy tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Indistinct or no clear line of <span class=\"customMeta\" data-dictid=\"6e26f8de1c1692777185d8f3885a0c\">demarcation</span> between affected and healthy tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Odor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Foul <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> due to bacterial infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Slow progression</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Rapid progression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Surgical intervention (amputation) may be necessary</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Immediate <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention and aggressive <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Better <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> with early intervention</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> due to high risk of <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> complications</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man visits the outpatient department with concerns of pain in the lower abdomen and rectal bleeding . After conducting additional tests, it is found that the patient has several shallow ulcers in the rectum that extend upwards to involve the entire colon . Upon examination of the tissue samples, it is discovered that only the mucosa and submucosa are affected. Which of the following complications associated with the aforementioned conditions is not harmful ?", "options": [{"label": "A", "text": "Toxic megacolon", "correct": false}, {"label": "B", "text": "Colonic polyp", "correct": true}, {"label": "C", "text": "Colonic obstruction", "correct": false}, {"label": "D", "text": "Massive colonic bleeding", "correct": false}], "correct_answer": "B. Colonic polyp", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Colonic polyp: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient complains of painless swelling over the face with difficulty in swallowing. The appearance of face is shown . The probable diagnosis is:", "options": [{"label": "A", "text": "Acute parotitis", "correct": false}, {"label": "B", "text": "Cancer of parotid gland", "correct": true}, {"label": "C", "text": "Angioedema of face", "correct": false}, {"label": "D", "text": "Acute sialadenitis", "correct": false}], "correct_answer": "B. Cancer of parotid gland", "question_images": ["https://image.prepladder.com/content/K5uIDIh7ZkPNahGHS56e1691492107.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Cancer of &lt;span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\"&gt;parotid&lt;/span&gt; g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old lady presented with a 6-month painless fluctuant, non-transilluminant swelling with a thin watery discharge. Clinical diagnosis is?", "options": [{"label": "A", "text": "Brachial cyst", "correct": false}, {"label": "B", "text": "Secondaries", "correct": false}, {"label": "C", "text": "TB", "correct": true}, {"label": "D", "text": "Lymphoma", "correct": false}], "correct_answer": "C. TB", "question_images": ["https://image.prepladder.com/content/OZDUuJJCq8WVOCuwGneW1716465197.png"], "explanation_images": [], "explanation": "<p>Correct Option C - TB\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for a 1-year-old patient diagnosed with Keratomalacia?", "options": [{"label": "A", "text": "1 Lac IU once", "correct": false}, {"label": "B", "text": "1 Lac IU three times", "correct": true}, {"label": "C", "text": "2 Lac IU once", "correct": false}, {"label": "D", "text": "2 Lac IU three times", "correct": false}], "correct_answer": "B. 1 Lac IU three times", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td>\n<p style=\"text-align:center\"><strong>&lt;6 months </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>6 months - 1 year </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>&gt; 1 year</strong></p>\n</td>\n</tr>\n<tr>\n<td>Day 0 </td>\n<td>50000 IU </td>\n<td>1 <span class=\"customMeta\" data-dictid=\"747531de8416927771915b0ec79f73\">lac</span> IU </td>\n<td>2 <span class=\"customMeta\" data-dictid=\"747531de8416927771915b0ec79f73\">lac</span> IU </td>\n</tr>\n<tr>\n<td>Day 1 </td>\n<td>50000 IU</td>\n<td>1 <span class=\"customMeta\" data-dictid=\"747531de8416927771915b0ec79f73\">lac</span> IU</td>\n<td>2 <span class=\"customMeta\" data-dictid=\"747531de8416927771915b0ec79f73\">lac</span> IU</td>\n</tr>\n<tr>\n<td>Day 2 </td>\n<td>50000 IU</td>\n<td>1 <span class=\"customMeta\" data-dictid=\"747531de8416927771915b0ec79f73\">lac</span> IU</td>\n<td>2 <span class=\"customMeta\" data-dictid=\"747531de8416927771915b0ec79f73\">lac</span> IU</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Beri-Beri seen in?", "options": [{"label": "A", "text": "Sorghum eaters", "correct": false}, {"label": "B", "text": "Wheat esters", "correct": false}, {"label": "C", "text": "Polished rice eaters", "correct": true}, {"label": "D", "text": "Maize eaters", "correct": false}], "correct_answer": "C. Polished rice eaters", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p>Aspect</p>\n</td>\n<td>\n<p>BERI BERI</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Definition</p>\n</td>\n<td>\n<p>Beriberi is a condition resulting from a <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> (vitamin B1) in the body.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"3\">\n<p>Types</p>\n<p> </p>\n</td>\n<td>\n<p>1. <strong>Wet beriberi</strong>: Affects the <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> system, causing <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> and <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (swelling).</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>2. <strong>Dry beriberi</strong>: Affects the nervous system, leading to muscle weakness, tingling, and <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> issues.</p>\n</td>\n</tr>\n<tr>\n<td>3.<strong> Infantile beriberi</strong>: Affects infants 2-4 months breast-fed by <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> deficient mother</td>\n</tr>\n<tr>\n<td>\n<p>Causes</p>\n</td>\n<td>\n<p>Inadequate <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> of thiamine-rich foods, such as whole grains, legumes, nuts, and pork.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"2\">\n<p>Risk Factors</p>\n<p> </p>\n</td>\n<td>\n<p>1. Poor diet lacking in essential nutrients, especially thiamine.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>2. Alcoholism: Alcohol can interfere with <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> and increase its excretion.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"3\">\n<p>Symptoms</p>\n<p> </p>\n</td>\n<td>\n<p>1. Wet beriberi: Shortness of breath, rapid heart rate, fatigue, swelling, and enlarged heart.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>2. Dry beriberi: Muscle weakness, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy, loss of coordination, and weight loss.</p>\n</td>\n</tr>\n<tr>\n<td>3.Infantile beriberi: Shows signs of <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy</td>\n</tr>\n<tr>\n<td>\n<p>Diagnosis</p>\n</td>\n<td>\n<p>Medical history, physical examination, assessment of symptoms, blood tests to measure <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> levels.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Treatment</p>\n</td>\n<td>\n<p>Thiamine supplementation through oral or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> administration, improvement of diet quality.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Prevention</p>\n</td>\n<td>\n<p>Adequate <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> through a balanced diet, especially foods rich in thiamine.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Complications</p>\n</td>\n<td>\n<p>If left untreated, <span class=\"customMeta\" data-dictid=\"8e0f24408f1692777182885a574cc7\">beriberi</span> can lead to severe complications, including <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> or Wernicke-Korsakoff syndrome.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common cause of LBW in India?", "options": [{"label": "A", "text": "Smoking during pregnancy", "correct": false}, {"label": "B", "text": "Maternal tetanus", "correct": false}, {"label": "C", "text": "Intra-uterine growth retardation", "correct": false}, {"label": "D", "text": "Premature birth", "correct": true}], "correct_answer": "D. Premature birth", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Premature birth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The proposal to control malaria in towns named as Urban Malaria Scheme. According to Urban Malaria Scheme, Which of the following is not true?", "options": [{"label": "A", "text": "SPR between 5% and 10%", "correct": false}, {"label": "B", "text": "Slide positivity rate more than 10%", "correct": true}, {"label": "C", "text": "Scheme is not based on blood examination", "correct": false}, {"label": "D", "text": "Towns having a population more than 10,000", "correct": false}], "correct_answer": "B. Slide positivity rate more than 10%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Slide positivity rate more than 10%\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male truck driver visited to the clinic with fever, skin rash, swollen glands and fatigue. The physician referred him to suraksha clinic. Which among the following is included in provision of services at Suraksha Clinic ?", "options": [{"label": "A", "text": "Immunization services", "correct": false}, {"label": "B", "text": "Blood transfusion safety services", "correct": false}, {"label": "C", "text": "RTI/ STI services", "correct": true}, {"label": "D", "text": "Diarrhea control services", "correct": false}], "correct_answer": "C. RTI/ STI services", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - RTI/ &lt;span class=\"customMeta\" data-dictid=\"1bb30b4815169277719923969b1a56\"&gt;STI&lt;/span&gt; serv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Ujjawala scheme is for prevention of?", "options": [{"label": "A", "text": "Child abuse", "correct": false}, {"label": "B", "text": "Child trafficking", "correct": true}, {"label": "C", "text": "Child labour", "correct": false}, {"label": "D", "text": "Child marriage", "correct": false}], "correct_answer": "B. Child trafficking", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Child trafficking\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Peripheral blood smear sample for malaria is done by?", "options": [{"label": "A", "text": "Pharmacist", "correct": false}, {"label": "B", "text": "ANM", "correct": false}, {"label": "C", "text": "Medical officer", "correct": false}, {"label": "D", "text": "Laboratory technician", "correct": true}], "correct_answer": "D. Laboratory technician", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Laboratory tech\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a rural village , a government school conducted a comprehensive health check-up for all its students. According to Vision 2020 , which of the following centre will the teacher refer school children to in order to check their visual acuity?", "options": [{"label": "A", "text": "Service centre", "correct": false}, {"label": "B", "text": "Training centre", "correct": false}, {"label": "C", "text": "Centre for excellence", "correct": false}, {"label": "D", "text": "Vision centre", "correct": true}], "correct_answer": "D. Vision centre", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D -V\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Health Care Level</strong></td>\n<td style=\"text-align:center\"><strong>Proposed Structure</strong></td>\n<td style=\"text-align:center\"><strong>Services Provided</strong></td>\n</tr>\n<tr>\n<td>Primary (1 per 50,000)</td>\n<td>Vision centers - 20000 (paramedic <span class=\"customMeta\" data-dictid=\"c09776e61f1692777194db295c590f\">ophthalmic</span> assistant)</td>\n<td>\n<ul>\n<li>Primary eye care</li>\n<li>School eye screening</li>\n<li>Refraction test and prescription of glass</li>\n<li>Screening and referral</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Secondary (1 per 5,00,000)</td>\n<td>Service centers - 2000 (ophthalmologist)</td>\n<td>\n<ul>\n<li>Facility for refraction, <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">cataract</span> and other common surgery referrals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Tertiary (1 per 5 million)</td>\n<td>Training centers - 200 (medical College)</td>\n<td>\n<ul>\n<li>Retinal surgery</li>\n<li>Corneal transplantation</li>\n<li>Glaucoma </li>\n<li>Surgery</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Next Level (1 per 50 million)</td>\n<td>Centers for excellence -20</td>\n<td>\n<ul>\n<li>Professional leadership, strategy making, CME, laying standards, and quality assurance and research</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A school has a small outbreak were children are showing symptoms like runny nose, cough, fever and skin rash. The doctors identified it as measles outbreak. Which of the following is the correct time to give post exposure measles vaccine?", "options": [{"label": "A", "text": "3-4 days", "correct": true}, {"label": "B", "text": "7-10 days", "correct": false}, {"label": "C", "text": "10-14 days", "correct": false}, {"label": "D", "text": "1-6 months", "correct": false}], "correct_answer": "A. 3-4 days", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 3-4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cholera period of Isolation :", "options": [{"label": "A", "text": "3 days after starting Tetracycline till 48 hours of antibiotics", "correct": true}, {"label": "B", "text": "7 days after starting Tetracycline", "correct": false}, {"label": "C", "text": "7-14 days", "correct": false}, {"label": "D", "text": "Until 3 weeks of effective antibiotic therapy", "correct": false}], "correct_answer": "A. 3 days after starting Tetracycline till 48 hours of antibiotics", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the additional amount of energy needed on a daily basis during pregnancy? (in Kcalories)", "options": [{"label": "A", "text": "+300 kcal", "correct": false}, {"label": "B", "text": "+600 kcal", "correct": false}, {"label": "C", "text": "+350 kcal", "correct": true}, {"label": "D", "text": "+520 kcal", "correct": false}], "correct_answer": "C. +350 kcal", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male presented to the hospital with fever, dry cough, sore throat, and muscle pain. RT-PCR confirmed the patient to be positive for COVID 19. Which of the following statements is incorrect regarding the epidemiology of Covid-19?", "options": [{"label": "A", "text": "1% Case Fatality rate in age ≥ 50 years", "correct": true}, {"label": "B", "text": "&amp;gt; 5% Case Fatality rate in age ≥ 80 years", "correct": false}, {"label": "C", "text": "Mode of transmission is droplets, contacts", "correct": false}, {"label": "D", "text": "Remdesivir is an emergency use authorization (EUA) from the FDA for COVID-19", "correct": false}], "correct_answer": "A. 1% Case Fatality rate in age ≥ 50 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 1% Case Fatality rate in age ≥ 5\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>COVID-19</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Virus</p>\n</td>\n<td>\n<ul>\n<li>\n<p>SARS-CoV-2 (Severe <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Syndrome <span class=\"customMeta\" data-dictid=\"d2d956f41b1692777185eb9af8193f\">Coronavirus</span> 2)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Disease</p>\n</td>\n<td>\n<ul>\n<li>\n<p>COVID-19 (Coronavirus Disease 2019)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Transmission</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Respiratory droplets (coughing, sneezing, talking)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Incubation Period</p>\n</td>\n<td>\n<ul>\n<li>\n<p>2-14 days (average: 5-6 days)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Symptoms</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Fever</p>\n</li>\n<li>\n<p>Cough</p>\n</li>\n<li>\n<p>Shortness of breath</p>\n</li>\n<li>\n<p>Fatigue</p>\n</li>\n<li>\n<p>Body aches</p>\n</li>\n<li>\n<p>Loss of taste or smell</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Severity</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Mild to severe (may result in <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> or death)</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which contraceptive method has the highest reported failure rate?", "options": [{"label": "A", "text": "Spermicidal methods", "correct": true}, {"label": "B", "text": "Implant", "correct": false}, {"label": "C", "text": "Oral contraceptive pills", "correct": false}, {"label": "D", "text": "IUD", "correct": false}], "correct_answer": "A. Spermicidal methods", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Contraceptive Method</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Typical Failure Rate</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Barrier Methods</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- Male Condom</p>\n</td>\n<td>\n<p>13% (with typical use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- Female Condom</p>\n</td>\n<td>\n<p>21% (with typical use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Hormonal Methods</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- Combined Oral Contraceptives</p>\n</td>\n<td>\n<p>Less than 1% (with perfect use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- Progestin-Only Pills</p>\n</td>\n<td>\n<p>5% (with typical use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"c3d7276c3e1692777190b4b6762dd0\">Injectable</span> Contraceptives</p>\n</td>\n<td>\n<p>Less than 1% (with perfect use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- Implant</p>\n</td>\n<td>\n<p>Less than 1% (with perfect use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Intrauterine Devices (IUDs)</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">Copper</span> IUD</p>\n</td>\n<td>\n<p>Less than 1% (with perfect use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- Hormonal IUD</p>\n</td>\n<td>\n<p>Less than 1% (with perfect use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Permanent Methods</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">Tubal</span> Ligation</p>\n</td>\n<td>\n<p>Less than 1% (with perfect use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- Vasectomy</p>\n</td>\n<td>\n<p>Less than 1% (with perfect use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Emergency Contraception</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- Emergency <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pill</p>\n</td>\n<td>\n<p>1-2% (with typical use)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">Copper</span> <span class=\"customMeta\" data-dictid=\"0a1f2085da1692777190fa4d489421\">IUD</span> as Emergency Contraception</p>\n</td>\n<td>\n<p>Less than 1% (with perfect use)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the introduction of a novel national health program and policy, the concept of population attributable risk is evaluated. Which of the subsequent statements provides the most accurate explanation of population attributable risk?", "options": [{"label": "A", "text": "Incidence of disease among exposed is so many times higher as compared to that among non-exposed", "correct": false}, {"label": "B", "text": "So much disease can be attributed to exposure", "correct": false}, {"label": "C", "text": "If risk factor is modified or eliminated, there will be so much annual reduction in incidence of disease in the given population", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. If risk factor is modified or eliminated, there will be so much annual reduction in incidence of disease in the given population", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - If risk factor is modified or eliminated, there will be so much annual reduction in &lt;span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\"&gt;incidence&lt;/span&gt; of disease in the given popu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gFnw0WUfRp61wTB73S2q1746262567.mp3", "video": ""}, {"text": "Human anatomical wastes are disposed of in the ____ BMW category?", "options": [{"label": "A", "text": "Red", "correct": false}, {"label": "B", "text": "Yellow", "correct": true}, {"label": "C", "text": "White", "correct": false}, {"label": "D", "text": "Blue", "correct": false}], "correct_answer": "B. Yellow", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Z5u5nOQpt3w5gjCDLxAJ1714558642.png"], "explanation": "<p>Correct Option B - Y\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options listed below pertains to the field of Disaster management, which deals with the mitigation and response to abrupt, devastating incidents that significantly impede the operations of a community or society, resulting in human, material, and economic or environmental consequences?", "options": [{"label": "A", "text": "Ministry of Health", "correct": false}, {"label": "B", "text": "Ministry of HRD", "correct": false}, {"label": "C", "text": "Ministry of Home", "correct": true}, {"label": "D", "text": "Ministry of Agriculture", "correct": false}], "correct_answer": "C. Ministry of Home", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C-Ministry of H\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nodal Ministry of Disaster Response</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Responsible for overall <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> of disaster management.</li>\n<li>Ministry: Ministry of Home Affairs.</li>\n<li>Chairperson: Prime Minister</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>National Disaster Management Authority</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prepares disaster management plans at national level.</li>\n<li>Responsible for execution of disaster management functions at the national level.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>National Institute of Disaster Management</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Responsible for capacity building, training, research, and for building a national base</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the phase(s) of the disaster cycle that occurs before the impact of the disaster?", "options": [{"label": "A", "text": "Disaster response", "correct": false}, {"label": "B", "text": "Medial relief and rehabilitation", "correct": false}, {"label": "C", "text": "Mitigation and preparedness", "correct": true}, {"label": "D", "text": "Rehabilitation", "correct": false}], "correct_answer": "C. Mitigation and preparedness", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/eeqwrEdsX6THJpkxNx3k1714559319.png"], "explanation": "<p>Correct Option C-Mitig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At a PHC, vaccine storage is done in?", "options": [{"label": "A", "text": "Vaccine carrier", "correct": false}, {"label": "B", "text": "ILR", "correct": true}, {"label": "C", "text": "Walk in Cold rooms", "correct": false}, {"label": "D", "text": "Ice packs", "correct": false}], "correct_answer": "B. ILR", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pJXqS0urlkgVq14PW2F71688451164.png"], "explanation": "<p>Correct Option B - Ice-Lined Refrigerator (ILR)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which group is excluded from targeted interventions, a specific set of services and interventions provided to individuals in the population who are at high risk of or have reported high risk of HIV?", "options": [{"label": "A", "text": "Migrant labourers", "correct": false}, {"label": "B", "text": "Street children", "correct": false}, {"label": "C", "text": "Long distance truckers", "correct": false}, {"label": "D", "text": "Doctors and nursing professionals", "correct": true}], "correct_answer": "D. Doctors and nursing professionals", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Doctors and &lt;span class=\"customMeta\" data-dictid=\"6f686e0c91169277719346f95361c8\"&gt;nursing&lt;/span&gt; professionals: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the purpose of administering ORS plus Zinc to a patient from a rural village?", "options": [{"label": "A", "text": "Reduces infection", "correct": false}, {"label": "B", "text": "Antispasmodic", "correct": false}, {"label": "C", "text": "Reduces duration of diarrhea", "correct": true}, {"label": "D", "text": "Enhance sodium absorption", "correct": false}], "correct_answer": "C. Reduces duration of diarrhea", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 310 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following ions is involved in cell injury?", "options": [{"label": "A", "text": "Calcium", "correct": true}, {"label": "B", "text": "Molybdenum", "correct": false}, {"label": "C", "text": "Selenium", "correct": false}, {"label": "D", "text": "Zinc", "correct": false}], "correct_answer": "A. Calcium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Calciu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a disorder associated with delusion?", "options": [{"label": "A", "text": "Thought", "correct": true}, {"label": "B", "text": "Affect", "correct": false}, {"label": "C", "text": "Perception", "correct": false}, {"label": "D", "text": "Memory", "correct": false}], "correct_answer": "A. Thought", "question_images": [], "explanation_images": [], "explanation": "\n<p><strong>References:</strong></p>\n<ul><li>↳ Stream/Flow of Thought Form of Thought Content of Thought Possession of Thought</li><li>↳ Stream/Flow of Thought</li><li>↳ Stream/Flow of Thought</li><li>↳ Stream/Flow of Thought</li><li>↳ Form of Thought</li><li>↳ Form of Thought</li><li>↳ Form of Thought</li><li>↳ Content of Thought</li><li>↳ Content of Thought</li><li>↳ Content of Thought</li><li>↳ Possession of Thought</li><li>↳ Possession of Thought</li><li>↳ Possession of Thought</li><li>↳ It involves the speed and continuity of thinking. It refers to the organization or association between thoughts. It refers to the ideas, beliefs, and concepts that a person thinks about. It involves the feeling that thoughts are controlled by oneself or some external force.</li><li>↳ It involves the speed and continuity of thinking.</li><li>↳ It involves the speed and continuity of thinking.</li><li>↳ It refers to the organization or association between thoughts.</li><li>↳ It refers to the organization or association between thoughts.</li><li>↳ It refers to the ideas, beliefs, and concepts that a person thinks about.</li><li>↳ It refers to the ideas, beliefs, and concepts that a person thinks about.</li><li>↳ It involves the feeling that thoughts are controlled by oneself or some external force.</li><li>↳ It involves the feeling that thoughts are controlled by oneself or some external force.</li><li>↳ Abnormalities may include Flight of ideas, inhibition, or slow thinking. It includes disorders like derailment, loosening of association, incoherence, tangentiality, neologism, circumstantiality, metonyms, clanging, and thought block. It includes different types of delusions, such as delusions of persecution (most common in schizophrenia), delusions of reference, grandiosity, infidelity, enormity, love, guilt, etc. It includes the disorders like thought allientation and obsessions .</li><li>↳ Abnormalities may include Flight of ideas, inhibition, or slow thinking.</li><li>↳ Abnormalities may include Flight of ideas, inhibition, or slow thinking.</li><li>↳ Flight of ideas, inhibition, or slow thinking.</li><li>↳ It includes disorders like derailment, loosening of association, incoherence, tangentiality, neologism, circumstantiality, metonyms, clanging, and thought block.</li><li>↳ It includes disorders like derailment, loosening of association, incoherence, tangentiality, neologism, circumstantiality, metonyms, clanging, and thought block.</li><li>↳ derailment, loosening of association, incoherence, tangentiality, neologism, circumstantiality, metonyms, clanging, and thought block.</li><li>↳ It includes different types of delusions, such as delusions of persecution (most common in schizophrenia), delusions of reference, grandiosity, infidelity, enormity, love, guilt, etc.</li><li>↳ It includes different types of delusions, such as delusions of persecution (most common in schizophrenia), delusions of reference, grandiosity, infidelity, enormity, love, guilt, etc.</li><li>↳ delusions of persecution (most common in schizophrenia), delusions of reference, grandiosity, infidelity, enormity, love, guilt, etc.</li><li>↳ It includes the disorders like thought allientation and obsessions .</li><li>↳ It includes the disorders like thought allientation and obsessions .</li><li>↳ thought allientation and obsessions</li><li>↳ Delusion Diagnosis:</li><li>↳ Delusion Diagnosis:</li><li>↳ Presence of one or more bizarre or non-bizarre delusional thoughts for at least one month or longer. In bizarre delusion, patients have scientifically impossible and un-understandable thoughts. In non-bizarre delusion, patients may have false but not impossible thoughts. The individual's cultural beliefs should also be considered when assessing the delusions.</li><li>↳ Presence of one or more bizarre or non-bizarre delusional thoughts for at least one month or longer.</li><li>↳ In bizarre delusion, patients have scientifically impossible and un-understandable thoughts.</li><li>↳ In non-bizarre delusion, patients may have false but not impossible thoughts.</li><li>↳ The individual's cultural beliefs should also be considered when assessing the delusions.</li></ul>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Stream/Flow of Thought </strong></p>\n</td>\n<td>\n<p><strong>Form of Thought </strong></p>\n</td>\n<td>\n<p><strong>Content of Thought </strong></p>\n</td>\n<td>\n<p><strong>Possession of Thought </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>It involves the speed and <span class=\"customMeta\" data-dictid=\"17e718612e1692777185f79acb759b\">continuity</span> of thinking.</p>\n</td>\n<td>\n<p>It refers to the organization or association between thoughts.</p>\n</td>\n<td>\n<p>It refers to the ideas, beliefs, and concepts that a person thinks about.</p>\n</td>\n<td>\n<p>It involves the feeling that thoughts are controlled by oneself or some external force.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Abnormalities may include <strong>Flight of ideas, inhibition, or slow thinking. </strong></p>\n</td>\n<td>\n<p>It includes disorders like <strong>derailment, <span class=\"customMeta\" data-dictid=\"15228e561416927771918a5e9e15db\">loosening</span> of association, incoherence, tangentiality, neologism, circumstantiality, metonyms, clanging, and thought block. </strong></p>\n</td>\n<td>\n<p>It includes different types of delusions, such as <strong>delusions of persecution (most common in schizophrenia), delusions of reference, grandiosity, infidelity, enormity, love, guilt, etc. </strong></p>\n</td>\n<td>\n<p>It includes the disorders like <strong>thought allientation and obsessions</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is inherited in an autosomal recessive manner?", "options": [{"label": "A", "text": "Hereditary spherocytosis", "correct": false}, {"label": "B", "text": "Sickle cell anemia", "correct": true}, {"label": "C", "text": "Osteogenesis imperfecta", "correct": false}, {"label": "D", "text": "Von Willebrand disease", "correct": false}], "correct_answer": "B. Sickle cell anemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Sickle cell anemia: Sickle cell is inherited in an autosomal &lt;span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\"&gt;recessive&lt;/span&gt; pattern.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Liquefactive necrosis is seen in which of the following?", "options": [{"label": "A", "text": "Heart", "correct": false}, {"label": "B", "text": "Brain", "correct": true}, {"label": "C", "text": "Lungs", "correct": false}, {"label": "D", "text": "Kidney", "correct": false}], "correct_answer": "B. Brain", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - B\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Types of necrosis</strong></td>\n<td style=\"text-align:center\"><strong>Typical sites</strong></td>\n<td style=\"text-align:center\"><strong>Pathological features</strong></td>\n</tr>\n<tr>\n<td>Coagulative necrosis</td>\n<td>Heart, Kidney, and Spleen</td>\n<td>Preservation of tissue architecture, <span class=\"customMeta\" data-dictid=\"4b8ccd7c3516927771851fdaee3f80\">denaturation</span> of proteins, loss of nuclei, <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> appearance</td>\n</tr>\n<tr>\n<td>Liquefactive necrosis</td>\n<td>Brain, Abscesses</td>\n<td>Dissolution of cells, formation of liquid, <span class=\"customMeta\" data-dictid=\"bf33f8775d169277720289f4026e23\">viscous</span> material, loss of tissue architecture, presence of <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells</td>\n</tr>\n<tr>\n<td>Caseous necrosis</td>\n<td>Tuberculosis granulomas, Fungal infections</td>\n<td>Cheese-like appearance, <span class=\"customMeta\" data-dictid=\"2334b7498b1692777188fa8b2eee36\">granuloma</span> formation, central necrotic area surrounded by <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells</td>\n</tr>\n<tr>\n<td>Fat necrosis</td>\n<td>Pancreas, Breast, and Mesentery</td>\n<td>Focal areas of fat destruction, release of free <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids, and formation of chalky white deposits (saponification)</td>\n</tr>\n<tr>\n<td>Gangrenous necrosis</td>\n<td>Extremities (e.g., lower limbs)</td>\n<td>Ischemic <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of multiple tissue layers, dry or wet appearance depending on bacterial infection or presence of liquefaction</td>\n</tr>\n<tr>\n<td>Fibrinoid necrosis</td>\n<td>Blood vessels (e.g., in vasculitis)</td>\n<td>Deposition of immune complexes and <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> within <span class=\"customMeta\" data-dictid=\"72c06d2cc71692777183b1cbaf5bae\">blood vessel</span> walls, destruction of vessel architecture, bright pink appearance</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable medical condition for a 25-year-old male who experienced a road traffic accident and is now experiencing anxiety about driving and going to the site of the incident for a period of 6 weeks? He is also having recurring memories of the accident and struggles with attending work.", "options": [{"label": "A", "text": "Acute stress disorder", "correct": false}, {"label": "B", "text": "Post-traumatic stress disorder", "correct": true}, {"label": "C", "text": "Panic disorder", "correct": false}, {"label": "D", "text": "Major depressive disorder", "correct": false}], "correct_answer": "B. Post-traumatic stress disorder", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Post-trau\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The cause of edema in nephrotic syndrome is:", "options": [{"label": "A", "text": "Increased colloid osmotic pressure", "correct": false}, {"label": "B", "text": "Increased hydrostatic pressure", "correct": false}, {"label": "C", "text": "Decreased colloid osmotic pressure", "correct": true}, {"label": "D", "text": "Decreased hydrostatic pressure", "correct": false}], "correct_answer": "C. Decreased colloid osmotic pressure", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Decreased &lt;span class=\"customMeta\" data-dictid=\"2e711a1abe1692777184b0bf50216b\"&gt;colloid&lt;/span&gt; osmotic pressu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following follows an autosomal dominant inheritance pattern?", "options": [{"label": "A", "text": "Von Willebrand disease", "correct": true}, {"label": "B", "text": "Wilson disease", "correct": false}, {"label": "C", "text": "Cystic fibrosis", "correct": false}, {"label": "D", "text": "Friedrichs ataxia", "correct": false}], "correct_answer": "A. Von Willebrand disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Von W\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which mineral deficiency can potentially cause the condition depicted in the image provided?", "options": [{"label": "A", "text": "Zinc – Treatment – 30-50 mg elemental zinc", "correct": true}, {"label": "B", "text": "Iron", "correct": false}, {"label": "C", "text": "Calcium", "correct": false}, {"label": "D", "text": "Vitamin – A", "correct": false}], "correct_answer": "A. Zinc – Treatment – 30-50 mg elemental zinc", "question_images": ["https://image.prepladder.com/content/L5drvv7Bn1o9SueRfF671695116190.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following can be given to a celiac disease patient?", "options": [{"label": "A", "text": "Rye", "correct": false}, {"label": "B", "text": "Wheat", "correct": false}, {"label": "C", "text": "Quinoa", "correct": true}, {"label": "D", "text": "Barley", "correct": false}], "correct_answer": "C. Quinoa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Qu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely karyotype for a 16-year-old girl who presents with short stature, primary amenorrhea, and widely spaced nipples?", "options": [{"label": "A", "text": "45, XO", "correct": true}, {"label": "B", "text": "46, XO", "correct": false}, {"label": "C", "text": "47, XXX", "correct": false}, {"label": "D", "text": "46, XY", "correct": false}], "correct_answer": "A. 45, XO", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/S1eSTd9ss8QiWGAKR7Na1714474064.png"], "explanation": "<p>Correct option A - 45, XO\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following antibodies is present in celiac disease?", "options": [{"label": "A", "text": "Tissue transglutaminase IgA (tTG IgA)", "correct": false}, {"label": "B", "text": "Endomysial IgA", "correct": false}, {"label": "C", "text": "Reticulin IgA", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Koplik spots are seen in:", "options": [{"label": "A", "text": "Mumps", "correct": false}, {"label": "B", "text": "Measles", "correct": true}, {"label": "C", "text": "Rubella", "correct": false}, {"label": "D", "text": "Varicella", "correct": false}], "correct_answer": "B. Measles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BoksIA46xdExmt3xNR5T1714031617.png", "https://image.prepladder.com/content/idivdmZ5O5wMjbSLTfBa1714048490.png"], "explanation": "<p>Correct Option B - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe a person experiencing a reduced sense of enjoyment in activities that they previously found pleasurable?", "options": [{"label": "A", "text": "Tangentiality", "correct": false}, {"label": "B", "text": "Anhedonia", "correct": true}, {"label": "C", "text": "Alexithymia", "correct": false}, {"label": "D", "text": "Asociality", "correct": false}], "correct_answer": "B. Anhedonia", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most specific antibody in systemic sclerosis?", "options": [{"label": "A", "text": "Anti-DNA", "correct": false}, {"label": "B", "text": "Anti-topoisomerase", "correct": true}, {"label": "C", "text": "ANA", "correct": false}, {"label": "D", "text": "Anti-Ro", "correct": false}], "correct_answer": "B. Anti-topoisomerase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - A\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Antibody</strong></td>\n<td style=\"text-align:center\"><strong>Description</strong></td>\n</tr>\n<tr>\n<td>Anti-centromere</td>\n<td>Found in approximately 20-25% of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> patients, mainly those with limited <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis</td>\n</tr>\n<tr>\n<td>Anti-topoisomerase I</td>\n<td>Also known as the anti-Scl-70 antibody, it is present in about 10-20% of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> patients and is often associated with <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis</td>\n</tr>\n<tr>\n<td>Anti-RNA <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> III</td>\n<td>Detected in around 10-15% of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> cases, it is primarily seen in patients with <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> and is associated with a higher risk of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> involvement</td>\n</tr>\n<tr>\n<td>Anti-U3 RNP</td>\n<td>Found in a small percentage of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> patients, particularly those with <span class=\"customMeta\" data-dictid=\"ea564f2f5e1692777194df1391fd69\">overlap</span> syndromes such as <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis/polymyositis</td>\n</tr>\n<tr>\n<td>Anti-U1 RNP</td>\n<td>Seen in some cases of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis, but more commonly associated with mixed <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue disease</td>\n</tr>\n<tr>\n<td>Anti-fibrillarin</td>\n<td>Identified in a subset of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> patients, often those with overlapping features of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> and polymyositis</td>\n</tr>\n<tr>\n<td>Anti-PM/Scl</td>\n<td>It occurs in a minority of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> cases and is associated with <span class=\"customMeta\" data-dictid=\"ea564f2f5e1692777194df1391fd69\">overlap</span> syndromes like <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> sclerosis/polymyositis</td>\n</tr>\n<tr>\n<td>Anti-Th/To</td>\n<td>Detected in a small number of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> patients, often in conjunction with other antibodies</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the rare and hazardous complication associated with Subacute Sclerosing Panencephalitis ?", "options": [{"label": "A", "text": "Measles", "correct": true}, {"label": "B", "text": "Mumps", "correct": false}, {"label": "C", "text": "Rubella", "correct": false}, {"label": "D", "text": "Varicella", "correct": false}], "correct_answer": "A. Measles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the probable diagnosis for a woman who has been brought to the psychiatrist 5 weeks post-delivery, displaying symptoms of fearfulness, irritability, and suicidal ideation?", "options": [{"label": "A", "text": "Post-partum blues", "correct": false}, {"label": "B", "text": "Post-partum psychosis", "correct": false}, {"label": "C", "text": "Post-partum depression", "correct": true}, {"label": "D", "text": "Panic disorder", "correct": false}], "correct_answer": "C. Post-partum depression", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\"&gt;Postpartum&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common brain tumor seen in children?", "options": [{"label": "A", "text": "Medulloblastoma", "correct": true}, {"label": "B", "text": "Ependymal tumors", "correct": false}, {"label": "C", "text": "Meningioma", "correct": false}, {"label": "D", "text": "Glioma", "correct": false}], "correct_answer": "A. Medulloblastoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: Medu\n<p>Correct option A: Medu\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JleNL1UH5WcxCLMQzNOQ1749368492.mp3", "video": ""}, {"text": "How long is the protection provided by the Yellow fever vaccine considered valid for?", "options": [{"label": "A", "text": "Life long", "correct": true}, {"label": "B", "text": "10 years", "correct": false}, {"label": "C", "text": "5 years", "correct": false}, {"label": "D", "text": "20 years", "correct": false}], "correct_answer": "A. Life long", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Life long\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>17D vaccine-strain</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Storage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>+5 to -30℃</li>\n<li>Yellow fever vaccine cannot be stored under cold chain temperature in India</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type of vaccine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reconstituted vaccine</li>\n<li>Should be kept on ice away from light</li>\n<li>Cold <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> <span class=\"customMeta\" data-dictid=\"6b7fed19e416927771860315097d8e\">diluent</span> is added</li>\n<li>Does not follow open <span class=\"customMeta\" data-dictid=\"cd235a18081692777202343e31b264\">vial</span> policy</li>\n<li>Should be used up to half an hour</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Route</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subcutaneous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5ml at <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> of deltoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immunity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immunity starts after 7-10 days and lasts lifelong</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a 21-year-old female who avoids using elevators due to fear and always opts for stairs instead?", "options": [{"label": "A", "text": "Social phobia", "correct": false}, {"label": "B", "text": "Agoraphobia", "correct": false}, {"label": "C", "text": "Specific phobia", "correct": true}, {"label": "D", "text": "Panic disorder", "correct": false}], "correct_answer": "C. Specific phobia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Specific ph\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Phobias </strong></p>\n</td>\n<td>\n<p><strong>Theme of <span class=\"customMeta\" data-dictid=\"74d12be85a169277719434379bc503\">phobia</span> (fear of)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Acrophobia</p>\n</td>\n<td>\n<p>Heights</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Claustrophobia</p>\n</td>\n<td>\n<p>Closed spaces</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nyctophobia</p>\n</td>\n<td>\n<p>Darkness</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Xenophobia</p>\n</td>\n<td>\n<p>Strangers</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mysophobia</p>\n</td>\n<td>\n<p>Germs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cyanophobia</p>\n</td>\n<td>\n<p>Dogs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ailurophobia</p>\n</td>\n<td>\n<p>Cats</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hydrophobia</p>\n</td>\n<td>\n<p>Water</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Thanatophobia</p>\n</td>\n<td>\n<p>Death</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pyrophobia</p>\n</td>\n<td>\n<p>Fire</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Exclusive breastfeeding should be continued for a minimum of how many months?", "options": [{"label": "A", "text": "6 months", "correct": true}, {"label": "B", "text": "2 months", "correct": false}, {"label": "C", "text": "12 months", "correct": false}, {"label": "D", "text": "5 months", "correct": false}], "correct_answer": "A. 6 months", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: 6 month\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Football player gets blow to the outer knee during match. Which structure is most commonly associated with this type of injury?", "options": [{"label": "A", "text": "Anterior cruciate ligament", "correct": false}, {"label": "B", "text": "Medial collat ligament", "correct": true}, {"label": "C", "text": "Posterior Cruciate ligament", "correct": false}, {"label": "D", "text": "Lateral lemniscus", "correct": false}], "correct_answer": "B. Medial collat ligament", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Clinical History</strong></p>\n</td>\n<td>\n<p><strong>Ligaments Commonly Injured</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Valgus stress injury</p>\n</td>\n<td>\n<p>Medial <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (MCL)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hyperextension injury</p>\n</td>\n<td>\n<p>Posterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (PCL)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pivot shift mechanism</p>\n</td>\n<td>\n<p>Anterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (ACL)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Direct blow to the knee</p>\n</td>\n<td>\n<p>Anterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (ACL), <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (MCL), <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (PCL), <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (LCL)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rotational force injury</p>\n</td>\n<td>\n<p>Anterior <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (ACL), <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (MCL), <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"0faa43e76516927771851bff22a1e2\">cruciate</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (PCL), <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (LCL), <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> meniscus, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> meniscus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A Clinician asks a patient “how is your mood”. Patient replies by saying “ It is going up &amp;amp; down”. What is the phenomenon seen here?", "options": [{"label": "A", "text": "Derailment", "correct": false}, {"label": "B", "text": "Tangentiality", "correct": true}, {"label": "C", "text": "Clang association", "correct": false}, {"label": "D", "text": "Neologism", "correct": false}], "correct_answer": "B. Tangentiality", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Term</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Tangentiality</strong></td>\n<td>The patient gives an <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> or irrelevant answer and never reaches the point.</td>\n</tr>\n<tr>\n<td><strong>Derailment</strong></td>\n<td>Sudden shifting of ideas with no logical connection between them.</td>\n</tr>\n<tr>\n<td><strong>Clang association</strong></td>\n<td>Speech based on sound (rhyming/punning) rather than logical connections.</td>\n</tr>\n<tr>\n<td><strong>Neologism</strong></td>\n<td>Newly invented words with idiosyncratic meaning.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Avascular necrosis of the femur head is due to which of the following artery?", "options": [{"label": "A", "text": "Medial circumflex femoral artery", "correct": true}, {"label": "B", "text": "Lateral circumflex femoral artery", "correct": false}, {"label": "C", "text": "Obturator artery", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Medial circumflex femoral artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/W5bnLRFpCbm9EYsRwx6Z1687159920.png", "https://image.prepladder.com/content/W5bnLRFpCbm9EYsRwx6Z1687159920.png"], "explanation": "<p>Correct Option A - Medial &lt;span class=\"customMeta\" data-dictid=\"ed0b0613a81692777184dc4b974a19\"&gt;Circumflex&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\"&gt;Femoral&lt;/span&gt; A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the course of action for the newborn if the mother, who is a first-time pregnant woman, arrives at the hospital at 37 weeks of pregnancy with no prior antenatal check-ups and is currently in labor, while also testing positive for Hepatitis B?", "options": [{"label": "A", "text": "Hep B vaccine only", "correct": false}, {"label": "B", "text": "Hep B vaccine + immunoglobulin", "correct": true}, {"label": "C", "text": "First immunoglobulin, then Hep B vaccine after 1 month", "correct": false}, {"label": "D", "text": "Only immunoglobulin", "correct": false}], "correct_answer": "B. Hep B vaccine + immunoglobulin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the options pertains to McNaughten's rule?", "options": [{"label": "A", "text": "IPC 84", "correct": true}, {"label": "B", "text": "IPC 85", "correct": false}, {"label": "C", "text": "IPC 86", "correct": false}, {"label": "D", "text": "IPC 87", "correct": false}], "correct_answer": "A. IPC 84", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identifying finding seen in TB knee is", "options": [{"label": "A", "text": "Reduction of joint space", "correct": true}, {"label": "B", "text": "Increase in joint space", "correct": false}, {"label": "C", "text": "Degeneration of cartilage", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Reduction of joint space", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a child who has abdominal pain, haematuria, and palpable purpura over the leg, as depicted in the image, with IgA deposition observed on biopsy of the skin lesions?", "options": [{"label": "A", "text": "IgA nephropathy", "correct": false}, {"label": "B", "text": "HSP", "correct": true}, {"label": "C", "text": "RPGN", "correct": false}, {"label": "D", "text": "PSGN", "correct": false}], "correct_answer": "B. HSP", "question_images": ["https://image.prepladder.com/content/05Ivx0ShtiMjdfrf40Yr1695207207.png"], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Criteria</strong></p>\n</td>\n<td>\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Palpable purpura</strong></p>\n</td>\n<td>\n<p>Palpable hemorrhagic skin lesions in the absence of thrombocytopenia.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Bowel angina</strong></p>\n</td>\n<td>\n<p>Diffuse <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain or the diagnosis of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> ischemia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Diagnostic biopsy</strong></p>\n</td>\n<td>\n<p>Histological changes showing granulocytes in the walls of arterioles or venules; <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">IgA</span> deposits in the vessel wall.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Pediatric age group</strong></p>\n</td>\n<td>\n<p>Age &lt; 20 years at onset of symptoms</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Vasculitis Type</strong></p>\n</td>\n<td>\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td>\n<p><strong>other features</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Giant Cell (Temporal)</p>\n</td>\n<td>\n<p>Temporal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> involvement, headache, vision loss, jaw claudication</p>\n</td>\n<td>\n<p>Associated with <span class=\"customMeta\" data-dictid=\"0e5d74e10b1692777196c6affd7d4f\">polymyalgia</span> rheumatica</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Kawasaki Disease</p>\n</td>\n<td>\n<p>Fever, rash, conjunctivitis, strawberry tongue, lymphadenopathy, <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> involvement</p>\n</td>\n<td>\n<p>Primarily affects children, <span class=\"customMeta\" data-dictid=\"1cc6e4677116927771870a10c66fe7\">exclusion</span> of other diseases, <span class=\"customMeta\" data-dictid=\"36376dc3a81692777186a5d60f88cd\">echocardiogram</span> for evaluation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Polyarteritis Nodosa</p>\n</td>\n<td>\n<p>Systemic vasculitis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> and visceral involvement, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, hypertension</p>\n</td>\n<td>\n<p>Not associated with granulomas, commonly associated with <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> B infection</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Granulomatosis withPolyangiitis (GPA)</p>\n</td>\n<td>\n<p>Upper and lower <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> involvement, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> ulcers, saddle-nose deformity, lung nodules</p>\n</td>\n<td>\n<p>PR3-ANCA or MPO-ANCA positive, <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> inflammation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Eosinophilic <span class=\"customMeta\" data-dictid=\"2db4616dd0169277718891a2a1b67c\">Granulomatosis</span> (EGPA)</p>\n</td>\n<td>\n<p>Asthma, eosinophilia, sinusitis, lung infiltrates, skin rash, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy</p>\n</td>\n<td>\n<p>Eosinophilia, asthma, ANCA-negative, <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> inflammation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Takayasu Arteritis</p>\n</td>\n<td>\n<p>Young Asian females, <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> disease, asymmetric <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> in upper extremities, visual disturbances</p>\n</td>\n<td>\n<p>Affects large vessels, involves the <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> and its branches</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Behçet's Disease</p>\n</td>\n<td>\n<p>Oral and <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> ulcers, uveitis, skin lesions, arthritis, neurological involvement</p>\n</td>\n<td>\n<p>Associated with HLA-B51, can involve multiple organs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Henoch-Schönlein Purpura</p>\n</td>\n<td>\n<p>Palpable purpura, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, arthralgia, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> involvement</p>\n</td>\n<td>\n<p>Most common <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> in children, associated with <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">IgA</span> deposits in affected tissues</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most potent opioid is?", "options": [{"label": "A", "text": "Fentanyl", "correct": true}, {"label": "B", "text": "Morphine", "correct": false}, {"label": "C", "text": "Pentazocine", "correct": false}, {"label": "D", "text": "Pethidine", "correct": false}], "correct_answer": "A. Fentanyl", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is not a contraindication for OPV?", "options": [{"label": "A", "text": "Leukemia", "correct": false}, {"label": "B", "text": "Diarrhoea", "correct": true}, {"label": "C", "text": "Malignancy", "correct": false}, {"label": "D", "text": "Immunocompromised", "correct": false}], "correct_answer": "B. Diarrhoea", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "1 st line treatment for acne and comedones should be:", "options": [{"label": "A", "text": "Topical steroids", "correct": false}, {"label": "B", "text": "Topical antibiotics", "correct": false}, {"label": "C", "text": "Topical retinoids", "correct": true}, {"label": "D", "text": "Benzoyl peroxide", "correct": false}], "correct_answer": "C. Topical retinoids", "question_images": ["https://image.prepladder.com/content/DgzMC34YUbpTKL8havTS1691336024.jpg"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\"&gt;Topical&lt;/span&g\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Acne Grade</strong></td>\n<td style=\"text-align:center\"><strong>Description</strong></td>\n<td style=\"text-align:center\"><strong>Treatment Options</strong></td>\n</tr>\n<tr>\n<td><strong>Grade I</strong></td>\n<td>Mild <span class=\"customMeta\" data-dictid=\"8b61bc6e361692777180695ac33e91\">acne</span> with comedones (blackheads and whiteheads)</td>\n<td>\n<ul>\n<li>Topical retinoids (e.g., tretinoin, adapalene)</li>\n<li>Topical <span class=\"customMeta\" data-dictid=\"f55a5f637616927771820bb58f591f\">benzoyl</span> peroxide</li>\n<li>Topical salicylic acid</li>\n<li>Topical antibiotics (e.g., clindamycin, erythromycin)</li>\n<li>Oil-free moisturizers and non-comedogenic cosmetics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Grade II</strong></td>\n<td>Moderate <span class=\"customMeta\" data-dictid=\"8b61bc6e361692777180695ac33e91\">acne</span> with papules (inflamed, red bumps)</td>\n<td>\n<ul>\n<li>Topical retinoids</li>\n<li>Topical <span class=\"customMeta\" data-dictid=\"f55a5f637616927771820bb58f591f\">benzoyl</span> peroxide</li>\n<li>Topical antibiotics</li>\n<li>Oral antibiotics (e.g., tetracyclines)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Grade III</strong></td>\n<td>Severe <span class=\"customMeta\" data-dictid=\"8b61bc6e361692777180695ac33e91\">acne</span> with nodules (large, painful bumps)</td>\n<td>\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"e6a88ded8b1692777190caead269e4\">isotretinoin</span> (for severe, resistant cases)</li>\n<li>Topical retinoids</li>\n<li>Topical <span class=\"customMeta\" data-dictid=\"f55a5f637616927771820bb58f591f\">benzoyl</span> peroxide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Grade IV</strong></td>\n<td>Cystic <span class=\"customMeta\" data-dictid=\"8b61bc6e361692777180695ac33e91\">acne</span> with scarring and extensive inflammation</td>\n<td>\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"e6a88ded8b1692777190caead269e4\">isotretinoin</span> (for severe, resistant cases)</li>\n<li>Topical retinoids</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which mineral is associated with the functioning of carbonic anhydrase?", "options": [{"label": "A", "text": "Zinc", "correct": true}, {"label": "B", "text": "Iron", "correct": false}, {"label": "C", "text": "Calcium", "correct": false}, {"label": "D", "text": "Potassium", "correct": false}], "correct_answer": "A. Zinc", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Z\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zinc</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carbonic anhydrase, Alcohol dehydrogenase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iron</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Catalase, Cytochromes, Hemoglobin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Copper</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytochrome c oxidase, <span class=\"customMeta\" data-dictid=\"7d51964ce51692777199dedcf19fc3\">Superoxide</span> dismutase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Magnesium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ATPases, DNA polymerases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Manganese</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superoxide dismutase, Arginase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calmodulin, Protein kinases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sodium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sodium-potassium ATPase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Potassium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sodium-potassium ATPase</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Unilateral renal agenesis in an infant is linked with:", "options": [{"label": "A", "text": "Single umbilical artery", "correct": true}, {"label": "B", "text": "Single umbilical Vein", "correct": false}, {"label": "C", "text": "Polyhydramnios", "correct": false}, {"label": "D", "text": "Maternal anemia", "correct": false}], "correct_answer": "A. Single umbilical artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Single &lt;span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\"&gt;umbilical&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mechanism of action of allopurinol is?", "options": [{"label": "A", "text": "Xanthine oxidase inhibition", "correct": true}, {"label": "B", "text": "Recombinant uricase", "correct": false}, {"label": "C", "text": "Increase uric acid excretion", "correct": false}, {"label": "D", "text": "Decrease chemotaxis", "correct": false}], "correct_answer": "A. Xanthine oxidase inhibition", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"c9a23eabc41692777202d1d98467d5\"&gt;Xanthine&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\"&gt;oxidase&lt;/span&gt; inh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gluconeogenesis is inhibited by", "options": [{"label": "A", "text": "Insulin", "correct": true}, {"label": "B", "text": "Glucagon", "correct": false}, {"label": "C", "text": "Lactate", "correct": false}, {"label": "D", "text": "None of above", "correct": false}], "correct_answer": "A. Insulin", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regulator of gluconeogenesis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Effect</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insulin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glucagon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stimulates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cortisol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stimulates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epinephrine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stimulates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth Hormone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stimulates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stimulates</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for a 7-year-old child presenting with bedwetting complaints?", "options": [{"label": "A", "text": "Bed alarm", "correct": true}, {"label": "B", "text": "Imipramine", "correct": false}, {"label": "C", "text": "Desmopressin spray", "correct": false}, {"label": "D", "text": "Fludrocortisone", "correct": false}], "correct_answer": "A. Bed alarm", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which glycosaminoglycan (GAG) is present in synovial fluid?", "options": [{"label": "A", "text": "Heparin", "correct": false}, {"label": "B", "text": "Keratan sulfate", "correct": false}, {"label": "C", "text": "Chondroitin sulfate", "correct": false}, {"label": "D", "text": "Hyaluronic acid", "correct": true}], "correct_answer": "D. Hyaluronic acid", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>GAG</strong></p>\n</td>\n<td>\n<p><strong>Predominantly Found In</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hyaluronic acid</p>\n</td>\n<td>\n<p>Synovial fluid, <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> humor, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chondroitin sulfate</p>\n</td>\n<td>\n<p>Cartilage, tendons, ligaments, bone, skin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dermatan sulfate</p>\n</td>\n<td>\n<p>Skin, blood vessels, heart valves, tendons, lungs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Heparan sulfate</p>\n</td>\n<td>\n<p>Basement membranes, cell surfaces, liver, lung, kidney</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Keratan sulfate</p>\n</td>\n<td>\n<p>Cornea, cartilage, bone, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues, brain</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Heparin</p>\n</td>\n<td>\n<p>Mast cells, liver, lung, intestinal mucosa, blood (as a medication)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>GAG</strong></p>\n</td>\n<td>\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hyaluronic acid</p>\n</td>\n<td>\n<p>Provides <span class=\"customMeta\" data-dictid=\"a195b609f61692777189953f3adaa6\">hydration</span> and viscoelasticity to tissues</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chondroitin sulfate</p>\n</td>\n<td>\n<p>Provides structural support to <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and other <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dermatan sulfate</p>\n</td>\n<td>\n<p>Present in skin and blood vessels, contributes to their structure</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Heparan sulfate</p>\n</td>\n<td>\n<p>Acts as a co-receptor for various growth factors and cytokines</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Keratan sulfate</p>\n</td>\n<td>\n<p>Helps maintain corneal transparency</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Heparin</p>\n</td>\n<td>\n<p>Acts as an anticoagulant, inhibits blood clotting</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the following drug that causes postural hypotension commonly ?", "options": [{"label": "A", "text": "Beta blocker", "correct": false}, {"label": "B", "text": "Alpha blocker", "correct": true}, {"label": "C", "text": "ACE inhibitor", "correct": false}, {"label": "D", "text": "Angiotensin receptor blockers", "correct": false}], "correct_answer": "B. Alpha blocker", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\"&gt;Alpha&lt;/span&gt; block\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition shown in the image below", "options": [{"label": "A", "text": "Malignant melanoma", "correct": true}, {"label": "B", "text": "BCC", "correct": false}, {"label": "C", "text": "Squamous cell carcinoma", "correct": false}, {"label": "D", "text": "Nevus", "correct": false}], "correct_answer": "A. Malignant melanoma", "question_images": ["https://image.prepladder.com/content/UV7koAJPujA08DqI4NXk1713941560.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following GAG has anticoagulant activity", "options": [{"label": "A", "text": "Heparin", "correct": true}, {"label": "B", "text": "Keratan sulfate", "correct": false}, {"label": "C", "text": "Chondroitin sulfate", "correct": false}, {"label": "D", "text": "Hyaluronic acid", "correct": false}], "correct_answer": "A. Heparin", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>GAG</strong></p>\n</td>\n<td>\n<p><strong>Predominantly Found In</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hyaluronic acid</p>\n</td>\n<td>\n<p>Synovial fluid, <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> humor, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chondroitin sulfate</p>\n</td>\n<td>\n<p>Cartilage, tendons, ligaments, bone, skin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dermatan sulfate</p>\n</td>\n<td>\n<p>Skin, blood vessels, heart valves, tendons, lungs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Heparan sulfate</p>\n</td>\n<td>\n<p>Basement membranes, cell surfaces, liver, lung, kidney</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Keratan sulfate</p>\n</td>\n<td>\n<p>Cornea, cartilage, bone, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues, brain</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Heparin</p>\n</td>\n<td>\n<p>Mast cells, liver, lung, intestinal mucosa, blood (as a medication)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>GAG</strong></p>\n</td>\n<td>\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hyaluronic acid</p>\n</td>\n<td>\n<p>Provides <span class=\"customMeta\" data-dictid=\"a195b609f61692777189953f3adaa6\">hydration</span> and viscoelasticity to tissues</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chondroitin sulfate</p>\n</td>\n<td>\n<p>Provides structural support to <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and other <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dermatan sulfate</p>\n</td>\n<td>\n<p>Present in skin and blood vessels, contributes to their structure</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Heparan sulfate</p>\n</td>\n<td>\n<p>Acts as a co-receptor for various growth factors and cytokines</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Keratan sulfate</p>\n</td>\n<td>\n<p>Helps maintain corneal transparency</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Heparin</p>\n</td>\n<td>\n<p>Acts as an anticoagulant, inhibits blood clotting</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the listed medications acts as a carbonic anhydrase inhibitor?", "options": [{"label": "A", "text": "Acetazolamide", "correct": true}, {"label": "B", "text": "Hydrochlorothiazide", "correct": false}, {"label": "C", "text": "Furosemide", "correct": false}, {"label": "D", "text": "Mannitol", "correct": false}], "correct_answer": "A. Acetazolamide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which specific glucose transporter is present in the skeletal muscle?", "options": [{"label": "A", "text": "GLUT 1", "correct": false}, {"label": "B", "text": "GLUT 2", "correct": false}, {"label": "C", "text": "GLUT 3", "correct": false}, {"label": "D", "text": "GLUT 4", "correct": true}], "correct_answer": "D. GLUT 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - GLUT 4\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Glut Transporters</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Locations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GLUT 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurons, RBCs, and Placenta</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GLUT 2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enterocytes, Hepatocytes, βcells of pancreas, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">Proximal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GLUT 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurons, RBCs, and Placenta</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GLUT 4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Insulin Dependent <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">Uptake</span> in Skeletal Muscles, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Muscles and <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">Adipose</span> Tissues</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GLUT 5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fructose <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">Absorption</span> along the intestine.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common presentation of generalised oedema and massive proteinuria?", "options": [{"label": "A", "text": "Nephrotic syndrome", "correct": true}, {"label": "B", "text": "Acute post-streptococcal glomerulonephritis", "correct": false}, {"label": "C", "text": "Renal tubular acidosis", "correct": false}, {"label": "D", "text": "Nephrolithiasis", "correct": false}], "correct_answer": "A. Nephrotic syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\"&gt;Nephrotic&lt;/span&gt; S\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephritic syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Massive <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> (&gt;3.5gm/24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> sample)</li>\n<li>Lipiduria</li>\n<li>Hypoalbuminemia</li>\n<li>Edema</li>\n<li>Thrombotic events (removal of AT-III through urine)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> (&lt;1gm/ 24-hour sample)</li>\n<li>Hypertension</li>\n<li>Oliguria</li>\n<li>Hematuria</li>\n<li>Azotemia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the substance that inhibits Complex 4 in the electron transport chain?", "options": [{"label": "A", "text": "Cyanide", "correct": true}, {"label": "B", "text": "Phenformin", "correct": false}, {"label": "C", "text": "Rotenone", "correct": false}, {"label": "D", "text": "Carboxin", "correct": false}], "correct_answer": "A. Cyanide", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Inhibitor</strong></p>\n</td>\n<td>\n<p><strong>Target Site in ETC</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rotenone</p>\n</td>\n<td>\n<p>Complex I (NADH dehydrogenase)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Antimycin A</p>\n</td>\n<td>\n<p>Complex III (cytochrome bc1 complex)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cyanide</p>\n</td>\n<td>\n<p>Complex IV (cytochrome c oxidase)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Carbon monoxide</p>\n</td>\n<td>\n<p>Complex IV (cytochrome c oxidase)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oligomycin</p>\n</td>\n<td>\n<p>ATP synthase</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dinitrophenol</p>\n</td>\n<td>\n<p>Uncoupling of <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> phosphorylation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>2,4-dinitrophenol</p>\n</td>\n<td>\n<p>Uncoupling of <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> phosphorylation</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is most cardiotoxic anticancer drug ?", "options": [{"label": "A", "text": "Anthracyclines", "correct": true}, {"label": "B", "text": "Cyclophosphamide", "correct": false}, {"label": "C", "text": "Tamoxifen", "correct": false}, {"label": "D", "text": "Imatinib", "correct": false}], "correct_answer": "A. Anthracyclines", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Anth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of skin cancer is commonly associated with the depicted cutaneous horn in the image?", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": true}, {"label": "B", "text": "Melanoma", "correct": false}, {"label": "C", "text": "BCC", "correct": false}, {"label": "D", "text": "Actinic Keratosis", "correct": false}], "correct_answer": "A. Squamous cell carcinoma", "question_images": ["https://image.prepladder.com/content/PBUqO8s1Li0sefHyQTWP1695116383.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently occurring amino acid in collagen?", "options": [{"label": "A", "text": "Proline", "correct": false}, {"label": "B", "text": "Lucine", "correct": false}, {"label": "C", "text": "Arginine", "correct": false}, {"label": "D", "text": "Glycine", "correct": true}], "correct_answer": "D. Glycine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - G\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In an individual traveling to an area with endemic malaria, which of the following is the preferred chemoprophylaxis option?", "options": [{"label": "A", "text": "Chloroquine", "correct": true}, {"label": "B", "text": "Quinine", "correct": false}, {"label": "C", "text": "Lumefantrine", "correct": false}, {"label": "D", "text": "Pyrimethamine", "correct": false}], "correct_answer": "A. Chloroquine", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The molecule responsible for the transport of ammonia from the brain to the liver is", "options": [{"label": "A", "text": "Glutamine", "correct": true}, {"label": "B", "text": "Leucine", "correct": false}, {"label": "C", "text": "Lysine", "correct": false}, {"label": "D", "text": "Aspartate", "correct": false}], "correct_answer": "A. Glutamine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kfMvy30F5eF8FQ7RHSMw1715661860.png"], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is not used for the prophylaxis of migraine?", "options": [{"label": "A", "text": "Propranolol", "correct": false}, {"label": "B", "text": "Imipramine", "correct": false}, {"label": "C", "text": "Flutamide", "correct": true}, {"label": "D", "text": "Flunarizine", "correct": false}], "correct_answer": "C. Flutamide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female – pain in the fingernail , on examination nail fold is seen with pus , most likely diagnosis?", "options": [{"label": "A", "text": "Yellow nail syndrome", "correct": false}, {"label": "B", "text": "Psoriasis", "correct": false}, {"label": "C", "text": "Alopecia Areata", "correct": false}, {"label": "D", "text": "Paronychia", "correct": true}], "correct_answer": "D. Paronychia", "question_images": ["https://image.prepladder.com/content/n6VFd43jsUSjY3rkSyWp1691373294.jpg"], "explanation_images": [], "explanation": "<p>Correct Option D - Paronych\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are found in DNA structures except", "options": [{"label": "A", "text": "Guanine", "correct": false}, {"label": "B", "text": "Adenine", "correct": false}, {"label": "C", "text": "Cytosine", "correct": false}, {"label": "D", "text": "Uracil", "correct": true}], "correct_answer": "D. Uracil", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the possible cause of poisoning in a farmer who has a pin-point pupil and an increase in secretions?", "options": [{"label": "A", "text": "Organophosphate poisoning", "correct": true}, {"label": "B", "text": "Dhatura poisoning", "correct": false}, {"label": "C", "text": "Opioid poisoning", "correct": false}, {"label": "D", "text": "Atropine poisoning", "correct": false}], "correct_answer": "A. Organophosphate poisoning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"505a21f8451692777194a113951c68\"&gt;Organophosphate&lt;/span&gt; poisoning\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient with a history of severe sunburn after only a few minutes exposure in the sun (photosensitivity) he noticed freckling in sun-exposed areas, dry skin, and changes in skin pigmentation. What is the Diagnosis?", "options": [{"label": "A", "text": "Xeroderma pigmentosa", "correct": true}, {"label": "B", "text": "Bloom syndrome", "correct": false}, {"label": "C", "text": "Warts", "correct": false}, {"label": "D", "text": "Melanocytes nevus", "correct": false}], "correct_answer": "A. Xeroderma pigmentosa", "question_images": ["https://image.prepladder.com/content/lcifRzc6ssngGbCtFYGJ1747748608.png"], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Photosensitivity</strong></td>\n<td>Severe sunburns after minimal UV exposure</td>\n</tr>\n<tr>\n<td><strong>Skin pigmentation</strong></td>\n<td>Early onset of <strong>freckling</strong>, <strong>hypo- and hyperpigmented macules</strong></td>\n</tr>\n<tr>\n<td><strong>Skin atrophy</strong></td>\n<td>Dry, parchment-like skin</td>\n</tr>\n<tr>\n<td><strong>Ocular involvement</strong></td>\n<td><strong>Photophobia</strong>, <strong>conjunctivitis</strong>, corneal opacities, and lid changes</td>\n</tr>\n<tr>\n<td><strong>Neurological symptoms</strong></td>\n<td>May include <strong>sensorineural deafness</strong>, <strong>ataxia</strong>, and <strong>intellectual disability</strong></td>\n</tr>\n<tr>\n<td><strong>Cancer risk</strong></td>\n<td>Markedly increased risk of <strong>basal cell carcinoma</strong>, <strong>squamous cell carcinoma</strong>, and <strong>melanoma</strong> at a young age</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drugs are subjected to therapeutic drug monitoring?", "options": [{"label": "A", "text": "Phenytoin", "correct": true}, {"label": "B", "text": "Heparin", "correct": false}, {"label": "C", "text": "Aspirin", "correct": false}, {"label": "D", "text": "Metformin", "correct": false}], "correct_answer": "A. Phenytoin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options listed below is an oral medication that directly inhibits thrombin?", "options": [{"label": "A", "text": "Dabigatran", "correct": true}, {"label": "B", "text": "Rivaroxaban", "correct": false}, {"label": "C", "text": "Warfarin", "correct": false}, {"label": "D", "text": "Lepirudin", "correct": false}], "correct_answer": "A. Dabigatran", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Dabig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cylinder associated with a black body and white shoulder?", "options": [{"label": "A", "text": "Oxygen", "correct": true}, {"label": "B", "text": "Nitric oxide", "correct": false}, {"label": "C", "text": "Helium", "correct": false}, {"label": "D", "text": "Entonox", "correct": false}], "correct_answer": "A. Oxygen", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ueiv0Gf2OGnRTBaP4uJn1694695617.png"], "explanation": "<p>Correct Option A - Oxyg\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Cylinder</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Colour</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Oxygen (gas)</strong></p>\n</td>\n<td>\n<p>Black body and white shoulder.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Nitrous <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">Oxide</span> (gas)</strong></p>\n</td>\n<td>\n<p>Blue</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Nitrogen (gas)</strong></p>\n</td>\n<td>\n<p>Black</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Air (gas)</strong></p>\n</td>\n<td>\n<p>Gray/black body with black/white shoulder</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Entonox (gas)</strong></p>\n</td>\n<td>\n<p>Blue body and white/blue shoulder</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The Pin Index of Entonox is", "options": [{"label": "A", "text": "7", "correct": true}, {"label": "B", "text": "1,5 – Air", "correct": false}, {"label": "C", "text": "2, 5 – Oxygen", "correct": false}, {"label": "D", "text": "3, 5 – Nitric oxide", "correct": false}], "correct_answer": "A. 7", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Pin Index</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Gas Type</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Pin Index Safety System (PISS)</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Oxygen</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">2-4-3-5</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Carbon <span class=\"customMeta\" data-dictid=\"0bd01a042116927771868e3482910e\">Dioxide</span> (CO2)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">1-5</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Nitrous <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">Oxide</span> (N2O)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">3-5</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Compressed Air</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">3-6</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Helium</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">5-6</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Nitrogen (N2)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">1-3</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Argon</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">1-6</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Hydrogen</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">2-5</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Medical Vacuum</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which medications exhibit zero order kinetics among the options provided?", "options": [{"label": "A", "text": "Phenytoin", "correct": true}, {"label": "B", "text": "Epinephrine", "correct": false}, {"label": "C", "text": "Morphine", "correct": false}, {"label": "D", "text": "Propranolol", "correct": false}], "correct_answer": "A. Phenytoin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ph\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\">\n<p><strong>Kinetic Type</strong></p>\n</td>\n<td style=\"text-align:center\">\n<p><strong>Zero-Order Kinetics </strong></p>\n</td>\n<td style=\"text-align:center\">\n<p><strong>First-Order Kinetics</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rate of Elimination </p>\n</td>\n<td>\n<p>Constant amount of drug is eliminated per unit of time </p>\n</td>\n<td>\n<p>Constant fraction of drug is eliminated per unit of time based on concentration </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Drug Concentration </p>\n</td>\n<td>\n<p>Does not affect the rate of elimination</p>\n</td>\n<td>\n<p>affects the rate of elimination</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Graphical Representation </p>\n</td>\n<td>\n<p>Straight line with a constant slope on a <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> concentration vs time plot </p>\n</td>\n<td>\n<p>Exponential decrease on a semi-logarithmic concentration vs time plot </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Half-Life </p>\n</td>\n<td>\n<p>Not constant, as it depends on the initial drug amount </p>\n</td>\n<td>\n<p>Constant, as it is independent of the drug concentration </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Factors Affecting Kinetics </p>\n</td>\n<td>\n<p>Enzyme saturation, limited capacity for <span class=\"customMeta\" data-dictid=\"557488ca4a1692777186befe1edb06\">drug metabolism</span> or elimination </p>\n</td>\n<td>\n<p>Enzyme activity, drug concentration, and factors affecting <span class=\"customMeta\" data-dictid=\"557488ca4a1692777186befe1edb06\">drug metabolism</span> or elimination</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Examples </p>\n</td>\n<td>\n<p>Phenytoin, <span class=\"customMeta\" data-dictid=\"f0705db1901692777187acdc0f9e24\">Ethanol</span> (at high concentrations) </p>\n</td>\n<td>\n<p> Morphine, Propranolol </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The color of the nitrous oxide cylinder is", "options": [{"label": "A", "text": "Completely Blue", "correct": true}, {"label": "B", "text": "Blue body with shoulder", "correct": false}, {"label": "C", "text": "Black body &amp;amp; white shoulder", "correct": false}, {"label": "D", "text": "Grey body &amp;amp; black white shoulder", "correct": false}], "correct_answer": "A. Completely Blue", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TaJihctsLpqConLldzO41694686293.png"], "explanation": "<p>Correct Option A - Completely Blue:</p>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Cylinder</strong></p>\n</td>\n<td>\n<p><strong>Colour</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Oxygen (gas)</strong></p>\n</td>\n<td>\n<p>Black body and white shoulder.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Nitrous <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">Oxide</span> (gas)</strong></p>\n</td>\n<td>\n<p>Blue</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Nitrogen (gas)</strong></p>\n</td>\n<td>\n<p>Black</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Air (gas)</strong></p>\n</td>\n<td>\n<p>Gray/black body with black/white shoulder</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Entonox (gas)</strong></p>\n</td>\n<td>\n<p>Blue body and white/blue shoulder</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which anti-amoebic medication, when combined with alcohol, may have caused the lady to experience symptoms such as nausea, vomiting, and dizziness at a social gathering?", "options": [{"label": "A", "text": "Metronidazole", "correct": true}, {"label": "B", "text": "Nitazoxanide", "correct": false}, {"label": "C", "text": "Paromomycin", "correct": false}, {"label": "D", "text": "Diloxanide", "correct": false}], "correct_answer": "A. Metronidazole", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - M\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Drug </strong></td>\n<td style=\"text-align:center\"><strong>Drug Class</strong></td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Metronidazole</td>\n<td style=\"text-align:center\">Nitroimidazole </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Cefotetan </td>\n<td style=\"text-align:center\">Cephalosporin </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Tinidazole </td>\n<td style=\"text-align:center\">Nitroimidazole </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Griseofulvin </td>\n<td style=\"text-align:center\">Antifungal </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Procarbazine </td>\n<td style=\"text-align:center\">Antineoplastic </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Certain Sulfonylurea</td>\n<td style=\"text-align:center\">Antidiabetic </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Drugs (e.g., tolbutamide)</td>\n<td style=\"text-align:center\"> </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Certain cephalosporins </td>\n<td style=\"text-align:center\">Cephalosporin </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">(E.g., cefoperazone, cefamandole)</td>\n<td style=\"text-align:center\"> </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Chlorpropamide</td>\n<td style=\"text-align:center\">Antidiabetic</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Disulfiram </td>\n<td style=\"text-align:center\">Alcohol Deterrent </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the best way to recognize the cylinder?", "options": [{"label": "A", "text": "Color coding", "correct": false}, {"label": "B", "text": "Label", "correct": true}, {"label": "C", "text": "Pin index system", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "B. Label", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hypoxic Hypoxia is seen in which of the following?", "options": [{"label": "A", "text": "CO poisoning", "correct": false}, {"label": "B", "text": "HCN poisoning", "correct": false}, {"label": "C", "text": "Ischemia", "correct": false}, {"label": "D", "text": "A-V shunt", "correct": true}], "correct_answer": "D. A-V shunt", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Type of Hypoxia</strong></p>\n</td>\n<td>\n<p><strong>Etiology</strong></p>\n</td>\n<td>\n<p><strong>Examples</strong></p>\n</td>\n<td>\n<p><strong>PaCO2</strong></p>\n</td>\n<td>\n<p><strong>PaO2</strong></p>\n</td>\n<td>\n<p><strong>Cyanosis</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hypoxic Hypoxia</p>\n</td>\n<td>\n<p>Inadequate oxygen supply or impaired utilization</p>\n</td>\n<td>\n<p>High altitude, <span class=\"customMeta\" data-dictid=\"44758fcec31692777184e24fa84582\">CO</span> poisoning, HCN poisoning, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> diseases</p>\n</td>\n<td>\n<p>Normal</p>\n</td>\n<td>\n<p>Low</p>\n</td>\n<td>\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anemic Hypoxia</p>\n</td>\n<td>\n<p>Reduced oxygen-carrying capacity of blood</p>\n</td>\n<td>\n<p>Anemia, blood loss, hemoglobinopathies, <span class=\"customMeta\" data-dictid=\"bb021d26d3169277718336718849a5\">carbon monoxide</span> poisoning</p>\n</td>\n<td>\n<p>Normal</p>\n</td>\n<td>\n<p>Low</p>\n</td>\n<td>\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Stagnant Hypoxia</p>\n</td>\n<td>\n<p>Impaired <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> or <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> circulation</p>\n</td>\n<td>\n<p>Heart failure, shock, <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> disorders, vasoconstriction</p>\n</td>\n<td>\n<p>Normal</p>\n</td>\n<td>\n<p>Low</p>\n</td>\n<td>\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Histotoxic Hypoxia</p>\n</td>\n<td>\n<p>Inability of cells to utilize oxygen effectively due to toxic substances or <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders</p>\n</td>\n<td>\n<p>Cyanide poisoning, certain <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders</p>\n</td>\n<td>\n<p>Variable</p>\n</td>\n<td>\n<p>Variable</p>\n</td>\n<td>\n<p>May be absent or mild</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>1.</strong></p>\n</td>\n<td>\n<p><strong>Hypoxic hypoxia</strong></p>\n</td>\n<td>\n<p><strong>Low SaO2 and low SvO2 </strong></p>\n</td>\n<td>\n<p><strong>Cyanosis ++</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>2.</strong></p>\n</td>\n<td>\n<p><strong>Anemic hypoxia</strong></p>\n</td>\n<td>\n<p><strong>1. Anaemia (Low Hb)</strong></p>\n<p><strong>2. CO- <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> </strong></p>\n<p><strong>3. Meth- Hb (brown colour)</strong></p>\n</td>\n<td>\n<p><strong>1. <span class=\"customMeta\" data-dictid=\"f3b66d8ec4169277718566066add68\">Cyanosis</span> is rare</strong></p>\n<p><strong>2. No cyanosis</strong></p>\n<p><strong>3. <span class=\"customMeta\" data-dictid=\"f3b66d8ec4169277718566066add68\">cyanosis</span> like appearance can be seen as not true cyanosis.</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>3.</strong></p>\n</td>\n<td>\n<p><strong>Stagnant <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> </strong></p>\n</td>\n<td>\n<p><strong>Very low SvO2</strong></p>\n</td>\n<td>\n<p><strong>Cyanosis ++</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>4. </strong></p>\n</td>\n<td>\n<p><strong>Histotoxic hypoxia</strong></p>\n</td>\n<td>\n<p><strong>SaO2 is Normal and high SvO2</strong></p>\n</td>\n<td>\n<p><strong>Cyanosis never seen</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which anti-asthma drug should be avoided with Erythromycin ?", "options": [{"label": "A", "text": "Salbutamol", "correct": false}, {"label": "B", "text": "Theophylline", "correct": true}, {"label": "C", "text": "Terbutaline", "correct": false}, {"label": "D", "text": "Ipratropium", "correct": false}], "correct_answer": "B. Theophylline", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Theoph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "PR interval in ECG denotes which of the following?", "options": [{"label": "A", "text": "Conduction through AV nodes", "correct": true}, {"label": "B", "text": "Ventricular depolarization", "correct": false}, {"label": "C", "text": "Ventricular repolarization", "correct": false}, {"label": "D", "text": "Atrial depolarization", "correct": false}], "correct_answer": "A. Conduction through AV nodes", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mopaxaza9ooiRGE1YlFk1687165975.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\"&gt;Conduction&lt;/span&gt; through AV\n<table>\n<tbody>\n<tr>\n<td colspan=\"4\">\n<p><strong>ECG waves</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Waves/ Interval</strong></p>\n</td>\n<td>\n<p><strong>Physiological Correlation</strong></p>\n</td>\n<td>\n<p><strong>Amplitude</strong></p>\n</td>\n<td>\n<p><strong>Duration</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>P wave</p>\n</td>\n<td>\n<p>Atrial depolarization</p>\n</td>\n<td>\n<p>0.1-0.3 mV</p>\n</td>\n<td>\n<p>&lt;0.1 second</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>PR interval</p>\n</td>\n<td>\n<p>Time between start of atrial <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> to start of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> depolarization</p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>0.12-0.2 seconds</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Q wave</p>\n</td>\n<td>\n<p>Septal depolarization</p>\n</td>\n<td>\n<p> </p>\n</td>\n<td rowspan=\"3\">\n<p>0.06-0.10 seconds</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>R wave</p>\n</td>\n<td>\n<p>Ventricular depolarization</p>\n</td>\n<td>\n<p>1 mV</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>S wave</p>\n</td>\n<td>\n<p>Depolarization of base of ventricles</p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>ST segment</p>\n</td>\n<td>\n<p>Depolarization complete. <span class=\"customMeta\" data-dictid=\"95f7d4c24d16927771904b4278640d\">Isoelectric</span> line</p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>0.08-0.12 seconds</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T wave</p>\n</td>\n<td>\n<p>Repolarization of both the right and left ventricles</p>\n</td>\n<td>\n<p>0.2-0.3 mV</p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>QT interval</p>\n</td>\n<td>\n<p>Ventricular <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> and repolarization</p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>0.2-0.4 seconds</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the suggested follow-up treatment for a patient post valve replacement?", "options": [{"label": "A", "text": "Warfarin", "correct": true}, {"label": "B", "text": "ACE inhibitors", "correct": false}, {"label": "C", "text": "Beta blockers", "correct": false}, {"label": "D", "text": "Thiazides", "correct": false}], "correct_answer": "A. Warfarin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\"&gt;Warfarin&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Antidote for opioid poisoning is?", "options": [{"label": "A", "text": "Naloxone", "correct": true}, {"label": "B", "text": "Pethidine", "correct": false}, {"label": "C", "text": "Flumazenil", "correct": false}, {"label": "D", "text": "Physostigmine", "correct": false}], "correct_answer": "A. Naloxone", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hyperkalemia refers to the serum potassium concentration of _____.", "options": [{"label": "A", "text": "4.5 mEq/L", "correct": false}, {"label": "B", "text": "6.0 mEq/L", "correct": true}, {"label": "C", "text": "4.0 mEq/L", "correct": false}, {"label": "D", "text": "5 meq/L", "correct": false}], "correct_answer": "B. 6.0 mEq/L", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 6.0 mEq/L: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Koplik spots are seen in?", "options": [{"label": "A", "text": "Measles", "correct": true}, {"label": "B", "text": "Mumps", "correct": false}, {"label": "C", "text": "Diptheria", "correct": false}, {"label": "D", "text": "Rubella", "correct": false}], "correct_answer": "A. Measles", "question_images": ["https://image.prepladder.com/content/4VzBKYEhiOglmDIpuAXw1712746474.png"], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Monoclonal antibody used in cancer ?", "options": [{"label": "A", "text": "Rituximab", "correct": true}, {"label": "B", "text": "Cisplatin", "correct": false}, {"label": "C", "text": "5-Fluorouracil", "correct": false}, {"label": "D", "text": "Methotrexate", "correct": false}], "correct_answer": "A. Rituximab", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ritu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is found in skeletal muscle among the options provided?", "options": [{"label": "A", "text": "GLUT-4", "correct": true}, {"label": "B", "text": "GLUT-5", "correct": false}, {"label": "C", "text": "GLUT-7", "correct": false}, {"label": "D", "text": "GLUT-2", "correct": false}], "correct_answer": "A. GLUT-4", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Glucose Transporter</strong></p>\n</td>\n<td>\n<p><strong>Location</strong></p>\n</td>\n<td>\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>GLUT 1</strong></p>\n</td>\n<td>\n<p>Various tissues, including brain, erythrocytes, and placenta</p>\n</td>\n<td>\n<p>Basal <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in various tissues (constitutive <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> transporter)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>GLUT 2</strong></p>\n</td>\n<td>\n<p>Liver, pancreatic <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cells, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubules, small intestine</p>\n</td>\n<td>\n<p>Facilitates bidirectional <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> transport</p>\n<p>in liver, pancreatic <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cells, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubules, and small intestine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>GLUT 3</strong></p>\n</td>\n<td>\n<p>Brain, placenta, testes</p>\n</td>\n<td>\n<p>Facilitates high-affinity <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> uptake</p>\n<p>in neurons and other glucose-dependent cells</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>GLUT 4</strong></p>\n</td>\n<td>\n<p>Adipose tissue, skeletal</p>\n<p>muscle</p>\n</td>\n<td>\n<p>Insulin-regulated <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> transporter</p>\n<p>Facilitates <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in response to insulin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>GLUT 5</strong></p>\n</td>\n<td>\n<p>Small intestine, testes, kidney, <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissue, skeletal muscle</p>\n</td>\n<td>\n<p>Facilitates <span class=\"customMeta\" data-dictid=\"d5bac53d50169277720363f48a6b3a\">fructose</span> transport (also transports <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> to a lesser extent)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>SGLT 1</strong></p>\n</td>\n<td>\n<p>Small intestine, kidney</p>\n</td>\n<td>\n<p>Sodium-dependent <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> co-transporter</p>\n<p>Facilitates active <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> in the small intestine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>SGLT 2</strong></p>\n</td>\n<td>\n<p>Kidney</p>\n</td>\n<td>\n<p>Sodium-dependent <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> co-transporter Facilitates <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in the kidneys</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the organism ?", "options": [{"label": "A", "text": "Influenza virus", "correct": false}, {"label": "B", "text": "Hantavirus", "correct": true}, {"label": "C", "text": "Adenovirus", "correct": false}, {"label": "D", "text": "None of above", "correct": false}], "correct_answer": "B. Hantavirus", "question_images": ["https://image.prepladder.com/content/9qbpHsLCFkOixtqvhkK91712744550.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Hantaviru\n<table>\n<tbody>\n<tr>\n<td><strong>Family</strong></td>\n<td>\n<ul>\n<li>Hantaviridae</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Genus</strong></td>\n<td>\n<ul>\n<li>Orthohantavirus (formerly Hantavirus).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Transmission</strong></td>\n<td>\n<ul>\n<li>Primarily transmitted to humans through contact with the urine, feces, or <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> of infected rodents (rodent-borne). - Some hantaviruses can also be transmitted through bites from infected rodents, and a few through person-to-person transmission (rare).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Natural Reservoir</strong></td>\n<td>\n<ul>\n<li>Rodents, especially deer mice, bank voles, and other species depending on the <span class=\"customMeta\" data-dictid=\"64f5c141d51692777188eb378afc37\">geographic</span> location. - <span class=\"customMeta\" data-dictid=\"8dcd2c17c316927771973b713c858f\">Reservoir</span> hosts typically remain asymptomatic.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Geographical Distribution</strong></td>\n<td>\n<ul>\n<li>Worldwide, with different hantaviruses found in specific regions. - <span class=\"customMeta\" data-dictid=\"992313c9861692777188cde008a66a\">Hantavirus</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Syndrome (HPS) in the Americas, and Hemorrhagic Fever with <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Syndrome (HFRS) in Eurasia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Clinical Syndromes</strong></td>\n<td>\n<ul>\n<li>Hantavirus <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Syndrome (HPS) in the Americas, characterized by <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> and a high mortality rate. - Hemorrhagic Fever with <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Syndrome (HFRS) in Eurasia, presenting with fever, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure, and hemorrhagic manifestations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Pathogenesis</strong></td>\n<td>\n<ul>\n<li>Primary target organs include the lungs (HPS) or kidneys (HFRS). - Severity of illness varies among hantaviruses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Clinical Presentation</strong></td>\n<td>\n<ul>\n<li>Early symptoms may include fever, fatigue, muscle aches, and <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> symptoms. - Severe cases progress to <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure with potential hemorrhagic manifestations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Incubation Period</strong></td>\n<td>\n<ul>\n<li>Typically ranges from 1 to 5 weeks, with symptoms appearing after exposure to the virus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Diagnosis</strong></td>\n<td>\n<ul>\n<li>Laboratory testing includes serological assays (IgM and <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> antibodies) and molecular tests such as PCR. - Chest <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for HPS cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td>\n<ul>\n<li>No specific <span class=\"customMeta\" data-dictid=\"0961725e7716927771811b32dec45d\">antiviral</span> treatment for <span class=\"customMeta\" data-dictid=\"992313c9861692777188cde008a66a\">hantavirus</span> infections.- Supportive care, including <span class=\"customMeta\" data-dictid=\"b45075a0e1169277719252465ca5ba\">mechanical ventilation</span> for severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> cases (HPS), and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> replacement therapy for severe <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cases (HFRS).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Prevention and Control</strong></td>\n<td>\n<ul>\n<li>Minimize contact with rodents and their <span class=\"customMeta\" data-dictid=\"1edc0f3d8b169277718700860e69a4\">excreta</span> in areas where hantaviruses are known to circulate. - Use protective measures when cleaning or working in environments where rodents may be present. - <span class=\"customMeta\" data-dictid=\"57d1018b9d1692777197393d47bd6a\">Rodent</span> control measures in and around living spaces.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the effects of dietary fibers?", "options": [{"label": "A", "text": "Reduces intestinal transit time", "correct": true}, {"label": "B", "text": "No role in metabolism", "correct": false}, {"label": "C", "text": "Causes constipation", "correct": false}, {"label": "D", "text": "Increased blood Glucose", "correct": false}], "correct_answer": "A. Reduces intestinal transit time", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Reduces &lt;span class=\"customMeta\" data-dictid=\"b643f545af1692777190088a3353d6\"&gt;intestinal transit&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following can result in gynaecomastia except ?", "options": [{"label": "A", "text": "Liver failure", "correct": false}, {"label": "B", "text": "Spironolactone", "correct": false}, {"label": "C", "text": "Digoxin", "correct": false}, {"label": "D", "text": "Aromatase inhibitors", "correct": true}], "correct_answer": "D. Aromatase inhibitors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"b249ba1c6a16927771821b83b1fd9b\"&gt;Aromatase&lt;/span&gt; inh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which test is most appropriate for the clinical diagnosis of a 3-year-old patient experiencing intermittent loose motions and weight loss ?", "options": [{"label": "A", "text": "Anti – Mitochondrial Antibody", "correct": false}, {"label": "B", "text": "Anti-tissue transglutaminase Antibody", "correct": true}, {"label": "C", "text": "Anti -SCL 70 antibody", "correct": false}, {"label": "D", "text": "Anti-Microsomal antibody", "correct": false}], "correct_answer": "B. Anti-tissue transglutaminase Antibody", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Anti-tissue &lt;span class=\"customMeta\" data-dictid=\"4a47b71b801692777200d06df00a08\"&gt;transglutaminase&lt;/span&gt; A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3vmK1YIquaD5EHgdhL081744567941.mp3", "video": ""}, {"text": "What are the consequences of experimental muscle spindle sectioning in frogs?", "options": [{"label": "A", "text": "Voluntary Axn &amp;amp; stretch reflex present", "correct": false}, {"label": "B", "text": "Voluntary Axn lost but stretch reflex present", "correct": false}, {"label": "C", "text": "Both are lost", "correct": true}, {"label": "D", "text": "Voluntary Axn present, stretch reflex is lost.", "correct": false}], "correct_answer": "C. Both are lost", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/obxGxhwE540tta1EJbO71687166776.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following parasite is transmitted by reduviid bug ?", "options": [{"label": "A", "text": "T. brucei", "correct": false}, {"label": "B", "text": "T. cruzi", "correct": true}, {"label": "C", "text": "Leishmania donovani", "correct": false}, {"label": "D", "text": "Both A &amp;amp; B", "correct": false}], "correct_answer": "B. T. cruzi", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - T. Cru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are signs of adequate breastfeeding in a 2-month-old infant, except?", "options": [{"label": "A", "text": "Baby sleeps for 2-3 hours after feeding", "correct": true}, {"label": "B", "text": "Baby urinates 6-8 times per day", "correct": false}, {"label": "C", "text": "Gains weight", "correct": false}, {"label": "D", "text": "Good skin tone", "correct": false}], "correct_answer": "A. Baby sleeps for 2-3 hours after feeding", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: Baby sleeps for 2-3 hours after feeding\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What medications should be administered to manage a patient who is 34 weeks pregnant and experiencing seizures, with a blood pressure reading of 200/110 mmHg?", "options": [{"label": "A", "text": "Oral Labetalol", "correct": false}, {"label": "B", "text": "IV labetalol plus magnesium sulphate", "correct": true}, {"label": "C", "text": "IV Lorazepam", "correct": false}, {"label": "D", "text": "IV Enalapril", "correct": false}], "correct_answer": "B. IV labetalol plus magnesium sulphate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - IV &lt;span class=\"customMeta\" data-dictid=\"5729c1fa1a16927771912963eea9a2\"&gt;labetalol&lt;/span&gt; plus &lt;span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\"&gt;magnesium&lt;/span&gt; sulph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred medication for treating hyperthyroidism during the third trimester of pregnancy?", "options": [{"label": "A", "text": "Carbimazole", "correct": true}, {"label": "B", "text": "Propylthiouracil", "correct": false}, {"label": "C", "text": "Sodium iodide", "correct": false}, {"label": "D", "text": "Radioactive iodine", "correct": false}], "correct_answer": "A. Carbimazole", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Two nuclei present at the tail tip are seen in?", "options": [{"label": "A", "text": "Wuchereria bancrofti", "correct": false}, {"label": "B", "text": "Brugia malayi", "correct": true}, {"label": "C", "text": "Loa loa", "correct": false}, {"label": "D", "text": "Onchocerca volvulus", "correct": false}], "correct_answer": "B. Brugia malayi", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"fde28feeb31692777183995b9efd0c\"&gt;Brugia&lt;/span&gt; M\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p><strong>Species </strong></p>\n</td>\n<td>\n<p><strong>Wuchereria bancrofti </strong></p>\n</td>\n<td>\n<p><strong>Brugia malayi </strong></p>\n</td>\n<td>\n<p><strong>Loa <span class=\"customMeta\" data-dictid=\"837e3834141692777191b05b4073bf\">loa</span> </strong></p>\n</td>\n<td>\n<p><strong>Mansonella perstans </strong></p>\n</td>\n<td>\n<p><strong>Mansonella ozzardi</strong></p>\n</td>\n<td>\n<p><strong>Onchocerca <span class=\"customMeta\" data-dictid=\"061f9a880e1692777202e47dbb3d3f\">volvulus</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tail nuclei</p>\n</td>\n<td>\n<p>Nuclei do not extent to the tip of tail</p>\n</td>\n<td>\n<p>2 <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> at the tip of the tail</p>\n</td>\n<td>\n<p>Nuclei from continuous row in the tip of the tail</p>\n</td>\n<td>\n<p>Nuclei extend to the tip of the tail</p>\n</td>\n<td>\n<p>Nuclei do not extent to the tip of the tail</p>\n</td>\n<td>\n<p>Nuclei do not extent to the tip of the tail</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sheath</p>\n</td>\n<td>\n<p>Sheathed</p>\n</td>\n<td>\n<p>Sheathed</p>\n</td>\n<td>\n<p>Sheathed</p>\n</td>\n<td>\n<p>Unsheathed</p>\n</td>\n<td>\n<p>Unsheathed</p>\n</td>\n<td>\n<p>Unsheathed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which specific antibody is detected during a recent infection?", "options": [{"label": "A", "text": "Ig M", "correct": true}, {"label": "B", "text": "Ig G", "correct": false}, {"label": "C", "text": "Ig E", "correct": false}, {"label": "D", "text": "Ig A", "correct": false}], "correct_answer": "A. Ig M", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following possesses cardio-protective properties?", "options": [{"label": "A", "text": "LDL", "correct": false}, {"label": "B", "text": "VLDL", "correct": false}, {"label": "C", "text": "HDL", "correct": true}, {"label": "D", "text": "IDL", "correct": false}], "correct_answer": "C. HDL", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - HDL\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Lipoprotein</strong></p>\n</td>\n<td>\n<p><strong>Source</strong></p>\n</td>\n<td>\n<p><strong>Origin</strong></p>\n</td>\n<td>\n<p><strong>Properties</strong></p>\n</td>\n<td>\n<p><strong>Actions</strong></p>\n</td>\n<td>\n<p><strong>Special Features</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Chylomicrons</strong></p>\n</td>\n<td>\n<p>Intestine</p>\n</td>\n<td>\n<p>Dietary fats</p>\n</td>\n<td>\n<p>Largest <span class=\"customMeta\" data-dictid=\"1f6f7d1976169277719178bd1ae135\">lipoprotein</span> particles</p>\n</td>\n<td>\n<p>Transport dietary triglycerides</p>\n</td>\n<td>\n<p>Transport of <span class=\"customMeta\" data-dictid=\"18a9d4c52716927771878ee08e63ee\">exogenous</span> (dietary) triglycerides</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>VLDL</strong></p>\n</td>\n<td>\n<p>Liver</p>\n</td>\n<td>\n<p>Endogenous triglycerides</p>\n</td>\n<td>\n<p>High in triglycerides</p>\n</td>\n<td>\n<p>Carry <span class=\"customMeta\" data-dictid=\"2a7f0b780c1692777187fe83ec76b1\">endogenous</span> triglycerides to tissues</p>\n</td>\n<td>\n<p>Precursor for <span class=\"customMeta\" data-dictid=\"4e4438ab5c16927771919ca536a59f\">LDL</span> formation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>LDL</strong></p>\n</td>\n<td>\n<p>VLDL metabolism</p>\n</td>\n<td>\n<p>VLDL remnants</p>\n</td>\n<td>\n<p>High in cholesterol</p>\n</td>\n<td>\n<p>Deliver cholesterol to cells for various functions</p>\n</td>\n<td>\n<p>Considered \"bad\" cholesterol due to its association with atherosclerosis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>HDL</strong></p>\n</td>\n<td>\n<p>Liver, Intestine</p>\n</td>\n<td>\n<p>Synthesized by the body</p>\n</td>\n<td>\n<p>High in protein, low in lipids</p>\n</td>\n<td>\n<p>Remove <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> cholesterol from tissues and cells</p>\n</td>\n<td>\n<p>Considered \"good\" cholesterol due to <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> protection</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Smallest cestode is?", "options": [{"label": "A", "text": "Echinococcus", "correct": false}, {"label": "B", "text": "T. solium", "correct": false}, {"label": "C", "text": "H. nana", "correct": true}, {"label": "D", "text": "D. latum", "correct": false}], "correct_answer": "C. H. nana", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 31-year-old presents with complains of tenderness just above the medial canthus. A condition that presents with \"Office headache\". What is the likely diagnosis?", "options": [{"label": "A", "text": "Frontal sinusitis", "correct": true}, {"label": "B", "text": "Maxillary sinusitis", "correct": false}, {"label": "C", "text": "Migraine", "correct": false}, {"label": "D", "text": "Temporal arteritis", "correct": false}], "correct_answer": "A. Frontal sinusitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: Office headach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mechanism of action of exenatide in diabetes mellitus is:", "options": [{"label": "A", "text": "It is an analogue of GLP and increases glucose dependent insulin secretion", "correct": true}, {"label": "B", "text": "It is DPP-4 inhibitor and result in decreased breakdown of GLP", "correct": false}, {"label": "C", "text": "It inhibits SGLT2 and cause glucosuria", "correct": false}, {"label": "D", "text": "It is amylin analogue and decrease glucagon", "correct": false}], "correct_answer": "A. It is an analogue of GLP and increases glucose dependent insulin secretion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - It is an &lt;span class=\"customMeta\" data-dictid=\"22e0051a181692777181872183edb2\"&gt;analogue&lt;/span&gt; of &lt;span class=\"customMeta\" data-dictid=\"a269dd4eda1692777188df922d4058\"&gt;GLP&lt;/span&gt; and increases glucose-dependent &lt;span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\"&gt;insulin&lt;/span&g\n<table>\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Medication Class</strong></td>\n<td style=\"text-align:center\"><strong>Examples</strong></td>\n</tr>\n<tr>\n<td>Biguanides</td>\n<td>Metformin</td>\n</tr>\n<tr>\n<td>Sulfonylureas</td>\n<td>Glimepiride, Glipizide, Glyburide</td>\n</tr>\n<tr>\n<td>Meglitinides</td>\n<td>Repaglinide, Nateglinide</td>\n</tr>\n<tr>\n<td>Thiazolidinediones (TZDs)</td>\n<td>Pioglitazone, Rosiglitazone</td>\n</tr>\n<tr>\n<td>Dipeptidyl Peptidase-4 (DPP-4) Inhibitors</td>\n<td>Sitagliptin, Saxagliptin, Linagliptin</td>\n</tr>\n<tr>\n<td>Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors</td>\n<td>Canagliflozin, Dapagliflozin, Empagliflozin</td>\n</tr>\n<tr>\n<td>Alpha-Glucosidase Inhibitors</td>\n<td>Acarbose, Miglitol</td>\n</tr>\n<tr>\n<td>Bile Acid Sequestrants</td>\n<td>Colesevelam</td>\n</tr>\n<tr>\n<td>Dopamine-2 Agonists</td>\n<td>Bromocriptine</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently encountered tumor in the anterior mediastinum?", "options": [{"label": "A", "text": "Thymoma", "correct": true}, {"label": "B", "text": "Lymphoma", "correct": false}, {"label": "C", "text": "Adenocarcinoma", "correct": false}, {"label": "D", "text": "Fibroma", "correct": false}], "correct_answer": "A. Thymoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Lacrimal gland is supplied through a parasympathetic system. It is supplied by which ganglion?", "options": [{"label": "A", "text": "Ciliary ganglion", "correct": false}, {"label": "B", "text": "Otic ganglion", "correct": false}, {"label": "C", "text": "Pterygopalatine ganglion", "correct": true}, {"label": "D", "text": "Submandibular ganglion", "correct": false}], "correct_answer": "C. Pterygopalatine ganglion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e10a7d508b16927771960a2f2fa92a\"&gt;Pterygopalatine&lt;/span&gt; ganglion: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify parasite?", "options": [{"label": "A", "text": "E. histolytica", "correct": true}, {"label": "B", "text": "E. coli", "correct": false}, {"label": "C", "text": "E. gingivalis", "correct": false}, {"label": "D", "text": "E. polecki", "correct": false}], "correct_answer": "A. E. histolytica", "question_images": ["https://image.prepladder.com/content/TVpfxEhsrG7ySBKPNhGU1713262300.png"], "explanation_images": ["https://image.prepladder.com/content/6F1lhtkK3zsMIaVruVDe1713262327.png"], "explanation": "<p>Correct Option A - E. H\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which antiepileptic drug has the lowest risk of causing birth defects during pregnancy?", "options": [{"label": "A", "text": "Valproate", "correct": false}, {"label": "B", "text": "Phenytoin", "correct": false}, {"label": "C", "text": "Carbamazepine", "correct": false}, {"label": "D", "text": "Levetiracetam", "correct": true}], "correct_answer": "D. Levetiracetam", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Lev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What types of organisms are capable of surviving in temperatures as high as 100 degrees Celsius?", "options": [{"label": "A", "text": "Pseudomonas", "correct": false}, {"label": "B", "text": "Geobacillus stearothermophilus", "correct": true}, {"label": "C", "text": "Bacillus anthrax", "correct": false}, {"label": "D", "text": "Staphylococcus epidermidis", "correct": false}], "correct_answer": "B. Geobacillus stearothermophilus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"a1f8bd55901692777188b383607b48\"&gt;Geobacillus&lt;/span&gt; stearothermophilu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person comes with the visual acuity in the right eye of 6/60 and left eye of 3/60. He should be categorized into which type of blindness?", "options": [{"label": "A", "text": "Mild", "correct": false}, {"label": "B", "text": "Moderate", "correct": false}, {"label": "C", "text": "Severe", "correct": true}, {"label": "D", "text": "No blindness", "correct": false}], "correct_answer": "C. Severe", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Severe:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>WHO’s <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Visual <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">Impairment</span> based on severity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CATEGORY OF VI</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CORRECTED VA (BETTER Eye)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DEGREE OF VI</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6/6 – 6/18</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 6/18 – 6/60</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate Visual Impairment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 6/60 – 3/60</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe Visual Impairment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 3/60 – 1/60</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blind</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 1/60 – PL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blind</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NPL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blind</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Vision 20/20- Which was added recently in India?", "options": [{"label": "A", "text": "Cataract", "correct": false}, {"label": "B", "text": "Childhood blindness", "correct": false}, {"label": "C", "text": "Glaucoma", "correct": false}, {"label": "D", "text": "Refractive error and low vision", "correct": true}], "correct_answer": "D. Refractive error and low vision", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used for egg cells that have been fertilized?", "options": [{"label": "A", "text": "Totipotent", "correct": true}, {"label": "B", "text": "Pluripotent", "correct": false}, {"label": "C", "text": "Multipotent", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Totipotent", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the lifelong treatment for individuals who have received a potent prosthetic mitral valve replacement?", "options": [{"label": "A", "text": "Aspirin", "correct": false}, {"label": "B", "text": "Clopidogrel", "correct": false}, {"label": "C", "text": "Atorvastatin", "correct": false}, {"label": "D", "text": "Warfarin", "correct": true}], "correct_answer": "D. Warfarin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - W\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old girl with short height, amenorrhea with widely spaced nipple visited to the OPD. What is the karyotype of this female?", "options": [{"label": "A", "text": "45 XO", "correct": true}, {"label": "B", "text": "46 XO", "correct": false}, {"label": "C", "text": "47 XXX", "correct": false}, {"label": "D", "text": "46 XY", "correct": false}], "correct_answer": "A. 45 XO", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Chromosomal Abnormality</strong></p>\n</td>\n<td>\n<p><strong>Defect</strong></p>\n</td>\n<td>\n<p><strong>Characteristic Features</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Turner Syndrome (45 XO)</p>\n</td>\n<td>\n<p>Missing or incomplete X <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> in females</p>\n</td>\n<td>\n<p>Short stature, <span class=\"customMeta\" data-dictid=\"80f9769a7f169277720291b1f34ef4\">webbed</span> neck, widely spaced nipples, primary ovarian insufficiency, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> abnormalities</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Down Syndrome (Trisomy 21)</p>\n</td>\n<td>\n<p>Extra copy of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 21</p>\n</td>\n<td>\n<p>Intellectual disability, distinct <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> features (such as slanted eyes and flat <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> profile), low muscle tone, heart defects, <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> issues</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Klinefelter Syndrome (47 XXY)</p>\n</td>\n<td>\n<p>Extra X <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> in males</p>\n</td>\n<td>\n<p>Male hypogonadism, infertility, tall stature, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> and body hair, <span class=\"customMeta\" data-dictid=\"78cd34126d16927771887bf6b44cf6\">gynecomastia</span> (enlarged breast tissue)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Triple X Syndrome (47 XXX)</p>\n</td>\n<td>\n<p>Extra X <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> in females</p>\n</td>\n<td>\n<p>Taller height, delayed motor and language development, mild intellectual disability, <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> irregularities</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Jacob's Syndrome (47 XYY)</p>\n</td>\n<td>\n<p>Extra Y <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> in males</p>\n</td>\n<td>\n<p>Taller stature, delayed speech and language development, behavioral and learning difficulties, increased risk of developmental disorders</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cri du <span class=\"customMeta\" data-dictid=\"6f33f106ca16927771849ff08a4c02\">Chat</span> Syndrome (5p-)</p>\n</td>\n<td>\n<p>Deletion of a portion of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 5</p>\n</td>\n<td>\n<p>High-pitched cry resembling a cat, intellectual disability, distinctive <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> features, delayed growth and development</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Edwards Syndrome (Trisomy 18)</p>\n</td>\n<td>\n<p>Extra copy of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 18</p>\n</td>\n<td>\n<p>Severe intellectual disability, multiple <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> abnormalities (e.g., heart defects, clenched fists, rocker-bottom feet), low birth weight</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Patau Syndrome (Trisomy 13)</p>\n</td>\n<td>\n<p>Extra copy of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 13</p>\n</td>\n<td>\n<p>Severe intellectual disability, <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> lip and palate, heart defects, <span class=\"customMeta\" data-dictid=\"c44ca75c89169277719632dfa923bc\">polydactyly</span> (extra fingers or toes), eye abnormalities</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Fragile X Syndrome</p>\n</td>\n<td>\n<p>Expansion of the CGG repeat in the <span class=\"customMeta\" data-dictid=\"5880c0054116927772031676750cea\">FMR1 gene</span> on the X chromosome</p>\n</td>\n<td>\n<p>Intellectual disability, behavioral problems, distinct <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> features, large ears, hyperflexible joints</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following Spermicidal cream is used in contraception?", "options": [{"label": "A", "text": "Gossypol", "correct": false}, {"label": "B", "text": "Nonoxynol -9", "correct": true}, {"label": "C", "text": "Centchroman", "correct": false}, {"label": "D", "text": "Clomiphene", "correct": false}], "correct_answer": "B. Nonoxynol -9", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Chemical Contraceptive</strong></p>\n</td>\n<td>\n<p><strong>How It Works</strong></p>\n</td>\n<td>\n<p><strong>Advantages</strong></p>\n</td>\n<td>\n<p><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nonoxynol-9</p>\n</td>\n<td>\n<p>Disrupts <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> membranes, immobilizing or killing sperm</p>\n</td>\n<td>\n<ul>\n<li>Readily available and affordable</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>May cause <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> or allergic reactions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Contraceptive Sponge</p>\n</td>\n<td>\n<p>Contains <span class=\"customMeta\" data-dictid=\"40cdb0896416927771998564e4c0e4\">spermicide</span> that immobilizes or kills sperm</p>\n</td>\n<td>\n<ul>\n<li>Convenient and non-hormonal</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Less effective than some other <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">contraceptive</span> methods</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Spermicidal Cream/Gel</p>\n</td>\n<td>\n<p>Contains chemicals that <span class=\"customMeta\" data-dictid=\"87bf05a56616927771893b9550e8ad\">immobilize</span> or kill sperm</p>\n</td>\n<td>\n<ul>\n<li>Non-hormonal and can be used on-demand</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>May cause <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> or allergic reactions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vaginal Suppositories</p>\n</td>\n<td>\n<p>Release <span class=\"customMeta\" data-dictid=\"fd1ea66547169277719990b69a6279\">spermicidal</span> chemicals into the vagina</p>\n</td>\n<td>\n<ul>\n<li>Easy to use and can be inserted discreetly</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Requires <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> prior to intercourse</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vaginal Film</p>\n</td>\n<td>\n<p>Dissolves and releases <span class=\"customMeta\" data-dictid=\"fd1ea66547169277719990b69a6279\">spermicidal</span> chemicals in the vagina</p>\n</td>\n<td>\n<ul>\n<li>Convenient and can be used on-demand</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Requires <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> prior to intercourse</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vaginal Foam</p>\n</td>\n<td>\n<p>Creates a <span class=\"customMeta\" data-dictid=\"40d72689211692777203fca86e25c9\">foam</span> that immobilizes or kills sperm</p>\n</td>\n<td>\n<ul>\n<li>Easy to use and provides <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> application</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Requires <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> prior to <span class=\"customMeta\" data-dictid=\"ad25936d1916927771900a1de2dd77\">intercourse</span> &lt;br&gt; - May cause <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> or discomfort</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the minimum duration for which Breastfeeding should be continued?", "options": [{"label": "A", "text": "6 months", "correct": true}, {"label": "B", "text": "2 month", "correct": false}, {"label": "C", "text": "12 months", "correct": false}, {"label": "D", "text": "5 months", "correct": false}], "correct_answer": "A. 6 months", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer has come with symptoms of pinpoint pupils, excessive salivation, and increased secretion from the body. The most probable diagnosis is", "options": [{"label": "A", "text": "Opioid overdose", "correct": false}, {"label": "B", "text": "Organophosphate poisoning", "correct": true}, {"label": "C", "text": "Stroke", "correct": false}, {"label": "D", "text": "Heat stroke", "correct": false}], "correct_answer": "B. Organophosphate poisoning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"505a21f8451692777194a113951c68\"&gt;Organophosphate&lt;/span&gt; poisoning\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscarinic effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nicotinic effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>D</strong> – <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">Diarrhea</span> (increased GI motility, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> sounds)</li>\n<li><strong>U</strong> - Increased frequency of Urination</li>\n<li><strong>M</strong> - <span class=\"customMeta\" data-dictid=\"cacca0f20e169277719222049c80a2\">Miosis</span> pupil</li>\n<li><strong>B</strong>-Bradycardia (by <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of M2 receptors)</li>\n<li><strong>B</strong>-Bronchorrhea, Bronchospasm</li>\n<li><strong>E</strong> - Emesis</li>\n<li><strong>L</strong>-Increased Lacrimation</li>\n</ul>\n<ul>\n<li>Red <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> or <span class=\"customMeta\" data-dictid=\"99ba7175ec16927771844d79117f07\">chromodacryorrhea</span> is seen due to <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of <span class=\"customMeta\" data-dictid=\"4a759c9f1016927771964b8325ac2f\">porphyrin</span> in tears</li>\n</ul>\n<ul>\n<li><strong>L</strong> - Lethargy</li>\n<li><strong>S</strong> – Salivation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headache, tremor, confusion slurred speech, coma, convulsions.</li>\n<li>Initially, it causes muscle fasciculations, areflexia.</li>\n<li>Later, muscle <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> occurs (Type-1 or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> syndrome).</li>\n<li>Death occurs due to <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> of <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> muscles (i.e <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26 year old female presents with infertility and is diagnosed with a bilateral cornual block on hysterography . What is the next step?", "options": [{"label": "A", "text": "IVF", "correct": false}, {"label": "B", "text": "Tuboplasty", "correct": false}, {"label": "C", "text": "Laparoscopy and hysteroscopy", "correct": true}, {"label": "D", "text": "USG", "correct": false}], "correct_answer": "C. Laparoscopy and hysteroscopy", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What condition is linked to Dilated Cardiomyopathy?", "options": [{"label": "A", "text": "Diphtheria", "correct": true}, {"label": "B", "text": "Syphilis", "correct": false}, {"label": "C", "text": "Meningococcus", "correct": false}, {"label": "D", "text": "Brucellosis", "correct": false}], "correct_answer": "A. Diphtheria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Diphth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Testosterone secreted by which of the following?", "options": [{"label": "A", "text": "Leydig cell", "correct": true}, {"label": "B", "text": "Sertoli cell", "correct": false}, {"label": "C", "text": "Theca lutein", "correct": false}, {"label": "D", "text": "Granulosa cell", "correct": false}], "correct_answer": "A. Leydig cell", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LUSV2oFjpzYs7XCa54Ug1715842230.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the type of inheritance seen in sickle cell anemia?", "options": [{"label": "A", "text": "AD", "correct": false}, {"label": "B", "text": "AR", "correct": true}, {"label": "C", "text": "X-linked dominant", "correct": false}, {"label": "D", "text": "X-linked recessive", "correct": false}], "correct_answer": "B. AR", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common complication that can occur as a result of forcefully pulling the umbilical cord after a normal delivery in a 27-year-old woman, while the placenta is still attached to the uterus?", "options": [{"label": "A", "text": "Haemorrhage", "correct": false}, {"label": "B", "text": "Uterine inversion", "correct": true}, {"label": "C", "text": "Uterine rupture", "correct": false}, {"label": "D", "text": "Placenta retraction", "correct": false}], "correct_answer": "B. Uterine inversion", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the screening test that is most sensitive for detecting vitamin A deficiency?", "options": [{"label": "A", "text": "Serum retinal &amp;lt;10 μg/decilitre", "correct": false}, {"label": "B", "text": "Beta carotene &amp;lt;50 μg/decilitre", "correct": false}, {"label": "C", "text": "Bitot spots", "correct": false}, {"label": "D", "text": "Night blindness", "correct": true}], "correct_answer": "D. Night blindness", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 year old pregnant woman at 37 weeks of gestation arrived at the hospital without having received any antenatal care and is now experiencing the start of labor. Upon examination, it was discovered that the mother is positive for hepatitis B. What steps should be taken to manage the health of the newborn?", "options": [{"label": "A", "text": "Hep B vaccine only", "correct": false}, {"label": "B", "text": "Hep B vaccine + IG", "correct": true}, {"label": "C", "text": "First IG then HEP B vaccine after 1 month", "correct": false}, {"label": "D", "text": "Only IG", "correct": false}], "correct_answer": "B. Hep B vaccine + IG", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 32-year-old woman who experienced uterine fetal death after a normal vaginal delivery and is currently experiencing urinary leakage from the vagina?", "options": [{"label": "A", "text": "Bladder rupture", "correct": false}, {"label": "B", "text": "Vesicovaginal fistula", "correct": true}, {"label": "C", "text": "Urge incontinence", "correct": false}, {"label": "D", "text": "Stress incontinence", "correct": false}], "correct_answer": "B. Vesicovaginal fistula", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis ?", "options": [{"label": "A", "text": "Anterior uveitis", "correct": false}, {"label": "B", "text": "Glaucoma", "correct": false}, {"label": "C", "text": "Optic neuritis", "correct": false}, {"label": "D", "text": "Keratoconus", "correct": true}], "correct_answer": "D. Keratoconus", "question_images": ["https://image.prepladder.com/content/z20cJ6fQrzN1fIa1V0j91695202654.png"], "explanation_images": ["https://image.prepladder.com/content/Qv1Rky5nOXnwGhczCZcn1714117936.png", "https://image.prepladder.com/content/LKfCAi3fVOUDg7uc0Xb41714117936.png", "https://image.prepladder.com/content/MfjYWwdweSUc7w9yEKs01714117936.png", "https://image.prepladder.com/content/z6Xp8rLrZmLB5GxpFgUt1714117936.png"], "explanation": "<p>Correct Option D - Keratoconu\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Signs of keratoconus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early signs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> /asymmetric astigmatism</li>\n<li>Scissor’s <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> on retinoscopy</li>\n<li>Fleischer's ring</li>\n</ul>\n<p><img src=\"https://image.prepladder.com/content/Qv1Rky5nOXnwGhczCZcn1714117936.png\" style=\"height:241px; width:336px\"/></p>\n<ul>\n<li>Vogt's striae</li>\n</ul>\n<p><img src=\"https://image.prepladder.com/content/LKfCAi3fVOUDg7uc0Xb41714117936.png\" style=\"height:314px; width:513px\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Late signs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Munson's sign: Lower lid notching on down gaze</li>\n<li>Acute hydrops</li>\n</ul>\n<p><img src=\"https://image.prepladder.com/content/MfjYWwdweSUc7w9yEKs01714117936.png\" style=\"height:303px; width:478px\"/></p>\n<ul>\n<li>Prominent corneal nerves (due to corneal thinning)</li>\n</ul>\n<p><img src=\"https://image.prepladder.com/content/z6Xp8rLrZmLB5GxpFgUt1714117936.png\" style=\"height:280px; width:378px\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Keratometer is used to assess", "options": [{"label": "A", "text": "Curvature of cornea", "correct": true}, {"label": "B", "text": "Diameter of cornea", "correct": false}, {"label": "C", "text": "Thickness of cornea", "correct": false}, {"label": "D", "text": "Curvature of lens", "correct": false}], "correct_answer": "A. Curvature of cornea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\"&gt;Curvature&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An HIV positive patient presented with a whitish plaque in the mouth and esophagus as shown in the image below. Most likely diagnosis is:", "options": [{"label": "A", "text": "Oral leukoplokia", "correct": false}, {"label": "B", "text": "Hairy cell leukemia", "correct": false}, {"label": "C", "text": "Oral candidiasis", "correct": true}, {"label": "D", "text": "Oral cancer", "correct": false}], "correct_answer": "C. Oral candidiasis", "question_images": ["https://image.prepladder.com/content/BGIHPxjd28LxU9XhN6k81714555689.png"], "explanation_images": [], "explanation": "<p>Correct Option C - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Internal hordeolum is due to inflammation of", "options": [{"label": "A", "text": "Zeis glands", "correct": false}, {"label": "B", "text": "Meibomian glands", "correct": true}, {"label": "C", "text": "Lacrimal glands", "correct": false}, {"label": "D", "text": "Moll glands", "correct": false}], "correct_answer": "B. Meibomian glands", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uJh7qjfagzPUaKCwhwsU1715343882.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the clinical condition", "options": [{"label": "A", "text": "Herpes simplex keratitis", "correct": false}, {"label": "B", "text": "Bacterial keratitis", "correct": false}, {"label": "C", "text": "Mycotic keratitis", "correct": false}, {"label": "D", "text": "Vernal keratoconjunctivitis", "correct": true}], "correct_answer": "D. Vernal keratoconjunctivitis", "question_images": ["https://image.prepladder.com/content/P3trN2h9iWXHbqHtgLif1715848403.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Vernal keratoconjunctiv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gynecomastia results from an imbalance between androgen and oestrogen activity. All of the below are causes of gynecomastia, except.", "options": [{"label": "A", "text": "Aromatase inhibitors", "correct": true}, {"label": "B", "text": "Liver failure", "correct": false}, {"label": "C", "text": "Spironolactone", "correct": false}, {"label": "D", "text": "Digoxin", "correct": false}], "correct_answer": "A. Aromatase inhibitors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"b249ba1c6a16927771821b83b1fd9b\"&gt;Aromatase&lt;/span&gt; inh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16 year old girl with acute bleeding per vaginal was presented to the clinic. What is immediate management ?", "options": [{"label": "A", "text": "Uterine ablation", "correct": false}, {"label": "B", "text": "Uterine artery block", "correct": false}, {"label": "C", "text": "Progesterone", "correct": true}, {"label": "D", "text": "Hysteroscopy examination", "correct": false}], "correct_answer": "C. Progesterone", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Cause</strong></p>\n</td>\n<td>\n<p><strong>BLEEDING PV IN YOUNG FEMALES</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hormonal Imbalance</p>\n</td>\n<td>\n<p>Irregular <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycles, anovulation, or hormonal changes</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Polycystic <span class=\"customMeta\" data-dictid=\"7b1a7ff355169277719401475de6fb\">Ovary</span> Syndrome (PCOS)</p>\n</td>\n<td>\n<p>Hormonal disorder causing <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> periods</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Uterine Fibroids</p>\n</td>\n<td>\n<p>Noncancerous growths in the uterus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Endometriosis</p>\n</td>\n<td>\n<p>Presence of endometrial tissue outside the uterus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Adenomyosis</p>\n</td>\n<td>\n<p>Endometrial tissue grows into the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> wall of the uterus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cervical Polyps</p>\n</td>\n<td>\n<p>Benign growths on the cervix</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cervical <span class=\"customMeta\" data-dictid=\"410b701d9916927771861ac447b041\">Ectropion</span> (Cervical Erosion)</p>\n</td>\n<td>\n<p>Outer layer of the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> becomes inflamed</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pelvic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> Disease (PID)</p>\n</td>\n<td>\n<p>Infection of the female <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> organs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vaginal Infections</p>\n</td>\n<td>\n<p>Bacterial or <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> infections affecting the vagina</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hormonal <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Use</p>\n</td>\n<td>\n<p>Irregular <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> as a <span class=\"customMeta\" data-dictid=\"79506a117416927771988bbe7a8302\">side effect</span> of <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">contraceptive</span> methods</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Coagulation Disorders</p>\n</td>\n<td>\n<p>Bleeding disorders affecting blood clotting</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pregnancy-related causes</p>\n</td>\n<td>\n<p>Ectopic pregnancy, miscarriage, or molar pregnancy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cervical or Endometrial Polyps</p>\n</td>\n<td>\n<p>Abnormal growths in the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> or uterus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cervical or Endometrial Cancer</p>\n</td>\n<td>\n<p>Malignant growths in the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> or uterus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the subsequent course of action in the case of a hypertensive and diabetic 67-year-old woman presenting with profuse vaginal bleeding?", "options": [{"label": "A", "text": "Uterine ablation", "correct": false}, {"label": "B", "text": "Uterine artery block", "correct": false}, {"label": "C", "text": "Hysterectomy", "correct": false}, {"label": "D", "text": "Endometrial biopsy", "correct": true}], "correct_answer": "D. Endometrial biopsy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "PR segment in ECG indicates", "options": [{"label": "A", "text": "Atrial depolarization", "correct": false}, {"label": "B", "text": "Atrioventricular nodal conduction", "correct": true}, {"label": "C", "text": "Ventricular depolarization", "correct": false}, {"label": "D", "text": "Ventricular repolarisation", "correct": false}], "correct_answer": "B. Atrioventricular nodal conduction", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Atrioventricular nodal condu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presented to the clinic with complaints of amenorrhea and galactorrhea. What is he most likely diagnosis??", "options": [{"label": "A", "text": "Pituitary adenoma", "correct": true}, {"label": "B", "text": "Adrenal hyperplasia", "correct": false}, {"label": "C", "text": "70 alpha-hydroxylase deficiency", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Pituitary adenoma", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female with 36-weeks of gestation came with a history of 5 convulsions at home . The diagnosis of eclampsia was made by the doctor . What would be the next next line of management in this patient?", "options": [{"label": "A", "text": "Labetalol", "correct": false}, {"label": "B", "text": "MgSO4", "correct": true}, {"label": "C", "text": "Termination", "correct": false}, {"label": "D", "text": "Clonidine", "correct": false}], "correct_answer": "B. MgSO4", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which heart sound is always pathological?", "options": [{"label": "A", "text": "S1", "correct": false}, {"label": "B", "text": "S2", "correct": false}, {"label": "C", "text": "S3", "correct": false}, {"label": "D", "text": "S4", "correct": true}], "correct_answer": "D. S4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - S4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of excessive bleeding after the removal of the placenta in a 34-year-old woman who has had 4 children and just had her 5th normal vaginal delivery?", "options": [{"label": "A", "text": "Estrogen", "correct": false}, {"label": "B", "text": "Progesterone", "correct": false}, {"label": "C", "text": "FSH and LH", "correct": false}, {"label": "D", "text": "PPH", "correct": true}], "correct_answer": "D. PPH", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fleischer’s ring is seen in", "options": [{"label": "A", "text": "Keratoconus", "correct": true}, {"label": "B", "text": "Keratomalacia", "correct": false}, {"label": "C", "text": "Keratoglobus", "correct": false}, {"label": "D", "text": "Trachoma", "correct": false}], "correct_answer": "A. Keratoconus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1a7SV43VbIfSENjKrDUR1714122467.png"], "explanation": "<p>Correct Option A - Keratoconu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye Ring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Condition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fleischer's Ring</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Base of the cornea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keratoconus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kayser-Fleischer Ring</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Descemet's membrane, corneal edge</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wilson's disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hudson-Stahli Line</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cornea central third</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aging</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vogt's Striae</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deep corneal stroma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keratoconus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Haab's Striae</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Descemet's membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital glaucoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stocker's Line</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior to head of pterygiumInner surface of the lens</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PterygiumNuclear <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> of the lens (cataract)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hassall-Henle Bodies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior lens capsule</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal aging</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fleischer's Ring</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limbal area</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pterygium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limbal Ring</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Outer edge of the iris</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal variation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following anti-epileptic drug is least teratogenic during pregnancy?", "options": [{"label": "A", "text": "Phenytoin", "correct": false}, {"label": "B", "text": "Valproate", "correct": false}, {"label": "C", "text": "Carbamazepine", "correct": false}, {"label": "D", "text": "Levetiracetam", "correct": true}], "correct_answer": "D. Levetiracetam", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/y6wcIkytcoPtolVR5g061713435453.png"], "explanation": "<p>Correct option D: Lev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended approach for managing a 32-year-old woman with a dichorionic diamniotic twin pregnancy, where the first baby is in breech presentation and the second baby is in cephalic presentation?", "options": [{"label": "A", "text": "C – Section", "correct": true}, {"label": "B", "text": "Assisted breech", "correct": false}, {"label": "C", "text": "Instrumental delivery", "correct": false}, {"label": "D", "text": "Normal vaginal delivery", "correct": false}], "correct_answer": "A. C – Section", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\"><strong>Maternal Indications</strong></td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Previous CS</li>\n<li>Abnormal placentation </li>\n<li>Classical CS </li>\n<li>Scar dehiscence </li>\n<li>Full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> myomectomy </li>\n<li>Genital <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> Obstructive mass </li>\n<li>Invasive <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> cancer (combine with hysterectomy) </li>\n<li>Prior Trachelectomy </li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Permanent cerclage </li>\n<li>Reconstructive Surgeries </li>\n<li>Pelvic deformities </li>\n<li>HSV or <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> Infection (only when <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">Viral</span> load is high) </li>\n<li>Cardiac &amp; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disorders </li>\n<li>Cerebral aneurysm </li>\n<li>Perimortem CS </li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\"><strong>Maternal - <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">Fetal</span> Indications </strong></td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Cephalopelvic Disproportion </li>\n<li>Failed <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">Operative</span> <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> delivery </li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Placenta Previa </li>\n<li>Abruption with <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> distress </li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\"><strong>Fetal Indications </strong></td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Non-assuring <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heart pattern / <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">Fetal</span> distress </li>\n<li>Mal-presentation </li>\n<li>Congenital anomalies </li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> studies (REDF </li>\n<li>Reverse End Diastolic flow) </li>\n<li>Prior <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">Fetal</span> birth trauma </li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\"><strong>Advantages for Mother</strong></td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Much less <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of Prolapse </li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Much less <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> incontinence </li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Advantages to Baby </strong></td>\n<td> </td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>↓ <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">Neonatal</span> <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">Morbidity</span> (≤1%) </li>\n<li>↓ Skin lacerations (MC problem) </li>\n<li>↓ Cephalohematoma </li>\n</ul>\n</td>\n<td>\n<ul>\n<li>↓ Skull &amp; <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> fracture </li>\n<li>↓ <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">Brachial</span> plexopathy </li>\n<li>↓ <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> nerve injury </li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "NITI AAYOG represents?", "options": [{"label": "A", "text": "Newer Initiative Transforming India", "correct": false}, {"label": "B", "text": "Nutrition Intake to India", "correct": false}, {"label": "C", "text": "National Institute for Transforming India", "correct": true}, {"label": "D", "text": "National Institute for Technical India", "correct": false}], "correct_answer": "C. National Institute for Transforming India", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vInE8qwxcZ6mbwtI1syO1715061354.png"], "explanation": "<p>Correct Option C - National Institute for Transforming India: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 29 year old woman at 36 weeks of pregnancy, with a history of a previous C-section, presents with symptoms of low blood pressure, tachycardia, and Ultrasound report showing fluid in the peritoneum . What is the likely diagnosis, and what would be the appropriate next steps in management?", "options": [{"label": "A", "text": "Uterine scar rupture with Laparotomy", "correct": true}, {"label": "B", "text": "Laparoscopy", "correct": false}, {"label": "C", "text": "Ectopic pregnancy and abortion", "correct": false}, {"label": "D", "text": "PID", "correct": false}], "correct_answer": "A. Uterine scar rupture with Laparotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "On Republic Day, a medical camp was held to screen individuals for hypertension (HTN) by measuring their blood pressure (BP) and for diabetes mellitus (DM) by assessing their body mass index (BMI) and blood sugar level. The purpose of this camp was to determine the level of prevention.", "options": [{"label": "A", "text": "Primary", "correct": false}, {"label": "B", "text": "Primordial", "correct": false}, {"label": "C", "text": "Secondary", "correct": true}, {"label": "D", "text": "Tertiary", "correct": false}], "correct_answer": "C. Secondary", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - S\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Level of Prevention</strong></td>\n<td style=\"text-align:center\"><strong>Definition</strong></td>\n<td style=\"text-align:center\"><strong>Example</strong></td>\n</tr>\n<tr>\n<td><strong>Primary Prevention</strong></td>\n<td>Focuses on preventing the occurrence of a disease or condition before it occurs</td>\n<td>\n<ul>\n<li>Immunizations to prevent <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> diseases</li>\n<li>Promotion of healthy lifestyle behaviors</li>\n<li>Environmental modifications to reduce exposure to hazards</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Secondary Prevention</strong></td>\n<td>Aims to detect and treat a disease or condition in its early stages to prevent further <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> and complications</td>\n<td>\n<ul>\n<li>Regular screenings for cancer, such as mammograms and <span class=\"customMeta\" data-dictid=\"db0c1e31b81692777194c625af6798\">Pap</span> smears</li>\n<li>Blood pressure and cholesterol screenings for <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> disease</li>\n<li>Early intervention programs for developmental delays in children</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Tertiary Prevention</strong></td>\n<td>Focuses on managing and rehabilitating individuals who already have a diagnosed disease or condition to reduce its impact and prevent complications</td>\n<td>\n<ul>\n<li>Cardiac rehabilitation programs for individuals with heart disease</li>\n<li>Support groups for individuals with chronic conditions</li>\n<li>Rehabilitation services for individuals with disabilities</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of blindness does the individual have if their right eye has a visual acuity of 6/60 and their left eye has a visual acuity of 3/60?", "options": [{"label": "A", "text": "Manifest blindness", "correct": false}, {"label": "B", "text": "Social blindness", "correct": false}, {"label": "C", "text": "Low vision", "correct": true}, {"label": "D", "text": "Absence of blindness", "correct": false}], "correct_answer": "C. Low vision", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hJL6UMfFBg3wqZxyGI0z1694515196.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a 32-year-old female who presented with pregnancy, experiencing mild bleeding and pain, and exhibits tenderness in the uterus with absence of fetal heart sound upon examination?", "options": [{"label": "A", "text": "Abruptio placenta", "correct": true}, {"label": "B", "text": "Fetal distress", "correct": false}, {"label": "C", "text": "Ectopic pregnancy", "correct": false}, {"label": "D", "text": "Placenta Previa", "correct": false}], "correct_answer": "A. Abruptio placenta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FxBxTcbzDtWtVKGPIRi11715842271.png"], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Grade</strong></td>\n<td><strong>Vaginal Bleeding </strong></td>\n<td><strong>Uterine Tetany </strong></td>\n<td><strong>Fetal Distress </strong></td>\n<td><strong>Maternal Shock </strong></td>\n<td><strong>USG</strong></td>\n</tr>\n<tr>\n<td>0</td>\n<td>-</td>\n<td>-</td>\n<td>-</td>\n<td>-</td>\n<td>RPC: Small </td>\n</tr>\n<tr>\n<td>1</td>\n<td>+</td>\n<td>+/-</td>\n<td>-</td>\n<td>-</td>\n<td>+/-</td>\n</tr>\n<tr>\n<td>2 (MC)</td>\n<td>+/-</td>\n<td>+/-</td>\n<td>+</td>\n<td>-</td>\n<td>+/-</td>\n</tr>\n<tr>\n<td>3</td>\n<td>+/-</td>\n<td>+</td>\n<td>Fetal Demise </td>\n<td>+ With possible DIC</td>\n<td>+/-</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which bag should recyclable tubing and catheters be placed?", "options": [{"label": "A", "text": "Red", "correct": true}, {"label": "B", "text": "Blue", "correct": false}, {"label": "C", "text": "Yellow", "correct": false}, {"label": "D", "text": "White", "correct": false}], "correct_answer": "A. Red", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/D3OZb0SHWMCaCFHxePgS1714546726.png", "https://image.prepladder.com/content/zQpsVMlVmRa82Ne4nBRl1714546726.png", "https://image.prepladder.com/content/lEFwbPKEIYAA6zSBYnq61714546726.png", "https://image.prepladder.com/content/hWdVymQQ4GgWhunVgJiR1714546726.png"], "explanation": "<p>Correct Option A-R\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Waste type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Method of disposal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow</strong></p>\n<p><img src=\"https://image.prepladder.com/content/D3OZb0SHWMCaCFHxePgS1714546726.png\" style=\"height:375px; width:539px\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infectious</li>\n<li>May or may not be pretreated.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incineration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red</strong></p>\n<p><img src=\"https://image.prepladder.com/content/zQpsVMlVmRa82Ne4nBRl1714546726.png\" style=\"height:319px; width:530px\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infectious.</li>\n<li>Rubber, plastic, tube</li>\n<li>No pretreatment</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recycling or</p>\n<p>reuse</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blue</strong></p>\n<p><img src=\"https://image.prepladder.com/content/lEFwbPKEIYAA6zSBYnq61714546726.png\" style=\"height:211px; width:528px\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Glass and <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> implants.</li>\n<li>No pretreatment.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recycling or reuse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>White</strong></p>\n<p><img src=\"https://image.prepladder.com/content/hWdVymQQ4GgWhunVgJiR1714546726.png\" style=\"height:546px; width:940px\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sharps.</li>\n<li>No pretreatment</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recycling or reuse after shredding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Main focus of UNICEF is on", "options": [{"label": "A", "text": "Social health", "correct": false}, {"label": "B", "text": "Mental health", "correct": false}, {"label": "C", "text": "Nutritional health", "correct": false}, {"label": "D", "text": "Child health", "correct": true}], "correct_answer": "D. Child health", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D-Child health\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a pregnant woman experiencing bleeding at 12 weeks of gestation, with a normal vaginal examination, closed internal cervical opening (OS), and ultrasound showing a live fetus with156 BPM fetal heart rate at a fundal height consistent with 13 weeks of gestation?", "options": [{"label": "A", "text": "Threatened Abortion", "correct": true}, {"label": "B", "text": "Complete Abortion", "correct": false}, {"label": "C", "text": "Incomplete Abortion", "correct": false}, {"label": "D", "text": "Inevitable Abortion", "correct": false}], "correct_answer": "A. Threatened Abortion", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Clinical Type</strong></p>\n</td>\n<td>\n<p><strong>Clinical Features</strong></p>\n</td>\n<td>\n<p><strong>USG Findings</strong></p>\n</td>\n<td>\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Threatened Abortion</p>\n</td>\n<td>\n<ul>\n<li>Vaginal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> during the first half of pregnancy (before 20 weeks)</li>\n<li>Light spotting to heavier bleeding</li>\n<li>Mild <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain or cramping</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Cervical os closed</li>\n</ul>\n<p>Normal <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> pregnancy (live fetus, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> activity)</p>\n</td>\n<td>\n<ul>\n<li>Bed rest</li>\n<li>Pelvic rest</li>\n<li>Close follow-up and monitoring</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inevitable Abortion</p>\n</td>\n<td>\n<ul>\n<li>Vaginal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> during the first half of pregnancy</li>\n<li>Heavy bleeding, often accompanied by severe <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain and cramping</li>\n<li>Passage of tissue or products of conception through the vagina</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Cervical os open</li>\n<li>Evidence of <span class=\"customMeta\" data-dictid=\"90ebb0185016927771892eda4f05cc\">incomplete abortion</span> (gestational sac, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> parts, placenta)</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Evaluation of <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> stability</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention (e.g., <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> and curettage)</li>\n</ul>\n<p>Rh immune <span class=\"customMeta\" data-dictid=\"1a8bcc07ca16927771882f63452d6e\">globulin</span> administration (if Rh-negative)</p>\n<ul>\n<li>Emotional support and counseling</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Incomplete Abortion</p>\n</td>\n<td>\n<ul>\n<li>Vaginal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> with passage of some <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> or <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> tissue</li>\n<li>Persistent <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and cramping</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Cervical os may be open or closed</li>\n<li>Retained products of conception (gestational <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> remnants, <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> tissue)</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Evaluation of <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> stability</li>\n</ul>\n<p>Surgical intervention (e.g., <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> and curettage)</p>\n<ul>\n<li>Rh immune <span class=\"customMeta\" data-dictid=\"1a8bcc07ca16927771882f63452d6e\">globulin</span> administration (if Rh-negative)</li>\n</ul>\n<p>Emotional support and counseling</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Missed Abortion</p>\n</td>\n<td>\n<ul>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> movements or loss of pregnancy symptoms</li>\n<li>Uterus stops growing, breast changes may regress</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (may or may not be present)</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Cervical os closed</li>\n<li>Empty gestational sac</li>\n</ul>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Confirm <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> demise through <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> or absence of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> activity</li>\n<li>Expectant management (allow natural expulsion of pregnancy)</li>\n<li>Surgical intervention (dilation and curettage) if necessary</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Complete Abortion</p>\n</td>\n<td>\n<ul>\n<li>Expulsion of all <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> and <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> tissue from the uterus</li>\n<li>Resolution of <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> bleeding</li>\n<li>Uterus returns to pre-pregnancy size</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Cervical os closed</li>\n<li>Absence of products of conception</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Confirm complete expulsion of products of conception</li>\n<li>Emotional support and counseling</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of phlyctenular conjunctivitis?", "options": [{"label": "A", "text": "Atropine", "correct": false}, {"label": "B", "text": "Asthma", "correct": false}, {"label": "C", "text": "Contact lens", "correct": false}, {"label": "D", "text": "Tuberculous proteins", "correct": true}], "correct_answer": "D. Tuberculous proteins", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZTQmOHMDsBtPfrWPcnTb1714042025.png"], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"a50c41365a1692777201501cb6b378\"&gt;Tuberculous&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the commonly preferred contraceptive method?", "options": [{"label": "A", "text": "Barrier method", "correct": false}, {"label": "B", "text": "OCP", "correct": true}, {"label": "C", "text": "Calendar method", "correct": false}, {"label": "D", "text": "Progesterone only pills", "correct": false}], "correct_answer": "B. OCP", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Method of Contraception</strong></p>\n</td>\n<td>\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td>\n<p><strong>Examples</strong></p>\n</td>\n<td>\n<p><strong>Advantages</strong></p>\n</td>\n<td>\n<p><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Barrier Methods</p>\n</td>\n<td>\n<p>Prevent <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> from reaching the egg</p>\n</td>\n<td>\n<p>Condoms, diaphragms, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> caps</p>\n</td>\n<td>\n<ul>\n<li>Provides some protection against sexually transmitted infections (STIs)</li>\n<li>Readily available and easily accessible</li>\n<li>No hormonal side effects</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Requires consistent and correct use</li>\n<li>May interrupt spontaneity</li>\n<li>Potential for allergic reactions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hormonal Methods</p>\n</td>\n<td>\n<p>Suppress <span class=\"customMeta\" data-dictid=\"264a9eb50d1692777194427a13247b\">ovulation</span> and/or thicken <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> mucus</p>\n</td>\n<td>\n<p>Combined oral contraceptives (COCs)</p>\n<p>Progestin-only pills (mini-pills)</p>\n<p>Contraceptive patch, <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> ring</p>\n</td>\n<td>\n<ul>\n<li>Highly effective when used correctly and consistently</li>\n<li>Regulates <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycles and reduces <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> pain and bleeding</li>\n<li>Reduced risk of <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy and certain types of cancer</li>\n<li>Improved <span class=\"customMeta\" data-dictid=\"8b61bc6e361692777180695ac33e91\">acne</span> and reduction in symptoms of <span class=\"customMeta\" data-dictid=\"a6ba2f95751692777196757ce73116\">premenstrual</span> syndrome (PMS)</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Requires daily or regular use</li>\n<li>Possible side effects such as nausea, breast tenderness, mood changes</li>\n<li>May not be suitable for individuals with certain medical conditions or risk factors</li>\n<li>Does not protect against STIs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Intrauterine Devices (IUDs)</p>\n</td>\n<td>\n<p>Prevent <span class=\"customMeta\" data-dictid=\"2a8e411e2116927772022dd4b365bc\">fertilization</span> and/or implantation</p>\n</td>\n<td>\n<p>Copper IUDs (non-hormonal)</p>\n<p>Hormonal IUDs (progestin-releasing)</p>\n</td>\n<td>\n<ul>\n<li>Long-acting and <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> contraception</li>\n<li>Highly effective with a low failure rate</li>\n<li>Reduced risk of <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy</li>\n<li>Provides long-term contraception, ranging from 3 to 10 years</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Requires <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> by a healthcare professional</li>\n<li>Possible side effects such as <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and cramping</li>\n<li>May not be suitable for individuals with certain medical conditions or risk factors</li>\n<li>Does not protect against STIs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sterilization</p>\n</td>\n<td>\n<p>Permanent <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> of the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes</p>\n</td>\n<td>\n<p>Tubal <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> (for women)</p>\n<p>Vasectomy (for men)</p>\n</td>\n<td>\n<ul>\n<li>Provides permanent contraception</li>\n<li>Does not require daily or regular use</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Irreversible</li>\n<li>Surgical procedure with associated risks and recovery time</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Natural Methods</p>\n</td>\n<td>\n<p>Monitoring <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">fertility</span> and avoiding intercourse</p>\n<p>during <span class=\"customMeta\" data-dictid=\"a936fba1291692777202e615b48cb4\">fertile</span> periods</p>\n</td>\n<td>\n<p>Fertility awareness-based methods (tracking cycles)</p>\n<p>Withdrawal (pull-out method)</p>\n</td>\n<td>\n<ul>\n<li>No side effects</li>\n<li>No hormonal or barrier-related side effects</li>\n<li>Can be used by individuals who cannot or prefer not to use other methods of contraception</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Requires commitment, consistency, and accurate monitoring</li>\n<li>High failure rate if not used correctly or consistently</li>\n<li>Does not protect against STIs</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is characterized by chronic granulomatous inflammation in the upper eyelid, causing painless swelling?", "options": [{"label": "A", "text": "Internal hordeolum", "correct": false}, {"label": "B", "text": "External hordeolum", "correct": false}, {"label": "C", "text": "Chalazion", "correct": true}, {"label": "D", "text": "Trachoma", "correct": false}], "correct_answer": "C. Chalazion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/npwxIsbr547Zb6KVXtqJ1715662666.png"], "explanation": "<p>Correct Option C - Chalazion: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old child presents with progressive cognitive decline, seizures, and motor abnormalities. The diagnosis confirms the presence of SSPE. Which initial infection is SSPE a complication of?", "options": [{"label": "A", "text": "Measles", "correct": true}, {"label": "B", "text": "Mumps", "correct": false}, {"label": "C", "text": "Rubella", "correct": false}, {"label": "D", "text": "Varicella", "correct": false}], "correct_answer": "A. Measles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In myopia, an image is formed at?", "options": [{"label": "A", "text": "Anterior to retina", "correct": true}, {"label": "B", "text": "Posterior to retina", "correct": false}, {"label": "C", "text": "On retina", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "A. Anterior to retina", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Subacute Sclerosing Panencephalitis is a complication of which of the following conditions?", "options": [{"label": "A", "text": "Mumps", "correct": false}, {"label": "B", "text": "Measles", "correct": true}, {"label": "C", "text": "Rubella", "correct": false}, {"label": "D", "text": "RSV", "correct": false}], "correct_answer": "B. Measles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B: Subacute &lt;span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\"&gt;Sclerosing&lt;/span&gt; Panencephalitis- \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis and appropriate treatment for a 36-week pregnant woman with a history of two pregnancies and one delivery, experiencing pain, hematuria, and no detectable fetal heart rate?", "options": [{"label": "A", "text": "Placenta previa and Suction and evacuation", "correct": false}, {"label": "B", "text": "Abruption placenta and CS", "correct": true}, {"label": "C", "text": "Obstructed labour and CS", "correct": false}, {"label": "D", "text": "Placenta accreta/increta/percreta", "correct": false}], "correct_answer": "B. Abruption placenta and CS", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oCXtylIPjTaGSXYssCg61715842333.png"], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Grade</strong></td>\n<td><strong>Vaginal Bleeding </strong></td>\n<td><strong>Uterine Tetany</strong></td>\n<td><strong>Fetal Distress</strong></td>\n<td><strong>Maternal Shock </strong></td>\n<td><strong>USG</strong></td>\n</tr>\n<tr>\n<td>0</td>\n<td>-</td>\n<td>-</td>\n<td>-</td>\n<td>-</td>\n<td>RPC: Small </td>\n</tr>\n<tr>\n<td>1</td>\n<td>+</td>\n<td>+/-</td>\n<td>-</td>\n<td>-</td>\n<td>+/-</td>\n</tr>\n<tr>\n<td>2 (MC)</td>\n<td>+/-</td>\n<td>+/-</td>\n<td>+</td>\n<td>-</td>\n<td>+/-</td>\n</tr>\n<tr>\n<td>3</td>\n<td>+/-</td>\n<td>+</td>\n<td>Fetal Demise </td>\n<td>+ With possible DIC </td>\n<td>+/-</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presents with recurrent fluctuations in his vision prescription . What is the probable diagnosis?", "options": [{"label": "A", "text": "Keratoconus", "correct": true}, {"label": "B", "text": "Pathological myopia", "correct": false}, {"label": "C", "text": "Glaucoma", "correct": false}, {"label": "D", "text": "Cataract", "correct": false}], "correct_answer": "A. Keratoconus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Keratoconu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred medication for treating Hyperthyroidism during the second trimester of pregnancy?", "options": [{"label": "A", "text": "Propyl Thiouracil", "correct": false}, {"label": "B", "text": "Carbimazole", "correct": true}, {"label": "C", "text": "Sodium iodide", "correct": false}, {"label": "D", "text": "Radioactive iodine", "correct": false}], "correct_answer": "B. Carbimazole", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Diagnose the clinical condition as shown in photo:", "options": [{"label": "A", "text": "Keratoglobus", "correct": false}, {"label": "B", "text": "Keratoconus", "correct": false}, {"label": "C", "text": "Limbal dermoid", "correct": true}, {"label": "D", "text": "Pinguecula", "correct": false}], "correct_answer": "C. Limbal dermoid", "question_images": ["https://image.prepladder.com/content/LkBqpd4H6Hw12ABAyzej1691374390.png"], "explanation_images": ["https://image.prepladder.com/content/cT279F4RRrNhuhTIw11V1695203850.png"], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"71928251b41692777191a31e57c47f\"&gt;Limbal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended angle of cut for an episiotomy considering wound extension ?", "options": [{"label": "A", "text": "‘J’ shaped", "correct": false}, {"label": "B", "text": "Lateral", "correct": false}, {"label": "C", "text": "Mediolateral", "correct": true}, {"label": "D", "text": "Median", "correct": false}], "correct_answer": "C. Mediolateral", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - M\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Features</strong></td>\n<td><strong>Midline/Median Episiotomy </strong></td>\n<td><strong>Medio <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Episiotomy</strong></td>\n</tr>\n<tr>\n<td>Repair </td>\n<td>Much easier </td>\n<td>Easier </td>\n</tr>\n<tr>\n<td>Healing</td>\n<td>Faster &amp; Better </td>\n<td>Late</td>\n</tr>\n<tr>\n<td>Blood Loss</td>\n<td>Minimal </td>\n<td>More </td>\n</tr>\n<tr>\n<td>Scar wound </td>\n<td>Even </td>\n<td>Uneven </td>\n</tr>\n<tr>\n<td>Dyspareunia </td>\n<td>Rare </td>\n<td>Occasionally present </td>\n</tr>\n<tr>\n<td>POST OP Pain</td>\n<td>Lesser </td>\n<td>More</td>\n</tr>\n<tr>\n<td>Wound Extension </td>\n<td>More Common </td>\n<td>Less Common </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Spermicide used in contraceptive is?", "options": [{"label": "A", "text": "Gossypol", "correct": false}, {"label": "B", "text": "Non-oxynol 9", "correct": true}, {"label": "C", "text": "Centchroman", "correct": false}, {"label": "D", "text": "Clomiphene", "correct": false}], "correct_answer": "B. Non-oxynol 9", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Chemical Contraceptive</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>How It Works</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Advantages</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Nonoxynol-9</strong></p>\n</td>\n<td>\n<p>Disrupts <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> membranes, immobilizing or killing sperm</p>\n</td>\n<td>\n<ul>\n<li>Readily available and affordable</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>May cause <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> or allergic reactions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Contraceptive Sponge</strong></p>\n</td>\n<td>\n<p>Contains <span class=\"customMeta\" data-dictid=\"40cdb0896416927771998564e4c0e4\">spermicide</span> that immobilizes or kills sperm</p>\n</td>\n<td>\n<ul>\n<li>Convenient and non-hormonal</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Less effective than some other <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">contraceptive</span> methods</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Spermicidal Cream/Gel</strong></p>\n</td>\n<td>\n<p>Contains chemicals that <span class=\"customMeta\" data-dictid=\"87bf05a56616927771893b9550e8ad\">immobilize</span> or kill sperm</p>\n</td>\n<td>\n<ul>\n<li>Non-hormonal and can be used on-demand</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>May cause <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> or allergic reactions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Vaginal Suppositories</strong></p>\n</td>\n<td>\n<p>Release <span class=\"customMeta\" data-dictid=\"fd1ea66547169277719990b69a6279\">spermicidal</span> chemicals into the vagina</p>\n</td>\n<td>\n<ul>\n<li>Easy to use and can be inserted discreetly</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Requires <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> prior to intercourse</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Vaginal Film</strong></p>\n</td>\n<td>\n<p>Dissolves and releases <span class=\"customMeta\" data-dictid=\"fd1ea66547169277719990b69a6279\">spermicidal</span> chemicals in the vagina</p>\n</td>\n<td>\n<ul>\n<li>Convenient and can be used on-demand</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Requires <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> prior to intercourse</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Vaginal Foam</strong></p>\n</td>\n<td>\n<p>Creates a <span class=\"customMeta\" data-dictid=\"40d72689211692777203fca86e25c9\">foam</span> that immobilizes or kills sperm</p>\n</td>\n<td>\n<ul>\n<li>Easy to use and provides <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> application</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Requires <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> prior to intercourse</li>\n<li>May cause <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> or discomfort</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended course of treatment for mild congenital ptosis?", "options": [{"label": "A", "text": "Blaskowic’s operation", "correct": false}, {"label": "B", "text": "Everbusch’s operation", "correct": false}, {"label": "C", "text": "Fasanella-Servat operation", "correct": true}, {"label": "D", "text": "Frontalis Sling operation", "correct": false}], "correct_answer": "C. Fasanella-Servat operation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Fasanella-Serv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is used as an antidote in opioid overdose?", "options": [{"label": "A", "text": "Naloxone", "correct": true}, {"label": "B", "text": "Flumazenil", "correct": false}, {"label": "C", "text": "Fomepizole", "correct": false}, {"label": "D", "text": "Pethidine", "correct": false}], "correct_answer": "A. Naloxone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the Investigation of choice for endometriosis?", "options": [{"label": "A", "text": "CT", "correct": false}, {"label": "B", "text": "MRI", "correct": false}, {"label": "C", "text": "USG", "correct": false}, {"label": "D", "text": "Laparoscopy", "correct": true}], "correct_answer": "D. Laparoscopy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following anti-CD 20 monoclonal antibodies is used in cancer therapy?", "options": [{"label": "A", "text": "Methotrexate", "correct": false}, {"label": "B", "text": "Rituximab", "correct": true}, {"label": "C", "text": "Cisplatin", "correct": false}, {"label": "D", "text": "5-Fluorouracil", "correct": false}], "correct_answer": "B. Rituximab", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ritu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which disease are Koplik spots observed?", "options": [{"label": "A", "text": "Mumps", "correct": false}, {"label": "B", "text": "Measles", "correct": true}, {"label": "C", "text": "Rubella", "correct": false}, {"label": "D", "text": "Varicella", "correct": false}], "correct_answer": "B. Measles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TAOb9rTcq31Yip6520Z11687176516.png", "https://image.prepladder.com/content/OEXVS01NsLTPWRlSgbX41687176552.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the subsequent course of action for a patient presenting with one eye displaying convergent squint and visual acuity of 6/60, while the other eye has no squint but also displays visual acuity of 6/60?", "options": [{"label": "A", "text": "MRI", "correct": false}, {"label": "B", "text": "Squint surgery", "correct": false}, {"label": "C", "text": "Botulinum toxin", "correct": false}, {"label": "D", "text": "Refraction", "correct": true}], "correct_answer": "D. Refraction", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Type of Squint</strong></p>\n</td>\n<td>\n<p><strong>Description</strong></p>\n</td>\n<td>\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Esotropia</p>\n</td>\n<td>\n<p>Inward <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of one or both eyes</p>\n</td>\n<td>\n<p>Observation, glasses, patching, <span class=\"customMeta\" data-dictid=\"116a50b7321692777194e1aab5b767\">orthoptic</span> exercises, surgery</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Exotropia</p>\n</td>\n<td>\n<p>Outward <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of one or both eyes</p>\n</td>\n<td>\n<p>Observation, glasses, patching, <span class=\"customMeta\" data-dictid=\"116a50b7321692777194e1aab5b767\">orthoptic</span> exercises, surgery</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hypertropia</p>\n</td>\n<td>\n<p>Upward <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of one or both eyes</p>\n</td>\n<td>\n<p>Observation, glasses, patching, <span class=\"customMeta\" data-dictid=\"116a50b7321692777194e1aab5b767\">orthoptic</span> exercises, surgery</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hypotropia</p>\n</td>\n<td>\n<p>Downward <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of one or both eyes</p>\n</td>\n<td>\n<p>Observation, glasses, patching, <span class=\"customMeta\" data-dictid=\"116a50b7321692777194e1aab5b767\">orthoptic</span> exercises, surgery</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Alternating</p>\n</td>\n<td>\n<p>Switching eye <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> between the two eyes</p>\n</td>\n<td>\n<p>Observation, glasses, patching, <span class=\"customMeta\" data-dictid=\"116a50b7321692777194e1aab5b767\">orthoptic</span> exercises, surgery</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Accommodative</p>\n</td>\n<td>\n<p>Eye misalignment due to <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> effort (refractive error)</p>\n</td>\n<td>\n<p>Glasses, patching, <span class=\"customMeta\" data-dictid=\"116a50b7321692777194e1aab5b767\">orthoptic</span> exercises, surgery (rare cases)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Non-accommodative</p>\n</td>\n<td>\n<p>Eye misalignment not due to <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> effort (neurological)</p>\n</td>\n<td>\n<p>Observation, glasses, patching, <span class=\"customMeta\" data-dictid=\"116a50b7321692777194e1aab5b767\">orthoptic</span> exercises, surgery</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Congenital</p>\n</td>\n<td>\n<p>Present at birth</p>\n</td>\n<td>\n<p>Observation, glasses, patching, <span class=\"customMeta\" data-dictid=\"116a50b7321692777194e1aab5b767\">orthoptic</span> exercises, surgery</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Acquired</p>\n</td>\n<td>\n<p>Develops later in life due to various causes</p>\n</td>\n<td>\n<p>Treat underlying cause (glasses, patching, <span class=\"customMeta\" data-dictid=\"116a50b7321692777194e1aab5b767\">orthoptic</span> exercises, surgery)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a labor room, after delivery and placenta removal, what is the primary reason for uncontrolled bleeding in a multigravida woman, leading to postpartum hemorrhage (PPH)?", "options": [{"label": "A", "text": "Atonic PPH", "correct": true}, {"label": "B", "text": "Traumatic PPH", "correct": false}, {"label": "C", "text": "Clotting factor deficiency", "correct": false}, {"label": "D", "text": "Retained placenta", "correct": false}], "correct_answer": "A. Atonic PPH", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Topic</strong></p>\n</td>\n<td>\n<p><strong>Information</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>PPH Definition</p>\n</td>\n<td>\n<ul>\n<li>Any <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in the <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> after delivery, including uterine, traumatic, and other causes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Traditionally, &gt; 500 ml in normal delivery and &gt; 1000 ml in a <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">cesarean</span> section</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Mild PPH: &gt; 500 ml to 1000 ml</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Moderate PPH: &gt; 1000 ml to 2000 ml</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Severe PPH: &gt; 2000 ml</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Massive Obstetric Hemorrhage: &gt; 1500 ml</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Causes</p>\n</td>\n<td>\n<ul>\n<li>Atonic <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">Uterus</span> (80%): Large <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> (big baby/twins/↑ liquor), infections (PROM/Chorioamnionitis), prolonged labor</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Injuries (Trauma): Uterus, cervix, vagina</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Coagulopathies: Von Willebrand's Disease (VWD), <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">Idiopathic</span> <span class=\"customMeta\" data-dictid=\"aba471988c16927772008c3881342b\">Thrombocytic</span> <span class=\"customMeta\" data-dictid=\"0acd34c758169277719644923511e5\">Purpura</span> (I.T.P)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Retained Tissues: Secondary PPH (after 24 hours, up till 12 weeks)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Primary PPH: Within the first 24 hours (the first 1 hour is the most common time)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Secondary PPH: &gt; 24 hours till 12 weeks</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Prevention</p>\n</td>\n<td>\n<ul>\n<li>Oxytocin is the drug of choice</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Prophylactic IM/IV <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">Oxytocin</span> (5-10 units) after delivery of shoulders</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Treatment</p>\n</td>\n<td>\n<p>1. IV <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">Oxytocin</span> [10-20 units drip] (Drug of Choice)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>2. IV <span class=\"customMeta\" data-dictid=\"bc09155adc169277719248f9543785\">Methyl</span> <span class=\"customMeta\" data-dictid=\"b2684621b0169277718769e2c1fd3c\">Ergometrine</span> 0.2 mg (can also be given IM)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>3. Tab (PGE1): 1000 μg <span class=\"customMeta\" data-dictid=\"3d9cd2fe7816927771956803deadcc\">per rectum</span> (Misoprostol)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>4. Inj. (PGF α) 2 Carboprost: IM only, can be given intra-myometrial</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>5. <span class=\"customMeta\" data-dictid=\"b566321fe8169277719716b1cf4df0\">Recombinant</span> VII: 90 mg/kg body weight in 3-5 min IV infusion</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>6. Carbetocin: <span class=\"customMeta\" data-dictid=\"61fbe2173416927771998e7aa0b432\">Synthetic</span> <span class=\"customMeta\" data-dictid=\"22e0051a181692777181872183edb2\">analogue</span> of oxytocin; 100 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> in 1 ml IV over 1 min</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>7. Tranexamic acid: 1 gm IV, an anti-fibrinolysis agent</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>8. Fibrinogen: Maintain &gt; 1 gm/Ltr (&gt;100 mg/dL) using <span class=\"customMeta\" data-dictid=\"a3dff375761692777185bc7afd561b\">cryoprecipitate</span> or <span class=\"customMeta\" data-dictid=\"0339123c621692777203964a9056bb\">fresh frozen plasma</span> (FFP)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>9. <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">Uterine</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> embolization: <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">Prophylaxis</span> for <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">Placenta</span> Previa, <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">Placenta</span> Accreta, and for treatment in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> conditions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>10. <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">Intravascular</span> AORTIC balloon compression: <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">Prophylactic</span> measure</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>11. Balloon Tamponade: Examples include Bakri's balloon, Sengstaken tube, Foley's catheter, condoms</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>12. <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Methods: Compression/Brace sutures (e.g., Christopher B Lynch), Hayman's sutures, <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">Uterine</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> ligation</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Deficiency of Vitamin B12 leads to what type of anemia?", "options": [{"label": "A", "text": "Normocytic normochromic", "correct": false}, {"label": "B", "text": "Microcytic hypochromic", "correct": false}, {"label": "C", "text": "Macrocytic hypochromic", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. Macrocytic hypochromic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Macrocytic hypoch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the origin of the Sustainable Development Goals?", "options": [{"label": "A", "text": "UNICEF", "correct": false}, {"label": "B", "text": "United Nations", "correct": true}, {"label": "C", "text": "WHO", "correct": false}, {"label": "D", "text": "Government of India", "correct": false}], "correct_answer": "B. United Nations", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/y4nYoe4TcCnSpRybJbRO1714477993.png"], "explanation": "<p>Correct Option B-United N\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the diagnosis for a diabetic patient experiencing an abrupt vision loss, having a visual acuity of 6/60, with a fundus picture provided?", "options": [{"label": "A", "text": "CRVO", "correct": false}, {"label": "B", "text": "CRAO", "correct": true}, {"label": "C", "text": "Diabetic retinopathy", "correct": false}, {"label": "D", "text": "Hypertensive retinopathy", "correct": false}], "correct_answer": "B. CRAO", "question_images": ["https://image.prepladder.com/content/odpQBr2yJ71fpqrbWAhW1695204130.png"], "explanation_images": [], "explanation": "<p>Correct Option B - CRAO: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "N95 respirator is used for:", "options": [{"label": "A", "text": "Droplet precautions", "correct": false}, {"label": "B", "text": "Airborne precautions", "correct": true}, {"label": "C", "text": "Contact precautions", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "B. Airborne precautions", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"5a986778421692777180f5f9dd3ea8\"&gt;Airborne&lt;/span&gt; precau\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended dosage of mifepristone for emergency contraception?", "options": [{"label": "A", "text": "25 mg", "correct": true}, {"label": "B", "text": "15 mg", "correct": false}, {"label": "C", "text": "10 mg", "correct": false}, {"label": "D", "text": "5 mg", "correct": false}], "correct_answer": "A. 25 mg", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the advantages of using contact lenses instead of eyeglasses?", "options": [{"label": "A", "text": "Less prismatic effect", "correct": true}, {"label": "B", "text": "Protection from UV rays", "correct": false}, {"label": "C", "text": "Decrease infection", "correct": false}, {"label": "D", "text": "Decrease inflammation", "correct": false}], "correct_answer": "A. Less prismatic effect", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Less &lt;span class=\"customMeta\" data-dictid=\"ebbe31bebf16927771969cb13b3b9e\"&gt;prismatic&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Kyoto Protocol is for", "options": [{"label": "A", "text": "To improve water sanitization", "correct": false}, {"label": "B", "text": "To study food and nutrition", "correct": false}, {"label": "C", "text": "To reduce Green-house gas emissions", "correct": true}, {"label": "D", "text": "To do water chlorination", "correct": false}], "correct_answer": "C. To reduce Green-house gas emissions", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C-To reduce green-house g\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Topic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kyoto Protocol</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Objective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To combat climate change by reducing greenhouse gas emissions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scope</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Applies to industrialized countries (Annex I countries)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Greenhouse Gases Covered</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carbon <span class=\"customMeta\" data-dictid=\"0bd01a042116927771868e3482910e\">dioxide</span> (CO2), <span class=\"customMeta\" data-dictid=\"a69836f1e916927771926366808510\">Methane</span> (CH4), <span class=\"customMeta\" data-dictid=\"b83d31a7d61692777193c128d13c7d\">Nitrous</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">Oxide</span> (N2O), Hydrofluorocarbons (HFCs), Perfluorocarbons (PFCs), <span class=\"customMeta\" data-dictid=\"978b9c4c1a1692777199fc90ace6a5\">Sulfur</span> hexafluoride (SF6)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clean Development Mechanism (CDM)</li>\n<li>Joint Implementation (JI)</li>\n<li>Emissions Trading (ET)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with the double decidual sign on ultrasound ?", "options": [{"label": "A", "text": "Uterine gestational sac", "correct": true}, {"label": "B", "text": "Pseudo gestational sac", "correct": false}, {"label": "C", "text": "Threatened Abortion", "correct": false}, {"label": "D", "text": "Ectopic pregnancy", "correct": false}], "correct_answer": "A. Uterine gestational sac", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VmrMzoy97gVwVQ0q9o4V1715842380.png"], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>Gestational Sac</strong></td>\n<td><strong>Cardiac Activity </strong></td>\n</tr>\n<tr>\n<td>TVS [Trans <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> Sonography] (Preferred)</td>\n<td>4 + weeks </td>\n<td>5 + weeks </td>\n</tr>\n<tr>\n<td>TAS [|Trans <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> Sonography]</td>\n<td>5 + weeks </td>\n<td>6 + weeks </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How would you approach the treatment of a 40-year-old male with fever, abdominal pain, and a diagnosis of HIV-TB?", "options": [{"label": "A", "text": "ATT and ART simultaneously", "correct": false}, {"label": "B", "text": "First start ATT then give ART", "correct": true}, {"label": "C", "text": "ATT only", "correct": false}, {"label": "D", "text": "First start ART and then give ATT", "correct": false}], "correct_answer": "B. First start ATT then give ART", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common organism causing pelvic inflammatory disease?", "options": [{"label": "A", "text": "Neisseria gonorrhoea", "correct": false}, {"label": "B", "text": "Gardenella Vaginalis", "correct": false}, {"label": "C", "text": "Bacteroids", "correct": false}, {"label": "D", "text": "Chlamydia", "correct": true}], "correct_answer": "D. Chlamydia", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>PID</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Definition</p>\n</td>\n<td>\n<p>An infection and <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the female <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> organs</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Causative Organisms</p>\n</td>\n<td>\n<p>Commonly caused by sexually transmitted bacteria, including:</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Chlamydia trachomatis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Neisseria gonorrhoeae</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>Other bacteria may also be involved, such as:</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Mycoplasma genitalium</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Gardnerella vaginalis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Risk Factors</p>\n</td>\n<td>\n<ul>\n<li>Multiple sexual partners</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>History of sexually transmitted infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Previous episode of PID</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Clinical Features</p>\n</td>\n<td>\n<ul>\n<li>Lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain and tenderness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> discharge</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Pain during <span class=\"customMeta\" data-dictid=\"ad25936d1916927771900a1de2dd77\">intercourse</span> (dyspareunia)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Irregular <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> or <span class=\"customMeta\" data-dictid=\"26238ddd49169277719651f05f59da\">postcoital</span> bleeding</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Diagnosis</p>\n</td>\n<td>\n<ul>\n<li>Clinical examination and history</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Pelvic examination</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Laboratory tests, including:</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Urine analysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Blood tests for <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> markers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Vaginal swabs for culture and sensitivity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Polymerase chain reaction (PCR) for specific organisms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Imaging studies (e.g., ultrasound, MRI) in complex cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Complications</p>\n</td>\n<td>\n<ul>\n<li>Tubo-ovarian abscess</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Infertility</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Ectopic pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Treatment</p>\n</td>\n<td>\n<ul>\n<li>Antibiotic therapy <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> the <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organisms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Treatment of sexual partners to prevent reinfection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Hospitalization may be necessary for severe cases or complications</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Prevention</p>\n</td>\n<td>\n<ul>\n<li>Safe sexual practices, including <span class=\"customMeta\" data-dictid=\"672aab321d16927771840ecbc284dd\">condom</span> use</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Regular screening for sexually transmitted infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Prompt treatment of sexually transmitted infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Vaccination against certain <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organisms (e.g., HPV)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "McNaughten's rule is?", "options": [{"label": "A", "text": "IPC 82", "correct": false}, {"label": "B", "text": "IPC 83", "correct": false}, {"label": "C", "text": "IPC 84", "correct": true}, {"label": "D", "text": "IPC 85", "correct": false}], "correct_answer": "C. IPC 84", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Legal Standard</strong></p>\n</td>\n<td>\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>McNaughten's Rule</p>\n</td>\n<td>\n<ul>\n<li>Originated in the United Kingdom.</li>\n<li>A defendant is not criminally responsible if, at the time of the act:\n\t\t\t\t<ul>\n<li>They were suffering from a mental disease or defect.</li>\n<li>They did not know the nature and quality of the act.</li>\n<li>They did not know that the act was wrong (morally or legally).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Currens Rule</p>\n</td>\n<td>\n<ul>\n<li>Developed in the United States, specifically in the state of New Hampshire</li>\n<li>.A defendant is not guilty if, at the time of the act: They lacked substantial capacity to either appreciate the criminality of their conduct or conform their conduct to the requirements of the law.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Durham Rule</p>\n</td>\n<td>\n<ul>\n<li>Also known as the \"Product Rule.\"</li>\n<li>The defendant is not criminally responsible if their unlawful act was the product of a mental disease or defect.</li>\n<li>The rule focuses on causation, examining whether the defendant's mental disease or <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> was a substantial factor in causing the criminal act.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where is the late rupture of tubal pregnancy commonly observed in terms of anatomical location?", "options": [{"label": "A", "text": "Interstitium", "correct": true}, {"label": "B", "text": "Isthmus", "correct": false}, {"label": "C", "text": "Ampulla", "correct": false}, {"label": "D", "text": "Fimbriae", "correct": false}], "correct_answer": "A. Interstitium", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "African suburb, all population given chemoprophylaxis for Malaria. This is", "options": [{"label": "A", "text": "Primordial", "correct": false}, {"label": "B", "text": "Primary", "correct": true}, {"label": "C", "text": "Secondary", "correct": false}, {"label": "D", "text": "Tertiary", "correct": false}], "correct_answer": "B. Primary", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of Prevention</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Focus</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Example</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Primordial Prevention</strong></p>\n</td>\n<td>\n<p>Targets social, economic, and environmental determinants of health to prevent the <span class=\"customMeta\" data-dictid=\"717a791bdf1692777187f5f058180c\">emergence</span> of risk factors.</p>\n</td>\n<td>\n<p>Addressing underlying causes of disease</p>\n</td>\n<td>\n<p>Promoting healthy urban planning to reduce <span class=\"customMeta\" data-dictid=\"484e72500916927771982789485f51\">sedentary</span> lifestyle and obesity.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Primary Prevention</strong></p>\n</td>\n<td>\n<p>Aims to prevent the occurrence of a disease or condition before it develops.</p>\n</td>\n<td>\n<p>Reducing the risk of disease</p>\n</td>\n<td>\n<p>Vaccination programs, health education on healthy lifestyle practices.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Secondary Prevention</strong></p>\n</td>\n<td>\n<p>Focuses on early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> and prompt treatment of a disease or condition to prevent its <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> and minimize its impact.</p>\n</td>\n<td>\n<p>Early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> and intervention</p>\n</td>\n<td>\n<p>Regular screenings for breast cancer, <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> testing, and treatment.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Tertiary Prevention</strong></p>\n</td>\n<td>\n<p>Aims to manage and reduce the complications and disabilities associated with a disease to improve the quality of life of individuals already affected.</p>\n</td>\n<td>\n<p>Managing complications and disabilities</p>\n</td>\n<td>\n<p>Cardiac rehabilitation programs after a heart attack, <span class=\"customMeta\" data-dictid=\"1f210719c116927771959b3083cb18\">physiotherapy</span> for stroke patients.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a woman who had sexual intercourse 96 hours ago, which contraceptive method is the most appropriate choice?", "options": [{"label": "A", "text": "OCP (Oral Contraceptive Pills)", "correct": false}, {"label": "B", "text": "IUCD (Intrauterine Contraceptive Device)", "correct": true}, {"label": "C", "text": "Mifepristone", "correct": false}, {"label": "D", "text": "Progesterone-only pills", "correct": false}], "correct_answer": "B. IUCD (Intrauterine Contraceptive Device)", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Emergency <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Method</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Dose or Timing</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Time Until Use</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Copper <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">Intrauterine</span> Device (IUD)</p>\n</td>\n<td>\n<p>Insertion of <span class=\"customMeta\" data-dictid=\"0a1f2085da1692777190fa4d489421\">IUD</span> within 5 days of unprotected intercourse</p>\n</td>\n<td>\n<p>Within 5 days of unprotected intercourse</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Levonorgestrel Emergency <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pill (LNG ECP)</p>\n</td>\n<td>\n<p>1.5 mg single dose or 0.75 mg in two doses, 12 hours apart</p>\n</td>\n<td>\n<p>Within 72 hours (3 days) of unprotected intercourse</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ulipristal <span class=\"customMeta\" data-dictid=\"47765053a81692777180738f50cd4e\">Acetate</span> Emergency <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pill (UPA ECP)</p>\n</td>\n<td>\n<p>30 mg single dose</p>\n</td>\n<td>\n<p>Within 120 hours (5 days) of unprotected intercourse</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Combined Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pills (COCs)</p>\n</td>\n<td>\n<p>Various regimens available, typically a high-dose of <span class=\"customMeta\" data-dictid=\"e4bcd9fe2c1692777187df0dbb0ddc\">ethinyl</span> <span class=\"customMeta\" data-dictid=\"d8cc09346f16927771878d48ba1ce8\">estradiol</span> and <span class=\"customMeta\" data-dictid=\"435b0d5b1616927771912550e61580\">levonorgestrel</span> or norgestrel</p>\n</td>\n<td>\n<p>Within 72 hours (3 days) of unprotected intercourse</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Progestin-only Pills (POP)</p>\n</td>\n<td>\n<p>Various regimens available, typically a high-dose of <span class=\"customMeta\" data-dictid=\"435b0d5b1616927771912550e61580\">levonorgestrel</span> or norgestrel</p>\n</td>\n<td>\n<p>Within 72 hours (3 days) of unprotected intercourse</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Combined Hormonal Patch</p>\n</td>\n<td>\n<p>Application of patch within 72 hours of unprotected intercourse</p>\n</td>\n<td>\n<p>Within 72 hours (3 days) of unprotected intercourse</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Combined Hormonal Ring</p>\n</td>\n<td>\n<p>Insertion of ring within 72 hours of unprotected intercourse</p>\n</td>\n<td>\n<p>Within 72 hours (3 days) of unprotected intercourse</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old farmer was presented in the hospital with pinpoint pupil &amp;amp; increased secretions . The diagnosis is", "options": [{"label": "A", "text": "Alcohol poisoning", "correct": false}, {"label": "B", "text": "Opioid poisoning", "correct": false}, {"label": "C", "text": "Organophosphorus poisoning", "correct": true}, {"label": "D", "text": "Datura poisoning", "correct": false}], "correct_answer": "C. Organophosphorus poisoning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Organophosphorus poisoning\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a measure of Dispersion?", "options": [{"label": "A", "text": "Standard error", "correct": false}, {"label": "B", "text": "Variance", "correct": false}, {"label": "C", "text": "Range", "correct": false}, {"label": "D", "text": "Mean", "correct": true}], "correct_answer": "D. Mean", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary cause of MALIGNANT OTITIS EXTERNA?", "options": [{"label": "A", "text": "Staphylococcus aureus", "correct": false}, {"label": "B", "text": "Streptococcus pyogenes", "correct": false}, {"label": "C", "text": "Hemophillus influenza", "correct": false}, {"label": "D", "text": "Pseudomonas aeruginosa", "correct": true}], "correct_answer": "D. Pseudomonas aeruginosa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: &lt;span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\"&gt;Pseudomonas&lt;/span&gt; aerug\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle pairs aid in the processes of both opening and closing the eustachian tube?", "options": [{"label": "A", "text": "Palatopharyngeus and salphinopharyngeus", "correct": false}, {"label": "B", "text": "Tensor veli palatini and levator veli palatini", "correct": true}, {"label": "C", "text": "Tensor tympani and tensor veli palatini", "correct": false}, {"label": "D", "text": "Stylohyoid and geniohyoid", "correct": false}], "correct_answer": "B. Tensor veli palatini and levator veli palatini", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"72dbd9ec8716927772005127a031ac\"&gt;Tensor&lt;/span&gt; veli palatini and &lt;span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\"&gt;levator&lt;/span&gt; v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the value of MAC in cases of severe malnutrition?", "options": [{"label": "A", "text": "14.5 cms", "correct": false}, {"label": "B", "text": "13.5 cms", "correct": false}, {"label": "C", "text": "12.5 cms", "correct": false}, {"label": "D", "text": "11.5 cms", "correct": true}], "correct_answer": "D. 11.5 cms", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>MUAC (cm)</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Inference</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\">&gt; 13.5 cm</p>\n</td>\n<td>\n<p style=\"text-align:center\">Normal</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\">12.5 to 13.5 cm</p>\n</td>\n<td>\n<p style=\"text-align:center\">Borderline</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\">&lt; 12.5</p>\n</td>\n<td>\n<p style=\"text-align:center\">Undernutrition</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently reported symptom of Nasopharyngeal Carcinoma?", "options": [{"label": "A", "text": "Nasal obstruction", "correct": false}, {"label": "B", "text": "Epistaxis", "correct": false}, {"label": "C", "text": "Neck node", "correct": true}, {"label": "D", "text": "Anosmia", "correct": false}], "correct_answer": "C. Neck node", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Neck\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In Marasmus, the mid-arm muscle circumference is less than:", "options": [{"label": "A", "text": "11.5 cm", "correct": true}, {"label": "B", "text": "17 cm", "correct": false}, {"label": "C", "text": "19 cm", "correct": false}, {"label": "D", "text": "21 cm", "correct": false}], "correct_answer": "A. 11.5 cm", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/l40zhSiReUqyYwDHd9Zn1687179717.png"], "explanation": "<p>Correct Option A: 11.5\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>MUAC (cm)</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Inference</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\">&gt; 13.5 cm</p>\n</td>\n<td>\n<p style=\"text-align:center\">Normal</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\">12.5 to 13.5 cm</p>\n</td>\n<td>\n<p style=\"text-align:center\">Borderline</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\">&lt; 12.5</p>\n</td>\n<td>\n<p style=\"text-align:center\">Undernutrition</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Epstein Barr Virus is attributed to the pathogenesis of which of the following?", "options": [{"label": "A", "text": "Juvenile nasopharyngeal angiofibroma", "correct": false}, {"label": "B", "text": "Nasopharyngeal carcinoma", "correct": true}, {"label": "C", "text": "Stewarts granuloma", "correct": false}, {"label": "D", "text": "Rhinoscleroma", "correct": false}], "correct_answer": "B. Nasopharyngeal carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\"&gt;Nasopharyngeal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the treatment method that is most commonly recommended for a patient diagnosed with advanced nasopharyngeal carcinoma?", "options": [{"label": "A", "text": "Surgical excision", "correct": false}, {"label": "B", "text": "Radiotherapy", "correct": false}, {"label": "C", "text": "Chemotherapy", "correct": false}, {"label": "D", "text": "Chemoradiotherapy", "correct": true}], "correct_answer": "D. Chemoradiotherapy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Chemoradioth\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p style=\"text-align: center;\"><strong>T-staging</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T<sub>1</sub></p>\n</td>\n<td>\n<p>Nose/nasopharynx or oropharynx</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T<sub>2</sub></p>\n</td>\n<td>\n<p>Parapharyngeal space</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T<sub>3</sub></p>\n</td>\n<td>\n<p>Skull bone</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T<sub>4</sub></p>\n</td>\n<td>\n<p>Intra-cranial</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p style=\"text-align: center;\"><strong>N-staging</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>N<sub>0</sub></p>\n</td>\n<td>\n<p>No <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> spread</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>N<sub>1</sub></p>\n</td>\n<td>\n<p>&lt; 6 cm : <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>N<sub>2</sub></p>\n</td>\n<td>\n<p>&lt; 6 cm : <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>N<sub>3</sub></p>\n</td>\n<td>\n<p>&gt; 6 cm</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p style=\"text-align: center;\"><strong>Metastasis</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>M<sub>0</sub></p>\n</td>\n<td>\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>M<sub>1</sub></p>\n</td>\n<td>\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20 year old female patient presented with throat pain and difficulty in swallowing. On examination, her right tonsil was found to be congested and uvula pushed to opposite side, left side tonsil was normal, what could be the diagnosis ?", "options": [{"label": "A", "text": "Retropharyngeal abscess", "correct": false}, {"label": "B", "text": "Acute parenchymatous tonsillitis", "correct": false}, {"label": "C", "text": "Quinsy", "correct": true}, {"label": "D", "text": "Parapharyngeal abscess", "correct": false}], "correct_answer": "C. Quinsy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cJ6pZTozuAam7lZce28z1713332544.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a characteristic of Meniere's disease?", "options": [{"label": "A", "text": "Low frequency sensorineural hearing loss", "correct": false}, {"label": "B", "text": "Idiopathic", "correct": false}, {"label": "C", "text": "Endolymphatic pathology", "correct": false}, {"label": "D", "text": "Radiofrequency ablation is the treatment of choice", "correct": true}], "correct_answer": "D. Radiofrequency ablation is the treatment of choice", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ax5jhTmtFCJcCiwAyoib1714373448.png"], "explanation": "<p>Correct Option D: &lt;span class=\"customMeta\" data-dictid=\"07f73f8986169277719716f3a62e1b\"&gt;Radiofrequency&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\"&gt;ablation&lt;/span&gt; is the treatment of ch\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute attack</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic phase</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vestibular sedatives</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dimenhydrinate, promethazine, prochlorperazine</li>\n<li>Diazepam suppresses activity of <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> nucleus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prochlorperazine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasodilators</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carbogen (5% CO<sub>2</sub> with 95% O<sub>2</sub>)</li>\n<li>Histamine drip</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nicotinic acid</li>\n<li>Betahistine (Vertin)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Other drugs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atropine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diuretics</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conservative procedures (preserve hearing)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Destructive procedure (Destroy hearing)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vestibular nerve sectioning</li>\n<li>Decompression of endolymphatic sac</li>\n<li>Endolymphatic shunt</li>\n<li>Sacculotomy (Ficks procedure)</li>\n<li>Cody tack procedure</li>\n<li>Cochleosacculostomy (cochlear <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> is punctured)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Labyrinthectomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which cartilage is responsible for the protrusion of the Adam's apple?", "options": [{"label": "A", "text": "Thyroid", "correct": true}, {"label": "B", "text": "Cricoid", "correct": false}, {"label": "C", "text": "Hyoid", "correct": false}, {"label": "D", "text": "Epiglottis", "correct": false}], "correct_answer": "A. Thyroid", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is implicated as the cause of office headaches ?", "options": [{"label": "A", "text": "Maxillary sinusitis", "correct": false}, {"label": "B", "text": "Ethmoid sinusitis", "correct": false}, {"label": "C", "text": "Frontal sinusitis", "correct": true}, {"label": "D", "text": "Sphenoid sinusitis", "correct": false}], "correct_answer": "C. Frontal sinusitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\"&gt;Frontal&lt;/span&gt; sinu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most constant and largest ethmoidal air cells?", "options": [{"label": "A", "text": "Aggar nasi cell", "correct": false}, {"label": "B", "text": "Bulla ethmoidalis", "correct": true}, {"label": "C", "text": "Haller cell", "correct": false}, {"label": "D", "text": "Onodi cell", "correct": false}], "correct_answer": "B. Bulla ethmoidalis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Xf9PMRBCA6nSzvR0V9uM1713526517.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"b221c6ceef16927771838d836a5d3b\"&gt;Bulla&lt;/span&gt; eth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with Pink color skin &amp;amp; mucosa , a bitter almond smell from breath, and frothy discharge . The cause of death is:", "options": [{"label": "A", "text": "H 2 S poisoning", "correct": false}, {"label": "B", "text": "CO poisoning", "correct": false}, {"label": "C", "text": "HCN poisoning", "correct": true}, {"label": "D", "text": "OPC poisoning", "correct": false}], "correct_answer": "C. HCN poisoning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - HCN poisoning\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the ideal investigation of choice for confirming CSF rhinorrhea ?", "options": [{"label": "A", "text": "Beta 2 transferrin analysis", "correct": true}, {"label": "B", "text": "CT-cisternogram", "correct": false}, {"label": "C", "text": "Nasal endoscopy", "correct": false}, {"label": "D", "text": "MRI with contrast", "correct": false}], "correct_answer": "A. Beta 2 transferrin analysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\"&gt;Beta&lt;/span&gt; 2 &lt;span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\"&gt;transferrin&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which poisoning is caused by a bullet retained inside the body ?", "options": [{"label": "A", "text": "Iron", "correct": false}, {"label": "B", "text": "Phosphorus", "correct": false}, {"label": "C", "text": "Nitrocellulose", "correct": false}, {"label": "D", "text": "Lead", "correct": true}], "correct_answer": "D. Lead", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the diagnosis for a 30-year-old woman who was involved in a road traffic accident, did not wear a helmet, experienced a brief loss of consciousness, and later presented to the ENT department with complaints of clear fluid discharge from her nose after 2 days?", "options": [{"label": "A", "text": "Allergic rhinitis", "correct": false}, {"label": "B", "text": "Infection due to hemosinus because of RTA", "correct": false}, {"label": "C", "text": "CSF rhinorrhea", "correct": true}, {"label": "D", "text": "Post traumatic rhinitis", "correct": false}], "correct_answer": "C. CSF rhinorrhea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\"&gt;CSF&lt;/span&gt; rhinorrh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In an autopsy of suspected poisoning , which organ, along with the stomach, part of the intestine, and liver, is preserved?", "options": [{"label": "A", "text": "Kidney", "correct": true}, {"label": "B", "text": "Lungs", "correct": false}, {"label": "C", "text": "Brain", "correct": false}, {"label": "D", "text": "Heart", "correct": false}], "correct_answer": "A. Kidney", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - K\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Organs preserved</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Poisoning</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Heart, Brain </p>\n</td>\n<td>\n<p style=\"text-align: center;\">Strychnine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Spleen</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Cyanide</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Brain</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Organophosphate</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Bones</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Arsenic</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Lungs</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Volatile poisons , like CO, H<sub>2</sub>S</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Small intestine </p>\n</td>\n<td>\n<p style=\"text-align: center;\">Vegetable poisons</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of a man who arrived at the emergency department with a head injury resulting from a vehicle accident, the preferred diagnostic test is?", "options": [{"label": "A", "text": "CECT (Contrast-enhanced CT)", "correct": false}, {"label": "B", "text": "MRI (Magnetic Resonance Imaging)", "correct": false}, {"label": "C", "text": "NCCT (Non-Contrast CT)", "correct": true}, {"label": "D", "text": "X-ray", "correct": false}], "correct_answer": "C. NCCT (Non-Contrast CT)", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the examination of injury, hair bulbs are noted to be crushed. The probable type of wound is:", "options": [{"label": "A", "text": "Abrasion", "correct": false}, {"label": "B", "text": "Laceration", "correct": true}, {"label": "C", "text": "Stab injury", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "B. Laceration", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6gKNXPiANhvhLOfeaxay1687236370.png"], "explanation": "<p>Correct Option B - L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 32-year-old male, who complained of fever and pain in the upper right abdomen following meals, the recommended diagnostic test is", "options": [{"label": "A", "text": "CECT", "correct": false}, {"label": "B", "text": "USG", "correct": true}, {"label": "C", "text": "MRI", "correct": false}, {"label": "D", "text": "HRCT", "correct": false}], "correct_answer": "B. USG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - USG\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the likely diagnosis for a 40-year-old patient presenting with a femur fracture accompanied by pulmonary infiltration and respiratory distress?", "options": [{"label": "A", "text": "Fat embolism", "correct": true}, {"label": "B", "text": "Pulmonary embolism", "correct": false}, {"label": "C", "text": "Air embolism", "correct": false}, {"label": "D", "text": "Obstruction", "correct": false}], "correct_answer": "A. Fat embolism", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Anthracosis is caused by", "options": [{"label": "A", "text": "Silica", "correct": false}, {"label": "B", "text": "Coal dust", "correct": true}, {"label": "C", "text": "Asbestos", "correct": false}, {"label": "D", "text": "Sugar cane", "correct": false}], "correct_answer": "B. Coal dust", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B-Coal Du\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Silicosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sandstone industry, granite industry, pottery industry, ceramic</p>\n<p>industry, gold, <span class=\"customMeta\" data-dictid=\"6f005286d01692777192d8168064ba\">mica</span> and steel industry, glass factory, building and</p>\n<p>construction work, rock mining</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asbestosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cement factory, fireproof industry, construction, airplanes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anthracosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coal mines</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Baritosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Photography, printing, <span class=\"customMeta\" data-dictid=\"55052c0f0616927771829c99eec183\">barium</span> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> works</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Byssinosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Textile industry</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bagassosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sugar <span class=\"customMeta\" data-dictid=\"48a9ab7c601692777183f6f9d2752a\">cane</span> factories, paper and cardboard factories-Fibrous residue</p>\n<p>from bagasse used in paper factories</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Farmer's lung</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Agricultural industry</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Siderosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iron mines, Iron, and steel industry</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the recommended chemoprophylaxis for an individual traveling to a region endemic for malaria?", "options": [{"label": "A", "text": "Lumefantrine", "correct": false}, {"label": "B", "text": "Pyrimethamine", "correct": false}, {"label": "C", "text": "Chloroquine", "correct": true}, {"label": "D", "text": "Quinine", "correct": false}], "correct_answer": "C. Chloroquine", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Medication</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Dosage</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Indication</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Common Side Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chloroquine</p>\n</td>\n<td>\n<p>300 mg once weekly</p>\n</td>\n<td>\n<p>Areas with chloroquine-sensitive Plasmodium species</p>\n</td>\n<td>\n<p>Nausea, headache, blurred vision</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Atovaquone-Proguanil (Malarone)</p>\n</td>\n<td>\n<ul>\n<li>Adult: 1 <span class=\"customMeta\" data-dictid=\"508e14a7ca16927772002140ece8fb\">tablet</span> daily</li>\n<li>Pediatric: Weight-based dosage</li>\n</ul>\n</td>\n<td>\n<p>Areas with chloroquine-resistant Plasmodium species</p>\n</td>\n<td>\n<p>Abdominal pain, headache, nausea</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Doxycycline</p>\n</td>\n<td>\n<ul>\n<li>Adult: 100 mg daily</li>\n<li>Pediatric: Weight-based dosage</li>\n</ul>\n</td>\n<td>\n<p>Areas with chloroquine-resistant Plasmodium species</p>\n</td>\n<td>\n<p>Nausea, sun sensitivity, gastrointestinal upset</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mefloquine</p>\n</td>\n<td>\n<ul>\n<li>Adult: 250 mg once weekly</li>\n<li>Pediatric: Weight-based dosage</li>\n</ul>\n</td>\n<td>\n<p>Areas with chloroquine-resistant Plasmodium species</p>\n</td>\n<td>\n<p>Nausea, dizziness, vivid dreams</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Thimble bladder is seen in:", "options": [{"label": "A", "text": "Acute TB", "correct": false}, {"label": "B", "text": "Chronic TB", "correct": true}, {"label": "C", "text": "Neurogenic bladder", "correct": false}, {"label": "D", "text": "Schistosomiasis", "correct": false}], "correct_answer": "B. Chronic TB", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Chronic TB\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What triad is characterized by abdominal pain, fever, and jaundice ?", "options": [{"label": "A", "text": "Saint triad", "correct": false}, {"label": "B", "text": "Charcot’s triad", "correct": true}, {"label": "C", "text": "Virchow triad", "correct": false}, {"label": "D", "text": "Reynold's Pentad", "correct": false}], "correct_answer": "B. Charcot’s triad", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Charcot’\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What methods would you employ to identify Vitamin A Deficiency in a school setting?", "options": [{"label": "A", "text": "Retinol", "correct": false}, {"label": "B", "text": "Night blindness", "correct": true}, {"label": "C", "text": "Carotene", "correct": false}, {"label": "D", "text": "Bitot spots", "correct": false}], "correct_answer": "B. Night blindness", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male presents with breast enlargement and tenderness without a substance abuse history . Examination shows visibly enlarged breasts with palpable tissue beneath the nipples . What is the least likely cause of his gynecomastia?", "options": [{"label": "A", "text": "Klinefelter syndrome", "correct": false}, {"label": "B", "text": "Liver cirrhosis", "correct": false}, {"label": "C", "text": "Hypothyroidism", "correct": false}, {"label": "D", "text": "Prostate cancer", "correct": true}], "correct_answer": "D. Prostate cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Completed family size depends on", "options": [{"label": "A", "text": "Number of adolescents", "correct": false}, {"label": "B", "text": "Number of women", "correct": false}, {"label": "C", "text": "Number of children", "correct": true}, {"label": "D", "text": "Number of persons", "correct": false}], "correct_answer": "C. Number of children", "question_images": [], "explanation_images": [], "explanation": "\n<p><strong>References:</strong></p>\n<ul><li>↳ Cultural and Social Norms</li><li>↳ Economic Considerations</li><li>↳ Access to Reproductive Health Services</li><li>↳ Individual Preferences</li><li>↳ .</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Yellow fever vaccine is valid for", "options": [{"label": "A", "text": "10 years", "correct": false}, {"label": "B", "text": "Life long", "correct": true}, {"label": "C", "text": "5 years", "correct": false}, {"label": "D", "text": "1 years", "correct": false}], "correct_answer": "B. Life long", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 28-year-old patient who is an alcoholic and presents to the hospital with symptoms of frequent vomiting, chest pain, fever, and hydropneumothorax?", "options": [{"label": "A", "text": "Boerrhave syndrome", "correct": true}, {"label": "B", "text": "Tension pneumothorax", "correct": false}, {"label": "C", "text": "PUD perforation", "correct": false}, {"label": "D", "text": "Mallory Weiss tear", "correct": false}], "correct_answer": "A. Boerrhave syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Fs7TgTN8qjDTiNp5M1zM1713356856.png"], "explanation": "<p>Correct Option A - Boerrhav\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the event of an accident, prompt action should be taken in the initial management following the arrival of the medical team. Excluding", "options": [{"label": "A", "text": "Stabilization of cervical vertebrae", "correct": false}, {"label": "B", "text": "Check BP", "correct": true}, {"label": "C", "text": "Check respiration", "correct": false}, {"label": "D", "text": "GCS score", "correct": false}], "correct_answer": "B. Check BP", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Check BP\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition shown below", "options": [{"label": "A", "text": "Strawberry stain", "correct": false}, {"label": "B", "text": "Erythema multiforme", "correct": false}, {"label": "C", "text": "Erythema subitem", "correct": false}, {"label": "D", "text": "Port wine stain", "correct": true}], "correct_answer": "D. Port wine stain", "question_images": ["https://image.prepladder.com/content/X8eafRstYpcupvhDL7JQ1691374531.jpg"], "explanation_images": ["https://image.prepladder.com/content/7z3qfY0FlCfB75aJgOZS1714038201.png", "https://image.prepladder.com/content/z9Rb0y6AgfSDidkXzp1Z1714038205.png"], "explanation": "\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:301px\">\n<p><strong>Port Wine <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">Stain</span> </strong></p>\n<ul>\n<li>Present at birth</li>\n<li>Grows along with child and persists</li>\n<li>Does not regress</li>\n<li>Most commonly present at face in the areas supplied by 5<sup>th</sup> <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve (trigeminal nerve)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:301px\"><img src=\"https://image.prepladder.com/content/7z3qfY0FlCfB75aJgOZS1714038201.png\" style=\"height:310px; width:315px\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:301px\">\n<p><strong>Strawberry <span class=\"customMeta\" data-dictid=\"43e163240216927771815a8295437e\">angioma</span> </strong></p>\n<ul>\n<li>Type of <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> hemangioma</li>\n<li>Baby is normal at birth</li>\n<li>Appears at age 1-3 weeks</li>\n<li>Grows along with child by 1 year of age</li>\n<li>Complete involuting in 90% cases by 9 years of age</li>\n<li>Emptying sign is positive</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:301px\"><img src=\"https://image.prepladder.com/content/z9Rb0y6AgfSDidkXzp1Z1714038205.png\" style=\"height:297px; width:289px\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are components of Kuppuswamy scale", "options": [{"label": "A", "text": "Income, Housing, Education", "correct": false}, {"label": "B", "text": "Income, Livestock, Housing", "correct": false}, {"label": "C", "text": "Housing, Livestock, Land", "correct": false}, {"label": "D", "text": "Income, Occupation, Education", "correct": true}], "correct_answer": "D. Income, Occupation, Education", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the possible cause of sweating and diarrhea occurring within 20 minutes of eating in a patient who has undergone gastrectomy?", "options": [{"label": "A", "text": "Early dumping syndrome", "correct": true}, {"label": "B", "text": "Late dumbing syndrome", "correct": false}, {"label": "C", "text": "Hyperglycemia", "correct": false}, {"label": "D", "text": "Hypoglycemia", "correct": false}], "correct_answer": "A. Early dumping syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Early &lt;span class=\"customMeta\" data-dictid=\"ccf758bda61692777186aef3eee253\"&gt;Dumping&lt;/span&g\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early <span class=\"customMeta\" data-dictid=\"ccf758bda61692777186aef3eee253\">Dumping</span> Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late <span class=\"customMeta\" data-dictid=\"ccf758bda61692777186aef3eee253\">Dumping</span> Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Time of occurrence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 30 minutes to 1 hour after a meal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 to 3 hours after a meal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pathophysiology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> of stomach contents into the small intestine, leading to a shift of fluid into the gut and rapid <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of glucose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reactive <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> due to excessive <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> release</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sweating, flushing, dizziness, lightheadedness, rapid heartbeat, palpitations, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cramps, bloating, nausea, vomiting, diarrhea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness, fatigue, lightheadedness, sweating, palpitations, confusion, hunger</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most sensitive test for microfilariae", "options": [{"label": "A", "text": "DEC challenge test", "correct": false}, {"label": "B", "text": "Immunofluorescence test", "correct": false}, {"label": "C", "text": "Membrane filter concentration technique", "correct": true}, {"label": "D", "text": "Thick films", "correct": false}], "correct_answer": "C. Membrane filter concentration technique", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6 months child presented with the following presentation. What is the management protocol ?", "options": [{"label": "A", "text": "Indication of surgery if not resolved by 2 years", "correct": false}, {"label": "B", "text": "Surgery after 5 year", "correct": true}, {"label": "C", "text": "Immediate surgery", "correct": false}, {"label": "D", "text": "Hernioplasty", "correct": false}], "correct_answer": "B. Surgery after 5 year", "question_images": ["https://image.prepladder.com/content/0VMvsmOVfY59KFuL5EEi1713416992.png"], "explanation_images": [], "explanation": "<p>Correct Option B -Surgery after 5\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended initial investigation for genital tuberculosis?", "options": [{"label": "A", "text": "Endometrial biopsy", "correct": false}, {"label": "B", "text": "Urine sample for acid-fast bacilli (AFB) culture", "correct": false}, {"label": "C", "text": "Genital swab for polymerase chain reaction (PCR) testing", "correct": true}, {"label": "D", "text": "Chest X-ray", "correct": false}], "correct_answer": "C. Genital swab for polymerase chain reaction (PCR) testing", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<thead>\n<tr>\n<th>Topic</th>\n<th>Genital Tuberculosis</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Definition</td>\n<td>Genital <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> is a <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> (TB) that affects the <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> organs, including the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes, uterus, ovaries, and male <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> tract. It results from the spread of <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> bacteria to the <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> organs from the primary site of infection (usually the lungs).</td>\n</tr>\n<tr>\n<td>Causative Agent</td>\n<td>Mycobacterium tuberculosis, the <span class=\"customMeta\" data-dictid=\"ff3e9793d01692777182b598b4a090\">bacterium</span> responsible for tuberculosis, causes <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> tuberculosis. It is transmitted through <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> of <span class=\"customMeta\" data-dictid=\"5a986778421692777180f5f9dd3ea8\">airborne</span> droplets containing the bacteria. The bacteria can spread from the lungs to other organs, including the <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> tract, through the <span class=\"customMeta\" data-dictid=\"a813884d6016927771838d2d1f9d1d\">bloodstream</span> or <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> system.</td>\n</tr>\n<tr>\n<td>Clinical Presentation</td>\n<td>- In females: <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> pain, <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> irregularities, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> discharge, and <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> (due to <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube involvement).</td>\n</tr>\n<tr>\n<td> </td>\n<td>- In males: Scrotal pain, testicular swelling, and <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> (due to epididymal or <span class=\"customMeta\" data-dictid=\"4e612482cf1692777201e5b0ae20f6\">vas</span> <span class=\"customMeta\" data-dictid=\"c8e17879f71692777185360caf5372\">deferens</span> involvement).</td>\n</tr>\n<tr>\n<td> </td>\n<td>- Both sexes may present with constitutional symptoms such as fatigue, weight loss, and night sweats.</td>\n</tr>\n<tr>\n<td>Risk Factors</td>\n<td>- Close contact with active <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> cases.</td>\n</tr>\n<tr>\n<td> </td>\n<td>- <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">Immunocompromised</span> individuals (e.g., HIV/AIDS patients).</td>\n</tr>\n<tr>\n<td> </td>\n<td>- Poor living conditions and overcrowding.</td>\n</tr>\n<tr>\n<td>Diagnosis</td>\n<td>- <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">Genital</span> <span class=\"customMeta\" data-dictid=\"b76c34e672169277719964ab6c1b56\">swab</span> or <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> for <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> chain reaction (PCR) testing to detect <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> DNA.</td>\n</tr>\n<tr>\n<td> </td>\n<td>- Histopathological examination of <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> samples to identify granulomas (a characteristic finding in tuberculosis).</td>\n</tr>\n<tr>\n<td> </td>\n<td>- <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> studies (ultrasound, hysterosalpingography, or scrotal ultrasound) to assess the extent of <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> organ involvement.</td>\n</tr>\n<tr>\n<td>Treatment</td>\n<td>Genital <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> is treated with standard anti-tuberculosis drug regimens, which typically include a combination of rifampicin, isoniazid, pyrazinamide, and ethambutol. Treatment duration may last several months to a year, depending on the severity of the disease and the response to therapy.</td>\n</tr>\n<tr>\n<td>Complications</td>\n<td>- <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">Infertility</span> due to <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">tubal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or damage in females, and obstructive <span class=\"customMeta\" data-dictid=\"30e3cd418e16927771829a413730c2\">azoospermia</span> (absence of <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> in semen) in males.</td>\n</tr>\n<tr>\n<td> </td>\n<td>- Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain and scrotal discomfort.</td>\n</tr>\n<tr>\n<td> </td>\n<td>- Rarely, <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> can lead to <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> fistulas, which are <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> connections between organs.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Vaccination &amp;amp; Mass chemoprophylaxis represent", "options": [{"label": "A", "text": "Health promotion", "correct": false}, {"label": "B", "text": "Specific protection", "correct": true}, {"label": "C", "text": "Early diagnosis and treatment", "correct": false}, {"label": "D", "text": "Rehabilitation", "correct": false}], "correct_answer": "B. Specific protection", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cellulitis is:", "options": [{"label": "A", "text": "Nonsuppurative &amp;amp; Noninvasive", "correct": false}, {"label": "B", "text": "Nonsuppurative &amp;amp; invasive", "correct": false}, {"label": "C", "text": "Suprative &amp;amp; Noninvasive", "correct": false}, {"label": "D", "text": "Suprative &amp;amp; Invasive", "correct": true}], "correct_answer": "D. Suprative &amp; Invasive", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n<table border=\"1\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Erysipelas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Cellulitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Well defined margin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Not well defined (Indistinct margins)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>MC organism: Strep. pyogenes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>MC organism: Strep. pyogenes (Staph. aureus -rarely)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Associated with bulla/Vesicle formation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Bulla formation in severe cases only</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Involvement of upper S/C tissue of lymphatics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Involvement of deeper S/C tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Common site</strong>: Face with bridge of nose &amp; cheeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Common site</strong>: Legs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the relationship between incidence and prevalence in a disease with 100% mortality rate?", "options": [{"label": "A", "text": "P = I", "correct": false}, {"label": "B", "text": "P &amp;lt; I", "correct": true}, {"label": "C", "text": "P &amp;gt; I", "correct": false}, {"label": "D", "text": "No relationship between both", "correct": false}], "correct_answer": "B. P &lt; I", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B- P &amp;lt; I\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Relationship</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Interpretation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mortality &gt; Incidence</p>\n</td>\n<td>\n<p>High case fatality rate; a significant proportion of cases result in death; <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> may be lower than incidence</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mortality &lt; Incidence</p>\n</td>\n<td>\n<p>Lower case fatality rate; a significant proportion of cases survive; <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> may be higher than incidence</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mortality = Incidence</p>\n</td>\n<td>\n<p>Steady state in the population; number of new cases balances the number of deaths; <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> remains relatively stable</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/POXM6vdyIGwcVeNvkQpQ1746254570.mp3", "video": ""}, {"text": "Prostate cancer most commonly seen in which zone:", "options": [{"label": "A", "text": "Central zone", "correct": false}, {"label": "B", "text": "Transition zone", "correct": false}, {"label": "C", "text": "Peripheral zone", "correct": true}, {"label": "D", "text": "Anterior fibromuscular stroma", "correct": false}], "correct_answer": "C. Peripheral zone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Periph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "SARS is caused by novel variant of", "options": [{"label": "A", "text": "Lyssavirus", "correct": false}, {"label": "B", "text": "Coronavirus", "correct": true}, {"label": "C", "text": "Pox virus", "correct": false}, {"label": "D", "text": "Toga virus", "correct": false}], "correct_answer": "B. Coronavirus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The distal ileum was removed from a 20-year-old girl. Which absorption deficiency will be seen?", "options": [{"label": "A", "text": "Iron", "correct": false}, {"label": "B", "text": "Folic acid", "correct": false}, {"label": "C", "text": "Copper", "correct": false}, {"label": "D", "text": "Bile salts", "correct": true}], "correct_answer": "D. Bile salts", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\"&gt;Bile&lt;/span&g\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Intestine part resected</strong></td>\n<td style=\"text-align:center\"><strong>Complications</strong></td>\n</tr>\n<tr>\n<td><strong>Duodenum</strong></td>\n<td>\n<ul>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</li>\n<li>Bile <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> gastritis</li>\n<li>Malabsorption of iron</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Jejunum</strong></td>\n<td>\n<ul>\n<li>Malabsorption of various nutrients, including carbohydrates, proteins, fats, vitamins, and minerals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Ileum</strong></td>\n<td>\n<ul>\n<li>Malabsorption of vitamin B12</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> salts</li>\n<li>Malabsorption of <span class=\"customMeta\" data-dictid=\"8ddb9380a816927772028a1805805e\">fat-soluble vitamins</span> (A, D, E, and K)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Colon</strong></td>\n<td>\n<ul>\n<li>Diarrhea (loose stools)</li>\n<li>Increased water content in the stool</li>\n<li>Electrolyte imbalances</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of water, sodium, and potassium</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In Disaster management, what is the term used when patients are classified based on their likelihood of survival?", "options": [{"label": "A", "text": "Triage", "correct": true}, {"label": "B", "text": "Tagging", "correct": false}, {"label": "C", "text": "Mitigation", "correct": false}, {"label": "D", "text": "Surge capacity", "correct": false}], "correct_answer": "A. Triage", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A-Triag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is NOT a risk factor for Esophageal carcinoma?", "options": [{"label": "A", "text": "GERD", "correct": false}, {"label": "B", "text": "Betel chewing", "correct": false}, {"label": "C", "text": "Oxalate food", "correct": true}, {"label": "D", "text": "Spicy food", "correct": false}], "correct_answer": "C. Oxalate food", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\"&gt;Oxalate&lt;/span&g\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>SCC (Squamous Cell Carcinoma)</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Adenocarcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Alcohol</p>\n</li>\n<li>\n<p>Smoking</p>\n</li>\n<li>\n<p>Zenker’s diverticula</p>\n</li>\n<li>\n<p>Achalasia cardia</p>\n</li>\n<li>\n<p>Intake of</p>\n<ul>\n<li>\n<p>Nitrites</p>\n</li>\n<li>\n<p>Nitrates</p>\n</li>\n<li>\n<p>Nitrosamine</p>\n</li>\n</ul>\n</li>\n<li>\n<p>Fungal toxins</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>GERD (gastroesophageal <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease)</p>\n</li>\n<li>\n<p>High fat diet</p>\n</li>\n<li>\n<p><strong>Scleroderma:</strong> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"d9e29ece3c1692777186ce4d23d81b\">dysmotility</span> and smooth muscle <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> cause <span class=\"customMeta\" data-dictid=\"01e03927231692777188168edc7b35\">GERD</span> (gastroesophageal <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease)</p>\n</li>\n<li>\n<p>Barret’s esophagus</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>HPV (human <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">papilloma</span> virus) infections (16, 18, 31, 33)</p>\n</li>\n<li>\n<p>Plummer: Vinson syndrome</p>\n</li>\n<li>\n<p>Hot liquid ingestion</p>\n</li>\n<li>\n<p>Tylosis <span class=\"customMeta\" data-dictid=\"2a7c79c3d01692777194c9e71d569b\">Palmaris</span> &amp; Plantaris</p>\n</li>\n<li>\n<p>Deficiency of</p>\n<ul>\n<li>\n<p><strong>MO</strong> -<strong>M</strong>olybdenum</p>\n</li>\n<li>\n<p><strong>Z -Z</strong>inc</p>\n</li>\n<li>\n<p><strong>A </strong>- Vitamin-<strong>A</strong></p>\n</li>\n</ul>\n</li>\n<li>\n<p>Bulimia nervosa</p>\n</li>\n</ul>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of anemia is caused by a deficiency of Vitamin B12?", "options": [{"label": "A", "text": "Microcytic hypochromic", "correct": false}, {"label": "B", "text": "Macrocytic hypochromic", "correct": true}, {"label": "C", "text": "Normocytic normochromic", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Macrocytic hypochromic", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The hospital received a patient with varicose veins, and an intern was on duty. Which test should the intern conduct to exclude the possibility of deep vein thrombosis (DVT)?", "options": [{"label": "A", "text": "Brodie Tredelenberg test", "correct": false}, {"label": "B", "text": "Perthe’s test", "correct": true}, {"label": "C", "text": "Thomas test", "correct": false}, {"label": "D", "text": "Ober test", "correct": false}], "correct_answer": "B. Perthe’s test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Perth\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Components - I</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Components - II</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\">Apply <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> and ask the patient to stand</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Remove <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">Tourniquet</span> in standing position</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Release the pressure</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Rapid <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> from above</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">It is suggestive of <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">Incompetent</span> SFJ</p>\n</td>\n<td>\n<p style=\"text-align:center\">Apply the tourniquet</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Ask the patient to stand</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Slow <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> from below</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">It is suggestive of <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">Incompetent</span> perforators</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is not a contraindication for OPV?", "options": [{"label": "A", "text": "Leukaemia", "correct": false}, {"label": "B", "text": "Diarrhoea", "correct": true}, {"label": "C", "text": "Malignancy", "correct": false}, {"label": "D", "text": "Immunocompromised", "correct": false}], "correct_answer": "B. Diarrhoea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Diarrh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "N95 respirator is used for", "options": [{"label": "A", "text": "Droplet precaution", "correct": false}, {"label": "B", "text": "Airborne precaution", "correct": true}, {"label": "C", "text": "Contact precaution", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Airborne precaution", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Alvarado score of 2 is given for:", "options": [{"label": "A", "text": "Nausea", "correct": false}, {"label": "B", "text": "Temperature", "correct": false}, {"label": "C", "text": "Tenderness in right lower quadrant", "correct": true}, {"label": "D", "text": "Migratory pain", "correct": false}], "correct_answer": "C. Tenderness in right lower quadrant", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Tenderness in right lower qu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Alvarado Score aka MANTRELS Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MANTREL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Migratory pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Anorexia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Nausea, Vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Tenderness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Rebound tenderness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Elevated Temperature</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Leukocytosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Shift to Left</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Score of 9-10</strong>: Diagnosis is certain</p>\n</li>\n<li>\n<p><strong>Score of 7-8</strong>: High likely <span class=\"customMeta\" data-dictid=\"b64d7fd68c1692777189e1bae32157\">hood</span> of diagnosis</p>\n</li>\n<li>\n<p><strong>Score of 5-6</strong>: Equivocal (most dangerous)</p>\n<ul>\n<li>\n<p>CECT is indicated in cases of Equivocal MANTREL score findings to confirm the diagnosis.</p>\n</li>\n</ul>\n</li>\n<li>\n<p><strong>Score of 1-4</strong>: Negative for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> appendicitis</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where will the left kidney transplant be positioned ?", "options": [{"label": "A", "text": "Iliac fossa", "correct": true}, {"label": "B", "text": "Kidney fossa", "correct": false}, {"label": "C", "text": "Retroperitoneal space", "correct": false}, {"label": "D", "text": "Hypogastric region", "correct": false}], "correct_answer": "A. Iliac fossa", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4cxVdkRoLw0qwVJHFcYw1714990766.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\"&gt;Iliac&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Rodent ulcer is:", "options": [{"label": "A", "text": "Squamous cell cancer", "correct": false}, {"label": "B", "text": "Basal cell cancer", "correct": true}, {"label": "C", "text": "Rhinophyma", "correct": false}, {"label": "D", "text": "Adenocarcinoma", "correct": false}], "correct_answer": "B. Basal cell cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Worms, bugs, parasites attached in the clothing’s of a person is called:", "options": [{"label": "A", "text": "Infestation", "correct": false}, {"label": "B", "text": "Contamination", "correct": true}, {"label": "C", "text": "Infection", "correct": false}, {"label": "D", "text": "Contagion", "correct": false}], "correct_answer": "B. Contamination", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Target couple is", "options": [{"label": "A", "text": "Currently married couple where the wife is in reproductive age (15-49 yr. of age)", "correct": false}, {"label": "B", "text": "Eligible couples who have 2 – 3 living children", "correct": true}, {"label": "C", "text": "Couple using contraception", "correct": false}, {"label": "D", "text": "Couple with 3 children", "correct": false}], "correct_answer": "B. Eligible couples who have 2 – 3 living children", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B: Eligible couples who have 2 – 3 living ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "20 year old female previously diagnosed with Adenocarcinoma of the stomach , on examination following image was seen . What is the probable diagnosis ?", "options": [{"label": "A", "text": "Virchow’s node", "correct": false}, {"label": "B", "text": "Irish node", "correct": false}, {"label": "C", "text": "Sister mary joseph nodule", "correct": true}, {"label": "D", "text": "Infected umbilical hernia", "correct": false}], "correct_answer": "C. Sister mary joseph nodule", "question_images": ["https://image.prepladder.com/content/uh9selo4r6HwquBpWzpu1713417050.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Sister mary joseph nodu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Under Vision 2020, a disease that was added later in India", "options": [{"label": "A", "text": "Cataract", "correct": false}, {"label": "B", "text": "Childhood blindness", "correct": false}, {"label": "C", "text": "Glaucoma", "correct": true}, {"label": "D", "text": "Diabetic retinopathy", "correct": false}], "correct_answer": "C. Glaucoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Glau\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lady with 50% TBSA burn + involvement of dermis &amp;amp; subcutaneous tissue came to the emergency department. Which degree burn is this:", "options": [{"label": "A", "text": "1 st degree", "correct": false}, {"label": "B", "text": "2 nd degreesuperficial", "correct": false}, {"label": "C", "text": "2 nd degreedeep", "correct": false}, {"label": "D", "text": "3 rd degree", "correct": true}], "correct_answer": "D. 3 rd degree", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DUmZzsRnFKLUVoAdy0yj1687240485.png"], "explanation": "<p>Correct Option D - 3&lt;sup&gt;rd&lt;/sup&gt; deg\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Superficial partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> burn</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Deep partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> burn</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Involvement of <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> dermis</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Involvement of <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">Reticular</span> dermis</p>\n</li>\n<li>\n<p>Burn surface area in <span class=\"customMeta\" data-dictid=\"66f4e1c35716927771929959483274\">mottled</span> having whitish and pinkish area</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Type of necrosis seen in brain is", "options": [{"label": "A", "text": "Coagulative", "correct": false}, {"label": "B", "text": "Liquefactive", "correct": true}, {"label": "C", "text": "Fat", "correct": false}, {"label": "D", "text": "Fibrinoid", "correct": false}], "correct_answer": "B. Liquefactive", "question_images": [], "explanation_images": [], "explanation": "\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p><strong>Type of Necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p><strong>Causes/Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Coagulative Necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Preservation of tissue architecture but loss of <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> details</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Ischemia, <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (e.g., myocardial infarction), severe hypoxia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Liquefactive Necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Formation of <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces filled with liquid debris</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Brain infarction, <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation, pancreatitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Caseous Necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Cheese-like appearance, <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> inflammation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Tuberculosis, fungal infections (e.g., histoplasmosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Fat Necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Damage to <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissue, release of <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Acute pancreatitis, trauma to adipose-rich areas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Fibrinoid Necrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Deposition of fibrin-like material in vessel walls, associated with immune-mediated reactions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:192px\">\n<p>Vasculitis, <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> hypertension</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "If the mother is found to be positive for HBsAg at 37 weeks of pregnancy, what is the recommended course of action for the baby?", "options": [{"label": "A", "text": "Hep B vaccine only", "correct": false}, {"label": "B", "text": "Hep B vaccine + HBIG", "correct": true}, {"label": "C", "text": "First HBIG then Hep B after 1 month", "correct": false}, {"label": "D", "text": "Only HBIG", "correct": false}], "correct_answer": "B. Hep B vaccine + HBIG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"d3d938151416927771887e91804b5b\"&gt;Hep&lt;/span&gt; B vaccine + HBIG\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old chronic smoker presents with pain in his right leg. Upon examination, the pulse in the bilateral popliteal fossa is absent, and he experiences pain in the both buttock . Which level block is most likely present?", "options": [{"label": "A", "text": "Femoral artery Disease", "correct": false}, {"label": "B", "text": "Aortoiliac artery", "correct": true}, {"label": "C", "text": "Popliteal artery Disease", "correct": false}, {"label": "D", "text": "Iliac artery Disease", "correct": false}], "correct_answer": "B. Aortoiliac artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"5e1cbaefc31692777181f98722a8f6\"&gt;Aortoiliac&lt;/span&gt; A\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Site of obstruction</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Manifestation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Aorto-iliac disease</p>\n</td>\n<td>\n<p>Buttock, thigh, calf claudication</p>\n<p style=\"text-align: center;\">Leriche syndrome</p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\">Erectile <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> → Impotence</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Common <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> disease</p>\n</td>\n<td>\n<p>Thigh + Calf claudication</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Superficial <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> disease</p>\n</td>\n<td>\n<p>Calf claudication</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Popliteal disease</p>\n</td>\n<td>\n<p>Calf claudication</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Crural <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease</p>\n</td>\n<td>\n<p>Calf claudication</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Keshan's disease is caused by a lack of", "options": [{"label": "A", "text": "Selenium", "correct": true}, {"label": "B", "text": "Zinc", "correct": false}, {"label": "C", "text": "Copper", "correct": false}, {"label": "D", "text": "Iron", "correct": false}], "correct_answer": "A. Selenium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diseases are NOT transmitted by this vector ?", "options": [{"label": "A", "text": "Kala azar", "correct": false}, {"label": "B", "text": "Oriental sore", "correct": false}, {"label": "C", "text": "Chagas disease", "correct": true}, {"label": "D", "text": "Cutaneous leishmaniasis", "correct": false}], "correct_answer": "C. Chagas disease", "question_images": ["https://image.prepladder.com/content/sSkDeteyiNOlFgHvIgzs1687242590.jpeg"], "explanation_images": [], "explanation": "<p>Correct Option C - Chag\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Vector</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Vector-Borne Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Mosquitoes</strong></p>\n</td>\n<td colspan=\"1\" rowspan=\"1\">\n<ul>\n<li>\n<p>Malaria</p>\n</li>\n<li>\n<p>Dengue</p>\n</li>\n<li>\n<p>Zika</p>\n</li>\n<li>\n<p>Chikungunya</p>\n</li>\n<li>\n<p>Yellow Fever</p>\n</li>\n<li>\n<p>West Nile Virus</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Ticks</strong></p>\n</td>\n<td colspan=\"1\" rowspan=\"1\">\n<ul>\n<li>\n<p>Lyme Disease</p>\n</li>\n<li>\n<p>Rocky Mountain</p>\n</li>\n<li>\n<p>Spotted Fever</p>\n</li>\n<li>\n<p>Ehrlichiosis</p>\n</li>\n<li>\n<p>Babesiosis</p>\n</li>\n<li>\n<p>Tick-borne</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Sandflies</strong></p>\n</td>\n<td colspan=\"1\" rowspan=\"1\">\n<ul>\n<li>\n<p>Leishmaniasis</p>\n</li>\n<li>\n<p>Sandfly Fever</p>\n</li>\n<li>\n<p>Visceral <span class=\"customMeta\" data-dictid=\"f60a0a7ad716927771916ed83e3586\">Leishmaniasis</span> (Kala-azar)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Fleas</strong></p>\n</td>\n<td colspan=\"1\" rowspan=\"1\">\n<ul>\n<li>\n<p>Plague</p>\n</li>\n<li>\n<p>Murine Typhus</p>\n</li>\n<li>\n<p>Bartonellosis</p>\n</li>\n<li>\n<p>Tularemia</p>\n</li>\n<li>\n<p>Rickettsialpox</p>\n</li>\n<li>\n<p>Cat Scratch Disease</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which contraceptive method should not be used in cases of deep vein thrombosis (DVT)?", "options": [{"label": "A", "text": "IUD", "correct": false}, {"label": "B", "text": "Condoms", "correct": false}, {"label": "C", "text": "OCP", "correct": true}, {"label": "D", "text": "No C/l", "correct": false}], "correct_answer": "C. OCP", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Contraceptive Method</strong></p>\n</td>\n<td>\n<p><strong>Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"9\">\n<p>Combined Oral Contraceptives</p>\n<p>(COCs)</p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>History of blood clots, stroke, or heart disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Liver disease or tumors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Breast cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (high blood pressure)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Migraine with aura</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Current or history of certain types of cancer, such as liver, cervical, or <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Smokers over the age of 35</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Uncontrolled diabetes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>History of <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"9\">\n<p>Progestin-Only Pills (POPs)</p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Current or history of breast cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Liver disease or tumors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Unexplained <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> bleeding</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (high blood pressure)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Migraine with aura</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Known or suspected pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Active liver disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Severe liver dysfunction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Previous <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"9\">\n<p>Contraceptive Patch</p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>History of blood clots, stroke, or heart disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Liver disease or tumors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Breast cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Uncontrolled <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (high blood pressure)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Migraine with aura</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>History of certain types of cancer, such as liver, cervical, or <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Smokers over the age of 35</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Obesity (BMI ≥ 30)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Age over 35 and heavy smoking (15 or more cigarettes per day)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"6\">\n<p>Contraceptive Implants</p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Known or suspected pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Active liver disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Liver tumors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Unexplained <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> bleeding</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Breast cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Hypersensitivity to the implant components</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"8\">Intrauterine Devices (IUDs)\n\t\t\t<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Current <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease (PID) or history of <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> PID</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Current or recent (within the past 3 months) <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Unexplained <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> bleeding</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Known or suspected pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Uterine abnormalities</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Active cervical, uterine, or ovarian cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Wilson's disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Copper <span class=\"customMeta\" data-dictid=\"aa1288c36b16927771814fa5aa84eb\">allergy</span> (for <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> IUD)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Barrier Methods</p>\n</td>\n<td>\n<ul>\n<li>None</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the absolute contraindications for intrauterine contraceptive devices (IUCDs)?", "options": [{"label": "A", "text": "Anaemia", "correct": false}, {"label": "B", "text": "DVT", "correct": false}, {"label": "C", "text": "Acute PID", "correct": true}, {"label": "D", "text": "Endometrioses", "correct": false}], "correct_answer": "C. Acute PID", "question_images": [], "explanation_images": [], "explanation": "<table style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Absolute</strong></td>\n<td><strong>Relative </strong></td>\n</tr>\n<tr>\n<td>Pregnancy</td>\n<td>Anemia, Menorrhagia </td>\n</tr>\n<tr>\n<td>Recurrent PID</td>\n<td>History of PID </td>\n</tr>\n<tr>\n<td>Vaginal <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> of undiagnosed etiology </td>\n<td>Purulent <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> discharge </td>\n</tr>\n<tr>\n<td>Cancer of cervix, <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> or adnexa </td>\n<td>Distortion of <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> cavities e.g., <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> malformations, fibroids </td>\n</tr>\n<tr>\n<td>Previous <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy </td>\n<td>Unmotivated person </td>\n</tr>\n</tbody>\n\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Contraceptive Method</strong></p>\n</td>\n<td>\n<p><strong>Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"8\">\n<p>Intrauterine Devices (IUDs)</p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Current <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease (PID) or history of <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> PID</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Current or recent (within the past 3 months) <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Unexplained <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> bleeding</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Known or suspected pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Uterine abnormalities</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Active cervical, uterine, or ovarian cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Wilson's disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Copper <span class=\"customMeta\" data-dictid=\"aa1288c36b16927771814fa5aa84eb\">allergy</span> (for <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> IUD)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most suitable contraceptive recommendation for a recently married couple is:", "options": [{"label": "A", "text": "OCPs", "correct": true}, {"label": "B", "text": "Condoms", "correct": false}, {"label": "C", "text": "Sterilization", "correct": false}, {"label": "D", "text": "IUD", "correct": false}], "correct_answer": "A. OCPs", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ When providing contraceptive advice to a newly married couple, several factors need to be considered, including effectiveness, convenience, safety, and personal preferences. While the choice ultimately depends on the couple's specific needs and circumstances, oral contraceptive pills (OCPs) are often a suitable option for many couples.</li><li>↳ OCPs (Oral Contraceptive Pills): OCPs are a highly effective form of contraception when used correctly. They provide reliable pregnancy prevention, are convenient to use, and have additional benefits such as regulating menstrual cycles, reducing menstrual pain, and improving acne. OCPs can be started immediately and discontinued when the couple decides to conceive.</li><li>↳ OCPs (Oral Contraceptive Pills):</li><li>↳ Incorrect Options:</li><li>↳ Incorrect Options:</li><li>↳ Option B: Condoms: Condoms are a barrier method of contraception that provide protection against both unintended pregnancies and sexually transmitted infections (STIs). They are easily accessible, affordable, and do not require a prescription. Condoms can be a good option for couples who prefer non-hormonal methods or need STI protection in addition to contraception. However, they may have a higher failure rate compared to hormonal methods like OCPs.</li><li>↳ Option B: Condoms:</li><li>↳ Option C: Sterilization: Sterilization, such as tubal ligation for women or vasectomy for men, is a permanent method of contraception. It is considered a long-term and highly effective option for couples who have completed their desired family size or do not wish to have biological children. Sterilization should be approached as a permanent decision, as reversal procedures are costly and not always successful.</li><li>↳ Option C: Sterilization:</li><li>↳ Option D: IUD (Intrauterine Device): IUDs are long-acting reversible contraceptives that offer highly effective contraception for an extended period. They can be a suitable choice for couples who desire long-term contraception without the need for daily or frequent user involvement. However, IUDs require a healthcare provider's insertion, which may not be immediately accessible for a newly married couple.</li><li>↳ Option D: IUD (Intrauterine Device):</li></u\n<p><strong>References:</strong></p>\n<ul><li>↳ Importance of Family Planning: Newly married couples may have different aspirations and plans for their future. Family planning through contraception enables them to establish a strong foundation in their marriage, pursue education or career goals, and ensure emotional and financial stability before starting a family.</li><li>↳ Choice of Contraceptive Methods: There are various contraceptive methods available for newly wedded couples. The choice of method depends on factors such as effectiveness, convenience, personal preferences, health conditions, and future pregnancy plans. Some commonly used methods include: a. Barrier Methods: These include male and female condoms, diaphragms, and cervical caps. They provide a physical barrier to prevent sperm from reaching the egg. b. Hormonal Methods: These include combined oral contraceptives (COCs), progestin-only pills (POPs), contraceptive patches, injections, implants, and hormonal intrauterine devices (IUDs). They work by altering hormone levels to inhibit ovulation, thinning the uterine lining, and thickening cervical mucus. c. Intrauterine Devices (IUDs): These small, T-shaped devices are inserted into the uterus to prevent pregnancy. They can be hormonal (releasing progestin) or non-hormonal (copper-based) and provide long-term contraception. d. Sterilization: Permanent methods like tubal ligation (for women) or vasectomy (for men) can be considered if the couple has completed their desired family size.</li><li>↳ Counseling and Education: Newly wedded couples should receive comprehensive counseling on different contraceptive methods. They should understand the benefits, effectiveness, possible side effects, and proper usage of each method. Couples should also be aware of emergency contraception options in case of contraceptive failure or unprotected intercourse.</li><li>↳ Dual Protection: Newly wedded couples may also consider using dual protection by combining two methods, such as using condoms along with hormonal contraceptives. This provides added protection against unintended pregnancies and reduces the risk of sexually transmitted infections (STIs).</li><li>↳ Regular Follow-up and Reassessment: Couples should have regular follow-up visits with a healthcare provider to assess the effectiveness of the chosen contraceptive method and address any concerns or side effects. As their needs may change over time, periodic reassessment of the contraceptive method may be necessary.</li><li>↳ Communication and Shared Decision-Making: It is important for newly wedded couples to openly communicate about their contraception preferences, concerns, and future plans. Shared decision-making ensures that both partners are actively involved in choosing the most suitable contraceptive method for their unique circumstances.</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following condition", "options": [{"label": "A", "text": "Osteosarcoma", "correct": true}, {"label": "B", "text": "Ewing sarcoma", "correct": false}, {"label": "C", "text": "Osteiod Osteoma", "correct": false}, {"label": "D", "text": "GCT", "correct": false}], "correct_answer": "A. Osteosarcoma", "question_images": ["https://image.prepladder.com/content/N5ZV0136R73L6iTRZcGD1700119176.png"], "explanation_images": [], "explanation": "<p>Correct Option A - O\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Radiological Findings</strong></p>\n</td>\n<td>\n<p><strong>Orthopedic <span class=\"customMeta\" data-dictid=\"d612c801d71692777194d0e00b8551\">Oncology</span> Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Codman's triangle</p>\n</td>\n<td rowspan=\"2\">\n<p>Osteosarcoma</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sunburst appearance</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Onion-skin appearance</p>\n</td>\n<td rowspan=\"2\">\n<p>Ewing's sarcoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Permeative bone destruction</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cartilage-capped bony projection</p>\n</td>\n<td>\n<p>Osteochondroma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Geode-like lesions</p>\n</td>\n<td>\n<p>Aneurysmal bone cyst</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Eccentric, soap-bubble appearance</p>\n</td>\n<td>\n<p>Chondroblastoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Expansile <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with thin <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> rim</p>\n</td>\n<td>\n<p>Simple bone cyst</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ground-glass appearance</p>\n</td>\n<td>\n<p>Fibrous dysplasia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Soap-bubble appearance</p>\n</td>\n<td>\n<p>Giant cell tumor (osteoclastoma)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Well-defined <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> margin</p>\n</td>\n<td>\n<p>Enchondroma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Geographical pattern of bone destruction</p>\n</td>\n<td>\n<p>Metastatic bone lesions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Multiple lucent lesions</p>\n</td>\n<td>\n<p>Multiple myeloma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Linear, vertical, or <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> striations</p>\n</td>\n<td>\n<p>Fibrosarcoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ill-defined, moth-eaten appearance</p>\n</td>\n<td>\n<p>Chondrosarcoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A Post-menopausal women slipped and fell down on an outstretched hand in the washroom. X-ray of her distal forearm is given below. Diagnose the following condition?", "options": [{"label": "A", "text": "Colle's Fracture", "correct": true}, {"label": "B", "text": "Montaggiea fracture", "correct": false}, {"label": "C", "text": "Smith Fracture", "correct": false}, {"label": "D", "text": "Galeazzi fracture", "correct": false}], "correct_answer": "A. Colle's Fracture", "question_images": ["https://image.prepladder.com/content/AmuCW6dvGrOshMHEGuVi1691375592.jpg"], "explanation_images": [], "explanation": "<p>Correct Option A - Colle's Fracture:</p>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Fracture Name</strong></p>\n</td>\n<td>\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td>\n<p><strong>Sites Involved</strong></p>\n</td>\n<td>\n<p><strong>Special History</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Colles' Fracture</p>\n</td>\n<td>\n<p>Dorsal <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius</p>\n</td>\n<td>\n<p>Distal radius</p>\n</td>\n<td>\n<p>Falling on an outstretched hand</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Smith's Fracture</p>\n</td>\n<td>\n<p>Volar <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius</p>\n</td>\n<td>\n<p>Distal radius</p>\n</td>\n<td>\n<p>Falling on a flexed wrist</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Monteggia Fracture</p>\n</td>\n<td>\n<p>Proximal <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head dislocation</p>\n</td>\n<td>\n<p>Proximal ulna, <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</p>\n</td>\n<td>\n<p>Direct blow to the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> or forearm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Galeazzi Fracture</p>\n</td>\n<td>\n<p>Distal <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint dislocation</p>\n</td>\n<td>\n<p>Distal radius, <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint</p>\n</td>\n<td>\n<p>Fall on an outstretched hand with an <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation</p>\n</td>\n</tr>\n</tbody>\n\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Fracture Name</strong></p>\n</td>\n<td>\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td>\n<p><strong>Sites Involved</strong></p>\n</td>\n<td>\n<p><strong>Special History</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Colles' Fracture</p>\n</td>\n<td>\n<p>Dorsal <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius</p>\n</td>\n<td>\n<p>Distal radius</p>\n</td>\n<td>\n<p>Falling on an outstretched hand</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Smith's Fracture</p>\n</td>\n<td>\n<p>Volar <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> radius</p>\n</td>\n<td>\n<p>Distal radius</p>\n</td>\n<td>\n<p>Falling on a flexed wrist</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Monteggia Fracture</p>\n</td>\n<td>\n<p>Proximal <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head dislocation</p>\n</td>\n<td>\n<p>Proximal ulna, <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</p>\n</td>\n<td>\n<p>Direct blow to the <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> or forearm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Galeazzi Fracture</p>\n</td>\n<td>\n<p>Distal <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint dislocation</p>\n</td>\n<td>\n<p>Distal radius, <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint</p>\n</td>\n<td>\n<p>Fall on an outstretched hand with an <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nightstick Fracture</p>\n</td>\n<td>\n<p>Isolated <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> shaft</p>\n</td>\n<td>\n<p>Midshaft ulna</p>\n</td>\n<td>\n<p>Direct blow to the forearm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Barton's Fracture</p>\n</td>\n<td>\n<p>Fracture of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> with <span class=\"customMeta\" data-dictid=\"f953c828ea16927771909cb3a51e36\">intra-articular</span> extension</p>\n</td>\n<td>\n<p>Distal radius</p>\n</td>\n<td>\n<p>Falling onto a pronated or supinated wrist</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Essex-Lopresti Fracture</p>\n</td>\n<td>\n<p>Radial head <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> associated with <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> dissociation</p>\n</td>\n<td>\n<p>Radial head, <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint</p>\n</td>\n<td>\n<p>Axial load transmitted through the forearm</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the shown image", "options": [{"label": "A", "text": "Ankle knee stabilizer", "correct": false}, {"label": "B", "text": "Patella tendon bearing brace", "correct": true}, {"label": "C", "text": "Thomas splint", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Patella tendon bearing brace", "question_images": ["https://image.prepladder.com/content/XOOFaD3RMOyQR2TLbr261700134974.png"], "explanation_images": ["https://image.prepladder.com/content/hOGJFmiN1rggxBNjwnR71700135070.png", "https://image.prepladder.com/content/S8CY3hVhGhF17ipAfJo81700135120.png"], "explanation": "<p>Correct Option B - Patella &lt;span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\"&gt;Tendon&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\"&gt;Bearing&lt;/span&gt; B\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Type</strong></p>\n</td>\n<td>\n<p><strong>Use/Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ankle Brace</p>\n</td>\n<td>\n<p>Ankle sprains, instability, post-injury protection</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Knee Brace</p>\n</td>\n<td>\n<p>Ligament injuries (ACL, PCL, MCL, LCL), <span class=\"customMeta\" data-dictid=\"4560fde2ec16927771944a8ef8c066\">patellofemoral</span> pain, osteoarthritis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cervical Collar</p>\n</td>\n<td>\n<p>Cervical spine injuries, neck pain, whiplash</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hip <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">Abduction</span> Orthosis</p>\n</td>\n<td>\n<p>Hip fractures, hip dislocations, post-surgical stabilization</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Knee Immobilizer</p>\n</td>\n<td>\n<p>Knee fractures, <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injuries, post-surgical immobilization</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Back Brace</p>\n</td>\n<td>\n<p>Low back pain, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fractures, post-surgical support</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Posterior Leg Splint</p>\n</td>\n<td>\n<p>Tibia or <span class=\"customMeta\" data-dictid=\"9e7e90693316927772027cba1a6018\">fibula</span> fractures, post-injury immobilization</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Air Cast</p>\n</td>\n<td>\n<p>Ankle fractures, sprains, post-injury protection</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Patellar Stabilizing Brace</p>\n</td>\n<td>\n<p>Patellar instability, <span class=\"customMeta\" data-dictid=\"4560fde2ec16927771944a8ef8c066\">patellofemoral</span> pain syndrome, patellar tendonitis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the lesion shown in the image given below.", "options": [{"label": "A", "text": "Port Wine stain", "correct": true}, {"label": "B", "text": "Melanoma", "correct": false}, {"label": "C", "text": "Molluscum contagiosum", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma", "correct": false}], "correct_answer": "A. Port Wine stain", "question_images": ["https://image.prepladder.com/content/9Y0pV7Il7Ccg7fnNzh0K1687408740.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Port W\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is shown in the image below?", "options": [{"label": "A", "text": "Pleural effusion", "correct": false}, {"label": "B", "text": "Pneumothorax", "correct": true}, {"label": "C", "text": "Consolidation", "correct": false}, {"label": "D", "text": "Cavity", "correct": false}], "correct_answer": "B. Pneumothorax", "question_images": ["https://image.prepladder.com/content/2ujAIWejCM7Wxhx9lSHq1712036165.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Pneumoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are true about Brown Sequard Syndrome except", "options": [{"label": "A", "text": "I/L loss of vibration", "correct": false}, {"label": "B", "text": "I/L loss of joint position", "correct": false}, {"label": "C", "text": "C/L loss of pain", "correct": false}, {"label": "D", "text": "C/L loss of vibration", "correct": true}], "correct_answer": "D. C/L loss of vibration", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D.\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The marked muscle is supplied by which nerve?", "options": [{"label": "A", "text": "Radial nerve", "correct": false}, {"label": "B", "text": "Ulnar nerve", "correct": false}, {"label": "C", "text": "Median nerve", "correct": false}, {"label": "D", "text": "Musculocutaneous nerve", "correct": true}], "correct_answer": "D. Musculocutaneous nerve", "question_images": ["https://image.prepladder.com/content/KgJVajV7VQsiS2Kho59w1712570286.png"], "explanation_images": [], "explanation": "<p>Correct Option D\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Innervation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biceps brachii</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Musculocutaneus nerve (C5, C6)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexes and supinates the forearm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brachialis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Musculocutaneus nerve (C5, C6)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexes the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> in all positions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coracobrachialis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Musculocutaneus nerve (C5, C6,C7)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexes and adducts the arms</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked structure in the given image", "options": [{"label": "A", "text": "Ischial spine", "correct": false}, {"label": "B", "text": "Anterior superior iliac spine", "correct": true}, {"label": "C", "text": "Anterior inferior iliac spine", "correct": false}, {"label": "D", "text": "Ischial tuberosity", "correct": false}], "correct_answer": "B. Anterior superior iliac spine", "question_images": ["https://image.prepladder.com/content/NFkyZCIi3RgfSHdAwsqb1712732145.png"], "explanation_images": ["https://image.prepladder.com/content/MpAxR8yfZ1H1RJvJkDy81712732164.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At which vertebral level can the celiac vessel be observed in?", "options": [{"label": "A", "text": "T9", "correct": false}, {"label": "B", "text": "T10", "correct": false}, {"label": "C", "text": "T12", "correct": true}, {"label": "D", "text": "L2", "correct": false}], "correct_answer": "C. T12", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rJo9JolzQE8w5ij37h9S1716552043.png"], "explanation": "<p>Correct Option C:T12\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Find therapeutic index of a drug from the information given below: LD 50: 400 ED 50: 100", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "4", "correct": true}, {"label": "D", "text": "8", "correct": false}], "correct_answer": "C. 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mid-arm circumference measurement for severe acute malnutrition?", "options": [{"label": "A", "text": "&amp;gt; 14.5 cm", "correct": false}, {"label": "B", "text": "13.5-14.5 cm", "correct": false}, {"label": "C", "text": "11.5-12.5 cm", "correct": false}, {"label": "D", "text": "&amp;lt; 11.5 cm", "correct": true}], "correct_answer": "D. &lt; 11.5 cm", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/t75JVqE75Wc4YfdjnvdM1713502341.png"], "explanation": "<p>Correct option D: &amp;lt; 11.5\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a 14-year-old child who has short stature, widely placed nipples, and primary amenorrhea?", "options": [{"label": "A", "text": "Turner syndrome", "correct": true}, {"label": "B", "text": "Down syndrome", "correct": false}, {"label": "C", "text": "Edward syndrome", "correct": false}, {"label": "D", "text": "Pattau syndrome", "correct": false}], "correct_answer": "A. Turner syndrome", "question_images": ["https://image.prepladder.com/content/MPPw962VFCk2Or3vcAUp1695215187.png"], "explanation_images": ["https://image.prepladder.com/content/yhOwFc7Z3I9a2fTRk2PJ1695215172.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the abnormal condition given below:", "options": [{"label": "A", "text": "Hydrocele", "correct": false}, {"label": "B", "text": "Varicocele", "correct": false}, {"label": "C", "text": "Testicular atrophy", "correct": false}, {"label": "D", "text": "Testicular Torsion", "correct": true}], "correct_answer": "D. Testicular Torsion", "question_images": ["https://image.prepladder.com/content/p8dCrcJU2k8g2BU2Lkc31695541356.png"], "explanation_images": ["https://image.prepladder.com/content/F2Rv4Jy5l4wKcblSGAxY1713259866.png"], "explanation": "<p>Correct Option D - Testicular T\n<table>\n<tbody>\n<tr>\n<td style=\"text-align:center\">\n<p><strong>Extra Vaginal</strong></p>\n</td>\n<td style=\"text-align:center\">\n<p><strong>Intra Vaginal</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Extra <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> <span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\">Torsion</span> occurs outside the <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Torsion occurs within the <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis</p>\n</li>\n<li>\n<p>Most common</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a 3-month-old baby who has a fever and a respiratory rate of 70/min, but shows no signs of stridor, chest indrawing, or convulsions?", "options": [{"label": "A", "text": "Pneumonia", "correct": true}, {"label": "B", "text": "Severe pneumonia", "correct": false}, {"label": "C", "text": "Very severe pneumonia", "correct": false}, {"label": "D", "text": "No Pneumonia", "correct": false}], "correct_answer": "A. Pneumonia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Pneumonia:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classify as</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of any general</p>\n<p>danger sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Give 1 dose of <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> <span class=\"customMeta\" data-dictid=\"e1a1f4fa35169277718150f74fa895\">ampicillin</span> and <span class=\"customMeta\" data-dictid=\"ca244a562f16927771884ac81c7d2e\">gentamicin</span> and refer urgently to hospital</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of either chest</p>\n<p>indrawing and/or fast</p>\n<p>breathing but no general</p>\n<p>danger sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Start oral <span class=\"customMeta\" data-dictid=\"d1e73ea72b1692777181fe0162bd92\">amoxicillin</span> x 5 days</li>\n<li>The child is sent home and assessed after 48 hours</li>\n<li>If the child has improved continue the same treatment</li>\n<li>If the child has worsened, refer to a higher center</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No fast breathing, no chest</p>\n<p>indrawing, no general</p>\n<p>danger signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No pneumonia: <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">Cough</span> or cold only</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Home-based supportive care</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fast breathing:</p>\n<ul>\n<li>&lt; 2 months: &gt; 60/ min</li>\n<li>2-12 months: &gt; 50/ min</li>\n<li>1-5 years: &gt; 40/ min</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General danger signs:</p>\n<ul>\n<li>Convulsions</li>\n<li>Lethargy</li>\n<li>Inability to drink or breastfeed</li>\n<li>Persistent vomiting</li>\n<li>Unconsciousness</li>\n<li>Stridor in a calm child</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classify as</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of any general</p>\n<p>danger sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Give 1 dose of <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> <span class=\"customMeta\" data-dictid=\"e1a1f4fa35169277718150f74fa895\">ampicillin</span> and <span class=\"customMeta\" data-dictid=\"ca244a562f16927771884ac81c7d2e\">gentamicin</span> and refer urgently to hospital</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of either chest</p>\n<p>indrawing and/or fast</p>\n<p>breathing but no general</p>\n<p>danger sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Start oral <span class=\"customMeta\" data-dictid=\"d1e73ea72b1692777181fe0162bd92\">amoxicillin</span> x 5 days</li>\n<li>The child is sent home and assessed after 48 hours</li>\n<li>If the child has improved continue the same treatment</li>\n<li>If the child has worsened, refer to a higher center</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No fast breathing, no chest</p>\n<p>indrawing, no general</p>\n<p>danger signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No pneumonia: <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">Cough</span> or cold only</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Home-based supportive care</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fast breathing:</p>\n<ul>\n<li>&lt; 2 months: &gt; 60/ min</li>\n<li>2-12 months: &gt; 50/ min</li>\n<li>1-5 years: &gt; 40/ min</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General danger signs:</p>\n<ul>\n<li>Convulsions</li>\n<li>Lethargy</li>\n<li>Inability to drink or breastfeed</li>\n<li>Persistent vomiting</li>\n<li>Unconsciousness</li>\n<li>Stridor in a calm child</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dVNhAVH0nhIe6PyYNVo21745046147.mp3", "video": ""}, {"text": "Long term diabetic patient with blisters, walked barefoot for a few miles on hot sand. He is presented with this clinical condition. What is the probable diagnosis", "options": [{"label": "A", "text": "Diabetic foot", "correct": false}, {"label": "B", "text": "Burn", "correct": false}, {"label": "C", "text": "Necrotizing fasciitis", "correct": true}, {"label": "D", "text": "Cellulitis", "correct": false}], "correct_answer": "C. Necrotizing fasciitis", "question_images": ["https://image.prepladder.com/content/tBT8Yec8QsYopec2VOfq1691377538.jpeg"], "explanation_images": ["https://image.prepladder.com/content/Vg1xUc4Lmf4b1bZjGyOw1695541004.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How many primary teeth does a 3-year-old child have?", "options": [{"label": "A", "text": "20", "correct": true}, {"label": "B", "text": "24", "correct": false}, {"label": "C", "text": "16", "correct": false}, {"label": "D", "text": "32", "correct": false}], "correct_answer": "A. 20", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 20:</p>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"76e17c45ef16927771851bc19cfc04\">Dentition</span> (milk/temporary teeth)</strong></p>\n</td>\n<td>\n<p><strong>Secondary <span class=\"customMeta\" data-dictid=\"76e17c45ef16927771851bc19cfc04\">Dentition</span> (permanent teeth)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Begin at</strong></p>\n</td>\n<td>\n<p>6 months</p>\n</td>\n<td>\n<p>6 years</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>1 tooth to erupt</strong></p>\n</td>\n<td>\n<p>Lower central incisor</p>\n</td>\n<td>\n<p>1<sup>st</sup> molar</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Last tooth</strong></p>\n</td>\n<td>\n<p>Second molar</p>\n</td>\n<td>\n<p>3<sup>rd</sup> molar (or) wisdom tooth</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Completes at</strong></p>\n</td>\n<td>\n<p>2.5-3 years</p>\n</td>\n<td>\n<p>12 years except for the 3rd molar (18-25 years)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Total no. of teeth</strong></p>\n</td>\n<td>\n<p>20</p>\n</td>\n<td>\n<p>28-32</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Teeth in each <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> (ICPM)</strong></p>\n</td>\n<td>\n<p>I C P M</p>\n</td>\n<td>\n<p>I C P M</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>2 1 0 2</p>\n</td>\n<td>\n<p>2 1 2 3</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the sign :", "options": [{"label": "A", "text": "Seashore sign", "correct": true}, {"label": "B", "text": "Barcode sign", "correct": false}, {"label": "C", "text": "Stratosphere sign", "correct": false}, {"label": "D", "text": "Deep sulcus sign", "correct": false}], "correct_answer": "A. Seashore sign", "question_images": ["https://image.prepladder.com/content/KuThWDCtbzFzBuhnB4fX1697605886.png"], "explanation_images": ["https://image.prepladder.com/content/8C767Z9hmbDBt0OspXrW1697605687.png", "https://image.prepladder.com/content/4pZVK6Z50dsxe0yoPSDO1697605719.png", "https://image.prepladder.com/content/EX4GWFB77R54aQPPwp911687413173.png", "https://image.prepladder.com/content/bzJtQDEw7AfLDgWRxziT1687413190.png", "https://image.prepladder.com/content/LrGQkzDsxxXkn1lXcBYt1687413210.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the probable cause of a back deformity in a 10-year-old female patient visiting the outpatient department?", "options": [{"label": "A", "text": "Congenital", "correct": false}, {"label": "B", "text": "NF1", "correct": false}, {"label": "C", "text": "Idiopathic", "correct": true}, {"label": "D", "text": "Neuromuscular", "correct": false}], "correct_answer": "C. Idiopathic", "question_images": ["https://image.prepladder.com/content/DLAQ88Lre9Znu68iTIPj1691377755.jpg"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the probable diagnosis for a 35-year-old male patient who has a history of chronic smoking and alcoholism, and is currently experiencing a productive cough? The provided image displays the chest X-ray for reference.", "options": [{"label": "A", "text": "Abscess", "correct": false}, {"label": "B", "text": "Consolidation", "correct": true}, {"label": "C", "text": "Cavity", "correct": false}, {"label": "D", "text": "Pleural effusion", "correct": false}], "correct_answer": "B. Consolidation", "question_images": ["https://image.prepladder.com/content/OBYsRVjpvCiNzxNpFsaz1687413459.png"], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>CXR Radiological Findings</strong></p>\n</td>\n<td>\n<p><strong>Associated Diseases</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Consolidation</p>\n</td>\n<td>\n<p>Pneumonia, Lung abscess</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Infiltrates</p>\n</td>\n<td>\n<p>Pulmonary edema, ARDS</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Atelectasis</p>\n</td>\n<td>\n<p>Obstructive lung disease, Pneumothorax</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pleural effusion</p>\n</td>\n<td>\n<p>Pleural effusion, Empyema</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cavity</p>\n</td>\n<td>\n<p>Tuberculosis, Lung abscess</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nodule/mass</p>\n</td>\n<td>\n<p>Lung cancer, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ground-glass opacities</p>\n</td>\n<td>\n<p>Interstitial lung diseases (e.g., <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> fibrosis, Pneumoconiosis)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Honeycombing</p>\n</td>\n<td>\n<p>Idiopathic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis, End-stage <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> lung disease</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Air bronchograms</p>\n</td>\n<td>\n<p>Consolidation, Alveolar processes</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mediastinal shift</p>\n</td>\n<td>\n<p>Pneumothorax, Large pleural effusion, <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">Mediastinal</span> mass</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has come in with a combination of fever, cough, and expectoration. The provided image displays the chest X-ray. What is the probable infectious agent responsible for these symptoms?", "options": [{"label": "A", "text": "Hemophilus influenza", "correct": false}, {"label": "B", "text": "Parainfluenza virus", "correct": false}, {"label": "C", "text": "Pneumococcus", "correct": true}, {"label": "D", "text": "S. aureus", "correct": false}], "correct_answer": "C. Pneumococcus", "question_images": ["https://image.prepladder.com/content/VN6Z1Bu2HBEXivK0dBEk1691377895.jpeg"], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Organism</strong></p>\n</td>\n<td>\n<p><strong>Radiological Features</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Streptococcus pneumoniae</p>\n</td>\n<td>\n<p>Lobar consolidation, air bronchograms</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Haemophilus influenzae</p>\n</td>\n<td>\n<p>Patchy or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> consolidation, may have pleural effusion</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mycoplasma pneumoniae</p>\n</td>\n<td>\n<p>Interstitial infiltrates, <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> or patchy opacities</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Legionella pneumophila</p>\n</td>\n<td>\n<p>Multilobar involvement, patchy infiltrates</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Staphylococcus aureus</p>\n</td>\n<td>\n<p>Lobar consolidation, cavitation, <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Klebsiella pneumoniae</p>\n</td>\n<td>\n<p>Lobar <span class=\"customMeta\" data-dictid=\"b1357efd5116927771859dfba380e7\">consolidation</span> with bulging fissures, <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pseudomonas aeruginosa</p>\n</td>\n<td>\n<p>Multilobar involvement, patchy infiltrates, cavitation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chlamydophila pneumoniae</p>\n</td>\n<td>\n<p>Interstitial infiltrates, <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> opacities</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Respiratory viruses (e.g., influenza, adenovirus)</p>\n</td>\n<td>\n<p>Diffuse or patchy opacities, may have <span class=\"customMeta\" data-dictid=\"b1357efd5116927771859dfba380e7\">consolidation</span> or <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> inflammation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arlt’s line is seen in which condition?", "options": [{"label": "A", "text": "Vernal keratoconjunctivitis", "correct": false}, {"label": "B", "text": "Phlyctenular conjunctivitis", "correct": false}, {"label": "C", "text": "Ophthalmia neonatorum", "correct": false}, {"label": "D", "text": "Trachoma", "correct": true}], "correct_answer": "D. Trachoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Trach\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In myopia, image is formed at:", "options": [{"label": "A", "text": "Anterior to retina", "correct": true}, {"label": "B", "text": "Posterior to retina", "correct": false}, {"label": "C", "text": "On retina", "correct": false}, {"label": "D", "text": "Uvea", "correct": false}], "correct_answer": "A. Anterior to retina", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;Anterior&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Maximum visual field is seen in?", "options": [{"label": "A", "text": "Temporal", "correct": true}, {"label": "B", "text": "Nasal", "correct": false}, {"label": "C", "text": "Inferior", "correct": false}, {"label": "D", "text": "Superior", "correct": false}], "correct_answer": "A. Temporal", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Failure of closure of rostral neuropore at 25th day leads to", "options": [{"label": "A", "text": "Craniorachischisis", "correct": false}, {"label": "B", "text": "Spina Bifida", "correct": false}, {"label": "C", "text": "Anencephaly", "correct": true}, {"label": "D", "text": "Hydranencephaly", "correct": false}], "correct_answer": "C. Anencephaly", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Anenceph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the mode of inheritance in a patient suffering from red-green colour blindness?", "options": [{"label": "A", "text": "Autosomal dominant", "correct": false}, {"label": "B", "text": "Autosomal recessive", "correct": false}, {"label": "C", "text": "X-linked dominant", "correct": false}, {"label": "D", "text": "X-linked recessive", "correct": true}], "correct_answer": "D. X-linked recessive", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"dd35346fc716927772029e2f0bb10f\"&gt;X-linked&lt;/span&gt; recessiv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UpiPGXrG1aNH3DCLQRBJ1748419317.mp3", "video": ""}, {"text": "An injury to the shown area can lead to fracture of which bone?", "options": [{"label": "A", "text": "Scaphoid", "correct": true}, {"label": "B", "text": "Lunate", "correct": false}, {"label": "C", "text": "Trapezium", "correct": false}, {"label": "D", "text": "Hamate", "correct": false}], "correct_answer": "A. Scaphoid", "question_images": ["https://image.prepladder.com/content/HS0iMMKsfmQPqiuCOSaj1714480369.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Scaph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle originates from medial epicondyle of humerus?", "options": [{"label": "A", "text": "Supinator", "correct": false}, {"label": "B", "text": "Pronator Teres", "correct": true}, {"label": "C", "text": "Pronator Quadratus", "correct": false}, {"label": "D", "text": "Brachioradialis", "correct": false}], "correct_answer": "B. Pronator Teres", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"51d02ec7e5169277719693f472fa48\"&gt;Pronator&lt;/span&gt; T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with hypothenar muscle wasting and loss of sensation of medial one and a half digits. Which of the following nerve is involved?", "options": [{"label": "A", "text": "Ulnar Nerve", "correct": true}, {"label": "B", "text": "Median Nerve", "correct": false}, {"label": "C", "text": "Radial nerve", "correct": false}, {"label": "D", "text": "Musculocutaneous nerve", "correct": false}], "correct_answer": "A. Ulnar Nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\"&gt;Ulnar&lt;/span&gt; Nerv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "p53 regulates which phase of cell cycle?", "options": [{"label": "A", "text": "G1S", "correct": true}, {"label": "B", "text": "G2", "correct": false}, {"label": "C", "text": "G2M", "correct": false}, {"label": "D", "text": "S", "correct": false}], "correct_answer": "A. G1S", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - G1S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nFr8eb8eDZSNF88Dbqhm1749369694.mp3", "video": ""}, {"text": "The inferior scapular angle is at which vertebrae level?", "options": [{"label": "A", "text": "T4", "correct": false}, {"label": "B", "text": "T7", "correct": true}, {"label": "C", "text": "T8", "correct": false}, {"label": "D", "text": "T2", "correct": false}], "correct_answer": "B. T7", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - T7\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertebral spine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Level</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior angle of the scapula</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Where the <span class=\"customMeta\" data-dictid=\"48528974ed1692777185cd29753db5\">crest</span> of the spine of the <span class=\"customMeta\" data-dictid=\"153f2ea4be16927771981ce5d9171f\">scapula</span> meets its <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> border</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior angle of the scapula</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>L4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highest point of the <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> crest</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>S2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior-superior <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> spine</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Flexion, adduction, and medial rotation of arm is done by which muscle?", "options": [{"label": "A", "text": "Pectoralis minor", "correct": false}, {"label": "B", "text": "Pectoralis Major", "correct": true}, {"label": "C", "text": "Subclavius", "correct": false}, {"label": "D", "text": "Serratus anterior", "correct": false}], "correct_answer": "B. Pectoralis Major", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\"&gt;Pectoralis&lt;/span&gt; Maj\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following shows breast necrosis and calcification?", "options": [{"label": "A", "text": "Comedo subtype of DCIS", "correct": true}, {"label": "B", "text": "Cribriform subtype of DCIS", "correct": false}, {"label": "C", "text": "Colloid carcinoma", "correct": false}, {"label": "D", "text": "Lobular carcinoma in situ", "correct": false}], "correct_answer": "A. Comedo subtype of DCIS", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"752b953a8c169277718425d3f6ad8c\"&gt;Comedo&lt;/span&gt; subtype of DCIS\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JbGfEJlDtjWJhKezVIT61749369815.mp3", "video": ""}, {"text": "Acute graft rejection occurs within:", "options": [{"label": "A", "text": "Minutes", "correct": false}, {"label": "B", "text": "Weeks to months", "correct": true}, {"label": "C", "text": "&amp;gt; 6 weeks to 6 months", "correct": false}, {"label": "D", "text": "&amp;gt; 6 months", "correct": false}], "correct_answer": "B. Weeks to months", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Weeks to month\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are derivatives of tryptophan EXCEPT:", "options": [{"label": "A", "text": "Melatonin", "correct": false}, {"label": "B", "text": "Seratonin", "correct": false}, {"label": "C", "text": "Niacin", "correct": false}, {"label": "D", "text": "Creatinine", "correct": true}], "correct_answer": "D. Creatinine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The glossopharyngeal nerve supplies which of the following glands?", "options": [{"label": "A", "text": "Parotid", "correct": true}, {"label": "B", "text": "Submandibular", "correct": false}, {"label": "C", "text": "Sublingual", "correct": false}, {"label": "D", "text": "Lacrimal", "correct": false}], "correct_answer": "A. Parotid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Deep inguinal ring is formed in:", "options": [{"label": "A", "text": "Internal oblique aponeurosis", "correct": false}, {"label": "B", "text": "External oblique aponeurosis", "correct": false}, {"label": "C", "text": "Transversalis fascia", "correct": true}, {"label": "D", "text": "Transversus abdominis", "correct": false}], "correct_answer": "C. Transversalis fascia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\"&gt;Transversalis&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mental retardation is a clinical feature of:", "options": [{"label": "A", "text": "Alkaptonuria", "correct": false}, {"label": "B", "text": "Albinism", "correct": false}, {"label": "C", "text": "Hawkinsuria", "correct": false}, {"label": "D", "text": "Phenylketonuria", "correct": true}], "correct_answer": "D. Phenylketonuria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"e7941fa4511692777195681046925e\"&gt;Phenylketonuria&lt;/span&gt; (PKU)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Inguinal ligament is formed due to:", "options": [{"label": "A", "text": "External oblique aponeurosis", "correct": true}, {"label": "B", "text": "Internal oblique aponeurosis", "correct": false}, {"label": "C", "text": "Transversalis fascia", "correct": false}, {"label": "D", "text": "Inguinal muscle", "correct": false}], "correct_answer": "A. External oblique aponeurosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"787b0ec4661692777187c06c757e51\"&gt;External oblique&lt;/span&gt; aponeu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Activation of trypsinogen is mainly done by:", "options": [{"label": "A", "text": "Chymotrypsinogen", "correct": false}, {"label": "B", "text": "Enteropeptidase", "correct": true}, {"label": "C", "text": "Trypsin", "correct": false}, {"label": "D", "text": "Hexokinase", "correct": false}], "correct_answer": "B. Enteropeptidase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - E\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Reverse transcriptase PCR analyzes:", "options": [{"label": "A", "text": "DNA", "correct": false}, {"label": "B", "text": "RNA", "correct": true}, {"label": "C", "text": "Amino acid", "correct": false}, {"label": "D", "text": "Protein particle", "correct": false}], "correct_answer": "B. RNA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - RNA\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gluconeogenesis is mainly seen in:", "options": [{"label": "A", "text": "Kidney", "correct": false}, {"label": "B", "text": "Liver", "correct": true}, {"label": "C", "text": "Spleen", "correct": false}, {"label": "D", "text": "Heart", "correct": false}], "correct_answer": "B. Liver", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Liv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Congenital rubella syndrome has all of the following except:", "options": [{"label": "A", "text": "Sensorineural deafness", "correct": false}, {"label": "B", "text": "Cataract", "correct": false}, {"label": "C", "text": "Cardiac defects", "correct": false}, {"label": "D", "text": "Hydrocephalus", "correct": true}], "correct_answer": "D. Hydrocephalus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Hydrocephalu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is correct about estriol level in Down’s syndrome?", "options": [{"label": "A", "text": "No change", "correct": false}, {"label": "B", "text": "Low", "correct": true}, {"label": "C", "text": "Elevated", "correct": false}, {"label": "D", "text": "Double-triple", "correct": false}], "correct_answer": "B. Low", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is useful in acute diarrhea?", "options": [{"label": "A", "text": "Zinc", "correct": true}, {"label": "B", "text": "Magnesium", "correct": false}, {"label": "C", "text": "Calcium", "correct": false}, {"label": "D", "text": "Potassium", "correct": false}], "correct_answer": "A. Zinc", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Z\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Z67R1YDdNpa1VVBPgCk91744570787.mp3", "video": ""}, {"text": "Mutation in NPHS 1 gene causes which disease?", "options": [{"label": "A", "text": "Alport syndrome", "correct": false}, {"label": "B", "text": "Congenital finnish type nephrotic syndrome", "correct": true}, {"label": "C", "text": "Focal segmental glomerulonephritis", "correct": false}, {"label": "D", "text": "Nail patella syndrome", "correct": false}], "correct_answer": "B. Congenital finnish type nephrotic syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\"&gt;Congenital&lt;/span&gt; Finnish Type &lt;span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\"&gt;Nephrotic&lt;/span&gt; S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following medicines can be used in a child with bronchiolitis?", "options": [{"label": "A", "text": "Ribavirin", "correct": true}, {"label": "B", "text": "Amantadine", "correct": false}, {"label": "C", "text": "Oseltamivir", "correct": false}, {"label": "D", "text": "Amoxicillin", "correct": false}], "correct_answer": "A. Ribavirin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ribav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Continuous murmur is heard in?", "options": [{"label": "A", "text": "Patent ductus arteriosus", "correct": true}, {"label": "B", "text": "VSD", "correct": false}, {"label": "C", "text": "ASD", "correct": false}, {"label": "D", "text": "Tetralogy of Fallot", "correct": false}], "correct_answer": "A. Patent ductus arteriosus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Patent &lt;span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\"&gt;ductus&lt;/span&gt; arteriosus (PDA)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Normal anion gap value is____ mEq/L?", "options": [{"label": "A", "text": "4-6", "correct": false}, {"label": "B", "text": "6-12", "correct": true}, {"label": "C", "text": "12-24", "correct": false}, {"label": "D", "text": "24-50", "correct": false}], "correct_answer": "B. 6-12", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 6-12\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> with</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">Anion</span> gap</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">Anion</span> gap</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">Anion</span> gap</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(i) <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> ketoacidosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(i) Diarrhea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(i) Multiple myeloma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(ii) Starvation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(ii) Renat tubular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(ii) <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">Lithium</span> intoxication</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(iii) Uremia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(iii) Addison's disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(iv) <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">Lactic</span> acidosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Why is sugar added to ORS?", "options": [{"label": "A", "text": "Enhance acceptability", "correct": false}, {"label": "B", "text": "Enhance shelf life", "correct": false}, {"label": "C", "text": "Enhance salt absorption", "correct": true}, {"label": "D", "text": "Enhance taste", "correct": false}], "correct_answer": "C. Enhance salt absorption", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Enh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Adequate oxygen delivery at cellular level is present in which type of hypoxia ?", "options": [{"label": "A", "text": "Anemic", "correct": false}, {"label": "B", "text": "Stagnant", "correct": false}, {"label": "C", "text": "Hypoxic", "correct": false}, {"label": "D", "text": "Histotoxic", "correct": true}], "correct_answer": "D. Histotoxic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - H\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Comment on the breathing pattern of a patient with prolonged inspiratory spasms that resemble breath holding?", "options": [{"label": "A", "text": "Cheyne stokes breathing", "correct": false}, {"label": "B", "text": "Kussmaul breathing", "correct": false}, {"label": "C", "text": "Apneustic breathing", "correct": true}, {"label": "D", "text": "Biot breathing", "correct": false}], "correct_answer": "C. Apneustic breathing", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Apneustic breathing\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of dicrotic notch?", "options": [{"label": "A", "text": "Passive filling of blood in ventricles", "correct": false}, {"label": "B", "text": "Rapid ejection phase", "correct": false}, {"label": "C", "text": "Peripheral resistance", "correct": true}, {"label": "D", "text": "Isovolumic contraction", "correct": false}], "correct_answer": "C. Peripheral resistance", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\"&gt;Peripheral&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is correct about isovolumetric relaxation?", "options": [{"label": "A", "text": "Semilunar valves open", "correct": false}, {"label": "B", "text": "C Wave of JVP", "correct": false}, {"label": "C", "text": "Corresponds to QT interval", "correct": false}, {"label": "D", "text": "AV Valves are closed", "correct": true}], "correct_answer": "D. AV Valves are closed", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - AV Valv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "If radius of a vessel is doubled then the blood flow is increased by:", "options": [{"label": "A", "text": "32 times", "correct": false}, {"label": "B", "text": "16 times", "correct": true}, {"label": "C", "text": "256 times", "correct": false}, {"label": "D", "text": "8 times", "correct": false}], "correct_answer": "B. 16 times", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman with secondary amenorrhea with history of, curettage for abortion. FSH 7 min/ml. What is your likely diagnosis?", "options": [{"label": "A", "text": "Pituitary failure", "correct": false}, {"label": "B", "text": "Ovarian failure", "correct": false}, {"label": "C", "text": "Uterine synechiae", "correct": true}, {"label": "D", "text": "Pregnancy", "correct": false}], "correct_answer": "C. Uterine synechiae", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\"&gt;Uterine&lt;/span&gt; synech\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The temperature in puerperal pyrexia is:", "options": [{"label": "A", "text": "98.4 Fahrenheit", "correct": false}, {"label": "B", "text": "99 Fahrenheit", "correct": false}, {"label": "C", "text": "100.4 Fahrenheit", "correct": true}, {"label": "D", "text": "104 Fahrenheit", "correct": false}], "correct_answer": "C. 100.4 Fahrenheit", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 100.4 Fahrenh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old lady presented with complaint of postcoital bleeding. On per speculum examination, the following is seen. It bleeds on touch. What is the possible diagnosis?", "options": [{"label": "A", "text": "Cervical fibroid", "correct": false}, {"label": "B", "text": "Cervical polyp", "correct": true}, {"label": "C", "text": "Cervical carcinoma", "correct": false}, {"label": "D", "text": "Hemorrhagic cyst", "correct": false}], "correct_answer": "B. Cervical polyp", "question_images": ["https://image.prepladder.com/content/K4Dq5z27j1GuTDpP1L3u1699609486.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\"&gt;Cervical&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Contraindications of the device shown in image:", "options": [{"label": "A", "text": "Breastfeeding", "correct": false}, {"label": "B", "text": "Monogamous", "correct": false}, {"label": "C", "text": "Hypertension", "correct": false}, {"label": "D", "text": "PID", "correct": true}], "correct_answer": "D. PID", "question_images": ["https://image.prepladder.com/content/cw95mcIAs448CEq0erdM1699609739.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"2c2d0c2ee2169277719514f0315d81\"&gt;PID&lt;/span&gt; (Pelvic &lt;span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\"&gt;Inflammatory&lt;/span&gt; Disease)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Theca lutein cysts are common in", "options": [{"label": "A", "text": "Vagina", "correct": false}, {"label": "B", "text": "Uterus", "correct": false}, {"label": "C", "text": "Ovary", "correct": true}, {"label": "D", "text": "Cervix", "correct": false}], "correct_answer": "C. Ovary", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C – Ov\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 14-year-old presents with cyclical abdominal pain and has not attained menarche yet. What is the diagnosis?", "options": [{"label": "A", "text": "Imperforate hymen", "correct": true}, {"label": "B", "text": "Prolapse", "correct": false}, {"label": "C", "text": "Tumor", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Imperforate hymen", "question_images": ["https://image.prepladder.com/content/f2x3luexDAHhlVjyWVIV1699610214.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"51aedf4b7a1692777189224a776ed8\"&gt;Imperforate&lt;/span&gt; h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common oral cancer is:", "options": [{"label": "A", "text": "Adenocarcinoma", "correct": false}, {"label": "B", "text": "Transition cell CA", "correct": false}, {"label": "C", "text": "Mucoepidermoid", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma", "correct": true}], "correct_answer": "D. Squamous cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\"&gt;Squamous&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "62 year old female has kidney stone and treated with PCNL. After 2 days she again comes to OPD with chills and fever. What is the complication?", "options": [{"label": "A", "text": "Acute pancreatitis", "correct": false}, {"label": "B", "text": "Splenic injury", "correct": false}, {"label": "C", "text": "Ureteric Stricture", "correct": false}, {"label": "D", "text": "Bacterial Sepsis", "correct": true}], "correct_answer": "D. Bacterial Sepsis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Bacterial S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lady during labor presented with persistent occiput posterior position . Manual rotation was tried but it was unsuccessful. What is the pelvis type ?", "options": [{"label": "A", "text": "Gynecoid", "correct": false}, {"label": "B", "text": "Android", "correct": true}, {"label": "C", "text": "Osteomalatic pelvis", "correct": false}, {"label": "D", "text": "Platypelloid", "correct": false}], "correct_answer": "B. Android", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B: A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which patient has better prognosis in breast cancer?", "options": [{"label": "A", "text": "Her2+", "correct": false}, {"label": "B", "text": "Triple negative", "correct": false}, {"label": "C", "text": "Luminal B", "correct": false}, {"label": "D", "text": "Luminal A", "correct": true}], "correct_answer": "D. Luminal A", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\"&gt;Luminal&lt;/span&gt; A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What will be the calorie requirement for a moderate working pregnant woman?", "options": [{"label": "A", "text": "2100", "correct": false}, {"label": "B", "text": "2300", "correct": false}, {"label": "C", "text": "2500", "correct": true}, {"label": "D", "text": "3100", "correct": false}], "correct_answer": "C. 2500", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C – 25\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are true about Crohn’s disease except", "options": [{"label": "A", "text": "Rectum is involved", "correct": true}, {"label": "B", "text": "Serpiginous ulcers are formed", "correct": false}, {"label": "C", "text": "Transmural involvement", "correct": false}, {"label": "D", "text": "Recurrence is more common", "correct": false}], "correct_answer": "A. Rectum is involved", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\"&gt;Rectum&lt;/span&gt; is involv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Late rupture of tubal pregnancy is seen if ectopic pregnancy occurs at which site?", "options": [{"label": "A", "text": "Interstitium", "correct": true}, {"label": "B", "text": "Isthmus", "correct": false}, {"label": "C", "text": "Ampula", "correct": false}, {"label": "D", "text": "Fimbriae", "correct": false}], "correct_answer": "A. Interstitium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Interstitiu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Killian Dehiscence is formed due to:", "options": [{"label": "A", "text": "Superior constrictor muscle", "correct": false}, {"label": "B", "text": "Inferior Constrictor muscle", "correct": true}, {"label": "C", "text": "Middle pharyngeal constrictor muscle", "correct": false}, {"label": "D", "text": "Esophageal fibers", "correct": false}], "correct_answer": "B. Inferior Constrictor muscle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vhTtA8g7nDofiOWGhxKp1715251524.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\"&gt;Inferior&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\"&gt;constrictor&lt;/span&gt; mu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Beta hCG is secreted by which of the following?", "options": [{"label": "A", "text": "Umbilical cord", "correct": false}, {"label": "B", "text": "Syncytiotrophoblast", "correct": true}, {"label": "C", "text": "Placenta", "correct": false}, {"label": "D", "text": "Yolk sac", "correct": false}], "correct_answer": "B. Syncytiotrophoblast", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Syncytiotroph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 309 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "The number of polio cases has been steadily declining in comparison to previous years. This pattern is known as:", "options": [{"label": "A", "text": "Seasonal", "correct": false}, {"label": "B", "text": "Cyclical", "correct": false}, {"label": "C", "text": "Periodical", "correct": false}, {"label": "D", "text": "Secular", "correct": true}], "correct_answer": "D. Secular", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cyclical trends (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Seasonal trends (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>They occur in cycles spread over short periods of time.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cycles are associated with seasons.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Examples:</p>\n<ul>\n<li>Measles: every 2-3 years.</li>\n<li>Rubella: every 6-9 years.</li>\n<li>Influenza: every 7-10 years.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Examples:</p>\n<ul>\n<li>Measles.</li>\n<li>Varicella.</li>\n<li>Cerebro-spinal meningitis.</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections.</li>\n<li>Malaria.</li>\n<li>Sunstroke.</li>\n<li>Hay fever.</li>\n<li>Snakebite.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cytotoxic drug is disposed in:", "options": [{"label": "A", "text": "Yellow bag", "correct": true}, {"label": "B", "text": "Red bag", "correct": false}, {"label": "C", "text": "Blue bag", "correct": false}, {"label": "D", "text": "Black bag", "correct": false}], "correct_answer": "A. Yellow bag", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Example of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment and disposal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Human <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Animal <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Soiled waste.</li>\n<li>Discarded or expired medicine.</li>\n<li>Microbiology, <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> and other <span class=\"customMeta\" data-dictid=\"3ec60edb4a16927771842bb9fd9aa4\">clinical laboratory</span> waste.</li>\n<li>Chemical waste.</li>\n<li>Chemical liquid waste.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Placenta.</li>\n<li>Post-operative body parts.</li>\n<li>Plaster of Paris (POP).</li>\n<li>Pathological waste.</li>\n<li>Cotton waste.</li>\n<li>Dressing materials.</li>\n<li>Beddings.</li>\n<li>Body fluid contaminated paper and cloth.</li>\n<li>Face mask, cap, shoe cover and head cover.</li>\n<li>Cytotoxic, expired and discarded medicines.</li>\n<li>Microbiology and <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> lab waste.</li>\n<li>Blood bag</li>\n<li>Vacutainers with blood</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incineration.</li>\n<li>Plasma pyrolysis.</li>\n<li>Deep burial.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contaminated waste that is recyclable.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Syringe without needles.</li>\n<li>Fixed needle syringes with their needle cut.</li>\n<li>IV set.</li>\n<li>Catheters.</li>\n<li>Gloves (soiled or unsoiled).</li>\n<li>Urine bag.</li>\n<li>Dialysis kit.</li>\n<li>IV bottles.</li>\n<li>Tubing's.</li>\n<li>Bottles.</li>\n<li>Vacutainers with needle cuts.</li>\n<li>Vacutainers without blood.</li>\n<li>ELISA plates and vials not containing blood samples.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoclaving or microwaving/ hydroclaving followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> and waste set to registered recyclers or for energy recovery/road making.</li>\n</ul>\n<ul>\n<li>Plastic waste should not be sent to landfill sites.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>White</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waste Sharps</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Needles</li>\n<li>Syringes with fixed needles</li>\n<li>Blades</li>\n<li>Scalpers</li>\n<li>Trocar cannula</li>\n<li>Insulin pen needle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Puncture proof , Leak proof, Tamper proof containers</li>\n<li>Autoclaving or <span class=\"customMeta\" data-dictid=\"2d95ddf7b8169277718654aee27077\">dry heat</span> <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> or <span class=\"customMeta\" data-dictid=\"5a7f7caa7716927771870658b1c5cf\">encapsulation</span> in metal container or <span class=\"customMeta\" data-dictid=\"d8691a48a91692777184708a8f2f0c\">cement</span> concrete</li>\n<li>Or sent for final disposal to iron foundries or <span class=\"customMeta\" data-dictid=\"601fb1538a16927771987048f6e712\">sanitary</span> landfills or designated concrete waste sharp pit</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blue (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glassware or <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> body implants.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Includes broken or discarded glass and <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> objects that are contaminated.</li>\n<li>Glass:\n\t\t\t\t<ul>\n<li>Broken glass.</li>\n<li>Ampoules.</li>\n<li>Lab slide</li>\n</ul>\n</li>\n<li>Metals:\n\t\t\t\t<ul>\n<li>Nails.</li>\n<li>Metallic body implants.</li>\n<li>Scissors.</li>\n<li>Artificial pacemakers.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardboard boxes with blue colored markings or blue coloured puncture-proof and tamper-proof containers.</li>\n<li>Disinfection (cleaning with <span class=\"customMeta\" data-dictid=\"24ff542ee616927771865a28edbc12\">detergent</span> and soaking in sodium hypochlorite) or autoclaving or microwaving or hydroclaving and then sent for recycling.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the value that appears most frequently in a set of data?", "options": [{"label": "A", "text": "Median", "correct": false}, {"label": "B", "text": "Mode", "correct": true}, {"label": "C", "text": "Standard deviation", "correct": false}, {"label": "D", "text": "Mean", "correct": false}], "correct_answer": "B. Mode", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YY1f63BSv0wyVDfHOOIL1746690275.png", "https://image.prepladder.com/content/Il9ewLrf0C4RhcG8iBua1746690285.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not considered a pillar of primary health care?", "options": [{"label": "A", "text": "Health education", "correct": true}, {"label": "B", "text": "Intersectoral coordination", "correct": false}, {"label": "C", "text": "Appropriate technology", "correct": false}, {"label": "D", "text": "Equitable distribution", "correct": false}], "correct_answer": "A. Health education", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Equitable distribution (Option D ruled out):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Equitable distribution of health services irrespective of their socio-economic status.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intersectoral <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> (Option B ruled out):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Involves collaboration from other sectors like agriculture, education, etc.</li>\n<li>Maintains good health.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appropriate technology (Option c ruled out):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Use of technology that is accessible, affordable, and suitable for the community</li>\n<li>Eg:\n\t\t\t\t<ul>\n<li>ORS</li>\n<li>VVM (Vaccine <span class=\"customMeta\" data-dictid=\"cd235a18081692777202343e31b264\">Vial</span> Monitor): Heat sensitive label</li>\n<li>Shakir tape: <span class=\"customMeta\" data-dictid=\"cbd2d1fd521692777191d00c1a4ede\">Malnutrition</span> grading</li>\n<li>Kangaroo mother care: <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">Preterm</span> care</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Community participation:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ensure the participation of the community in planning, implementing and maintaining.</li>\n<li>For the promotion and maintenance of their health.</li>\n<li>Eg: <span class=\"customMeta\" data-dictid=\"817804153a16927771822a30e05c60\">ASHA</span> workers are residents of the same community.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the ultimate desired state towards which objectives and resources are aimed in the medical field?", "options": [{"label": "A", "text": "Target", "correct": false}, {"label": "B", "text": "Mission", "correct": false}, {"label": "C", "text": "Goal", "correct": true}, {"label": "D", "text": "Plan", "correct": false}], "correct_answer": "C. Goal", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 year old female is using vaginal sponge as a barrier contraceptive during sexual intercourse. Which of the following Spermicide is used in contraceptive 'TODAY'?", "options": [{"label": "A", "text": "NET-EN", "correct": false}, {"label": "B", "text": "DMPA", "correct": false}, {"label": "C", "text": "Nonoxynol-9", "correct": true}, {"label": "D", "text": "Norethisterone", "correct": false}], "correct_answer": "C. Nonoxynol-9", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iuMFV40gpuHXMFQniSKH1746690985.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:1px solid #333438; vertical-align:top\">\n<p><strong>Brand name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:1px solid #333438; vertical-align:top\">\n<p>TODAY</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p><strong>Material</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p>Small <span class=\"customMeta\" data-dictid=\"fc50d9885a1692777196fa5cad6a17\">polyurethane</span> <span class=\"customMeta\" data-dictid=\"40d72689211692777203fca86e25c9\">foam</span> sponge</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p>Combines barrier and <span class=\"customMeta\" data-dictid=\"fd1ea66547169277719990b69a6279\">spermicidal</span> methods to prevent conception Saturated with 1000 mg of spermicide<strong> ‘Non-oxynol-9’</strong><strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p><strong>Technique of use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<ul>\n<li>Must be run under water till thoroughly wet before insertion</li>\n<li>Inserted vaginally and must be ‘placed over the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> to be effective</li>\n<li>Must be left in place for 6 hours after ejaculation</li>\n<li>All sponges must be removed within the time limits specified by the manufacturer (24 hours for Today)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<ul>\n<li>No protection from HIV or STDs</li>\n<li>May lead to <strong>Toxic Shock Syndrome if left beyond 24 hours</strong></li>\n<li>Has to be left for 6 hours post ejaculation</li>\n<li>Increased risk of <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> infection and UTI</li>\n<li>Higher failure rate than diaphragm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p><strong>Failure rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<ul>\n<li>Parous women: 20-40 per HWY</li>\n<li>Nulliparous women: 9-20 per HWY</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The true statement about cow's milk (per 100 gm) when compared to breast milk is:", "options": [{"label": "A", "text": "Lower sodium content", "correct": false}, {"label": "B", "text": "Higher lactose content", "correct": false}, {"label": "C", "text": "Lower protein", "correct": false}, {"label": "D", "text": "High protein", "correct": true}], "correct_answer": "D. High protein", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nutritional Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Human Milk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cow Milk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protein Content</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower, easily digestible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher, harder to digest <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Essential <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">Amino</span> Acids (e.g., cysteine, taurine)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rich</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vitamin A &amp; C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rich</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iron</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher bioavailability</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower bioavailability</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adequate, better absorbed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher content, less effectively absorbed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fat Content</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher proportion of essential <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids (e.g., linoleic, alpha-linolenic)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower proportion of essential <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carbohydrate content</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lactose: 7.5 g/100 mL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lactose: 5 g/100 mL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Digestibility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Almost completely digested</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Much is excreted undigested</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk of Overloading Kidneys</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High (hence <span class=\"customMeta\" data-dictid=\"409e887c94169277718652d5db3c32\">dilution</span> recommended)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequent side effect experienced by a 24-year-old woman of reproductive age who visited a rural primary healthcare center in India for the purpose of having an IUCD inserted to prevent pregnancy?", "options": [{"label": "A", "text": "Ectopic pregnancy", "correct": false}, {"label": "B", "text": "Pelvic infection", "correct": false}, {"label": "C", "text": "Pain", "correct": false}, {"label": "D", "text": "Bleeding", "correct": true}], "correct_answer": "D. Bleeding", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Side effects of IUDs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bleeding (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Most common side effect</strong>; <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> resolves in 1-3 months. Iron supplementation may be needed.</li>\n<li>Persistent <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> despite treatment may necessitate IUD removal.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pain (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequently causes removal; managed with analgesics. Resolves in 3 months. Severe pain may indicate <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> (rare).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pelvic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease</strong> <strong>(OptionB ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Certain organisms reach the uterus, <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes, and ovaries via the IUD thread. Presents with fever, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, and discharge. Higher risk in women with multiple sexual partners. Requires <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics; IUD removal if no improvement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uterine <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare complications <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to immediate <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> or poor technique. 1st generation IUDs are associated with a higher risk of pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Failure of <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">contraception</span> </strong>➜ <strong> pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Least pregnancies are reported with MIRENA.</li>\n<li>If a woman requests an <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> abortion – legally allowed.</li>\n<li>If a woman wants to continue pregnancy and threads are visible:\n\t\t\t\t<ul>\n<li>Pull the thread and continue pregnancy.</li>\n<li>Explain the risk of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> abortion or <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies.</li>\n</ul>\n</li>\n<li>If a woman wants to continue pregnancy and threads are not visible:\n\t\t\t\t<ul>\n<li>Uterus examination for any complications</li>\n<li>Evacuation of <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> if any <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> is identified.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ectopic pregnancy (OPTION A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recognized by lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, dark <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> bleeding, or amenorrhea. Women at high risk should avoid IUDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Expulsion </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically occurs within weeks of <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> or during menstruation; higher risk in young, nulliparous, <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> women or using 1st generation IUDs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Migration of IUD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely causes intestinal obstruction; diagnosed via X-ray <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> if suspected.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A couple approaches the doctor with a query regarding sexual precautions following the male partner's vasectomy procedure conducted a month ago. What guidance should be provided in this situation?", "options": [{"label": "A", "text": "Oral contraceptive pills for 1 month for the woman", "correct": false}, {"label": "B", "text": "Use condoms for 3 months", "correct": true}, {"label": "C", "text": "No special advice", "correct": false}, {"label": "D", "text": "Hormonal treatment given for 2 more months for the man", "correct": false}], "correct_answer": "B. Use condoms for 3 months", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/88q7TIwWPXzGnx31stcT1746691686.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the method employed to gather agreement on predictions among a substantial group of individuals?", "options": [{"label": "A", "text": "Television", "correct": false}, {"label": "B", "text": "GATHER approach", "correct": false}, {"label": "C", "text": "Conferences", "correct": false}, {"label": "D", "text": "Delphi method", "correct": true}], "correct_answer": "D. Delphi method", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the diagnosis for a child who exhibits below-average mathematical skills despite having a normal IQ and age-appropriate learning abilities and remains unaffected by a year-long private mathematics tutoring?", "options": [{"label": "A", "text": "ADHD", "correct": false}, {"label": "B", "text": "Mathematics learning disorder", "correct": false}, {"label": "C", "text": "Aspergers syndrome", "correct": false}, {"label": "D", "text": "Specific learning disorder", "correct": true}], "correct_answer": "D. Specific learning disorder", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is defined as the systematic observation and recording of activities of one or more individuals at predetermined or random intervals?", "options": [{"label": "A", "text": "Model", "correct": false}, {"label": "B", "text": "Decision making", "correct": false}, {"label": "C", "text": "Personnel management", "correct": false}, {"label": "D", "text": "Work sampling", "correct": true}], "correct_answer": "D. Work sampling", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old male who underwent appendectomy 7 hours ago and is currently experiencing auditory hallucinations and confusion about the source of the voices? The patient maintains orientation, and his vital signs are stable. Upon inquiry, his wife reveals that he occasionally consumes alcohol.", "options": [{"label": "A", "text": "Delirium tremens", "correct": false}, {"label": "B", "text": "Acute transient psychotic disorder", "correct": false}, {"label": "C", "text": "Delirium", "correct": false}, {"label": "D", "text": "Alcoholic hallucinosis", "correct": true}], "correct_answer": "D. Alcoholic hallucinosis", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features of Alcohol Withdrawal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Onset after last drink</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild anxiety</li>\n<li>Tremulousness</li>\n<li>Nausea</li>\n<li>Headache</li>\n<li>Palpitations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-8 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate (Alcoholic hallucinosis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Visual, auditory, or <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> hallucinations</li>\n<li>Intact orientation</li>\n<li>Normal vital signs</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8- 12 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe (Withdrawal seizures)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> seizures</li>\n<li>Usually brief and self-limited</li>\n<li>Also known as rum fits</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Life threatening (Delirium tremens)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe agitation</li>\n<li>Confusion and disorientation</li>\n<li>Hallucinations (often visual)</li>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"2e780c7fd416927771895c61217c12\">hyperactivity</span> (tachycardia, hypertension, fever)</li>\n<li>Profound sweating</li>\n<li>Tremors</li>\n<li>Insomnia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 72 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following options does not meet the minimum standards for maintaining sanitation in schools and their surroundings in India?", "options": [{"label": "A", "text": "Desks to be of 'Minus type'", "correct": false}, {"label": "B", "text": "Combined doors + windows area = 25% of floor space area", "correct": false}, {"label": "C", "text": "Maximum 40 students per classroom", "correct": false}, {"label": "D", "text": "One urinal for 10 students and one latrine for 25 students", "correct": true}], "correct_answer": "D. One urinal for 10 students and one latrine for 25 students", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Centrally situated with proper approach roads, away from busy places like roads, factories, and marketplaces. School premises should be fenced and hazard-free.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High, well-drained land. 10 acres for higher elementary schools, 5 acres for primary schools, with additional 1 acre per 100 students.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Single-story buildings preferred. Exterior walls should be 10 inches thick and heat-resistant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Doors and windows</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Combined door + window area = atleast 25% of floor area.</li>\n<li>Cross <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> should be present. <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classroom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No more than 40 students per room. Minimum 10 sq. ft. per student. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Color of Interior</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White interior walls, periodically white-washed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Furniture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Desks should be of ‘minus type’.</li>\n<li>Chair with proper back rest. <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lighting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Natural light from the left side, not from the front.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Water Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Independent source of safe, <span class=\"customMeta\" data-dictid=\"e0b9b6647b1692777196072340adcd\">potable</span> water, continuous supply distributed from taps.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lavatory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>One <span class=\"customMeta\" data-dictid=\"24c775f05716927772010e1b4d56a8\">urinal</span> per 60 students, one latrine per 100 students. Separate facilities for boys and girls. <strong>(Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A concerned grandmother brings an 18-year-old boy to you, reporting that he had multiple episodes of body jerking the day before his final exam. There were no signs of confusion or tongue biting after the episodes, and his medical tests came back normal. Which of the following conditions should be taken into consideration?", "options": [{"label": "A", "text": "Malingering", "correct": true}, {"label": "B", "text": "Factitious disorder", "correct": false}, {"label": "C", "text": "Somatisation syndrome", "correct": false}, {"label": "D", "text": "Hypochondriasis", "correct": false}], "correct_answer": "A. Malingering", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options below aids in determining the severity of a disease?", "options": [{"label": "A", "text": "Proportional mortality rate", "correct": false}, {"label": "B", "text": "Incidence", "correct": false}, {"label": "C", "text": "Case fatality rate", "correct": true}, {"label": "D", "text": "Prevalence", "correct": false}], "correct_answer": "C. Case fatality rate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uCsoIqIzrnwP8Plvcfwq1746692597.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a 40-year-old man who has been experiencing excessive and uncontrollable worry about daily life activities, finances, and his health for the past two years? He also presents with restlessness, fatigue, disturbed sleep, and waking up once due to a fear that his family was involved in an accident.", "options": [{"label": "A", "text": "Depression", "correct": false}, {"label": "B", "text": "Illness anxiety disorder", "correct": false}, {"label": "C", "text": "Somatoform disorder", "correct": false}, {"label": "D", "text": "Generalized anxiety disorder", "correct": true}], "correct_answer": "D. Generalized anxiety disorder", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0vXDiWxzGYulHZZDMFyR1746692721.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is not true according to the sustainable development goals?", "options": [{"label": "A", "text": "End the epidemics of AIDS, tuberculosis, malaria and combat hepatitis", "correct": false}, {"label": "B", "text": "Reduce the global maternal mortality ratio to less than 70 (per 100,000 liver births)", "correct": false}, {"label": "C", "text": "Reduce the neonatal mortality rate to as low as 25 (per 1,000 liver births)", "correct": true}, {"label": "D", "text": "Reduce under-5 mortality to as low as 25 (peer 1,000 liver births)", "correct": false}], "correct_answer": "C. Reduce the neonatal mortality rate to as low as 25 (per 1,000 liver births)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YzxgrFXIuxSE3FPrmqfD1746692837.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\">1.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>End poverty</strong> everywhere in all its forms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">2.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zero hunger</strong>-<strong> </strong>Achieve food security, improve nutrition, and promote sustainable agriculture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">3.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ensure healthy lives</strong> and well-being for all ages.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">4.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provide inclusive and equitable <strong>quality education</strong> and lifelong learning opportunities.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">5.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Achieve <strong>gender equality</strong> and empower women and girls.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">6.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure access to <strong>sustainable &amp; clean water and sanitation</strong> for all.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">7.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure access to <strong>affordable, clean and modern energy</strong> for all.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">8.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Promote sustainable <strong>economic growth</strong>, full employment, <strong>and decent work.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">9.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Build <span class=\"customMeta\" data-dictid=\"691088249a1692777197943b52a313\">resilient</span> infrastructure, promote <strong>sustainable industrialization, and foster innovation</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">10.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reduce inequality</strong> within and among countries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">11.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Make cities and <strong>human settlements inclusive, safe, resilient, and sustainable</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">12.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure <strong>sustainable consumption and production</strong> patterns.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">13.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Take urgent action to <strong>combat climate change</strong> and its impacts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">14.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conserve and<strong> sustainably use water bodies -</strong> oceans, seas, and marine resources.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">15.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protect, restore, and<strong> sustainably use terrestrial ecosystems</strong> and preserve biodiversity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">16.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Promote peaceful and inclusive societies,<strong> ensure access to justice, and build effective institutions.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">17.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Strengthen global partnerships</strong> for sustainable development.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Target 3.1: Reduce <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> mortality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>By 2030, reduce the global <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> mortality ratio to less than 70 per 100,000 live births <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Target 3.2: End all preventable deaths under five years of age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> mortality to at least as low as 12 per 1,000 live births <strong>(Option C) </strong>and under‑5 mortality to at least as low as 25 per 1,000 live births <strong>(Option D ruled out) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Target 3.3: Fight <span class=\"customMeta\" data-dictid=\"6f6ef8bf7c1692777184dfdf8cf45d\">communicable</span> diseases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>By 2030, end the epidemics of AIDS, tuberculosis, <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> and neglected tropical diseases and combat hepatitis, <span class=\"customMeta\" data-dictid=\"4f48a2cf151692777202bd4779a491\">water-borne</span> diseases and other <span class=\"customMeta\" data-dictid=\"6f6ef8bf7c1692777184dfdf8cf45d\">communicable</span> diseases <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Target 3.4: Reduce mortality from non-communicable diseases and promote mental health</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>By 2030, reduce by one-third <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Target 3.5: Prevent and treat substance abuse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Strengthen the prevention and treatment of substance abuse, including <span class=\"customMeta\" data-dictid=\"172b474c791692777193a54fab4553\">narcotic</span> <span class=\"customMeta\" data-dictid=\"3078e1e3071692777186da0df10649\">drug abuse</span> and harmful use of alcohol</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Target 3.6: Reduce road injuries and deaths</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>By 2020, halve (50% less) the number of global deaths and injuries from road traffic accidents</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Target 3.7: Universal access to sexual and <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> care, family planning and education</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>By 2030, ensure universal access to sexual and <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> health-care services, including for family planning, information and education, and the integration of <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> health into national strategies and programs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Target 3.8: Achieve universal health coverage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Target 3.9: Reduce illnesses and deaths from hazardous chemicals and pollution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about the given image is not true?", "options": [{"label": "A", "text": "It is inserted by withdrawal technique", "correct": false}, {"label": "B", "text": "The copper in this device has a surface area of 380 square mm", "correct": false}, {"label": "C", "text": "It has a life-span of 5 years", "correct": true}, {"label": "D", "text": "It is used in emergency contraception", "correct": false}], "correct_answer": "C. It has a life-span of 5 years", "question_images": ["https://image.prepladder.com/content/4ZC5Ei4sONakVpmW0YYf1746695620.png"], "explanation_images": ["https://image.prepladder.com/content/rjauzCDNuSzYvDoIar4Y1746695832.png", "https://image.prepladder.com/content/c8jstG3BUeslMdqSwjyQ1746695840.png", "https://image.prepladder.com/content/EKAc6Iem1Y1ScPo0Q7dp1746695848.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>2nd generation IUDs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Copper containing device</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> and survival\n\t\t\t\t<ul>\n<li>alters <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> mucus</li>\n<li>affects <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> enzymes</li>\n<li>increases <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> response in endometrium</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Strong anti-fertility effect</li>\n<li>Low expulsion rate</li>\n<li>Easy to fit in <span class=\"customMeta\" data-dictid=\"341daa40bb169277719303fbd1ce1a\">nulliparous</span> women</li>\n<li>Lesser side effects</li>\n<li>Effective post-coital <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">contraceptive</span> <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bleeding</li>\n<li>Pain</li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease</li>\n<li>Uterine perforation</li>\n<li>Failure of <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">contraception</span> ➜ Pregnancy</li>\n<li>Ectopic pregnancy</li>\n<li>Expulsion</li>\n<li>Migration of IUD</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Insertion technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdrawl technique <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CuT 380A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"LeiaWonder \" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Copper_IUD#/media/File:IUD_with_scale.jpg\" data-tags=\"\" height=\"613\" src=\"https://image.prepladder.com/content/rjauzCDNuSzYvDoIar4Y1746695832.png\" width=\"422\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>380 mm² of <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> wire around a stem with <span class=\"customMeta\" data-dictid=\"7d418b8fa91692777193a09dec2dca\">nylon</span> thread attached <strong>(Option B ruled out)</strong></li>\n<li><strong>Shelf life -10 years (Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nova-T</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hubacher, David &amp; Schreiber, Courtney &amp; Turok, David &amp; Jensen, Jeffrey &amp; Creinin, Mitchell &amp; Nanda, Kavita &amp; White, Katharine &amp; Dayananda, Ila &amp; Teal, Stephanie &amp; Chen, Pai-Lien &amp; Chen, Beatrice &amp; Goldberg, Alisa &amp; Kerns, Jennifer &amp; Dart, Clint &amp; Nelson, Anita &amp; Thomas, Michael &amp; Archer, David &amp; Brown, Jill &amp; Castaño, Paula &amp; Blithe, Diana\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Dimensions-of-TCu380A-and-NT380-Mini_fig3_362053544\" data-tags=\"\" height=\"545\" src=\"https://image.prepladder.com/content/c8jstG3BUeslMdqSwjyQ1746695840.png\" width=\"421\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>CuT 380 A with a silver (Ag) core</strong> attached to it</li>\n<li><strong>Shelf life - 5 years</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Multiload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"LeiaWonder\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Copper_IUD#/media/File:Multiload-Gynefix-Paragard.jpg\" data-tags=\"\" height=\"390\" src=\"https://image.prepladder.com/content/EKAc6Iem1Y1ScPo0Q7dp1746695848.png\" width=\"372\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>U-shaped ring</li>\n<li>Most commonly used IUD</li>\n<li>CuT 375</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Jet black pigmentation of the tongue with tactile hallucinations is a feature of:", "options": [{"label": "A", "text": "Heroin", "correct": false}, {"label": "B", "text": "Opium", "correct": false}, {"label": "C", "text": "Alcohol", "correct": false}, {"label": "D", "text": "Cocaine", "correct": true}], "correct_answer": "D. Cocaine", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cocaine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Source</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Derived from the leaves of the <span class=\"customMeta\" data-dictid=\"442d1d735b16927771847e0cbbd1ca\">coca</span> plant (<em>Erythroxylum coca</em>).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inhibits <span class=\"customMeta\" data-dictid=\"e91c7a22e71692777196ef9e02b8c0\">presynaptic</span> transporters of NE, DA, and 5-HT.</li>\n<li>Blocks <span class=\"customMeta\" data-dictid=\"e28fd027b416927771932bc23ba0a5\">neurotransmitter</span> reuptake, increasing <span class=\"customMeta\" data-dictid=\"5c4592475a1692777199991c761d11\">synaptic</span> levels and enhancing <span class=\"customMeta\" data-dictid=\"978bd0e89f1692777196add72e1254\">postsynaptic</span> effects.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methods of Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Snorting: <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">Inhalation</span> through the nose; less dangerous than other methods.</li>\n<li>Injection: <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">Subcutaneous</span> or intravenous; high risk of overdose, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> issues.</li>\n<li>Smoking: <span class=\"customMeta\" data-dictid=\"2b495cb5541692777185c47ef79d63\">Crack cocaine</span> or freebasing; most dangerous, intense <span class=\"customMeta\" data-dictid=\"f6feed79981692777180c082188cc7\">addiction</span> and behavioural changes.</li>\n<li>Oral Use: Rare and ineffective.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Combination Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cocaine + <span class=\"customMeta\" data-dictid=\"94ad3b8b511692777188ae2fd60d16\">Heroin</span> = \"Speed Balls.\"</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intoxication Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Euphoria, hyperactivity, agitation, tachycardia, hypertension, dilated pupils, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> risks.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adverse Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertension, tachycardia, myocardial ischemia/infarction, seizures, arrhythmias, hyperthermia, paranoia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cocaine Withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms: Cravings, anhedonia, dysphoria, hypersomnia, irritability, increased appetite.</li>\n<li>No physical complications (e.g., seizures).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cocaine-Induced Psychosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Paranoid delusions and hallucinations (auditory &gt; tactile/visual).</li>\n<li>Formication (\"cocaine bugs\").</li>\n<li>More common in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> and IV/crack cocaine users.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment for Withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Supportive care for mood symptoms and suicidal ideation.</li>\n<li>Behavioral interventions like CBT for <span class=\"customMeta\" data-dictid=\"b4b361c37616927771979541177070\">relapse</span> prevention.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment for Psychosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short-term antipsychotics (e.g., haloperidol).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which neurotransmitters are implicated in depression?", "options": [{"label": "A", "text": "GABA and dopamine", "correct": false}, {"label": "B", "text": "Serotonin and norepinephrine", "correct": true}, {"label": "C", "text": "Dopamine and serotonin", "correct": false}, {"label": "D", "text": "GABA and norepinephrine", "correct": false}], "correct_answer": "B. Serotonin and norepinephrine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The likely diagnosis for a girl who exhibits typical language milestones but primarily focuses on observing her own hands and lacks interaction with others is:", "options": [{"label": "A", "text": "ADHD", "correct": false}, {"label": "B", "text": "Autism", "correct": true}, {"label": "C", "text": "Asperger's syndrome", "correct": false}, {"label": "D", "text": "Rett's syndrome", "correct": false}], "correct_answer": "B. Autism", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 37-year-old male who is a chronic alcoholic and has recently stopped drinking alcohol but presents to the emergency department after three days with symptoms of disorientation, tremors, hallucinations, and hypertension?", "options": [{"label": "A", "text": "Alcoholic hallucinosis", "correct": false}, {"label": "B", "text": "Korsakoff’s psychosis", "correct": false}, {"label": "C", "text": "Delirium tremens", "correct": true}, {"label": "D", "text": "Marchiafava-Bignami disease", "correct": false}], "correct_answer": "C. Delirium tremens", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features of Alcohol Withdrawal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Onset after last drink</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild anxiety</li>\n<li>Tremulousness</li>\n<li>Nausea</li>\n<li>Headache</li>\n<li>Palpitations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-8 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate (Alcoholic hallucinosis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Visual, auditory, or <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> hallucinations</li>\n<li>Intact orientation</li>\n<li>Normal vital signs</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8- 12 hours</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe (Withdrawal seizures)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> seizures</li>\n<li>Usually brief and self-limited</li>\n<li>Also known as rum fits</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Life-threatening (Delirium tremens)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe agitation</li>\n<li>Confusion and disorientation</li>\n<li>Hallucinations (often visual)</li>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"2e780c7fd416927771895c61217c12\">hyperactivity</span> (tachycardia, hypertension, fever)</li>\n<li>Profound sweating</li>\n<li>Tremors</li>\n<li>Insomnia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 72 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following enzymes is responsible for the immortality of cancer cells?", "options": [{"label": "A", "text": "Telomerase", "correct": true}, {"label": "B", "text": "Topoisomerase", "correct": false}, {"label": "C", "text": "Helicase", "correct": false}, {"label": "D", "text": "RNA polymerase", "correct": false}], "correct_answer": "A. Telomerase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kQbvT4xVZ9yM5AGFpCS91749405968.mp3", "video": ""}, {"text": "A 60-year-old male came to the emergency department after sustaining a fall. X-ray showed a fractured neck of the femur and was operated on for the same. On postoperative day 2, he experienced a sharp, severe, constant burning pain over his right back. On examination, the lesion is as seen below. The area is tender to light touch, with a rash over the area. What is the most appropriate treatment for this patient?", "options": [{"label": "A", "text": "Amitriptyline", "correct": false}, {"label": "B", "text": "Topical steroid", "correct": false}, {"label": "C", "text": "Valacyclovir", "correct": true}, {"label": "D", "text": "Mupirocin", "correct": false}], "correct_answer": "C. Valacyclovir", "question_images": ["https://image.prepladder.com/content/BKRgp6Dm2XNTY7Av0VNt1746696785.png"], "explanation_images": ["https://image.prepladder.com/notes/BZJSQP9BJwPhraqhYlnc1747987219.png"], "explanation": "<p>Correct Answer C - Valacyclovir:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Valacyclovir</strong> (a <span class=\"customMeta\" data-dictid=\"1c0d8a64fa1692777196f90166732c\">prodrug</span> of acyclovir)</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PPH051 Valacyclovir MOA\" data-author=\"NA\" data-hash=\"13245\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/BZJSQP9BJwPhraqhYlnc1747987219.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varicella <span class=\"customMeta\" data-dictid=\"03350c16f71692777202dbca70976e\">zoster</span> virus (VZV) - Most effective</p>\n<p>Epstein Barr virus</p>\n<p>Herpes simplex virus-1 and 2</p>\n<ul>\n<li>Genital herpes</li>\n<li>Mucocutaneous <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">herpes</span> simplex (use IV)</li>\n<li>Herpes labialis, Keratoconjunctivitis (use topical)</li>\n<li>HSV <span class=\"customMeta\" data-dictid=\"9644652a1f16927771873765457fcc\">encephalitis</span> (use IV)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated with <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> <span class=\"customMeta\" data-dictid=\"e32083bfa81692777200f1407487aa\">thymidine</span> <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> mutation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thrombocytopenia</p>\n<p>Neurotoxicity: seizures, confusion, hallucinations</p>\n<p>Nephrotoxicity: Obstructive <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure (crystalluria)</p>\n<ul>\n<li>Contraindicated with <span class=\"customMeta\" data-dictid=\"fa041055ec16927771858fe49c76d3\">cyclosporine</span> and probenecid</li>\n<li>Administer plenty of IV fluid and water</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who has swelling in the middle of their neck, along with weight loss, and a thyroid biopsy showing the presence of 'Orphan Annie eye nuclei?", "options": [{"label": "A", "text": "Follicular thyroid carcinoma", "correct": false}, {"label": "B", "text": "Papillary thyroid carcinoma", "correct": true}, {"label": "C", "text": "Anaplastic thyroid carcinoma", "correct": false}, {"label": "D", "text": "Medullary thyroid carcinoma", "correct": false}], "correct_answer": "B. Papillary thyroid carcinoma", "question_images": ["https://image.prepladder.com/content/r2TNoSQ0M73dD1G2gzrR1746696791.png"], "explanation_images": ["https://image.prepladder.com/content/Z80HcghGwich1VpKUVIu1746696881.png", "https://image.prepladder.com/content/1664NwS8CXuVVfiBoK271746696890.png", "https://image.prepladder.com/content/C5AIl3l3Nw2tpg3GccD51746696903.png", "https://image.prepladder.com/content/ImAS2IjWtDn1IVgV5uXu1746696913.png", "https://image.prepladder.com/content/iSged9AVaI3Ecgcgl5rV1746696922.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 36-year-old farmer who presented with a cough, chest pain lasting one week, fatigue persisting for a month, and a chest x-ray revealing the image provided below?", "options": [{"label": "A", "text": "Hydatid cyst", "correct": true}, {"label": "B", "text": "Anthrax", "correct": false}, {"label": "C", "text": "Silicosis", "correct": false}, {"label": "D", "text": "Byssinosis", "correct": false}], "correct_answer": "A. Hydatid cyst", "question_images": ["https://image.prepladder.com/content/QsX3UqY0pCSLCDVvI20V1746696642.png"], "explanation_images": ["https://image.prepladder.com/content/wtV3xXigNHAmWMPr7FV21746696917.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which medication can be administered to reduce the frequency of future headache episodes in a 26-year-old female patient who experiences one-sided pulsating headaches accompanied by nausea, vomiting, and sensitivity to light and finds relief in a dimly lit environment?", "options": [{"label": "A", "text": "Propranolol", "correct": true}, {"label": "B", "text": "Alprazolam", "correct": false}, {"label": "C", "text": "Diazepam", "correct": false}, {"label": "D", "text": "Fluoxetine", "correct": false}], "correct_answer": "A. Propranolol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Propranolol</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Use of <span class=\"customMeta\" data-dictid=\"082f7143eb1692777196df69a3b6cb\">propranolol</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug of choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Migraine prophylaxis</li>\n<li>Essential tremors</li>\n<li>Aortic <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> if they also have hypertension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"8\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Other Uses</strong></p>\n</td>\n<td rowspan=\"8\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypertension-second-line drugs</li>\n<li>Stable angina</li>\n<li>Cardiac arrhythmias</li>\n<li>Congestive heart failure</li>\n<li>Thyrotoxicosis</li>\n<li>Hypertrophic <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">Cardiomyopathy</span> (Improve <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output).</li>\n<li>Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (Ml): Secondary <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> of Ml and myocardial <span class=\"customMeta\" data-dictid=\"53d0f40d261692777198244a05ec72\">salvage</span> during evolution of Ml (decreases mortality).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute management of <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> attack </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Triptans: Decrease the release of CGRP and cause vasoconstriction. E.g., Sumatriptan, Rizatriptan.</li>\n<li>CGRP <span class=\"customMeta\" data-dictid=\"6e1f8c026516927771919d54418520\">ligand</span> blockers: Eptinezumab, Fremanezumab</li>\n<li>CGRP <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> blockers: Rimegepant</li>\n<li>5-HT1F agonist: Causes <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of neuronal firing. E.g., Lasmiditan</li>\n<li>Ergot alkaloids: Vasoconstrictor. E.g., Ergotamine</li>\n<li>D2 Blockers: Metoclopramide</li>\n<li>Opioids and NSAIDs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prophylaxis of <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Propranolol (Beta-blocker, <span class=\"customMeta\" data-dictid=\"357ecf18f2169277718661a76111ea\">DOC</span> for <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> prophylaxis).</li>\n<li>Flunarizine (Calcium channel blocker)</li>\n<li>Cyproheptadine: (Antihistamine that can help alleviate <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> symptoms).</li>\n<li>Candesartan: (Angiotensin II <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> blocker).</li>\n<li>Clonidine</li>\n<li>Pizotifen (Serotonin <span class=\"customMeta\" data-dictid=\"2e432a4f3c1692777181e8e244ca0e\">antagonist</span> that can help reduce <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> frequency).</li>\n<li>Gabapentin, valproate, nortriptyline, and <span class=\"customMeta\" data-dictid=\"b4bc3f01b316927772005b04f0e449\">topiramate</span> are medications that can help manage <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> symptoms by releasing the <span class=\"customMeta\" data-dictid=\"e28fd027b416927771932bc23ba0a5\">neurotransmitter</span> GABA.</li>\n<li>Topiramate</li>\n<li>Methysergide (Manages <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> symptoms by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> receptors).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient took a drug for migraine treatment, following which there was numbness, and his hand appeared as below. What is the possible drug that was taken?", "options": [{"label": "A", "text": "Dihydroergotamine", "correct": true}, {"label": "B", "text": "Sumatriptan", "correct": false}, {"label": "C", "text": "Butorphanol", "correct": false}, {"label": "D", "text": "Aspirin", "correct": false}], "correct_answer": "A. Dihydroergotamine", "question_images": ["https://image.prepladder.com/notes/Ui0N5XPvVQOiQZDpD0p71747987306.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - Dihydroergotamine</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dihydroergotamine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug class </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ergot alkaloids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Partial <span class=\"customMeta\" data-dictid=\"7d8d28cda71692777180c89a3c86ce\">agonist</span> activity at <strong>5HT1B/1D receptors</strong> causes vasoconstriction, reducing migraine-associated inflammation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> attack</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral vasoconstriction\n\t\t\t\t<ul>\n<li>Manifest as numbness, tingling, and discolouration of the fingers, commonly <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as Raynaud's phenomenon.</li>\n<li>Discolouration of fingers - White <strong>→ </strong>Blue<strong>→</strong> Red</li>\n<li>It can lead to <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> of extremities and organs with end arteries.</li>\n</ul>\n</li>\n<li>Nausea and vomiting</li>\n<li>Paradoxical headache and dizziness</li>\n<li>Flushing</li>\n<li>Nasal congestion</li>\n<li>Chest pain</li>\n<li>Muscle pain</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man was admitted to the emergency ward with severe, sudden-onset chest pain radiating to the left arm and profuse sweating. The ECG showed ST-segment elevation in precordial leads. The person succumbed after 3 hours. During the autopsy, his heart was taken out and immersed in a solution. The normal area of the heart turned brick-red, whereas the infarcted portion turned pale. Which of the following is a likely component of the solution?", "options": [{"label": "A", "text": "Formalin", "correct": false}, {"label": "B", "text": "Triphenyl tetrazolium chloride", "correct": true}, {"label": "C", "text": "Ethanol", "correct": false}, {"label": "D", "text": "Glutaraldehyde", "correct": false}], "correct_answer": "B. Triphenyl tetrazolium chloride", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4bxrnYYoOi23npo0LFhY1746697158.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 13-year-old boy presents to you with a limitation of abduction and internal rotation of the left hip. The x-ray appearance of his left hip joint is shown in the below image. What is the diagnosis of this patient?", "options": [{"label": "A", "text": "Slipped capital femoral epiphysis", "correct": true}, {"label": "B", "text": "Perthes disease", "correct": false}, {"label": "C", "text": "Development of dysplasia of the hip", "correct": false}, {"label": "D", "text": "Ankylosing spondylitis", "correct": false}], "correct_answer": "A. Slipped capital femoral epiphysis", "question_images": ["https://image.prepladder.com/content/NQzzoqZ2UxMVodNr2UMU1746697116.png"], "explanation_images": ["https://image.prepladder.com/content/w9wfKE29705bo07UlkBh1746697211.png", "https://image.prepladder.com/content/IYdkEE16LkEphsvyJQho1746697228.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs acts by inhibiting the catechol-o-methyl transferase enzyme?", "options": [{"label": "A", "text": "Amantidine", "correct": false}, {"label": "B", "text": "Rotigotine", "correct": false}, {"label": "C", "text": "Tolcapone", "correct": true}, {"label": "D", "text": "Selegiline", "correct": false}], "correct_answer": "C. Tolcapone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Tolcapone</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tolcapone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It inhibits the catechol-o-methyl <span class=\"customMeta\" data-dictid=\"2288cbf3741692777200318d2f5b39\">transferase</span> enzyme, which is responsible for the <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of catecholamines, which prolongs the action of catechols in the <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> tissue.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adjunct therapy in Parkinson’s disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hepatotoxicity</li>\n<li>On/Off phenomenon</li>\n</ul>\n<p>Neurological Symptoms:</p>\n<ul>\n<li>Dyskinesia (due to increased <span class=\"customMeta\" data-dictid=\"398108f4501692777191f60f958fb2\">levodopa</span> bioavailability)</li>\n<li>Dizziness</li>\n<li>Headache</li>\n<li>Sleep disturbances (e.g., insomnia)</li>\n</ul>\n<p>Psychiatric Symptoms:</p>\n<ul>\n<li>Hallucinations</li>\n<li>Confusion</li>\n<li>Increased impulsive behaviors</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the drug of choice for central diabetes insipidus?", "options": [{"label": "A", "text": "Insulin", "correct": false}, {"label": "B", "text": "Desmopressin", "correct": true}, {"label": "C", "text": "Diazoxide", "correct": false}, {"label": "D", "text": "Chlorpropamide", "correct": false}], "correct_answer": "B. Desmopressin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Desmopressin</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Desmopressin</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DDAVP, or desmopressin, is a <span class=\"customMeta\" data-dictid=\"61fbe2173416927771998e7aa0b432\">synthetic</span> <span class=\"customMeta\" data-dictid=\"22e0051a181692777181872183edb2\">analogue</span> of <span class=\"customMeta\" data-dictid=\"699f9aa3cf1692777201b501b79deb\">vasopressin</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acts on V2 receptors located in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubules, which increases water <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubule</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diabetes insipidus(central)</li>\n<li>Nocturnal Enuresis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Route </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nasal or intravenous, as the oral route is less efficacious due to getting metabolised by <span class=\"customMeta\" data-dictid=\"be1c04825c169277720006550a3ab2\">trypsin</span> in the gut</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyponatremia</li>\n<li>Cerebral edema</li>\n<li>Fluid overload</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man has been diagnosed with solid cancer of the bowel. He also experienced massive proteinuria a few months after the initial diagnosis of cancer. What do you think is the likely cause of the development of urinary findings?", "options": [{"label": "A", "text": "Membranous nephropathy", "correct": true}, {"label": "B", "text": "Focal segmental glomerulosclerosis", "correct": false}, {"label": "C", "text": "Membranoproliferative glomerulonephritis", "correct": false}, {"label": "D", "text": "Dense deposit disease", "correct": false}], "correct_answer": "A. Membranous nephropathy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JIWHYRBgR0ukqwnJ4Dh11746697332.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic Features of Membranous Nephropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoantibodies against <strong>phospholipase A2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> (PLA2R)</strong> on podocytes (most common in <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> cases).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autoimmune diseases (SLE), infections (Hepatitis B/C), drugs (NSAIDs, penicillamine), and malignancies (lung, breast, <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nephrotic Syndrome Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Massive <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> (&gt;3.5 g/day), hypoalbuminemia, oedema, hyperlipidemia, lipiduria.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of Thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</strong> is a known complication.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Light Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse thickening of the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (GBM)</strong> without hypercellularity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electron Microscopy (EM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subepithelial immune deposits</strong> create a <strong>\"spike and dome\" appearance</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunofluorescence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granular IgG and C3 deposits</strong> along the GBM.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PLA2R Antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Specific for primary membranous nephropathy</strong> and helps <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> from secondary causes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ACE inhibitors/ARBs (reduce proteinuria), steroids + immunosuppressants (cyclophosphamide, rituximab) for severe cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>⅓ <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> remission, ⅓ persistent proteinuria, ⅓ progress to ESRD.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the drug of choice for UTI in pregnancy?", "options": [{"label": "A", "text": "Amoxicillin", "correct": false}, {"label": "B", "text": "Azithromycin", "correct": false}, {"label": "C", "text": "Clarithromycin", "correct": false}, {"label": "D", "text": "Ceftriaxone", "correct": true}], "correct_answer": "D. Ceftriaxone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Ceftriaxone</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses of cephalosporins</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First generation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>ENT, upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> &amp; <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> infections</li>\n<li>Surgical prophylaxis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Second generation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mixed aerobic-anaerobic infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><strong>Third generation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Empirical therapy for meningitis</li>\n<li>Pseudomonas meningitis</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection in pregnancy</li>\n<li>STI : Gonorrhea, chancroid, syphilis</li>\n<li>Enteric fever</li>\n<li>Patients with neutropenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fourth generation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nosocomial infections (intensive care borne)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p><strong>Fifth generation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Penicillin-resistant <span class=\"customMeta\" data-dictid=\"d7ccdaffea1692777184e4c19a10aa\">community-acquired</span> and hospital-acquired <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> by S.pneumoniae</li>\n<li>Penicillinase-producing S.aureus infections</li>\n<li>MRSA</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 20-year-old male who presents with pain in the right flank, along with fever and chills? The patient experiences pain when the hip is passively extended on the right side. Lab tests indicate an increased white blood cell count, and a CT scan reveals specific findings.", "options": [{"label": "A", "text": "Pyelonephritis", "correct": false}, {"label": "B", "text": "Psoas abscess", "correct": true}, {"label": "C", "text": "Appendicitis", "correct": false}, {"label": "D", "text": "Torsion of right undescended testis", "correct": false}], "correct_answer": "B. Psoas abscess", "question_images": ["https://image.prepladder.com/notes/kaTnKWDI5ge86ENNHYdz1747997653.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is Zileuton's mechanism of action?", "options": [{"label": "A", "text": "Cycloxygenase inhibitor", "correct": false}, {"label": "B", "text": "5-Lipooxygenase inhibitor", "correct": true}, {"label": "C", "text": "5-Phosphodiesterase inhibitor", "correct": false}, {"label": "D", "text": "Prevents mass cell degradation", "correct": false}], "correct_answer": "B. 5-Lipooxygenase inhibitor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5BLyIwi3tE6PJSa67nTC1746697671.png", "https://image.prepladder.com/content/VLQib27XFS98wcDnNNfl1746697678.png"], "explanation": "<p>Correct Answer B - 5-Lipooxygenase inh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female presents with the development of seizures, for which a CT-guided biopsy was done. The histopathological image showed the presence of psammoma bodies. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Astrocytoma", "correct": false}, {"label": "B", "text": "Medulloblastoma", "correct": false}, {"label": "C", "text": "Meningioma", "correct": true}, {"label": "D", "text": "Ependymoma", "correct": false}], "correct_answer": "C. Meningioma", "question_images": ["https://image.prepladder.com/content/SZU046KYFtSzP3uMcPFE1746697540.png"], "explanation_images": ["https://image.prepladder.com/content/cqPI2wBqQOqZurKuPN2B1746697592.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Tumours</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Glial Cell</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Astrocytoma, Ependymoma, Oligodendroglioma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Undifferentiated Cell </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Medulloblastoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Neuronal Cell</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Neurocytoma, Ganglioglioma, Ganglioneuroma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Meningeal Cell</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Meningioma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presented with burning micturition. A diagnosis of cystitis was made. Which of the following drugs will be used for treatment?", "options": [{"label": "A", "text": "Amoxycillin", "correct": false}, {"label": "B", "text": "TMP-SMX", "correct": true}, {"label": "C", "text": "Ciprofloxacin", "correct": false}, {"label": "D", "text": "Doxycycline", "correct": false}], "correct_answer": "B. TMP-SMX", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - TMP-SMX is the first-line treatment for uncomplicated cystitis.</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Trimethoprim-sulfamethoxazole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trimethoprim (TMP)</strong>: Inhibits <span class=\"customMeta\" data-dictid=\"0f9fe95f081692777186e5071229c6\">dihydrofolate</span> reductase, <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> the conversion of <span class=\"customMeta\" data-dictid=\"0f9fe95f081692777186e5071229c6\">dihydrofolate</span> acid to tetrahydrofolic acid</p>\n<p><strong>Sulfamethoxazole (SMX)</strong>: Inhibits dihydropteroate synthase, preventing the <span class=\"customMeta\" data-dictid=\"7bc107ea09169277719095466ee864\">incorporation</span> of <span class=\"customMeta\" data-dictid=\"2840845b5b16927771946abe018ef6\">para-aminobenzoic acid</span> (PABA) into dihydropteroic acid, an essential <span class=\"customMeta\" data-dictid=\"ae13cdc5c3169277719683e9f6bda5\">precursor</span> in <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> synthesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections (DOC for mild cases)</li>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections</li>\n<li>GIT Infections</li>\n<li>Prevention and treatment of Pneumocystis jirovecii <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> in <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea and Vomiting</li>\n<li>Diarrhoea</li>\n<li>Rash</li>\n<li>Hypersensitivity reactions (including Stevens-Johnson syndrome and toxic <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> necrolysis)</li>\n<li>Blood dyscrasias (e.g., neutropenia, thrombocytopenia)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Note</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contraindicated in patients with <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> deficiency</li>\n<li>Use with caution in pregnant women, infants, and individuals with G6PD deficiency</li>\n<li>Increased risk of <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> with potassium-sparing diuretics</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with hepatic angiosarcoma?", "options": [{"label": "A", "text": "Iron", "correct": false}, {"label": "B", "text": "Copper", "correct": false}, {"label": "C", "text": "Zinc", "correct": false}, {"label": "D", "text": "Arsenic", "correct": true}], "correct_answer": "D. Arsenic", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following DMARD uses require regular monitoring of visual acuity and fundus examination?", "options": [{"label": "A", "text": "Methotrexate", "correct": false}, {"label": "B", "text": "Hydroxychloroquine", "correct": true}, {"label": "C", "text": "Sulfasalazine", "correct": false}, {"label": "D", "text": "Leflunomide", "correct": false}], "correct_answer": "B. Hydroxychloroquine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PGOYeAqYZqejT2N3lh5K1746697921.png", "https://image.prepladder.com/content/pEMGQhrMUKwPAGfszWtK1746697927.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Hydroxychloroquine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>MAO</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Hydroxychloroquine⟶ Lysosome Accumulation ⟶ ↑ Lysosomal pH ⟶ Inhibits Antigen Processing ⟶ ↓ Antigen-MHC Presentation ⟶ ↓ T-Cell Activation ⟶ Inhibits TLRs ⟶ ↓ Pro-inflammatory Cytokines ⟶ ↓ Inflammation in RA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Rheumatoid arthritis.</li>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus (SLE)</li>\n<li>Prevention and treatment of malaria</li>\n<li>Autoimmune diseases like Sjögren's syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Gastrointestinal (nausea, vomiting, diarrhoea)</li>\n<li>Dermatological (rash, <span class=\"customMeta\" data-dictid=\"b5f46d7e431692777195efd6b43e9f\">pigmentation</span> changes)</li>\n<li>Ocular toxicity:\n\t\t\t\t<ul>\n<li><strong>Vortex keratopathy</strong> (cornea verticallata)</li>\n<li><strong>Posterior <span class=\"customMeta\" data-dictid=\"550fa75ff216927771992c0987c58e\">subcapsular</span> cataract</strong></li>\n<li><strong>Bull’s eye <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">retinopathy</span> </strong>(deposits like <span class=\"customMeta\" data-dictid=\"9bb62139a81692777184648bfef564\">concentric</span> rings in the retina)</li>\n</ul>\n</li>\n<li>Cardiovascular (cardiomyopathy, QT prolongation)</li>\n<li>Neurological (headache, dizziness)</li>\n<li>Hematologic (anaemia, leukopenia)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Note</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Regular ophthalmologic examinations to monitor for <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> toxicity.</li>\n<li>The maximum safe dose of hydroxychloroquine to minimise the risk of bull's-eye <span class=\"customMeta\" data-dictid=\"e2819a366f1692777191b1bf2bb04f\">maculopathy</span> is recommended to be <strong>5 mg/kg of real body weight per day.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the labelled structure in the image?", "options": [{"label": "A", "text": "Midbrain", "correct": true}, {"label": "B", "text": "Pons", "correct": false}, {"label": "C", "text": "Medulla", "correct": false}, {"label": "D", "text": "Cerebellum", "correct": false}], "correct_answer": "A. Midbrain", "question_images": ["https://image.prepladder.com/notes/XJi35TQpZAMY1VV4JwZe1748002897.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old man has presented with chronic lower back pain, fatigue, and headaches for the last few weeks. On examination, he has pallor and bony tenderness. Lab investigations revealed an increased ESR, and his skull radiograph revealed several punched-out lytic lesions. Which of the following is the best investigation for this patient among the following options?", "options": [{"label": "A", "text": "Serum electrophoresis showing IgG", "correct": true}, {"label": "B", "text": "Serum levels of CA 15-3", "correct": false}, {"label": "C", "text": "Whole-body scan", "correct": false}, {"label": "D", "text": "CT head with contrast", "correct": false}], "correct_answer": "A. Serum electrophoresis showing IgG", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presented with burning micturition and symptoms of UTI. Which of the following fluoroquinolones is least likely to be effective if UTI is caused by Enterococcus species?", "options": [{"label": "A", "text": "Ofoxacin", "correct": false}, {"label": "B", "text": "Cirpofloxacin", "correct": false}, {"label": "C", "text": "Moxifloxacin", "correct": true}, {"label": "D", "text": "Levofloxacin", "correct": false}], "correct_answer": "C. Moxifloxacin", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/IB5QulHfgA8BFkwUZwh51747987469.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fluoroquinolones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>First Generation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Second Generation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Norfloxacin</li>\n<li>Ciprofloxacin <strong>(Option B)</strong></li>\n<li>Ofloxacin <strong>(Option A)</strong></li>\n<li>Pefloxacin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sparfloxacin</li>\n<li>Levofloxacin <strong>(Option D)</strong></li>\n<li>Moxifloxacin <strong>(Option C)</strong></li>\n<li>Gemifloxacin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pharmacokinetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Good oral absorption</li>\n<li>Moderate half-life</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Good oral absorption</li>\n<li>Longer half-life</li>\n<li>Better tissue penetration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit bacterial <strong>DNA gyrase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit bacterial<strong> DNA gyrase</strong> and <strong>topoisomerase IV</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PPH047 MOA of Fluoroquinolones\" data-author=\"NA\" data-hash=\"13247\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/IB5QulHfgA8BFkwUZwh51747987469.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spectrum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Effective against Gram-negative bacteria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Broader spectrum, including Gram (+ve), Gram (-ve) and Atypical pathogens.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections</li>\n<li>Prostatitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Respiratory infections</li>\n<li>Skin infections</li>\n<li>Complicated UTIs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea and Vomiting</li>\n<li>Diarrhea</li>\n<li>Dizziness</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>QT prolongation</li>\n<li>Tendonitis</li>\n<li>CNS effects</li>\n<li>Phototoxicity</li>\n<li>Peripheral neuropathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pregnancy</li>\n<li>Children</li>\n<li>Myasthenia gravis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Same as the first-generation</li>\n<li>Patients with <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary protein that binds to thyroxine?", "options": [{"label": "A", "text": "Follistatin", "correct": false}, {"label": "B", "text": "Transthyretin", "correct": false}, {"label": "C", "text": "Thyroxine-binding globulin", "correct": true}, {"label": "D", "text": "Transferrin", "correct": false}], "correct_answer": "C. Thyroxine-binding globulin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug is most suitable for treating edema in a patient with heart disease and presenting with breathlessness with rales?", "options": [{"label": "A", "text": "ACE inhibitors", "correct": false}, {"label": "B", "text": "Na-K-2Cl symporter inhibitor in the loop in Henle", "correct": true}, {"label": "C", "text": "Na-Cl symporter inhibitor in DCT", "correct": false}, {"label": "D", "text": "Aldosterone blocker in DCT", "correct": false}], "correct_answer": "B. Na-K-2Cl symporter inhibitor in the loop in Henle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Na-K-2Cl &lt;span class=\"customMeta\" data-dictid=\"1bede64bc91692777199b477cf43f1\"&gt;symporter&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\"&gt;inhibitor&lt;/span&gt; in the loop in Henle</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Loop diuretic</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inhibit the Na-K-2Cl symporter</strong> in the <strong>thick <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> loop of Henle,</strong> increasing the <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of sodium, chloride, and water, resulting in <span class=\"customMeta\" data-dictid=\"09562877f516927771865e4cf1fd7e\">diuresis</span> and reduction of edema.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Furosemide, Bumetanide</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</p>\n</li>\n<li>\n<p>Chronic heart failure</p>\n</li>\n<li>\n<p>Hypercalcemia</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Hypokalemia,</p>\n</li>\n<li>\n<p>Ototoxicity,</p>\n</li>\n<li>\n<p>Metabolic alkalosis,</p>\n</li>\n<li>\n<p>Hyperglycemia,</p>\n</li>\n<li>\n<p>Hyperuricemia</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a clinical trial evaluating the efficacy of a new drug, a normal efficacy potecy graph is used. Which of the following statements regarding the graph is true?", "options": [{"label": "A", "text": "The graph shows the relationship between drug potency and its efficacy", "correct": false}, {"label": "B", "text": "The graph demonstrates that higher potency always leads to higher efficacy", "correct": false}, {"label": "C", "text": "The graph represents the dose-response curve for the drug", "correct": true}, {"label": "D", "text": "The graph indicates that drugs with low potency can never be effective", "correct": false}], "correct_answer": "C. The graph represents the dose-response curve for the drug", "question_images": ["https://image.prepladder.com/content/qXmtoOLuvLUmKKvX1KOK1746698324.png"], "explanation_images": [], "explanation": "<p>Correct Answer C - The &lt;span class=\"customMeta\" data-dictid=\"90b63cdcfe16927771885e9612aecb\"&gt;graph&lt;/span&gt; represents the &lt;span class=\"customMeta\" data-dictid=\"24e5d1dd8e1692777186ce70f3f91b\"&gt;dose-response curve&lt;/span&gt; for the drug\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the structure labelled 'X' in the given ultrasound image of the liver. ", "options": [{"label": "A", "text": "Portal vein", "correct": true}, {"label": "B", "text": "Hepatic artery", "correct": false}, {"label": "C", "text": "Hepatic vein", "correct": false}, {"label": "D", "text": "Inferior vena cava", "correct": false}], "correct_answer": "A. Portal vein", "question_images": ["https://image.prepladder.com/notes/iVVeqz31AHzSGMWABZNW1747997909.png"], "explanation_images": ["https://image.prepladder.com/notes/O94CrcX9ciTVq3NJTWqx1747997977.png", "https://image.prepladder.com/notes/UaOq1dPetYou1uFPI1kQ1747998016.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient on anti-cancer therapy developed an infection. Blood analysis revealed a total leucocyte count of 2000/mm3. Which of the following drugs is likely to be effective in this patient?", "options": [{"label": "A", "text": "Romiplostim", "correct": false}, {"label": "B", "text": "Oprelvekin", "correct": false}, {"label": "C", "text": "Filgrastim", "correct": true}, {"label": "D", "text": "Erythropoietin", "correct": false}], "correct_answer": "C. Filgrastim", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Filgrastim</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs promoting WBC formation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>G-CSF</strong></p>\n<p>(Glycoprotein with 175 <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids)</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Stimulates colony-forming unit (CFU) granulocytes to increase <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">neutrophil</span> production.</li>\n<li>Enhances <span class=\"customMeta\" data-dictid=\"b68a8f1b37169277719547f1cfda59\">phagocytic</span> and cytotoxic activities of neutrophils.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Treats severe <span class=\"customMeta\" data-dictid=\"3925bbe5df1692777193bd03c159a8\">neutropenia</span> after <span class=\"customMeta\" data-dictid=\"0a266da66816927771824d58668832\">autologous</span> <span class=\"customMeta\" data-dictid=\"d2e0ab499c169277718886ab5a46bf\">hematopoietic</span> <span class=\"customMeta\" data-dictid=\"467c0b4fc016927771997e1043aeda\">stem cell transplantation</span> and high-dose cancer chemotherapy</li>\n<li>Treats severe <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> neutropenias</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Filgrastim</strong></p>\n<p>(Recombinant human G-CSF)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Same use as G-CSF</li>\n<li>Treats <span class=\"customMeta\" data-dictid=\"3925bbe5df1692777193bd03c159a8\">neutropenia</span> in patients with AIDS receiving zidovudine</li>\n<li>Used in patients undergoing <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood stem cell collection for stem cell transplantation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PEG-Filgrastim</strong></p>\n<p>(Longer acting <span class=\"customMeta\" data-dictid=\"761475dbbd169277719523f180ef28\">pegylated</span> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of G-CSF)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prevention of chemotherapy-induced neutropenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sargramostim</strong></p>\n<p>(Recombinant human GM-CSF)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates myelopoiesis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autologous <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> treatment</li>\n<li>Mobilizes CD34+ progenitor cells for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood stem cell collection post-myeloablative chemotherapy</li>\n<li>Treats <span class=\"customMeta\" data-dictid=\"3925bbe5df1692777193bd03c159a8\">neutropenia</span> in patients on <span class=\"customMeta\" data-dictid=\"901bf573f216927771905f0abedca2\">intensive</span> cancer chemotherapy</li>\n<li>Supports <span class=\"customMeta\" data-dictid=\"9a34416acd16927771930416df6115\">myelopoiesis</span> in <span class=\"customMeta\" data-dictid=\"1d84248e9f16927771850f8b75c26a\">cyclic</span> neutropenia, myelodysplasia, <span class=\"customMeta\" data-dictid=\"1ea06afcbd1692777181199bfa3300\">aplastic</span> anemia, and AIDS-associated neutropenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Molgramostim</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Targets GM-CSF receptors on <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"ae13cdc5c3169277719683e9f6bda5\">precursor</span> cells</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increases granulocytes and monocytes</li>\n<li>Approved for chemotherapy-induced neutropenia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male underwent a bone marrow examination, which revealed the presence of the following findings, as shown in the image. What is the likely diagnosis of this patient?", "options": [{"label": "A", "text": "Multiple myeloma", "correct": true}, {"label": "B", "text": "ALL", "correct": false}, {"label": "C", "text": "Tuberculosis", "correct": false}, {"label": "D", "text": "Sickle cell disease", "correct": false}], "correct_answer": "A. Multiple myeloma", "question_images": ["https://image.prepladder.com/content/QZnWPJ0JSoqLARsTa5T71746698090.png"], "explanation_images": ["https://image.prepladder.com/content/4PgtbfbpMxIFGQV1iO091746698229.png", "https://image.prepladder.com/content/hVg4eoVjRK7R0yaMXz4A1746698238.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnostic Criteria for Multiple myeloma:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>≥10% clonal <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells (or)<strong> </strong>a biopsy-proven bony or <span class=\"customMeta\" data-dictid=\"0ba1f7edfa1692777187ae6f51e603\">extramedullary</span> plasmacytoma</li>\n</ul>\n<p><strong> + (PLUS)</strong></p>\n<ul>\n<li>Evidence of one or more <span class=\"customMeta\" data-dictid=\"652999e42416927771936e1f3246e3\">multiple myeloma</span> defining events (MDE): (CRAB features)\n\t\t\t\t<ul>\n<li>Hyper<strong>C</strong>alcemia <strong>(S.Ca2+ &gt;11g/dl)</strong><strong> </strong></li>\n<li><strong>R</strong>enal failure <strong>(S. Creatinine &gt;2mg/dl) </strong></li>\n<li><strong>A</strong>naemia <strong>(Hb &lt;10gm)</strong><strong> </strong></li>\n<li>Lytic <strong>B</strong>one lesions are attributable to the <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cell disorder.</li>\n</ul>\n</li>\n</ul>\n<p><strong> (OR)</strong></p>\n<p>One or more biomarkers of <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (<strong>SLIM </strong>criteria)</p>\n<ul>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> clonal plasmacytosis<strong> </strong><strong>≥60%</strong> (<strong>S</strong>ixty per cent)</li>\n<li>Serum involved/uninvolved free <strong>Li</strong>ght chain (FLC) ratio<strong> </strong><strong>≥ 100</strong> (provided involved FLC is ≥100 mg/L)</li>\n<li><strong>&gt;1</strong> <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on<strong> M</strong>RI.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person presents with acute chest pain. Nitro-glycerine was given sublingually, and pain relief occurred within a minute. What is the mechanism of this drug?", "options": [{"label": "A", "text": "Release of endothelin", "correct": false}, {"label": "B", "text": "Release of nitric oxide", "correct": true}, {"label": "C", "text": "Calcium channel blockade", "correct": false}, {"label": "D", "text": "Beta blockade", "correct": false}], "correct_answer": "B. Release of nitric oxide", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/lNxYLcNSI4nBzv8tTlXc1747987556.png"], "explanation": "<p>Correct Answer B - Release of &lt;span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\"&gt;nitric&lt;/span&gt; oxide</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Nitrates</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Glyceryl trinitrate</li>\n<li>Isosorbide dinitrate</li>\n<li>Isosorbide mononitrate</li>\n<li>Pentaerythritol tetranitrate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PPH050 Nitrates MOA\" data-author=\"NA\" data-hash=\"13248\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/lNxYLcNSI4nBzv8tTlXc1747987556.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Venodilation → Reduce <span class=\"customMeta\" data-dictid=\"628ed9c26316927771964889249b3b\">preload</span> → Reduce myocardial <span class=\"customMeta\" data-dictid=\"3d46029a83169277718580263882c3\">contractility</span> → Decreased O<sub>2</sub> demand.</li>\n<li>Dilates <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (increase cGMP): effective in <span class=\"customMeta\" data-dictid=\"1af6c1e77d169277720168838edbbe\">vasospastic</span> angina.</li>\n<li>Redistribution of <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the ischemic area (<strong>Robinhood phenomenon</strong>).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Angina (stable, <span class=\"customMeta\" data-dictid=\"1af6c1e77d169277720168838edbbe\">vasospastic</span> and chronic)</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> syndrome or myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (STEMI/NSTEMI)</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</li>\n<li>Abdominal colicky pain</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old boy with Down syndrome presents with mediastinal mass (presenting as SVC-like syndrome), and Peripheral blood and bone marrow have increased lymphoblasts. What is the probable diagnosis?", "options": [{"label": "A", "text": "Acute myeloblastic leukemia", "correct": false}, {"label": "B", "text": "Chronic lymphoblastic leukemia", "correct": false}, {"label": "C", "text": "Acute lymphoblastic leukemia", "correct": true}, {"label": "D", "text": "Chronic myeloid leukemia", "correct": false}], "correct_answer": "C. Acute lymphoblastic leukemia", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to a decline in normal <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> function.</li>\n<li>Fatigue (Anaemia).</li>\n<li>Infections (Neutropenia)</li>\n<li>Bleeding (Thrombocytopenia)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mass effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bone pain due to <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> expansion and <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> of the subperiosteum.</li>\n<li>Generalised lymphadenopathy.</li>\n<li>Hepatosplenomegaly.</li>\n<li>Testicular enlargement.</li>\n<li>Mediastinal mass in T-ALL (Superior <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> syndrome).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CNS manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headache.</li>\n<li>Vomiting.</li>\n<li>Nerve palsies.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has pain in the facial nerve distribution while chewing and speaking. Which of the following drugs should be given for the treatment?", "options": [{"label": "A", "text": "Lamotrigine", "correct": false}, {"label": "B", "text": "Carbamazepine", "correct": true}, {"label": "C", "text": "Phenobarbitone", "correct": false}, {"label": "D", "text": "Haloperidol", "correct": false}], "correct_answer": "B. Carbamazepine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Carbamazepine</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs for <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> <span class=\"customMeta\" data-dictid=\"c4cb87045a169277719307432604a6\">neuralgia</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carbamazepine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits high-frequency neuronal discharges and modulates voltage-gated sodium channels.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trigeminal neuralgia</p>\n<p>GTCS, partial seizures, <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> disorder.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sedation, dizziness, ataxia, GI disturbances, <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> suppression, <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reactions, water retention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gabapentin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enhances GABA release modulates voltage-sensitive Ca2+ channels.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Partial seizures, post-herpetic neuralgia, <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> prophylaxis.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sedation, tiredness, dizziness, tremor, unsteadiness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diazepam</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enhances GABAergic neurotransmission.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Status epilepticus,</p>\n<p>Febrile seizure.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thrombophlebitis, hypotension, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> depression.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Topiramate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple mechanisms, including <span class=\"customMeta\" data-dictid=\"276be2047116927771989f7bf5ed02\">sodium channel</span> inactivation, GABA potentiation, <span class=\"customMeta\" data-dictid=\"ada5fcf7e416927771886ff24152ff\">glutamate</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonism, and <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> channel modulation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GTCS, myoclonic epilepsy, and absence of seizures.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impairment of attention, sedation, ataxia, word-finding difficulties, poor memory, weight loss, paresthesias, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Among the following, which molecule is required for the presentation of the antigens by the APCs to TH2 cells?", "options": [{"label": "A", "text": "NK cells", "correct": false}, {"label": "B", "text": "G-protein coupled receptor", "correct": false}, {"label": "C", "text": "MHC", "correct": true}, {"label": "D", "text": "Lectin receptor", "correct": false}], "correct_answer": "C. MHC", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man was treated for a high-grade soft-tissue sarcoma with radiotherapy. Since he was not responding, he was shifted to chemotherapy. After initiating chemotherapy, he developed erythematous rashes over the areas where radiotherapy was administered earlier.Which of the following drugs causes this condition?", "options": [{"label": "A", "text": "Vincristine", "correct": false}, {"label": "B", "text": "Doxorubicin", "correct": true}, {"label": "C", "text": "Cyclophosphamide", "correct": false}, {"label": "D", "text": "6-Mercaptopurine", "correct": false}], "correct_answer": "B. Doxorubicin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Doxorubicin</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Doxorubicin</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This leads to DNA Intercalation, Topoisomerase II Inhibition, and <span class=\"customMeta\" data-dictid=\"9d5d6b68e616927772031cfb280823\">free radical</span> formation, causing DNA damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Soft tissue sarcoma</li>\n<li>Hodgkins and Non-Hodgkins Lymphoma</li>\n<li>Lung carcinoma</li>\n<li>Leukaemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Radiation recall dermatitis</li>\n<li>Alopecia</li>\n<li>Stomatitis</li>\n<li>Dilated cardiomyopathy</li>\n<li>Peripheral neuropathy</li>\n<li>Hypersensitivity reaction - <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">Rash</span> and fever</li>\n<li>Hyperpigmentation of skin and nails</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mode of inheritance in a patient suffering from colour blindness?", "options": [{"label": "A", "text": "AD", "correct": false}, {"label": "B", "text": "AR", "correct": false}, {"label": "C", "text": "XLR", "correct": true}, {"label": "D", "text": "XLD", "correct": false}], "correct_answer": "C. XLR", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>X-linked Recessive</strong></p>\n<p style=\"text-align: center;\"><strong>(WISE ABCDEFGH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wise-</strong>Wiskott Aldrich Syndrome</p>\n<p><strong>AB- </strong>Hemophilia A, B</p>\n<p><strong>B- </strong>Bruton's Hypogammaglobulinemia<strong>.</strong></p>\n<p><strong>C- </strong>Chronic Granulomatous Disease, Red Green Color Blindness</p>\n<p><strong>D- </strong>DMD, BMD</p>\n<p><strong>E- </strong>Lesch Nyhan Syndrome</p>\n<p><strong>F- </strong>Fabry Disease, Fragile X Syndrome</p>\n<p><strong>G- </strong>G6PD Deficiency</p>\n<p><strong>H- </strong>Hunter Disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Macrophages play an important role in phagocytosis and chronic inflammation. Which of the following cells perform the same function in the liver?", "options": [{"label": "A", "text": "Hepatocytes", "correct": false}, {"label": "B", "text": "Merkel cells", "correct": false}, {"label": "C", "text": "Sinusoid all cells", "correct": false}, {"label": "D", "text": "Kupffer cells", "correct": true}], "correct_answer": "D. Kupffer cells", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Igk4qdG6P5iyY35iQ5to1747986551.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate order of muscle utilization during ejaculation?", "options": [{"label": "A", "text": "Ischiocavernosus relaxation-external urethral sphincter relaxation-Bulbospongiosus contraction", "correct": false}, {"label": "B", "text": "Ischiocavernosus relaxation-External urethral sphincter contraction-Bulbospongiosus relaxation", "correct": false}, {"label": "C", "text": "Ischiocaveernosus contraction- external urethral sphincter relaxation- Bulbospongiosus relaxation", "correct": true}, {"label": "D", "text": "Ischiocavernosus contraction- External urethral sphincter relaxation- Bulbospongiosus relaxation", "correct": false}], "correct_answer": "C. Ischiocaveernosus contraction- external urethral sphincter relaxation- Bulbospongiosus relaxation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a characteristic feature of Barrett's oesophagus?", "options": [{"label": "A", "text": "Squamous metaplasia", "correct": false}, {"label": "B", "text": "Severe dysplasia", "correct": false}, {"label": "C", "text": "Intestinal metaplasia", "correct": true}, {"label": "D", "text": "Cuboidal metaplasia", "correct": false}], "correct_answer": "C. Intestinal metaplasia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4FHhzpZmVOkZoBZ84w7n1746699478.png", "https://image.prepladder.com/content/RtUFRLEBnZ6sJW2eSNTv1746699486.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Oxytocin plays a role in-", "options": [{"label": "A", "text": "Milk production", "correct": false}, {"label": "B", "text": "Milk ejection", "correct": true}, {"label": "C", "text": "Milk storage", "correct": false}, {"label": "D", "text": "Osmoregulation", "correct": false}], "correct_answer": "B. Milk ejection", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the image below represent in terms of murmurs?", "options": [{"label": "A", "text": "End diastolic", "correct": false}, {"label": "B", "text": "Pan systolic", "correct": false}, {"label": "C", "text": "Ejection systolic", "correct": true}, {"label": "D", "text": "Mid diastolic", "correct": false}], "correct_answer": "C. Ejection systolic", "question_images": ["https://image.prepladder.com/content/a7U0IWF2BgxQcr4VP6QI1746699683.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 64-year-old woman with a history of trauma to the left eye 5 days back now presented with complaints of complete loss of vision. Upon examination the following findings were seen. What should be the subsequent course of action to manage this condition?", "options": [{"label": "A", "text": "Keratoplasty", "correct": true}, {"label": "B", "text": "Keratotomy", "correct": false}, {"label": "C", "text": "LASIK", "correct": false}, {"label": "D", "text": "DCR", "correct": false}], "correct_answer": "A. Keratoplasty", "question_images": ["https://image.prepladder.com/content/gAyzXbnfFbTGKZu5aX031746699577.png"], "explanation_images": ["https://image.prepladder.com/content/ZsxRnF436vfu4icOduUm1746699680.png", "https://image.prepladder.com/content/Wo0UFTFEkWUBJIgq1Ls01746699684.png", "https://image.prepladder.com/content/UTY5p61TcjMGA5M3pDQ81746699690.png"], "explanation": "<p>Correct Option A - Keratoplasty</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n<p><strong>Optical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Corneal opacity</li>\n<li>Bullous keratopathy</li>\n<li>Corneal dystrophies</li>\n<li>Advanced keratoconus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Therapeutic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To replace an inflamed <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> that does not respond to conventional therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tectonic Graft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To restore the integrity of the eyeball, e.g., after corneal <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> <strong>(Option A)</strong> or in cases of significant corneal thinning.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cosmetic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To improve the appearance of the eye</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statement is accurate regarding a 50-year-old male who was diagnosed with a submandibular gland tumor, underwent tumor removal, and subsequently experienced damage to the lingual nerve?", "options": [{"label": "A", "text": "The taste sensation of the posterior one-third of the tongue is lost", "correct": true}, {"label": "B", "text": "The taste sensation of the anterior two-thirds of the tongue is lost", "correct": false}, {"label": "C", "text": "A general sensation of the posterior one-third of the tongue is lost", "correct": false}, {"label": "D", "text": "A general sensation of the anterior two-thirds of the tongue is lost", "correct": false}], "correct_answer": "A. The taste sensation of the posterior one-third of the tongue is lost", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has a road traffic accident and is now bleeding profusely. He is hypotensive and needs large volume replacement with IV fluids. What cannula gauge will you use in this patient?", "options": [{"label": "A", "text": "14 G", "correct": true}, {"label": "B", "text": "13 G", "correct": false}, {"label": "C", "text": "16 G", "correct": false}, {"label": "D", "text": "18 G", "correct": false}], "correct_answer": "A. 14 G", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Surfactant is secreted by which of the following?", "options": [{"label": "A", "text": "Type I pneumocyte", "correct": false}, {"label": "B", "text": "Type Il pneumocyte", "correct": true}, {"label": "C", "text": "Sertoli cell", "correct": false}, {"label": "D", "text": "Leydig cell", "correct": false}], "correct_answer": "B. Type Il pneumocyte", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 50-year-old female patient who shows a progressive decline in visual clarity in her eye? A post-contrast CT scan of her head indicates the presence of thickening in a specific structure, in the image.", "options": [{"label": "A", "text": "Optic nerve sheath meningioma", "correct": true}, {"label": "B", "text": "Optic nerve glioma", "correct": false}, {"label": "C", "text": "Retinoblastoma", "correct": false}, {"label": "D", "text": "Rhabdomyosarcoma", "correct": false}], "correct_answer": "A. Optic nerve sheath meningioma", "question_images": ["https://image.prepladder.com/notes/zEnmrrCc8j0tix5oKTWe1747998067.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Intravenous induction agent of choice for day care anesthesia is?", "options": [{"label": "A", "text": "Ketamine", "correct": false}, {"label": "B", "text": "Propofol", "correct": true}, {"label": "C", "text": "Etomidate", "correct": false}, {"label": "D", "text": "Thiopentone", "correct": false}], "correct_answer": "B. Propofol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old patient came with complaints of blurring of vision, photophobia, redness, pain in the left eye, and joint pain. Upon examination keratic precipitates and aqueous cells were observed. Which of the following major histocompatibility complex is be associated with this condition?", "options": [{"label": "A", "text": "HLA B27", "correct": true}, {"label": "B", "text": "HLA B51", "correct": false}, {"label": "C", "text": "HLA B47", "correct": false}, {"label": "D", "text": "HLA B57", "correct": false}], "correct_answer": "A. HLA B27", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7IH1iTlsFKo7Cql1Py0j1746700076.png", "https://image.prepladder.com/content/Cut7rBJVLym6tQnljMmR1746700088.png", "https://image.prepladder.com/content/ws50joqXNmytMvBmoCqJ1746700101.png", "https://image.prepladder.com/content/bwdRrUJ2AUDMsnR3kPwq1746700113.png", "https://image.prepladder.com/content/f1amSlsvXENFVabvsKQm1746700123.png", "https://image.prepladder.com/content/DOinHMms6OyYH0sgSAhV1746700148.png"], "explanation": "<p>Correct Option A - HLA B27</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease primarily affecting the <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"70f596ae8f16927771983211d9e56f\">skeleton</span> (spine and <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joints), leading to pain, stiffness, and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion<strong> (bamboo spine)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unknown; genetic<strong> (HLA-B27</strong>) and environmental factors involved. HLA-B27 is positive in 90% of cases, but not all carriers develop AS.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inflammation at entheses → Erosive changes → New bone formation → Syndesmophytes → <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (ankylosis).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"635\" src=\"https://image.prepladder.com/content/7IH1iTlsFKo7Cql1Py0j1746700076.png\" width=\"635\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Musculoskeletal Symptoms:</strong></p>\n<ul>\n<li>Chronic low back pain (worse after inactivity, better with activity)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> mobility</li>\n<li>Enthesitis (Achilles, <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> fascia)</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (hips, shoulders, knees)</li>\n</ul>\n<p><strong>Extra-articular Symptoms:</strong></p>\n<ul>\n<li><strong>Ocular:</strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">uveitis</span> (pain, redness, photophobia)</li>\n<li><strong>Cardiovascular:</strong> Aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> issues</li>\n<li><strong>Pulmonary: </strong>Apical fibrosis</li>\n<li><strong>Gastrointestinal:</strong> Associated with IBD</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on clinical features, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies, and HLA-B27 gene presence. <strong>Modified New York Criteria:</strong></p>\n<p><strong>Clinical Criteria:</strong></p>\n<ul>\n<li>Low back pain &gt; 3 months (improves with exercise, not with rest)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine motion (sagittal/frontal planes)</li>\n<li>Reduced chest expansion (relative to age/sex)</li>\n</ul>\n<p><strong>Radiographic Criteria (X-ray):</strong> Bilateral <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 2-4) or <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 3-4)</p>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Blurring/haziness of <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hyun Kyu Chang, Eun Hee Cho, Jeong Uk Kim, Hwan Herr\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/Plain-pelvis-radiograph-shows-the-obliteration-of-joint-space-in-both-sacroiliac-joints_fig3_12601898\" data-tags=\"\" height=\"414\" src=\"https://image.prepladder.com/content/Cut7rBJVLym6tQnljMmR1746700088.png\" width=\"739\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Juxta-articular sclerosis</li>\n<li>Vertical/bridging syndesmophytes</li>\n<li>Squaring of vertebrae</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Glitzy_queen00\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Ankylosing_spondylitis_lumbar_spine.jpg\" data-tags=\"\" height=\"916\" src=\"https://image.prepladder.com/content/ws50joqXNmytMvBmoCqJ1746700101.png\" width=\"455\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Bamboo spine</li>\n<li>Trolley track sign</li>\n<li>Dagger sign</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Feger J, Niknejad M, et al.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/dagger-sign-spine\" data-tags=\"\" height=\"604\" src=\"https://image.prepladder.com/content/bwdRrUJ2AUDMsnR3kPwq1746700113.png\" width=\"454\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Shiny corner sign/Romanus <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> </strong>(inflammatory lesions at edges of vertebrae)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/shiny-corner-sign-ankylosing-spondylitis\" data-tags=\"\" height=\"995\" src=\"https://image.prepladder.com/content/f1amSlsvXENFVabvsKQm1746700123.png\" width=\"534\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>MRI:</strong> Early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of inflammation</p>\n<p><strong>Clinical Tests:</strong></p>\n<p><strong>For Sacroiliitis:</strong></p>\n<ul>\n<li>Gaenslen’s test</li>\n<li>Patrick/FABER test</li>\n<li>Figure of 4 test</li>\n<li>Pump handle test</li>\n</ul>\n<p><strong>For <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">Lumbar</span> Spine:</strong></p>\n<p><strong>Schober/ Modified Schober test</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"607\" src=\"https://image.prepladder.com/content/DOinHMms6OyYH0sgSAhV1746700148.png\" width=\"607\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HLA-B27 positive (90% of cases)</li>\n<li>ESR, CRP: Elevated during active disease, but can be normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mechanical low back pain</li>\n<li>Other spondyloarthropathies (e.g., psoriatic arthritis)</li>\n<li>Degenerative disc disease</li>\n<li>Fibromyalgia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Pharmacological:</strong></p>\n<ul>\n<li>Physical therapy (mobility/posture exercises)</li>\n<li>Patient education on disease and exercise importance</li>\n</ul>\n<p><strong>Pharmacological:</strong></p>\n<ul>\n<li>NSAIDs (first-line for pain, stiffness)</li>\n<li>TNF inhibitors (for NSAID-resistant cases)</li>\n<li>IL-17 inhibitors (Secukinumab)</li>\n<li>Sulfasalazine (for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> arthritis)</li>\n<li>Corticosteroids (short-term <span class=\"customMeta\" data-dictid=\"68e7440bd91692777202d8a14c33e0\">flare</span> control)</li>\n</ul>\n<p><strong>Surgical:</strong></p>\n<ul>\n<li>Hip replacement (for severe hip involvement)</li>\n<li>Spinal surgery (for severe deformities/fractures)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Spinal fractures (minimal trauma)</li>\n<li>Cardiac issues (aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> defects)</li>\n<li>Osteoporosis leading to <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> risk</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Conditions mimicking Ankylosing Spondylitis with <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diffuse Idiopathic Skeletal Hyperostosis (DISH) (Forestier’s disease)</li>\n<li>Ossification of Posterior Longitudinal Ligament (OPLL)</li>\n<li>Spondylosis (Degenerative Disc Disease)</li>\n<li>Psoriatic Arthritis</li>\n<li>Enteropathic Arthritis (IBD-associated)</li>\n<li>Reactive Arthritis</li>\n<li>Rheumatoid Arthritis (RA)</li>\n<li>Juvenile Idiopathic Arthritis (JIA)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the best stimulus for the release of vasopressin", "options": [{"label": "A", "text": "Hypotonicity of extracellular fluid", "correct": false}, {"label": "B", "text": "Hypertension", "correct": false}, {"label": "C", "text": "Hypotension", "correct": true}, {"label": "D", "text": "Hypo-osmolarity of extracellular fluid", "correct": false}], "correct_answer": "C. Hypotension", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During recovery from anesthesia, a patient started experiencing hallucinations and vivid dreams. Which inducing agent is most likely responsible?", "options": [{"label": "A", "text": "Ketamine", "correct": true}, {"label": "B", "text": "Propofol", "correct": false}, {"label": "C", "text": "Thiopentone", "correct": false}, {"label": "D", "text": "Etomidate", "correct": false}], "correct_answer": "A. Ketamine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who exhibits miosis, anhidrosis, mild ptosis, and a persistent small pupil even in low light conditions?", "options": [{"label": "A", "text": "Adie’s tonic people", "correct": false}, {"label": "B", "text": "Horner syndrome", "correct": true}, {"label": "C", "text": "Marcus gunn pupil", "correct": false}, {"label": "D", "text": "Argyll Robertson pupil", "correct": false}], "correct_answer": "B. Horner syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is required for the conversion of prothrombin to thrombin?", "options": [{"label": "A", "text": "Calcium", "correct": true}, {"label": "B", "text": "Magnesium", "correct": false}, {"label": "C", "text": "Potassium", "correct": false}, {"label": "D", "text": "Sodium", "correct": false}], "correct_answer": "A. Calcium", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/LGLlYA9ubtCtzFZUWGjT1747988161.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement below does not accurately describe the clinical condition mentioned?", "options": [{"label": "A", "text": "Abnormal activity of p53 is seen in the pterygium tissue", "correct": false}, {"label": "B", "text": "Decreased activity of tissue inhibitors of metalloproteinases is seen", "correct": false}, {"label": "C", "text": "Destruction of Bowman’s layer occurs when the pterygium invades the cornea", "correct": true}, {"label": "D", "text": "Elastotic degeneration and hyalinization of the connective tissue of the conjunctivaoccur.", "correct": false}], "correct_answer": "C. Destruction of Bowman’s layer occurs when the pterygium invades the cornea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Destruction of Bowman’s layer occurs when the &lt;span class=\"customMeta\" data-dictid=\"9571debfbe1692777196de3e804df2\"&gt;pterygium&lt;/span&gt; invades th\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How do local anesthetics work?", "options": [{"label": "A", "text": "Block sodium channels", "correct": true}, {"label": "B", "text": "Block potassium channels", "correct": false}, {"label": "C", "text": "Block calcium channels", "correct": false}, {"label": "D", "text": "Block chloride channels", "correct": false}], "correct_answer": "A. Block sodium channels", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents with progressive weakness and spasticity in his right leg. He also notices increased muscle tone, hyperreflexia, and a positive Babinski sign on the same side. His left leg and upper limbs appear unaffected. MRI of the brain reveals a lesion involving the left motor cortex. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Parkinson's disease", "correct": false}, {"label": "B", "text": "Amyotrophic lateral sclerosis (ALS)", "correct": false}, {"label": "C", "text": "Multiple sclerosis (MS)", "correct": false}, {"label": "D", "text": "Right-sided upper motor neuron lesion", "correct": true}], "correct_answer": "D. Right-sided upper motor neuron lesion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the anesthesia of choice in a daycare dental surgery?", "options": [{"label": "A", "text": "General anesthesia", "correct": false}, {"label": "B", "text": "Spinal anesthesia", "correct": false}, {"label": "C", "text": "Epidural anesthesia", "correct": false}, {"label": "D", "text": "Infiltration anesthesia", "correct": true}], "correct_answer": "D. Infiltration anesthesia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman is being counseled for surgery for her long-standing dacryocystitis. Which of the following is the surgery of choice?", "options": [{"label": "A", "text": "Dacryocystorhinostomy", "correct": true}, {"label": "B", "text": "Dacryocystectomy", "correct": false}, {"label": "C", "text": "Probing", "correct": false}, {"label": "D", "text": "Balloon catheter dilation", "correct": false}], "correct_answer": "A. Dacryocystorhinostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iOuNWdU3H3MFjChfd3xu1746700636.png", "https://image.prepladder.com/content/eAczuIhj2MHkoxr91WaP1746700626.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"eaea364ab91692777185bcc8181eff\"&gt;Dacryocystorhinostomy&lt;/span&gt; (DCR)</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Acute Dacryocystitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Chronic Dacryocystitis</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> of chronic dacryocystitis</li>\n<li>Spread from neighbouring infected structures (e.g., sinuses, bones, <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> abscess)</li>\n<li><strong>Causative organisms: </strong>Streptococcus haemolyticus, Pneumococcus, Staphylococcus</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Stasis and mild infection of long duration</li>\n<li>Common in women aged 40-60</li>\n<li>Causes: <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> factors (narrow bony canal), <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> diseases, foreign bodies, infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Features/ Sequelae</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ol>\n<li><strong>Stage of cellulitis: </strong>Painful <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> at the <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> sac, epiphora, fever, redness, and oedema.</li>\n<li><strong>Lacrimal abscess: </strong>Pus-filled sac, <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> swelling, may <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> forming an abscess.</li>\n<li><strong>Fistula formation: </strong>Untreated <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> leads to <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> discharge, forming a fistula.</li>\n</ol>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ol>\n<li><strong>Stage of chronic catarrhal dacryocystitis: </strong>Watering eye, mild redness, NLD block</li>\n<li><strong>Lacrimal mucocele: </strong>Swelling below inner canthus, <span class=\"customMeta\" data-dictid=\"14f3af3bf516927771939c1efb8726\">mucoid</span> fluid regurgitation.</li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> dacryocystitis: </strong>Purulent <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> (d/t infection), <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> conjunctivitis.</li>\n</ol>\n<ol>\n<li><strong>Chronic fibrotic sac: </strong>Thickened mucosa, persistent epiphora, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> folds.</li>\n</ol>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"Chaiti Aranke Waman Chavan\"' data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Acute-dacryocystitis-with-pre-septal-cellulitis-with-fistula_fig1_381056510\" data-tags=\"\" height=\"305\" src=\"https://image.prepladder.com/content/iOuNWdU3H3MFjChfd3xu1746700636.png\" width=\"376\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Alexis Mathieu 1,*,Stéphanie Baillif 2,3ORCID,Marie-Noelle Delyfer 1,4ORCID,Éric Longueville 1,Valentine Coste-Verdier 1,Jacques Lagier 2,Abdulrhman Alrabiah 2 andArnaud Martel 2,3ORCID\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://www.mdpi.com/2077-0383/13/17/5129\" data-tags=\"\" height=\"378\" src=\"https://image.prepladder.com/content/eAczuIhj2MHkoxr91WaP1746700626.png\" width=\"352\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Conjunctivitis, corneal ulcer, lid abscess, <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> cellulitis, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> cellulitis, rarely <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombosis.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Conjunctivitis, <span class=\"customMeta\" data-dictid=\"410b701d9916927771861ac447b041\">ectropion</span> of lower lid, risk of corneal ulcers.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Cellulitis:</strong> Systemic antibiotics, anti-inflammatory drugs, hot fomentation.</li>\n<li><strong>Lacrimal abscess:</strong> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">Drainage</span> with incision, antibiotics, possible DCT or DCR later.</li>\n<li><strong>External fistula: </strong>Fistulectomy with DCT or DCR after controlling infection.</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Conservative: </strong>Probing and syringing (early stages).</li>\n<li><strong>Dacryocystorhinostomy (DCR):</strong> Preferred surgery to re-establish <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> drainage.</li>\n<li><strong>Dacryocystectomy (DCT):</strong> Indicated if DCR is contraindicated or in cases of fibrosis, infection, or old age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 51-year-old man complains of abdominal pain and blood-stained stools. The X ray of his intestines shows the following finding. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Intussusception", "correct": true}, {"label": "B", "text": "Volvulus", "correct": false}, {"label": "C", "text": "Diverticulitis", "correct": false}, {"label": "D", "text": "Ulcerative colitis", "correct": false}], "correct_answer": "A. Intussusception", "question_images": ["https://image.prepladder.com/content/5VhBMPQsdMrS6gACdivu1746700543.png"], "explanation_images": ["https://image.prepladder.com/content/BiInZkbJLF25mzqlVEvn1746700605.png", "https://image.prepladder.com/content/TTb8JOoZF4iJwxVoaUx71746700629.png", "https://image.prepladder.com/content/kbzWfVi3RbLGjxlfFeBZ1746700643.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In ORS, sodium is given along with glucose to facilitate?", "options": [{"label": "A", "text": "Co-transport", "correct": true}, {"label": "B", "text": "Osmosis", "correct": false}, {"label": "C", "text": "Facilitated diffusion", "correct": false}, {"label": "D", "text": "Primary active transport", "correct": false}], "correct_answer": "A. Co-transport", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the instrument.", "options": [{"label": "A", "text": "Evisceration spatula", "correct": false}, {"label": "B", "text": "Chalazion clamp", "correct": true}, {"label": "C", "text": "Enucleation spoon", "correct": false}, {"label": "D", "text": "Bone punch", "correct": false}], "correct_answer": "B. Chalazion clamp", "question_images": ["https://image.prepladder.com/notes/Ea1Zsr27FWeGv4Mkrrjx1747985557.png"], "explanation_images": ["https://image.prepladder.com/content/TPdDiJqCIxhFs7LT6ocU1746700809.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"3f62f9a1931692777184416b7a5d06\"&gt;Chalazion&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": " What is the cause of the following appearance in IVP? ", "options": [{"label": "A", "text": "Horseshoe kidney", "correct": false}, {"label": "B", "text": "Ureterocoele", "correct": true}, {"label": "C", "text": "Bladder tumor", "correct": false}, {"label": "D", "text": "Posterior urethral valve", "correct": false}], "correct_answer": "B. Ureterocoele", "question_images": ["https://image.prepladder.com/content/HTrlHMwsZKu4bz4ZCEys1746700807.png"], "explanation_images": ["https://image.prepladder.com/content/2wamZgTHhs1EWK7IPDg01746700875.png", "https://image.prepladder.com/content/a3zs614WB3xr9WsG4tBQ1746700879.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ureterocele</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Maulik S Patel\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/ureterocele-bilateral#image-872455\" data-tags=\"\" height=\"261\" src=\"https://image.prepladder.com/content/2wamZgTHhs1EWK7IPDg01746700875.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>USG showing <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> pouching at left and right ureteral orifices</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Maulik S Patel\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/ureterocele-bilateral#image-872455\" data-tags=\"\" height=\"381\" src=\"https://image.prepladder.com/content/a3zs614WB3xr9WsG4tBQ1746700879.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Bilateral “Cobra head” appearance of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ureters on X-ray Intravenous Urography</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Grainger and Allison’s Diagnostic Radiology, 7th Edition, Page no: 678, 758</li><li>↳ Textbook of Radiology and Imaging, David Sutton, 8th Edition, Volume 1, Page 2903</li><li>↳ Maiden waist deformity | Radiology Reference Article | Radiopaedia.org</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the clinical presentation of a patient with a tumor located in the anterior pituitary gland causing compression on the optic chiasma?", "options": [{"label": "A", "text": "Homonymous hemianopia", "correct": false}, {"label": "B", "text": "Inferior quadrantanopia hemianopia", "correct": false}, {"label": "C", "text": "Bitemporal hemianopia", "correct": true}, {"label": "D", "text": "Superior quadrantanopia hemianopia", "correct": false}], "correct_answer": "C. Bitemporal hemianopia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ljeIta1qtHQsvEdNQgc81746707012.png", "https://image.prepladder.com/content/6rsnCwyXlsvvw7LvNSuf1746707095.png"], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"3b17da47ce16927771831d5dde3af3\"&gt;Bitemporal&lt;/span&gt; h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which glycosaminoglycan is responsible for the transparency of the cornea?", "options": [{"label": "A", "text": "Keratan sulfate", "correct": true}, {"label": "B", "text": "Hyaluronic acid", "correct": false}, {"label": "C", "text": "Heparan sulfate", "correct": false}, {"label": "D", "text": "Dermatan sulfate", "correct": false}], "correct_answer": "A. Keratan sulfate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Keratan sulfate</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mucopolysaccharide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Functions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyaluronic Acid (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Connective tissues, tendons, <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> fluid, <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> humor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serves as a <span class=\"customMeta\" data-dictid=\"ddc9f397e716927771916135359875\">lubricant</span> in joint cavities and contributes to the structure of <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Heparin (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver, lungs, spleen, monocytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acts as an <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">anticoagulant</span> by activating <span class=\"customMeta\" data-dictid=\"fa202015a216927771814a0dc268ba\">antithrombin</span> III, which inactivates <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> and other <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chondroitin <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">Sulfate</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cartilage, bone, tendons, cornea, skin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides structural support to <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues and contributes to their <span class=\"customMeta\" data-dictid=\"b11364e7ed169277719777251a2bfe\">resilience</span> and elasticity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Keratan <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">Sulfate</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cornea, cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dermatan <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">Sulfate</span> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin, blood vessels, heart valves</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contributes to the structure of the skin, blood vessels, and heart valves</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old man who has a previous history of wearing contact lenses, and is currently experiencing pain, redness, and the presence of pus coming from his right eye? During examination, a greyish-white ulcer in the shape of a snake was observed on the lower portion of the cornea. Additionally, a hypopyon measuring 4 mm was found in the anterior chamber, along with a moderate flare reaction.", "options": [{"label": "A", "text": "Viral corneal ulcer", "correct": false}, {"label": "B", "text": "Bacterial corneal ulcer", "correct": true}, {"label": "C", "text": "Fungal corneal ulcer", "correct": false}, {"label": "D", "text": "Parasitic corneal ulcer", "correct": false}], "correct_answer": "B. Bacterial corneal ulcer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Bacterial corneal u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A smoker who underwent an interscalene block for an arthroscopic acromioclavicular joint reconstruction 2 days ago presents for a follow-up. A chest X-ray is performed, which shows an abnormality. The patient is asymptomatic and is resting comfortably in bed. What is the next step in management?", "options": [{"label": "A", "text": "Insert chest drain as soon as possible", "correct": false}, {"label": "B", "text": "Do thoracostomy", "correct": false}, {"label": "C", "text": "Elective intubation and IPPV", "correct": false}, {"label": "D", "text": "Wait and watch and give supplementary oxygen if needed", "correct": true}], "correct_answer": "D. Wait and watch and give supplementary oxygen if needed", "question_images": ["https://image.prepladder.com/content/tB5ppkxD8CZXy4u7b8QY1746701405.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old male comes with complaints of dry cough, fever and shortness of breath for 2 days along with a loss of taste and smell. He is a social worker who has been traveling a lot. What would be the investigation of choice for this patient to confirm the diagnosis of COVID-19?", "options": [{"label": "A", "text": "PCR", "correct": false}, {"label": "B", "text": "ELISA", "correct": false}, {"label": "C", "text": "Serology", "correct": false}, {"label": "D", "text": "Real-time RT-PCR", "correct": true}], "correct_answer": "D. Real-time RT-PCR", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the site of maximum water reabsorption?", "options": [{"label": "A", "text": "Proximal tubule", "correct": true}, {"label": "B", "text": "Loop of Henle", "correct": false}, {"label": "C", "text": "Distal convoluted tubule", "correct": false}, {"label": "D", "text": "Collecting duct", "correct": false}], "correct_answer": "A. Proximal tubule", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which molecular motor protein results in spread of the rabies virus from the site of inoculation to the central nervous system?", "options": [{"label": "A", "text": "Kinesin", "correct": false}, {"label": "B", "text": "Dynein", "correct": true}, {"label": "C", "text": "Actin", "correct": false}, {"label": "D", "text": "Myosin", "correct": false}], "correct_answer": "B. Dynein", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the medical condition of a tennis player who is able to repeatedly and independently reduce a shoulder dislocation?", "options": [{"label": "A", "text": "Acute shoulder dislocation", "correct": false}, {"label": "B", "text": "Recurrent shoulder dislocation", "correct": true}, {"label": "C", "text": "Inferior shoulder dislocation", "correct": false}, {"label": "D", "text": "Fracture upper end humerus", "correct": false}], "correct_answer": "B. Recurrent shoulder dislocation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:649px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Early Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Delayed Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Rotator <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> tear</strong> - Common in the elderly due to degenerative changes in the tendons and less common in younger patients.</li>\n<li><strong>Axillary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> injury</strong> - Rare; Occurs with severe trauma</li>\n<li><strong>Nerve injury</strong> - The <strong>axillary nerve </strong>is most commonly affected; other nerve injuries and complete <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> are rare.</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Recurrence</strong> - Most common, due to instability.</li>\n<li><strong>Joint stiffness</strong> - Results from prolonged immobility.</li>\n<li><strong>Unreduced dislocation</strong> - Due to missed or undiagnosed dislocation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The egg shown below belongs to? ", "options": [{"label": "A", "text": "Hookworm", "correct": false}, {"label": "B", "text": "Whipworm", "correct": true}, {"label": "C", "text": "Pinworm", "correct": false}, {"label": "D", "text": "Round worm", "correct": false}], "correct_answer": "B. Whipworm", "question_images": ["https://image.prepladder.com/content/YZZkJ2gpigiORLpmoDKV1746701696.png"], "explanation_images": ["https://image.prepladder.com/content/gDeAz8MbgHSsyFU6ukEd1746701860.png", "https://image.prepladder.com/content/BbEb6xgA3gmA6H71RP8V1746701860.png", "https://image.prepladder.com/content/cVwmiHX6OaMLF9dIg1UG1746701860.png", "https://image.prepladder.com/content/vArMh0b43h2KS4U1vNDW1746701860.png", "https://image.prepladder.com/content/DJRnDeUSVPgjIj6yDqUu1746701860.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adult worm</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/gDeAz8MbgHSsyFU6ukEd1746701860.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The male <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">worm</span> is 30-45 mm long.</li>\n<li>The female <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">worm</span> is 40-50 mm long (slightly larger).</li>\n<li>Appearance:\n\t\t\t\t<ul style=\"list-style-type:circle\">\n<li>Flesh-colored.</li>\n<li>Whip-shaped: <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> (3/5) thin and thread-like; <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> (2/5) thick and <span class=\"customMeta\" data-dictid=\"384d0cc3641692777202e927a4d222\">fleshy</span> (like a handle).</li>\n<li>The end of the male worms is coiled ventrally.</li>\n<li>The end of the female <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">worm</span> is straight, blunt, and rounded.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Body structure:\n\t\t\t\t<ul style=\"list-style-type:circle\">\n<li>The <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> portion contains a <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> esophagus.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> part contains the intestines and <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> organs.</li>\n</ul>\n</li>\n<li>Lifespan: 5-10 years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eggs </strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"CDC Division of Parasitic Diseases\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://www.cdc.gov/dpdx/trichuriasis/index.html\" data-tags=\"\" height=\"299\" src=\"https://image.prepladder.com/content/BbEb6xgA3gmA6H71RP8V1746701860.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics:</strong></p>\n<ul>\n<li>The eggs appear <strong>brown </strong>as they are bile-stained.</li>\n<li>They are <strong>barrel-shaped</strong>.</li>\n<li>They have a triple shell with a brown outer layer and a colorless <strong>mucus <span class=\"customMeta\" data-dictid=\"7803d1e7ea169277719552dc5e49d4\">plug</span> </strong>at each pole containing an unsegmented ovum.</li>\n</ul>\n<p><strong>Infectivity:</strong></p>\n<ul>\n<li>Freshly passed eggs contain an <strong>unsegmented ovum</strong> and are <strong>not infective</strong> for humans.</li>\n<li>The egg <strong>floats in a <span class=\"customMeta\" data-dictid=\"bd2ac838bb16927771983dd9afc74c\">saturated</span> salt solution.</strong></li>\n<li>The fertilized female lays about 5,000 eggs per day.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distribution:\n\t\t\t\t<ul style=\"list-style-type:circle\">\n<li>Worldwide, with higher <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> in tropical regions.</li>\n<li>Common in tropical Africa, South America, and Southeast Asia.</li>\n<li>Widespread in India.</li>\n</ul>\n</li>\n<li>Prevalence:\n\t\t\t\t<ul style=\"list-style-type:circle\">\n<li>An estimated 800 million people are infected globally.</li>\n<li>While <span class=\"customMeta\" data-dictid=\"170c045a511692777202cdca12aae0\">whipworm</span> infections are frequent, <span class=\"customMeta\" data-dictid=\"170c045a511692777202cdca12aae0\">whipworm</span> disease is relatively rare.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An AIDS-positive patient came with a history of fever, vomiting, and meningismus. Which of the following tests help in the rapid diagnosis of cryptococcal meningitis?", "options": [{"label": "A", "text": "India ink preparation of CSF", "correct": false}, {"label": "B", "text": "Blood culture", "correct": false}, {"label": "C", "text": "CSF culture", "correct": false}, {"label": "D", "text": "Urine lateral flow assay for cryptococcal antigen", "correct": true}], "correct_answer": "D. Urine lateral flow assay for cryptococcal antigen", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rldlO4za7hIhFKzrWdUy1746702379.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical features of <span class=\"customMeta\" data-dictid=\"e828e24db216927771854e0dd69280\">cryptococcosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory system </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cryptococcus typically enters the body via <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> and can cause <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infection / <span class=\"customMeta\" data-dictid=\"5a679034841692777196d988b49eb5\">pneumonitis</span> - primary site of infection</li>\n<li>Patients may present with cough, pleuritic chest pain, and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress.</li>\n<li>Imaging shows a <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> nodule</li>\n<li>Dissemination of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infection leads to involvement of involvement of other organs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central Nervous System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meningitis:</strong> Characterized by severe headaches, fever, altered mental status, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> and memory loss, <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve <span class=\"customMeta\" data-dictid=\"fec3fca4a316927771949da843f588\">paresis</span> and loss of vision</p>\n<p>It is the most serious type of <span class=\"customMeta\" data-dictid=\"6bd3522c4516927771855962983e97\">cryptococcal</span> infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cutaneous Cryptococcosis:</strong> Causes skin lesions, particularly in <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> patients.</p>\n<p>Associated with C.neoformans var neoformans (serotype D)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver, spleen, and bones maybe involved in <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> infections</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong><strong> of cryptococcosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>India ink</strong>- Demonstrates the capsule, which appears as clear space surrounding the round <span class=\"customMeta\" data-dictid=\"38e3eb755216927771834bb7e72a61\">budding</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells</li>\n<li><strong>Mucicarmine stain:</strong> It stains the carminophilic <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> of C. neoformans</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sabouraud <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> Agar</strong>, forming smooth, mucoid, cream-coloured colonies.</li>\n<li><strong>Niger seed <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> </strong>and <strong>bird seed agar</strong>: Demonstrates <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> production (brown colored colonies) due to <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> oxidase/laccase enzyme.</li>\n<li>The ability to grow at <strong>37°C</strong> and <strong>hydrolyse <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> </strong>differentiates C. neoformans from non-pathogenic cryptococci</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Dhoubhadel, Bhim &amp; Laghu, Ujjwal &amp; Paudel, Raju &amp; Morimoto, Konosuke &amp; Ariyoshi, Koya.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Culture-of-CSF-showing-white-smooth-colonies-of-Cryptococcus-neoformans-in-Sabouraud_fig2_353574146\" data-tags=\"\" height=\"284\" src=\"https://image.prepladder.com/content/rldlO4za7hIhFKzrWdUy1746702379.png\" width=\"294\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antigen <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Demonstration of the capsular <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> by <strong>Precipitation </strong>and <strong>Latex agglutination</strong> <strong>test</strong></p>\n<p><strong>Urine <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Flow <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">Assay</span> for <span class=\"customMeta\" data-dictid=\"6bd3522c4516927771855962983e97\">Cryptococcal</span> Antigen</strong>- Best rapid <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial Treatment with <strong>liposomal Amphotericin B </strong>and <strong>Flucytosine</strong></li>\n<li>Maintenance Therapy<strong> </strong>with <strong>Fluconazole</strong> for 6-12 months, depending on immune status.</li>\n<li>Monitoring: Regularly check CSF for fungal clearance, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, and electrolytes.</li>\n<li>Management of Underlying Conditions: Optimize ART to reduce <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Except in which of the following is laryngeal crepitus not present?", "options": [{"label": "A", "text": "Post-cricoid malignancy", "correct": false}, {"label": "B", "text": "Hypopharyngeal abscess", "correct": false}, {"label": "C", "text": "Parapharyngeal abscess", "correct": false}, {"label": "D", "text": "Prevertebral abscess", "correct": true}], "correct_answer": "D. Prevertebral abscess", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ouMbtw3N0clv6z7c2hq31746703048.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Laryngeal <span class=\"customMeta\" data-dictid=\"2483707fe9169277718541a169f5b4\">Crepitus</span> Presence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Reason</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-cricoid malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Present</strong> (unless advanced)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumors in this area usually do not fix the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> early</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypopharyngeal abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Present or reduced</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May affect laryngeal movement but not always abolish crepitus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parapharyngeal abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Present or reduced</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can restrict <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> movement but does not fix <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> completely</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevertebral abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fixes the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> to the spine, preventing movement</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable cause of bleeding in a patient who experienced a hyphema after being struck in the eye by a tennis ball?", "options": [{"label": "A", "text": "Circulus arteriosus major", "correct": false}, {"label": "B", "text": "Anterior ciliary artery", "correct": true}, {"label": "C", "text": "Posterior ciliary artery", "correct": false}, {"label": "D", "text": "Circulus arteriosus minor", "correct": false}], "correct_answer": "B. Anterior ciliary artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;Anterior&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\"&gt;ciliary&lt;/span&gt; artery</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Arterial Supply</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cornea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Avascular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conjunctiva</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> arteries, branches of <span class=\"customMeta\" data-dictid=\"c09776e61f1692777194db295c590f\">ophthalmic</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sclera</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> arteries (short and long branches) (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iris</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Major <span class=\"customMeta\" data-dictid=\"7e753993b1169277718285a7ef80d6\">arterial circle</span> of the <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">iris</span> (circulus arteriosus major) (Option A) </strong>formed by <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> and long <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> arteries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ciliary Body</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> arteries</strong> and long <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> arteries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Choroid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Short <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> arteries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Retina </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Avascular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extraocular Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Muscular branches of the <span class=\"customMeta\" data-dictid=\"c09776e61f1692777194db295c590f\">ophthalmic</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (including <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> arteries)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eyelids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ophthalmic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (superior and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> palpebral branches), <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lacrimal Gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lacrimal artery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for a patient with Bell's palsy, who is experiencing symptoms of dry eye, redness, and irritation, along with the presence of multiple punctate epithelial erosions in the cornea as observed through a slit lamp examination?", "options": [{"label": "A", "text": "Tarsorrhaphy", "correct": true}, {"label": "B", "text": "Contact lens", "correct": false}, {"label": "C", "text": "Corneal replacement", "correct": false}, {"label": "D", "text": "LASIK", "correct": false}], "correct_answer": "A. Tarsorrhaphy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Tarsorrhaph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 50-year-old woman who is experiencing sudden eye pain and redness? An image of her eye is provided for reference.", "options": [{"label": "A", "text": "Acute retrobulbar neuritis", "correct": false}, {"label": "B", "text": "Acute angle-closure glaucoma", "correct": true}, {"label": "C", "text": "Acute anterior uveitis", "correct": false}, {"label": "D", "text": "Severe keratoconjunctivitis", "correct": false}], "correct_answer": "B. Acute angle-closure glaucoma", "question_images": ["https://image.prepladder.com/notes/3qBMtgCHsks5EwHDT1of1747985683.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; angle-closure glau\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presents with fever and swelling of the left eyelid for the past two days. He has no history of trauma but experienced a mild flu-like illness one week ago. On examination, there is no chemosis or protrusion of the eyeball. Based on these observations, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Orbital cellulitis", "correct": false}, {"label": "B", "text": "Preseptal cellulitis", "correct": true}, {"label": "C", "text": "Panophthalmitis", "correct": false}, {"label": "D", "text": "Lid tumour", "correct": false}], "correct_answer": "B. Preseptal cellulitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ifHCRf4va3WRgVvLXnxP1746703783.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"788578009c1692777196a0a397bdc4\"&gt;Preseptal&lt;/span&gt; cellulitis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Chandler’s Classification of <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> Cellulitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I - <span class=\"customMeta\" data-dictid=\"788578009c1692777196a0a397bdc4\">Preseptal</span> cellulitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection confined to the eyelid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eyelid swelling, no <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>II - <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> <span class=\"customMeta\" data-dictid=\"0985f5f6041692777184d2e82e558c\">cellulitis</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection spreads to the orbit</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pain with eye movement, restricted mobility, no <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation, <span class=\"customMeta\" data-dictid=\"13976f70431692777184676bb77924\">chemosis</span> or proptosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>III - Subperiosteal abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pus collection beneath periosteum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localized pus, proptosis, pain on movement, swelling</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IV - <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pus collection within the <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> tissues</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe proptosis, potential vision loss, risk of <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>V - <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">Cavernous</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spread of infection to the <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> sinus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral eye involvement, headache, <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsies</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 3-year-old boy who has displayed growing clumsiness over the last half a year, has leukocoria, and lacks red reflex in his left eye? After diagnosis, enucleation was performed, and the specimen displayed Flexner-Wintersteiner rosettes under microscopic examination?", "options": [{"label": "A", "text": "Congenital glaucoma", "correct": false}, {"label": "B", "text": "Retinoblastoma", "correct": true}, {"label": "C", "text": "Toxocariasis", "correct": false}, {"label": "D", "text": "Neurofibroma", "correct": false}], "correct_answer": "B. Retinoblastoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9o42wU1BaSXr5wFNwuh81746704089.png", "https://image.prepladder.com/content/GcRqySblQV025GQwIdD71746704119.png"], "explanation": "<p>Correct Option B - R\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not seen in Meniere's Disease?", "options": [{"label": "A", "text": "Tinnitus", "correct": false}, {"label": "B", "text": "Vertigo", "correct": false}, {"label": "C", "text": "Fullness of ear", "correct": false}, {"label": "D", "text": "Ear Pain", "correct": true}], "correct_answer": "D. Ear Pain", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vD5845FVzNiAnJzsYCjN1746704725.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excess <strong>endolymph accumulation</strong> (endolymphatic hydrops)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triad of Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Vertigo</strong> (episodic, lasts minutes to hours)</p>\n<p>2. <strong>Tinnitus</strong> (low-frequency, <span class=\"customMeta\" data-dictid=\"2499b2018a16927771978059423918\">roaring</span> type)</p>\n<p>3. <strong>Hearing loss</strong> (sensorineural, fluctuating, progressive)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aural fullness</strong> (blocked ear sensation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not Typically Seen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ear pain</strong>, except in secondary infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical + <strong>Audiometry</strong> (low-frequency SNHL)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dietary modifications (low sodium), diuretics, <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> suppressants, <span class=\"customMeta\" data-dictid=\"f50648764c16927771908f5217bb54\">intratympanic</span> steroids, and surgery in <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable reason for the swelling in the tonsils of a 40-year-old woman who has difficulty swallowing food, no past medical history of fever, sore throat, or smoking, but a family history of Marfan's syndrome in her father, and shows unilateral swelling of the tonsils along with pulsation upon oral examination?", "options": [{"label": "A", "text": "Extracranial internal carotid artery aneurysm", "correct": true}, {"label": "B", "text": "Intracranial external carotid artery aneurysm", "correct": false}, {"label": "C", "text": "Extracranial external carotid artery aneurysm", "correct": false}, {"label": "D", "text": "Intracranial internal carotid artery aneurysm", "correct": false}], "correct_answer": "A. Extracranial internal carotid artery aneurysm", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakening of ICA wall (due to <strong>atherosclerosis, Marfan’s syndrome, Ehlers-Danlos syndrome, infections, or trauma</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Unilateral <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> swelling</strong></p>\n<p>2. <strong>Dysphagia</strong> (difficulty swallowing)</p>\n<p>3. <strong>Pulsation on oral exam</strong></p>\n<p>4. <strong>Absence of infection or <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Connective tissue disorders (Marfan's, Ehlers-Danlos), atherosclerosis, hypertension</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rupture, thrombosis, stroke, or <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve compression</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT/MR angiography, Doppler ultrasound</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical repair or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> stenting</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following organisms does not cause croup?", "options": [{"label": "A", "text": "Parainfluenza 1", "correct": false}, {"label": "B", "text": "Parainfluenza 2", "correct": false}, {"label": "C", "text": "Rhinovirus", "correct": true}, {"label": "D", "text": "RSV", "correct": false}], "correct_answer": "C. Rhinovirus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parainfluenza virus (Types 1, 2, 3) - most common</strong>, RSV, Influenza, Adenovirus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6 months - 3 years</strong> (most common)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Barking cough</strong></p>\n<p>2. <strong>Inspiratory stridor</strong></p>\n<p>3. <strong>Hoarseness</strong></p>\n<p>4. <strong>Respiratory distress</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steeple Sign on X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subglottic narrowing</strong> on <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> neck X-ray</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild:</strong> Supportive care, humidified air</p>\n<p><strong>Moderate-Severe:</strong> <strong>Dexamethasone + Nebulized Epinephrine</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Dohlman’s procedure is for:", "options": [{"label": "A", "text": "Meckel’s diverticulum", "correct": false}, {"label": "B", "text": "Zenker’s diverticulum", "correct": true}, {"label": "C", "text": "Bochadlek hernia", "correct": false}, {"label": "D", "text": "Menetrier’s disease", "correct": false}], "correct_answer": "B. Zenker’s diverticulum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PnqvSlLqrVG2lPfu08nl1746705292.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Outpouching of <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> through Killian’s dehiscence</strong> (weak area in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharynx)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cricopharyngeal dysfunction</strong> leading to high pressure and <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> formation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Dysphagia</strong></p>\n<p>2. <strong>Regurgitation of undigested food</strong></p>\n<p>3. <strong>Halitosis</strong> (bad breath)</p>\n<p>4. <strong>Aspiration pneumonia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Barium swallow X-ray</strong> (shows a <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal pouch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dohlman’s procedure (endoscopic diverticulotomy)</strong></p>\n<p>Open surgery if large</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65 year old male presented with history of dysphagia, halitosis and aspiration pneumonia. A barium swallow was done and is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Diffuse oesophageal spasm", "correct": false}, {"label": "B", "text": "Achalasia cardia", "correct": false}, {"label": "C", "text": "Zenker’s diverticulum", "correct": true}, {"label": "D", "text": "Esophageal cancer", "correct": false}], "correct_answer": "C. Zenker’s diverticulum", "question_images": ["https://image.prepladder.com/content/be9q14U3GtKEXYiCfHFZ1746705402.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <strong>false diverticulum</strong> formed due to <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> of pharyngeal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> through <strong>Killian’s dehiscence</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cricopharyngeal muscle dysfunction</strong> leading to increased pressure and <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> formation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Dysphagia</strong> (difficulty swallowing)</p>\n<p>2. <strong>Regurgitation of undigested food</strong></p>\n<p>3. <strong>Halitosis</strong> (bad breath)</p>\n<p>4. <strong>Aspiration pneumonia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Barium swallow X-ray</strong> (shows a <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal pouch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic diverticulotomy (Dohlman’s procedure)</strong> or <strong>open diverticulectomy</strong> in large cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the structure shown in this endoscopic image of the nasopharynx.", "options": [{"label": "A", "text": "Sinus of Morgagni", "correct": false}, {"label": "B", "text": "Passavant’s ridge", "correct": false}, {"label": "C", "text": "Fossa of Rossenmuller", "correct": true}, {"label": "D", "text": "Rathke’s pouch", "correct": false}], "correct_answer": "C. Fossa of Rossenmuller", "question_images": ["https://image.prepladder.com/content/VoUqDB3DY6DcVTEVLKX11746705614.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fossa of Rosenmüller</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">recess</span> behind the <strong>torus tubarius</strong>, <strong>common site of <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sinus of Morgagni</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gap between the <strong>base of the skull and superior pharyngeal <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Passavant’s Ridge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscular ridge formed by the <strong>superior pharyngeal constrictor</strong>, involved in <span class=\"customMeta\" data-dictid=\"35a7cfc3341692777201b27c58dc6d\">velopharyngeal</span> closure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rathke’s Pouch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Embryological <span class=\"customMeta\" data-dictid=\"bead1cecfa16927771979940742ada\">remnant</span> from which the <strong>anterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> gland</strong> develops</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Molluscum contagiosum is caused by", "options": [{"label": "A", "text": "Bacteria", "correct": false}, {"label": "B", "text": "Fungus", "correct": false}, {"label": "C", "text": "Protozoa", "correct": false}, {"label": "D", "text": "Virus", "correct": true}], "correct_answer": "D. Virus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/F3BhHETI6gpC1uhYJ6zo1746705746.png", "https://image.prepladder.com/content/Velv8Cmvi2ExgdKtDBW01746705746.png", "https://image.prepladder.com/content/fcAWQD8BlXLESbBMxC9w1746705746.png", "https://image.prepladder.com/content/BXBBym15fG9T0rcdowMx1746705747.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Poxviruses</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poxviruses are the largest viruses that <span class=\"customMeta\" data-dictid=\"eb32e458601692777190ed974ab329\">infect</span> vertebrates.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphology </strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Dr Graham Beards\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Electron_micrograph_of_smallpox_virus.jpg\" data-tags=\"\" height=\"147\" src=\"https://image.prepladder.com/content/F3BhHETI6gpC1uhYJ6zo1746705746.png\" width=\"215\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Poxviruses measure approximately <strong>400 nm</strong> in length and <strong>230 nm</strong> in diameter, making them visible under a light microscope.</li>\n<li>Poxviruses are typically brick-shaped or ellipsoid.</li>\n<li>They possess an envelope consisting of two <span class=\"customMeta\" data-dictid=\"1f6f7d1976169277719178bd1ae135\">lipoprotein</span> membranes (outer and inner), and the outer <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> features ridges.</li>\n<li>The envelope encases a core, along with two structures of unknown function known as <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> bodies.</li>\n<li>The core or <span class=\"customMeta\" data-dictid=\"39455b2c13169277719341eed7992a\">nucleocapsid</span> is <span class=\"customMeta\" data-dictid=\"896c5b0b3616927771836c801b78c2\">biconcave</span> and shaped like a dumbbell.</li>\n<li>Poxviruses contain a single <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <strong>double-stranded DNA</strong> (dsDNA) genome.</li>\n<li>They are unique among DNA viruses for<strong> replicating in the cytoplasm</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Human-Important poxviruses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Variola</strong> is the <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> agent of smallpox, the first disease to be eradicated globally.</li>\n<li><strong>Vaccinia</strong>: Used as a vaccine for smallpox.</li>\n<li><strong>Molluscum contagiosum Virus</strong>: Causes warty lesions known as <span class=\"customMeta\" data-dictid=\"3c4e017ee21692777192753aa09ff6\">molluscum</span> contagiosum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genera <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Orthopoxvirus: Smallpox, monkeypox, vaccinia.</li>\n<li>Molluscipoxvirus: <span class=\"customMeta\" data-dictid=\"3c4e017ee21692777192753aa09ff6\">Molluscum</span> contagiosum.</li>\n<li>Parapoxvirus: Milker’s nodules, <span class=\"customMeta\" data-dictid=\"6c086f82651692777183dedda5f99a\">bovine</span> papular <span class=\"customMeta\" data-dictid=\"bd37d444e4169277719901cca5282d\">stomatitis</span> viruses, etc.</li>\n<li>Capripoxvirus: Sheeppox, goatpox, lumpy skin disease, etc.</li>\n<li>Avipoxvirus: Fowlpox, pigeon pox, etc.</li>\n<li>Leporipoxvirus: Myxoma, hare fibroma, etc.</li>\n<li>Suipoxvirus: Swinepox virus.</li>\n<li>Yatapoxvirus: Tanapox, Yabapox viruses.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Molluscum contagiosum </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Molluscum contagiosum virus is an <strong>obligate human poxvirus</strong> known for producing characteristic skin lesions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Evanherk\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Molluscaklein.jpg\" data-tags=\"\" height=\"159\" src=\"https://image.prepladder.com/content/Velv8Cmvi2ExgdKtDBW01746705746.png\" width=\"213\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lesions:</strong></p>\n<ul>\n<li><strong>Dome-shaped, pink, pearly wart-like lesions (2–5 mm in size) with a <span class=\"customMeta\" data-dictid=\"e372bbd8f7169277718666a06a88c2\">dimple</span> at the center.</strong></li>\n<li>Lesions can appear singly or in clusters, located anywhere on the body <strong>except on the palms and soles</strong>.</li>\n<li>Lesions are <strong>umbilicated.</strong></li>\n<li>Genital lesions are commonly observed in adults.</li>\n<li>Lesions typically resolve on their own within 3–4 months.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Evanherk\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Mollusca1klein.jpg\" data-tags=\"\" height=\"215\" src=\"https://image.prepladder.com/content/fcAWQD8BlXLESbBMxC9w1746705746.png\" width=\"280\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmission </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primarily affects children, transmitted through <strong>direct and <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> contact </strong>(e.g., barbers, shared towels, swimming pools).</li>\n<li>Rare instances of<strong> sexual transmission </strong>have been reported in young adults.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory diagnosis</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Molluscum_contagiosum_low_mag.jpg\" data-tags=\"\" height=\"454\" src=\"https://image.prepladder.com/content/BXBBym15fG9T0rcdowMx1746705747.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Molluscum bodies:</strong></p>\n<ul>\n<li>Characteristic<strong> <span class=\"customMeta\" data-dictid=\"45e0bd1529169277719054d85830ce\">intracytoplasmic</span> <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> inclusions </strong>were observed in <strong>skin scrapings</strong> stained with histopathological stains.</li>\n</ul>\n<p><strong>Confirmation methods:</strong></p>\n<ul>\n<li>Electron microscopy</li>\n<li>PCR</li>\n</ul>\n<p><strong>Cultivation:</strong></p>\n<ul>\n<li>The virus<strong> cannot be propagated</strong> in tissue culture, embryonated eggs, or animals.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgical removal of the lesions by <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> (by <span class=\"customMeta\" data-dictid=\"7a2baeba7416927771858fcddc798f\">cryotherapy</span> or laser therapy) is the mainstay of treatment.</li>\n<li>Cidofovir has been shown to have some efficacy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the TNM staging for a patient with carcinoma in the pyriform fossa, presenting with a 5 cm lesion on laryngoscopy, non-mobile right vocal folds, no lymph node involvement, and no distant metastasis?", "options": [{"label": "A", "text": "T2N0M0", "correct": false}, {"label": "B", "text": "T3N0M0", "correct": true}, {"label": "C", "text": "T4aN0M0", "correct": false}, {"label": "D", "text": "T4bN0M0", "correct": false}], "correct_answer": "B. T3N0M0", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tumor Size/Extent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vocal Cord Mobility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Metastasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor confined to one subsite of hypopharynx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No nodes (N0)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No (M0)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor extends to more than one subsite or adjacent areas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor <strong>&gt;4 cm</strong> or <strong>vocal cord fixation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fixed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades adjacent structures (e.g., thyroid/cricoid cartilage, hyoid, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> gland, esophagus)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fixed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0/N+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> fascia, encases <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, or involves <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fixed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0/N+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Oral hairy leukoplakia is associated with which of the following infections?", "options": [{"label": "A", "text": "Cytomegalovirus", "correct": false}, {"label": "B", "text": "Human papilloma virus", "correct": false}, {"label": "C", "text": "Herpes simplex 1 virus", "correct": false}, {"label": "D", "text": "Epstein-Barr virus", "correct": true}], "correct_answer": "D. Epstein-Barr virus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25 year old Volleyball player presents to your OPD with injury to thumb,along with pain, swelling, and tenderness at the base of the thumb. On examination the thumb is in the position of abduction. Which of the following is the diagnosis of the presenting condition?", "options": [{"label": "A", "text": "Game keepers thumb", "correct": true}, {"label": "B", "text": "Bowler's thumb", "correct": false}, {"label": "C", "text": "Kaplan injury", "correct": false}, {"label": "D", "text": "Mallet finger", "correct": false}], "correct_answer": "A. Game keepers thumb", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is brought to you with complaints of noisy breathing. On examination, you notice the inspiratory stridor in the child, and the laryngeal examination is as below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Vocal cord paralysis", "correct": false}, {"label": "B", "text": "Subglottic stenosis", "correct": false}, {"label": "C", "text": "Laryngeal papilloma", "correct": false}, {"label": "D", "text": "Laryngomalacia", "correct": true}], "correct_answer": "D. Laryngomalacia", "question_images": ["https://image.prepladder.com/content/Gsj6SzxSkV2vf7Im59JF1746705982.png"], "explanation_images": ["https://image.prepladder.com/content/BgvchF6RF0q9HnlvaHx81746706072.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital <strong>floppy laryngeal cartilage</strong>, especially affecting the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> and arytenoids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inspiratory stridor</strong> (worse when supine, feeding, or crying)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>At birth or within the first few weeks of life</strong>, peaks at <strong>4–8 months</strong>, resolves by <strong>12–24 months</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flexible laryngoscopy</strong> → shows <strong>omega-shaped epiglottis</strong>, redundant <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> mucosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Observation</strong> in mild cases, <strong>surgical intervention (supraglottoplasty)</strong> in severe cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Blount Disease results from the involvement of", "options": [{"label": "A", "text": "Proximal tibia", "correct": true}, {"label": "B", "text": "Distal tibia", "correct": false}, {"label": "C", "text": "Proximal femur", "correct": false}, {"label": "D", "text": "Distal femur", "correct": false}], "correct_answer": "A. Proximal tibia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rCIAC0VmsDzVj91Umb221746706138.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Infantile Blount disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Adolescent Blount disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diagnosed in children between age 1-3 years.</li>\n<li>Bilateral condition.</li>\n<li>Characterised by <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> with identification of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> thrust.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Emerges in children in their late childhood or early adolescent.</li>\n<li>Unilateral or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> conditions.</li>\n<li>Characterised by pain in the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> aspect of the knee.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Angles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metaphyseal-Diaphyseal angle(MDA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"293bd03891169277719013dbc608fd\">intersection</span> occurs between a line drawn from the most <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> point on the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> beaks of the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> to a line perpendicular to the long <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> of the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> diaphysis.</li>\n<li>An angle &gt;16° is associated with a 95% risk of <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> progression.</li>\n<li>An angle &lt;10° is likely physiological, with a 95% chance of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> resolution.</li>\n<li>An angle between 11° and 16° necessitates close observation for the potential <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> vara progression.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tibiofemoral angle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Measures the severity of <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> deformity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial Metaphyseal <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">Beak</span> angle(MMBA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diagnostic screening tool for individual risk of blount disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which joints are affected in a condition where the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints are involved, while the metacarpophalangeal (MCP) joints and wrist are spared?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": true}, {"label": "B", "text": "Rheumatoid arthritis", "correct": false}, {"label": "C", "text": "Psoriasis", "correct": false}, {"label": "D", "text": "Hyperparathyroidism", "correct": false}], "correct_answer": "A. Osteoarthritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GMFhtIZcOzN5NQNjOO7w1746706226.png", "https://image.prepladder.com/content/HxUnNFMbwuapuxcDvpf91746706226.png", "https://image.prepladder.com/content/65QI5t8jtqmSBY6N2FJu1746706226.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 year old man presented with a gradual progressive swelling, and was diagnosed with Adamantinoma. Which of the following bones is typically affected by this tumor?", "options": [{"label": "A", "text": "Radius", "correct": false}, {"label": "B", "text": "Humerus", "correct": false}, {"label": "C", "text": "Femur", "correct": false}, {"label": "D", "text": "Tibia", "correct": true}], "correct_answer": "D. Tibia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Adamantinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rare, <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> bone tumors of uncertain histogenesis</li>\n<li>Commonly affects the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> and <span class=\"customMeta\" data-dictid=\"604558eae21692777186613f3915a9\">diaphysis</span> tibia, close to the skin surface.</li>\n<li>Immunohistochemical studies suggest epithelial origin.</li>\n<li>Commonly affects individuals aged 20-40 years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Macroscopic:</strong> Well-defined, <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> tumors with yellowish-gray appearance and possible <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces.</li>\n<li><strong>Microscopic:</strong> Biphasic composition (epithelial and osteofibrous components) with basaloid, tubular, spindle-cell, squamous, and osteofibrous dysplasia-like patterns.</li>\n<li><strong>Immunohistochemistry:</strong>\n<ul>\n<li>Epithelial cells: Positive for keratin, EMA, vimentin, p63, podoplanin.</li>\n<li>Fibrous component: Positive for vimentin.</li>\n<li>Expression of EGF, EGFR (epithelial), FGF2, FGFR1 (both components).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prolonged clinical course with slow-growing swelling, possible pain, bone deformities, or <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fractures (~23%).</li>\n<li>Rarely involves neurological deficits when the spine is affected.</li>\n<li>Metastases commonly involve lungs, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, or spine.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>X-ray:</strong> Well-circumscribed, multilobulated, osteolytic <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> tumor with a \"soap-bubble\" appearance.</li>\n<li><strong>CT Scan:</strong> Assesses soft tissue extension and <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> involvement.</li>\n<li><strong>MRI:</strong> Locoregional staging; visualizes tumor margins, <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> involvement, and soft tissue extension.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Wide Resection: </strong>En bloc removal with wide margins preferred.</li>\n<li><strong>Metastasectomy: </strong>First-line for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> recurrences.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely pathogen responsible for an 8-year-old boy's continuous diarrhea, starting 20 hours ago, which is rice watery in consistency, causing drowsiness, unresponsiveness, sunken eyes, and poor skin turgor?", "options": [{"label": "A", "text": "Vibrio cholera", "correct": true}, {"label": "B", "text": "Entamoeba coli", "correct": false}, {"label": "C", "text": "Escherichia", "correct": false}, {"label": "D", "text": "Shigella sonnei", "correct": false}], "correct_answer": "A. Vibrio cholera", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old woman comes to the emergency department after a road traffic accident. She was a non-restrained passenger in a car. She has pain in her neck and difficulty in neck movements. She has no associated neurological deficits. A neck collar is applied to protect the spinal cord. An X-ray of the neck is shown in the image below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hangman fracture", "correct": true}, {"label": "B", "text": "Jefferson's fracture", "correct": false}, {"label": "C", "text": "Clay Shveler fracture", "correct": false}, {"label": "D", "text": "Sciwora", "correct": false}], "correct_answer": "A. Hangman fracture", "question_images": ["https://image.prepladder.com/notes/nRA265H3h9XG8vIVPll81747985950.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Levine &amp; Edward Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 1</strong>: Less than 3 mm subluxation, stable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rigid <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> collar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2</strong>: Greater than 4 mm subluxation, unstable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-Less than 5 mm - Reduction in <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> and <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> for 6 to 12 weeks</p>\n<p>-Greater than 5 mm - Require surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2a</strong>: Unstable with <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> injury and <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> deformity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Halo fixation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 3</strong>: Unstable with <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> and <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> disruption</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Require surgery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Albers Schonberg disease is", "options": [{"label": "A", "text": "Paget", "correct": false}, {"label": "B", "text": "Osteogenesis imperfecta", "correct": false}, {"label": "C", "text": "Osteoporosis", "correct": false}, {"label": "D", "text": "Osteopetrosis", "correct": true}], "correct_answer": "D. Osteopetrosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qNrxQMpw8zsEe74ssOKs1746706465.png", "https://image.prepladder.com/content/ZoGo2YmkB8JsQnUK2yn21746706465.png", "https://image.prepladder.com/content/kPBn77hVY39AKwNqL33X1746706465.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Osteopetrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Osteopetrosis, also known as Albers-Schönberg disease, is a rare condition characterized by abnormally dense bones due to <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> function, which impairs bone resorption.</p>\n<p>As a result, bones become thickened but brittle, leading to structural abnormalities and complications. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infantile Malignant <span class=\"customMeta\" data-dictid=\"4f3d56310a16927771941d13dfb53c\">Osteopetrosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adult Benign <span class=\"customMeta\" data-dictid=\"4f3d56310a16927771941d13dfb53c\">Osteopetrosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autosomal recessive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autosomal dominant</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Early onset with severe symptoms, including growth retardation, </strong>genu valgum, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> skull development, <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve entrapment, pancytopenia, and hepatosplenomegaly.</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> and discovered incidentally in adulthood. When symptomatic, it may present with non-specific bone pain, compressive neuropathies, and <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> fractures.</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased risk of hydrocephalus, hearing loss, and <span class=\"customMeta\" data-dictid=\"dc4ced4b86169277719422ad2689a5\">osteitis</span> of the mandible.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delayed union</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptom management with vitamin D, γ-interferon, erythropoietin, and corticosteroids.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally not required unless symptoms are present. <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">Symptomatic</span> management includes pain relief and <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> care.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Findings in osteopetrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rugger Jersey Spine (Also seen in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> osteodystrophy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sandwich Vertebra</strong></p>\n<p>Endplates of the <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> become densely <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> resembling a sandwich.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Densely <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">Sclerotic</span> bones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Anish A. Patel, Rohit Ramanathan, Joshua Kuban, and Marc H. Willis\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:CT_of_rugger-jersey_spine_of_renal_osteodystrophy.jpg\" data-tags=\"\" height=\"572\" src=\"https://image.prepladder.com/content/qNrxQMpw8zsEe74ssOKs1746706465.png\" width=\"291\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Dr Maulik S Patel\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Osteopetrosis-4.jpg\" data-tags=\"\" height=\"353\" src=\"https://image.prepladder.com/content/ZoGo2YmkB8JsQnUK2yn21746706465.png\" width=\"291\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Unknown author\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://www.wikiwand.com/en/articles/Osteopetrosis\" data-tags=\"\" height=\"223\" src=\"https://image.prepladder.com/content/kPBn77hVY39AKwNqL33X1746706465.png\" width=\"290\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the following fracture:", "options": [{"label": "A", "text": "Colles Fracture", "correct": false}, {"label": "B", "text": "Monteggia Fracture", "correct": true}, {"label": "C", "text": "Barton's Fracture", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Monteggia Fracture", "question_images": ["https://image.prepladder.com/content/GztlMknw4eg9LvKmQTee1746706527.png"], "explanation_images": ["https://image.prepladder.com/content/Eo1Tf5O9lTnVTcVv6KVg1746706560.png", "https://image.prepladder.com/content/tQCpqjSQkuagYRkK4xsl1746706560.png", "https://image.prepladder.com/content/ciBVlp8sAAz4ZSbCp5jm1746706560.png", "https://image.prepladder.com/content/ZWvlOXC1frAsKco6Bwyc1746706560.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Monteggia fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fracture of the <strong>proximal third of the ulna</strong> is accompanied by a <strong>radial head dislocation</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fall on an outstretched hand</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"402\" src=\"https://image.prepladder.com/content/Eo1Tf5O9lTnVTcVv6KVg1746706560.png\" width=\"711\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Nerve injury (Posterior Interosseous Nerve)</strong></li>\n<li>Malunion</li>\n<li>Non-union</li>\n<li>Cubitus valgus.</li>\n<li>Radio <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"6aec71db0e169277719908863ce421\">synostosis</span> (Type 4 Monteggia Fracture)</li>\n<li>Myositis Ossificans.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is characterized by the presence of both reservoir sign and mastoid tenderness?", "options": [{"label": "A", "text": "Otosclerotic lesion", "correct": false}, {"label": "B", "text": "Acute mastoiditis", "correct": true}, {"label": "C", "text": "Intratympanic glomus tumor", "correct": false}, {"label": "D", "text": "Chronic suppurative otitis media", "correct": false}], "correct_answer": "B. Acute mastoiditis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic asthmatic patient who is on inhaled steroids presents with a history of burning sensation on eating hot or spicy food, and the following findings are seen. What is the most possible diagnosis?", "options": [{"label": "A", "text": "Candidiasis", "correct": true}, {"label": "B", "text": "Burning mouth syndrome", "correct": false}, {"label": "C", "text": "Geographical tongue", "correct": false}, {"label": "D", "text": "Oral lichen planus", "correct": false}], "correct_answer": "A. Candidiasis", "question_images": ["https://image.prepladder.com/content/xwPDDnWjLaPjq8qb1app1746706578.png"], "explanation_images": ["https://image.prepladder.com/content/EFaZafFX5dqFI4fy9o981746706657.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Oral candidiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral candidiasis, commonly known as <strong>thrush</strong>, is an infection caused by an <span class=\"customMeta\" data-dictid=\"2840cd55771692777194448139206d\">overgrowth</span> of Candida albicans, a type of yeast.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of white patches that can be scraped off leaving behind a red inflamed base</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"CDC\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Oral_thrush_Aphthae_Candida_albicans._PHIL_1217_lores.jpg\" data-tags=\"\" height=\"213\" src=\"https://image.prepladder.com/content/EFaZafFX5dqFI4fy9o981746706657.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diabetes</strong>: Poorly controlled diabetes creates a favorable environment for Candida growth due to elevated <span class=\"customMeta\" data-dictid=\"88b48cf7241692777183e5f5b8adf1\">blood sugar</span> levels.</li>\n<li><strong>Neutropenia</strong></li>\n<li><strong>Immunosuppression</strong>: HIV/AIDS, cancer, or <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> medications increases susceptibility.</li>\n<li><strong>Use of inhaled corticosteroids </strong></li>\n<li><strong>Antibiotic Use</strong>: Broad-spectrum antibiotics can disrupt normal oral flora, allowing Candida to overgrow.</li>\n<li><strong>Poor Oral Hygiene</strong>: Lead to an increase in fungal colonization.</li>\n<li><strong>Dry Mouth</strong>: Conditions that lead to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> production can promote candidiasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antifungal medications, such as <span class=\"customMeta\" data-dictid=\"4fb71710a61692777193d5ad608167\">nystatin</span> or fluconazole, along with addressing any underlying risk factors.</li>\n<li>C. krusei- Resistant to azoles</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 79 yrs old lady had a fall in the bathroom, the following X-rays were taken in order to make a diagnosis. Which of the following is treatment of this condition?", "options": [{"label": "A", "text": "Hemiarthroplasty", "correct": true}, {"label": "B", "text": "Hip spica", "correct": false}, {"label": "C", "text": "Total Hip Replacement", "correct": false}, {"label": "D", "text": "Nailing", "correct": false}], "correct_answer": "A. Hemiarthroplasty", "question_images": ["https://image.prepladder.com/content/f8vyA9zlu2eV3nmCOYDo1746706625.png"], "explanation_images": ["https://image.prepladder.com/content/80nmylkdlsgDQmmmDJsG1746706656.png", "https://image.prepladder.com/content/nRVmSL25F9KFZIHHlgUP1746706657.png", "https://image.prepladder.com/content/fdHcnfc77xRbcA2HrNkH1746706657.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:618px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low-Energy Trauma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common in elderly with <strong>osteoporosis</strong>; simple fall from <span class=\"customMeta\" data-dictid=\"f428f17ce1169277719924aafd0e51\">standing height</span> can cause a fracture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osteoporosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Age-related bone loss; post-menopausal women at higher risk; fractures occur with minimal trauma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathological Fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by conditions like metastatic bone disease, multiple myeloma, or Paget’s disease; minimal force needed for fracture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stress Fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seen in athletes or military personnel due to repetitive stress.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Groin pain radiating to <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> thigh or knee; sharp pain worsened by movement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inability to Bear Weight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unable to stand or walk due to pain, less severe in stress fractures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Attitude of affected limb</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shortened and externally rotated limb in displaced fractures; limited internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and flexion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bruising and Swelling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimal <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> due to deep <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> neck location; sometimes bruising around hip or groin.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X-ray (AP and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> views) is the primary modality; fractures are classified using the Garden classification.</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Rohan Bhimani \" data-hash=\"\" data-license=\"CC BY-SA \" data-source=\"https://www.wikidoc.org/index.php/File:Xray_Femoral_neck_fracture.gif\" data-tags=\"\" height=\"392\" src=\"https://image.prepladder.com/content/80nmylkdlsgDQmmmDJsG1746706656.png\" width=\"272\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Non-displaced:</strong> Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (e.g., cannulated screws)</li>\n<li><strong>Displaced:</strong> Surgical <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (<strong>hemiarthroplasty</strong>, total hip replacement)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High risk of <span class=\"customMeta\" data-dictid=\"52a1dd8c4f1692777193dd58a0d51c\">nonunion</span> and <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"371\" src=\"https://image.prepladder.com/content/nRVmSL25F9KFZIHHlgUP1746706657.png\" width=\"371\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Garden’s <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment in adults </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment in children </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Garden’s type 1</strong></p>\n<p>(incomplete, impacted, or abducted fracture)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conservative methods</li>\n<li>Immobilization in a Thomas <span class=\"customMeta\" data-dictid=\"7f606f911b1692777199eb69ab67c5\">splint</span> with traction</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with screws (if <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is feared)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hip <span class=\"customMeta\" data-dictid=\"f2ad4340681692777199d8bf0f5cbb\">spica</span> <strong>(Option B ruled out)</strong></li>\n<li>Traction is applied through a pin (Moore’s pin) or wire in older adolescents</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Garden’s type 2</strong></p>\n<p>(complete but undisplaced)</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with cannulated screws, dynamic hip screws, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> locking plates, and cephalomedullary nails.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Garden’s <span class=\"customMeta\" data-dictid=\"6f809a27121692777201d1ccde5ace\">type 3</span> </strong></p>\n<p>(complete &amp; partially displaced)<strong> </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hemiarthroplasty </strong>(done in inactive elderly of &gt;60years of age with comorbidities)</li>\n<li>Total hip <span class=\"customMeta\" data-dictid=\"54ac01f4f116927771829dd4d10428\">arthroplasty</span> (done in active older patients)</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (done in young adults)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (using Knowle’s screw)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Garden’s type 4</strong></p>\n<p>(complete &amp; fully displaced)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with hoarseness of voice. On examination an ulceroproliferative mass is seen on the right vocal cord; the cord was however mobile. There is no lymph node involvement and no metastasis. Which of the following is the best treatment modality for this patient?", "options": [{"label": "A", "text": "Total laryngectomy", "correct": false}, {"label": "B", "text": "Radiotherapy", "correct": true}, {"label": "C", "text": "Conservative laryngectomy", "correct": false}, {"label": "D", "text": "Chemotherapy", "correct": false}], "correct_answer": "B. Radiotherapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents to the orthopedic OPD with a limp and limb shortening. His X-ray is given below, What is the diagnosis?", "options": [{"label": "A", "text": "Perthes", "correct": false}, {"label": "B", "text": "SCFE", "correct": false}, {"label": "C", "text": "DDH", "correct": true}, {"label": "D", "text": "Fracture neck of femur", "correct": false}], "correct_answer": "C. DDH", "question_images": ["https://image.prepladder.com/content/3vOlWlCZyGXwj51vU3CF1746706732.png"], "explanation_images": ["https://image.prepladder.com/content/4JNmQAsybzltW0T7gtaM1746706763.png", "https://image.prepladder.com/content/dJrn2JOSjQCEmaqm7WJJ1746706763.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigation of choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Classification used</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>USG (screening investigation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Graf’s classification</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MRI (diagnostic investigation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Kashiwagi’s classification</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Von rosen splint</strong> and <strong>Pavlik harness</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"444\" src=\"https://image.prepladder.com/content/4JNmQAsybzltW0T7gtaM1746706763.png\" width=\"442\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6-18 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed reduction with Hip spica</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Katharina Gather, Ivan Mavrev, Simone Gantz, Thomas Dreher, Sébastien Hagmann, Nicholas Andreas Beckmann\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Shows-a-patient-in-a-spica-cast-with-hip-abduction-and-flexion_fig2_361826954\" data-tags=\"\" height=\"382\" src=\"https://image.prepladder.com/content/dJrn2JOSjQCEmaqm7WJJ1746706763.png\" width=\"766\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt;18 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open reduction with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> osteotomies (Salter’s/Chiari osteotomy)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred diagnostic procedure prior to performing functional endoscopic sinus surgery (FESS)?", "options": [{"label": "A", "text": "MRI scan", "correct": false}, {"label": "B", "text": "X-ray", "correct": false}, {"label": "C", "text": "Antral lavage", "correct": false}, {"label": "D", "text": "CT scan", "correct": true}], "correct_answer": "D. CT scan", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male who is a professional trumpet blower presented with a swelling on the left side of the neck. On examination, there is a gurgling sound when compressing the swelling. As the X-ray neck was inconclusive a CT neck was taken which is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pharyngeal pouch", "correct": false}, {"label": "B", "text": "Laryngocele", "correct": true}, {"label": "C", "text": "Trachea-oesophageal fistula", "correct": false}, {"label": "D", "text": "Tonsillar", "correct": false}], "correct_answer": "B. Laryngocele", "question_images": ["https://image.prepladder.com/notes/qNEQnPRlq3f8E6N9qcBn1747983661.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequent location of obstruction caused by a nasal polyp originating from the maxillary sinus?", "options": [{"label": "A", "text": "Inferior meatus", "correct": false}, {"label": "B", "text": "Superior meatus", "correct": false}, {"label": "C", "text": "Middle meatus", "correct": true}, {"label": "D", "text": "Sphenoethmoidal recess", "correct": false}], "correct_answer": "C. Middle meatus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following least likely causes nasal septal perforation?", "options": [{"label": "A", "text": "Rhinosporidiosis", "correct": false}, {"label": "B", "text": "Seasonal influenza", "correct": true}, {"label": "C", "text": "Syphilis", "correct": false}, {"label": "D", "text": "Tuberculosis", "correct": false}], "correct_answer": "B. Seasonal influenza", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the most probable cause for the progressive vision loss in both eyes of a 25-year-old male who has been undergoing low-dose oral steroid therapy for the past decade?", "options": [{"label": "A", "text": "Cataract", "correct": true}, {"label": "B", "text": "Glaucoma", "correct": false}, {"label": "C", "text": "Cystoid macular edema", "correct": false}, {"label": "D", "text": "Retinal detachment", "correct": false}], "correct_answer": "A. Cataract", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the dermatophyte based on the macroconidia shown in the image below:", "options": [{"label": "A", "text": "Trichophyton", "correct": false}, {"label": "B", "text": "Microsporum", "correct": false}, {"label": "C", "text": "Epidermophyton", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. Epidermophyton", "question_images": ["https://image.prepladder.com/notes/M5rVEJ3QjMpIUeoe4Qa21747984261.png"], "explanation_images": ["https://image.prepladder.com/content/m1gQz8EvSHYfeQavfclh1746707463.png", "https://image.prepladder.com/content/kDieQYCibERR2WDxa04O1746707463.png", "https://image.prepladder.com/content/tW9WQI635SX3c0y5fJco1746707463.png", "https://image.prepladder.com/content/lUefTbBReIY0k6GG9hGm1746707463.png", "https://image.prepladder.com/content/Vwj4BhtcCteTOXcMOyqx1746707463.png", "https://image.prepladder.com/content/n7DG7BaFnByXg4xJvUzt1746707463.png", "https://image.prepladder.com/content/i5VzW5BSlrSCX1Xu4VPX1746707654.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tinea barbae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection of the <strong>bearded areas of the face and neck</strong> (barber's itch).</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"CDC\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Tinea_barbae_4807_lores.jpg\" data-tags=\"\" height=\"159\" src=\"https://image.prepladder.com/content/m1gQz8EvSHYfeQavfclh1746707463.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tinea capitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection of the <strong>scalp;</strong> variants include <span class=\"customMeta\" data-dictid=\"946f81c2911692777202d3930ab94f\">favus</span> and kerion.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Gzzz\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Teigne_tondante_enfant.jpg\" data-tags=\"\" height=\"172\" src=\"https://image.prepladder.com/content/kDieQYCibERR2WDxa04O1746707463.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tinea corporis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection of <strong>smooth, non-hairy skin</strong> (Tinea glabrosa).</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"CDC/ Dr. Lucille K. Georg\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Ringworm_on_the_arm,_or_tinea_corporis_due_to_Trichophyton_mentagrophytes_PHIL_2938_lores.jpg\" data-tags=\"\" height=\"142\" src=\"https://image.prepladder.com/content/tW9WQI635SX3c0y5fJco1746707463.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tinea cruris</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection of the <strong>groin and <span class=\"customMeta\" data-dictid=\"ea5dd28db71692777195ee64c2f690\">perineum</span> </strong>(jock itch).</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:FeetFungal.JPG\" data-tags=\"\" height=\"175\" src=\"https://image.prepladder.com/content/lUefTbBReIY0k6GG9hGm1746707463.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tinea imbricata</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tropical <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> of Tinea corporis with <span class=\"customMeta\" data-dictid=\"9bb62139a81692777184648bfef564\">concentric</span> <span class=\"customMeta\" data-dictid=\"a37fd1603c1692777198f87a4a51dc\">scaly</span> patches.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tinea manuum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection of the<strong> hand.</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Mohammad2018\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Tinea_manum.jpg\" data-tags=\"\" height=\"265\" src=\"https://image.prepladder.com/content/Vwj4BhtcCteTOXcMOyqx1746707463.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tinea pedis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection of the<strong> foot</strong> (athlete's foot).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tinea unguium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection of the <strong>nails.</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Oncymycosis.JPG\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/n7DG7BaFnByXg4xJvUzt1746707463.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microsporum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predominantly macroconidia; spindle-shaped, <span class=\"customMeta\" data-dictid=\"688c032c5f169277719340e2e620d1\">multicellular</span> structures; <strong>infects hair and skin. </strong><strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trichophyton</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More abundant microconidia in clusters; macroconidia are thin, and elongated; include species like <em>T. rubrum</em> which is common in humans. <strong>Infects hair, nails and skin.</strong> <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidermophyton</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lacks microconidia; club-shaped, <span class=\"customMeta\" data-dictid=\"688c032c5f169277719340e2e620d1\">multicellular</span> macroconidia; infects <strong>skin and nails but not hair. </strong><strong>(Option C) </strong><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trichophyton</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microsporum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidermophyton</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Site of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hair, nail, and skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hair and skin only</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin and nail only</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Colony</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Powdery pigmented</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cotton-like pigmented</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Powdery greenish yellow</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Spores</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>a. Microconidia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abundant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Relatively scanty</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>b. Macroconidia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pencil or cylindrical-shaped</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spindle-shaped</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Club or pear-shaped</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 year old apparently healthy man who was carrying laxatives and enema apparatus developed abdominal pain at the airport and an x-ray was done which appears as shown below. Which of the following is the likely diagnosis?", "options": [{"label": "A", "text": "Bezoar syndrome", "correct": false}, {"label": "B", "text": "Pica due to anaemia", "correct": false}, {"label": "C", "text": "Body packer syndrome", "correct": true}, {"label": "D", "text": "Constipation due to fecalith", "correct": false}], "correct_answer": "C. Body packer syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EX3fb5ISjDeFVGFZhHRL1746707911.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 36-year-old man who has been experiencing bluish-black discoloration of the sclera and pinna for the past 6 months, along with a history of black urine upon standing since childhood?", "options": [{"label": "A", "text": "Phenylketonuria", "correct": false}, {"label": "B", "text": "Alkaptonuria", "correct": true}, {"label": "C", "text": "Tyrosinemia", "correct": false}, {"label": "D", "text": "Maple syrup urine disease", "correct": false}], "correct_answer": "B. Alkaptonuria", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/isf53u4mhdqrrChi6fpn1746708053.png", "https://image.prepladder.com/content/8PLiCCruitKmtjVkoS8z1746708053.png", "https://image.prepladder.com/content/AnQ0nKG1bb8itmFFiOat1746708053.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Garrod's <span class=\"customMeta\" data-dictid=\"8520f0f8381692777200370bfb958c\">tetrad</span> in alkaptonuria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. Homogentisic Aciduria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of <span class=\"customMeta\" data-dictid=\"d442747c48169277718942db69fa7e\">homogentisic acid</span> in the urine, which turns dark upon standing or when exposed to air.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2. Ochronosis</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Siavashi, Babak &amp; Zehtab, Mohammad &amp; Pendar, Ehsan. \" data-hash=\"\" data-license=\"CC BY SA 2.0\" data-source=\"https://www.researchgate.net/figure/Ochronotic-pigmentation-of-the-sclera-Photography-of-patients-eye-after-admission_fig2_40900293\" data-tags=\"\" height=\"244\" src=\"https://image.prepladder.com/content/isf53u4mhdqrrChi6fpn1746708053.png\" width=\"323\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deposition of dark <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> in <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues, particularly noticeable in the ear cartilage, sclera, and other <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues, leading to a bluish-black discoloration.The image shows Osler’s sign.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3. Arthropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Degenerative joint disease, especially affecting the spine and large joints, leading to chronic pain and stiffness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4. <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Includes <span class=\"customMeta\" data-dictid=\"efba33a3fd1692777189906f884236\">heart valve</span> <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> and <span class=\"customMeta\" data-dictid=\"2991baa5dd16927771828a23544924\">atherosclerosis</span> due to the deposition of <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> in <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tissues.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man continues to call females. Achieves sexual gratification by talking obscenity &amp;amp; sharing obscene pictures.The condition is?", "options": [{"label": "A", "text": "Frotteurism", "correct": false}, {"label": "B", "text": "Voyeurism", "correct": false}, {"label": "C", "text": "Scatologia", "correct": true}, {"label": "D", "text": "Coprophilia", "correct": false}], "correct_answer": "C. Scatologia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Complex IV is inhibited by --?", "options": [{"label": "A", "text": "Rotenone", "correct": false}, {"label": "B", "text": "Cyanide", "correct": true}, {"label": "C", "text": "Carboxin", "correct": false}, {"label": "D", "text": "Antimycin A", "correct": false}], "correct_answer": "B. Cyanide", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xkIy7Ev425z9aKTHT94P1746708180.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:708px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Inhibitor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Target Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rotenone (Option A)</strong></p>\n<p><strong>Amobarbital</strong></p>\n<p><strong>Piericidin A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complex I</p>\n<p>(NADH dehydrogenase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex I to ubiquinone</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TTFA (Thenoyltrifluoroacetone)</strong></p>\n<p><strong>Carboxin</strong> <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complex II</p>\n<p>(Succinate dehydrogenase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex II to ubiquinone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malonate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complex II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malonate is a competitive <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> of Complex II.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antimycin A (Option D)</strong></p>\n<p><strong>BAL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complex III</p>\n<p>Cytochrome bc1 complex</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex III to <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">Cytochrome</span> C.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cyanide (CN−)</strong> <strong>(Option B)</strong></p>\n<p><strong>Carbon <span class=\"customMeta\" data-dictid=\"03077f6c8716927771923763487a9e\">monoxide</span> (CO)</strong></p>\n<p><strong>Hydrogen Sulfide (H2S)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complex IV</p>\n<p>(Cytochrome c Oxidase)</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prevents <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex IV to oxygen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oligomycin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ATP <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">Synthase</span> (Complex V)</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks the <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> channel of ATP synthase, preventing ATP synthesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Atractyloside</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adenine Nucleotide Translocase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks ADP/ATP exchange across the mitochondrial membrane</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was brought to the casualty with greenish color skin and a rotten egg odour. The most probable poisoning could be.", "options": [{"label": "A", "text": "Carbon monoxide", "correct": false}, {"label": "B", "text": "Nitrite", "correct": false}, {"label": "C", "text": "Cyanide", "correct": false}, {"label": "D", "text": "Hydrogen sulfide", "correct": true}], "correct_answer": "D. Hydrogen sulfide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which enzymes show deficiency in Von Gierke's disease?", "options": [{"label": "A", "text": "Liver glycogen phosphorylase", "correct": false}, {"label": "B", "text": "Muscle glycogen phosphorylase", "correct": false}, {"label": "C", "text": "Glycogen debranching enzyme", "correct": false}, {"label": "D", "text": "Glucose-6-phosphatase", "correct": true}], "correct_answer": "D. Glucose-6-phosphatase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/l7JOrztWAwqYYQJzXmej1746708320.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Von Gierke's Disease (Glycogen Storage Disease Type I)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deficiency of <span class=\"customMeta\" data-dictid=\"bcab733e981692777188fe634201b6\">glucose-6-phosphatase</span> enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inability to convert glucose-6-phosphate to glucose; leads to accumulation of glycogen, lactate, and triglycerides</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Severe hypoglycemia</strong></li>\n<li><strong>Hepatomegaly and Renomegaly</strong></li>\n<li>Growth retardation</li>\n<li>Lactic acidosis</li>\n<li>Hyperuricemia and Hyperlipidemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Biochemical tests (hypoglycemia, <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis, hyperuricemia, hyperlipidemia)</li>\n<li>Genetic testing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Frequent feedings with slow-release carbohydrates</li>\n<li>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> monitoring</li>\n<li>Medications for associated conditions</li>\n<li>Liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> (in severe cases)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Glycogen Storage Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type 0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glycogen <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">synthase</span> deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type I (von Gierke's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucose-6-phosphatase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type II (Pompe's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acid α-glucosidase (acid maltase)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type III (Cori's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Debranching <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> (amylo-1,6-glucosidase)</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type IV (Andersen's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Branching enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type V (McArdle's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Muscle <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">glycogen</span> <span class=\"customMeta\" data-dictid=\"1fa65725491692777195ead6a7c81b\">phosphorylase</span> (myophosphorylase)</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type VI (Hers' Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">glycogen</span> phosphorylase</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type VII (Tarui's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Phosphofructokinase (muscle type)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Nitric oxide is synthesized from", "options": [{"label": "A", "text": "L-arginine", "correct": true}, {"label": "B", "text": "L-citrulline", "correct": false}, {"label": "C", "text": "Glycine", "correct": false}, {"label": "D", "text": "Lysine", "correct": false}], "correct_answer": "A. L-arginine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the specific name of the test performed by the doctor during the autopsy where they tied the bronchus and submerged the lung in water to determine if it floats or sinks?", "options": [{"label": "A", "text": "Gettler's test", "correct": false}, {"label": "B", "text": "Ploucquet's test", "correct": false}, {"label": "C", "text": "Hydrostatic test", "correct": true}, {"label": "D", "text": "Diatom's test", "correct": false}], "correct_answer": "C. Hydrostatic test", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the method of substance abuse as shown in the image below.", "options": [{"label": "A", "text": "Snorting", "correct": false}, {"label": "B", "text": "Bagging", "correct": true}, {"label": "C", "text": "Sniffing", "correct": false}, {"label": "D", "text": "Huffing", "correct": false}], "correct_answer": "B. Bagging", "question_images": ["https://image.prepladder.com/notes/BBax4yDfsO11SB1w3Uj11747983808.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Methods of substance abuse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bagging</strong></p>\n<p><strong>(</strong><strong>Option B</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bagging refers to a method of inhaling substances by placing them inside a bag and then inhaling or breathing in the vapors.</li>\n<li>The bag is typically held over the nose and mouth, allowing the person to <span class=\"customMeta\" data-dictid=\"fa8e7de4491692777190b78c13e43a\">inhale</span> the substance contained within the bag.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Snorting</strong></p>\n<p><strong>(</strong><strong>Option A</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Snorting involves the <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> of powdered substances, typically drugs, through the nose.</li>\n<li>The substance is crushed into a fine powder and then snorted through the nostrils using a straw, rolled-up paper, or other devices.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sniffing</strong></p>\n<p><strong>(</strong><strong>Option C</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sniffing refers to the act of inhaling or smelling substances, often <span class=\"customMeta\" data-dictid=\"656e217bb81692777202d82810ba2a\">volatile</span> or <span class=\"customMeta\" data-dictid=\"5bdef37bf01692777182f5780db753\">aromatic</span> substances.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Huffing</strong></p>\n<p><strong>(</strong><strong>Option D</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Huffing involves the deliberate <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> of <span class=\"customMeta\" data-dictid=\"656e217bb81692777202d82810ba2a\">volatile</span> substances or inhalants directly from their container or source.</li>\n<li>This method is associated with the misuse of chemicals, solvents, or other <span class=\"customMeta\" data-dictid=\"656e217bb81692777202d82810ba2a\">volatile</span> substances for recreational purposes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While collecting a blood sample for investigations, you accidentally dropped a 5 ml tube of blood and spilled blood. Which among the following is the best solution to clean it?", "options": [{"label": "A", "text": "1:100 sodium hypochlorite", "correct": true}, {"label": "B", "text": "Isopropyl alcohol", "correct": false}, {"label": "C", "text": "Hydrogen peroxide", "correct": false}, {"label": "D", "text": "1:1000 sodium hypochlorite", "correct": false}], "correct_answer": "A. 1:100 sodium hypochlorite", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QVnaou4Acnl21kde6GW81746708475.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tincture Iodine (2% Iodine): <span class=\"customMeta\" data-dictid=\"501eeb4a9716927771827a72cc5476\">bactericidal</span> + sporicidal</li>\n<li><strong>Povidone Iodine (Betadine): </strong>has <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> action</li>\n<li><strong>Sodium <span class=\"customMeta\" data-dictid=\"183f5ac20a16927771890da7bafd33\">hypochlorite</span> (5.25%): </strong>Both <span class=\"customMeta\" data-dictid=\"501eeb4a9716927771827a72cc5476\">bactericidal</span> + virucidal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Oxidisation</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Skin antiseptic, wound <span class=\"customMeta\" data-dictid=\"5d07a26d7516927771863e5f43d8d0\">dressing</span> (Betadine preferred)</li>\n<li>Town water supply, Swimming pools (Chlorine)</li>\n<li><strong>Sodium hypochlorite: Blood spills (1:10/1:100 <span class=\"customMeta\" data-dictid=\"409e887c94169277718652d5db3c32\">dilution</span> of 5.25% solution used)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man was found to be lying dead on the ground. His friend saw a snake passing in the area and took a picture of it and showed it to the doctor (image below). What is the most probable cause of death of this man?", "options": [{"label": "A", "text": "Shock", "correct": false}, {"label": "B", "text": "Respiratory failure", "correct": true}, {"label": "C", "text": "Coagulopathy", "correct": false}, {"label": "D", "text": "Renal failure", "correct": false}], "correct_answer": "B. Respiratory failure", "question_images": ["https://image.prepladder.com/notes/NtMrwE5ioZ5lqKc7dWSE1747983890.png"], "explanation_images": ["https://image.prepladder.com/notes/NtMrwE5ioZ5lqKc7dWSE1747983890.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old HIV-positive male presented with low-grade fever, cough, night sweats, and weight loss for the past 3 weeks. In view of TB investigations, the Mantoux test was negative; chest X-ray showed non-specific findings, and an adequate amount of sputum could not be collected for slide examination. Which of the following is used to diagnose latent TB infection in this patient?", "options": [{"label": "A", "text": "CBNAAT", "correct": false}, {"label": "B", "text": "MGIT system", "correct": false}, {"label": "C", "text": "Interferon-gamma release assay", "correct": true}, {"label": "D", "text": "Line probe assay", "correct": false}], "correct_answer": "C. Interferon-gamma release assay", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sputum <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial screening for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> TB.</li>\n<li>Samples are stained using the Ziehl-Neelsen method or Auramine-O <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB) under a microscope.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Quick and inexpensive. Can provide results within a few hours.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Low sensitivity, especially in cases of <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB or in patients with HIV.</li>\n<li>Cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between Mycobacterium <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> and non-tuberculous <span class=\"customMeta\" data-dictid=\"46f768d2e41692777193d69cbc7eec\">mycobacteria</span> (NTM).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Confirm the diagnosis of TB and assess drug susceptibility.</li>\n<li><strong>Solid Media:</strong> <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">Sputum</span> is inoculated onto solid culture media like <strong>Löwenstein-Jensen </strong>or Middlebrook agar.</li>\n<li><strong>Liquid Media: </strong>Automated systems like <strong>BACTEC or MGIT</strong> are used to detect growth faster.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The gold standard for TB diagnosis.</li>\n<li>Allows for drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Time-consuming; results can take weeks.</li>\n<li>Requires specialized laboratory facilities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Xpert MTB/RIF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Detects Mycobacterium <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> and <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</li>\n<li><strong>Method</strong>:</li>\n<li>A cartridge-based system that performs <span class=\"customMeta\" data-dictid=\"6483f3ef3116927771935d328a8ab2\">nucleic acid</span> <span class=\"customMeta\" data-dictid=\"13e14b31b21692777181520d7c651c\">amplification</span> (NAAT).</li>\n<li>Sputum or other specimens are processed directly in the cartridge.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid results (within 2 hours).</li>\n<li>High sensitivity and specificity.</li>\n<li>Simultaneously detects <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More expensive than <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> microscopy.</li>\n<li>Does not provide full drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LAMP (Loop-Mediated Isothermal Amplification)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Detects DNA of Mycobacterium tuberculosis.</li>\n<li><strong>Method</strong>:</li>\n<li>Amplifies DNA at a constant temperature without the need for <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> cycling.</li>\n<li>Sputum or other specimens are used.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid results (within 1-2 hours).</li>\n<li>High <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> and sensitivity.</li>\n<li>Can be performed at the point of care.</li>\n<li>Used for patients with HIV with CD4+ counts of less than 100 cells/μL irrespective of signs and symptoms of TB.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less widely available than PCR-based tests.</li>\n<li>Cannot detect <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> directly.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TrueNat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Point-of-care test for TB detection.</li>\n<li><strong>Method</strong>:</li>\n<li>Uses a micro-PCR technology to amplify DNA.</li>\n<li>Results are available within 60 minutes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Portable and easy to use in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> health facilities.</li>\n<li>Provides results quickly, facilitating immediate treatment decisions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Line <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">Probe</span> <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">Assay</span> (LPA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Detects TB and <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> (rifampicin and isoniazid).</li>\n<li><strong>Method</strong>:\n\t\t\t\t<ul>\n<li>Sputum samples are processed, and DNA is extracted.</li>\n<li>Amplified DNA is hybridized to specific probes on a <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> strip.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid results (within 1-2 days).</li>\n<li>Can detect multiple mutations associated with drug resistance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires a laboratory <span class=\"customMeta\" data-dictid=\"3a6d14db861692777198565f57828c\">setup</span> and trained personnel.</li>\n<li>Not suitable for all strains of TB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RFLP</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>IS6110 <span class=\"customMeta\" data-dictid=\"3668babc2b169277719777e6f04c66\">restriction fragment</span> length <span class=\"customMeta\" data-dictid=\"15d98152c61692777196a0f2fb42a0\">polymorphism</span> (RFLP)</strong> analysis is widely used for molecular epidemiological studies of tuberculosis.</li>\n<li>Restriction enzymes Nru I, EcoN I, Pst I, and Pvu II were used to analyze IS6110 fingerprints in Mycobacterium <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> strains H37Rv (virulent) and H37Ra (avirulent).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The World Health Organization (WHO) has defined blindness as a condition where the level of visual acuity is below", "options": [{"label": "A", "text": "6/60", "correct": false}, {"label": "B", "text": "3/60", "correct": true}, {"label": "C", "text": "1/60", "correct": false}, {"label": "D", "text": "6/18", "correct": false}], "correct_answer": "B. 3/60", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>WHO Classification of Visual Impairment</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li>The World Health Organization (WHO) defines <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">blindness</span> as <strong>\"visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 3/60 (Snellen) or its equivalent\".</strong></li>\n<li>The International Classification of Disease 11 (2018) classifies vision <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> into distance and near-presenting vision impairment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Visual Acuity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mild Distance Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 6/12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Moderate Distance Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 6/18 <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Severe Distance Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 6/60 <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Blindness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 3/60 <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Near Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Presenting near vision <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than N6 or M0.8 at 40 cm with existing <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old healthy man with a history of small streaks of blood in his stools is being sent for a colonoscopy to screen for colon cancer. This type of prevention is-", "options": [{"label": "A", "text": "Primordial", "correct": false}, {"label": "B", "text": "Secondary", "correct": true}, {"label": "C", "text": "Primary", "correct": false}, {"label": "D", "text": "Tertiary", "correct": false}], "correct_answer": "B. Secondary", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Levels of prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primordial (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prevention of establishment of risk factors.</li>\n<li>It aims to discourage people from adopting harmful habits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary</strong> <strong>(Option C ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prevention of onset of disease in a high-risk group/individual.</li>\n<li>It aims to protect the health of those who are at risk.</li>\n<li>Reduces the <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of the disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Disease <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> can be prevented at an early stage (Disease is reversible).</li>\n<li>It aims to reduce the <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of the disease by early identification and prompt treatment of diseases, and it also prevents complications.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tertiary </strong> <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prevention or limitation of <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> and disability in a diseased patient who has developed complications due to the disease and the disease has become irreversible.</li>\n<li>It aims to minimise a patient's suffering and maximise potential years of useful life.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When is the population evaluated to calculate the crude death rate?", "options": [{"label": "A", "text": "1st July", "correct": true}, {"label": "B", "text": "1st January", "correct": false}, {"label": "C", "text": "31st December", "correct": false}, {"label": "D", "text": "1st may", "correct": false}], "correct_answer": "A. 1st July", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a train accident, there were 74 dead, 64 were severely injured, 20 moderately injured and 12 mildly injured. Colour coding in triage, from highest to lowest priority is:", "options": [{"label": "A", "text": "Green-Yellow- Red-Black", "correct": false}, {"label": "B", "text": "Yellow- Red-Green-Black", "correct": false}, {"label": "C", "text": "Black-Red-Yellow- Green", "correct": false}, {"label": "D", "text": "Red-Yellow-Green-Black", "correct": true}], "correct_answer": "D. Red-Yellow-Green-Black", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/l2k1hnth1HWYRVNeSA391746709476.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the mechanism of action of cholera toxin?", "options": [{"label": "A", "text": "Inhibit elongation factor -2", "correct": false}, {"label": "B", "text": "Toxin causes increased guanyl cyclase activity", "correct": false}, {"label": "C", "text": "Activates adenylate cyclase", "correct": true}, {"label": "D", "text": "Inhibit 60S subunit", "correct": false}], "correct_answer": "C. Activates adenylate cyclase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old boy presents with complaints of fever and sore throat. On examination, he has extensive cervical swelling and a well-demarcated white-gray exudative substance adherent to his oropharynx and attempts to remove this membrane result in bleeding. The parents report that all his childhood vaccines were skipped due to religious beliefs. A throat swab under Albert's staining is as below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Streptococcal pharyngitis", "correct": false}, {"label": "B", "text": "Diphtheria", "correct": true}, {"label": "C", "text": "Tetanus", "correct": false}, {"label": "D", "text": "Pertussis", "correct": false}], "correct_answer": "B. Diphtheria", "question_images": ["https://image.prepladder.com/content/harlPitpjiwdjIrtLfu01746709954.png"], "explanation_images": ["https://image.prepladder.com/content/CvsBV53JNSIDY0WuvU6k1746710048.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diphtheria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Sore throat</li>\n<li>Difficulty <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> (dysphagia)</li>\n<li>Low-grade fever</li>\n<li>Grey Pseudomembrane formation in the throat that bleeds on removal</li>\n<li>Non-healing ulcers covered by grey <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> on the skin</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Myocarditis</li>\n<li>Neurological complications (e.g., paralysis, neuropathy)</li>\n<li>Renal failure</li>\n<li>Airway obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture Media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colony appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Evaluation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Loeffler’s <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> slope</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Small</li>\n<li>Circular <span class=\"customMeta\" data-dictid=\"1b8aa0db391692777194178f73c98c\">opaque</span> disks</li>\n<li>Glistening,</li>\n<li>White with a yellow tinge</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Advantage: </u>Growth can be detected as early as 6–8 hours.</li>\n<li>The best medium for <span class=\"customMeta\" data-dictid=\"2a980628c2169277719296f9072e4a\">metachromatic</span> <span class=\"customMeta\" data-dictid=\"fd69fc99d41692777188cc051aafa5\">granule</span> production</li>\n<li><u>Disadvantage: </u>Supports the growth of other throat commensals also</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Potassium tellurite agar</strong></p>\n<p><strong>(McLeod’s and Hoyle’s-modified PTA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Grey or black colour</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Advantage:</u> Throat commensals are inhibited</li>\n<li><u>Disadvantage: </u>Colonies appear only after 48 hours of incubation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sheep blood agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Small</li>\n<li>Circular</li>\n<li>White</li>\n<li>Sometimes hemolytic(mitis biotype)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Differentiate colonies from streptococcal or <span class=\"customMeta\" data-dictid=\"8bd72cc36b1692777199668da84fcd\">staphylococcal</span> pharyngitis, which may simulate diphtheria.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> slope may show growth in 4-8 hours but, if negative, will have to be incubated for 24 hours</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Albert Solution 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malachite Green for organism staining</li>\n<li>Toluidine Blue for <span class=\"customMeta\" data-dictid=\"2a980628c2169277719296f9072e4a\">metachromatic</span> staining</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Enhances contrast and <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> in staining.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Albert Solution 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Iodine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Specifically targets <span class=\"customMeta\" data-dictid=\"6dd80630fd16927772026fda726e31\">volutin</span> or Babes-Ernst granules.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the average incubation period of plasmodium falciparum?", "options": [{"label": "A", "text": "12", "correct": true}, {"label": "B", "text": "16", "correct": false}, {"label": "C", "text": "30", "correct": false}, {"label": "D", "text": "28", "correct": false}], "correct_answer": "A. 12", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Properties P.vivax P.ovale P.falciparum P.malariae</li><li>↳ Properties</li><li>↳ Properties</li><li>↳ Properties</li><li>↳ P.vivax</li><li>↳ P.vivax</li><li>↳ P.vivax</li><li>↳ P.ovale</li><li>↳ P.ovale</li><li>↳ P.ovale</li><li>↳ P.falciparum</li><li>↳ P.falciparum</li><li>↳ P.falciparum</li><li>↳ P.malariae</li><li>↳ P.malariae</li><li>↳ P.malariae</li><li>↳ Relapse (Hypnozoites) Seen Seen Not seen Not seen</li><li>↳ Relapse (Hypnozoites)</li><li>↳ Relapse (Hypnozoites)</li><li>↳ Relapse (Hypnozoites)</li><li>↳ Seen</li><li>↳ Seen</li><li>↳ Seen</li><li>↳ Seen</li><li>↳ Not seen</li><li>↳ Not seen</li><li>↳ Not seen</li><li>↳ Not seen</li><li>↳ Recrudescence Not seen Not seen Seen Seen</li><li>↳ Recrudescence</li><li>↳ Recrudescence</li><li>↳ Recrudescence</li><li>↳ Not seen</li><li>↳ Not seen</li><li>↳ Not seen</li><li>↳ Not seen</li><li>↳ Seen</li><li>↳ Seen</li><li>↳ Seen</li><li>↳ Seen</li><li>↳ Preference Reticulocytes Reticulocytes Young erythrocytes Old erythrocytes</li><li>↳ Preference</li><li>↳ Preference</li><li>↳ Preference</li><li>↳ Reticulocytes</li><li>↳ Reticulocytes</li><li>↳ Reticulocytes</li><li>↳ Reticulocytes</li><li>↳ Young erythrocytes</li><li>↳ Young erythrocytes</li><li>↳ Old erythrocytes</li><li>↳ Old erythrocytes</li><li>↳ Erythrocytic Cycle 48 hours 48 hours 36–48 hours 72 hours</li><li>↳ Erythrocytic Cycle</li><li>↳ Erythrocytic Cycle</li><li>↳ Erythrocytic Cycle</li><li>↳ 48 hours</li><li>↳ 48 hours</li><li>↳ 48 hours</li><li>↳ 48 hours</li><li>↳ 36–48 hours</li><li>↳ 36–48 hours</li><li>↳ 72 hours</li><li>↳ 72 hours</li><li>↳ Prepatent Period 8 days 9 days 5 days 13 days</li><li>↳ Prepatent Period</li><li>↳ Prepatent Period</li><li>↳ Prepatent Period</li><li>↳ 8 days</li><li>↳ 8 days</li><li>↳ 9 days</li><li>↳ 9 days</li><li>↳ 5 days</li><li>↳ 5 days</li><li>↳ 13 days</li><li>↳ 13 days</li><li>↳ Incubation Period 12- 17 days 14-17 days 12 days 28-30 days</li><li>↳ Incubation Period</li><li>↳ Incubation Period</li><li>↳ Incubation Period</li><li>↳ 12- 17 days</li><li>↳ 12- 17 days</li><li>↳ 12- 17 days</li><li>↳ 14-17 days</li><li>↳ 14-17 days</li><li>↳ 14-17 days</li><li>↳ 12 days</li><li>↳ 12 days</li><li>↳ 12 days</li><li>↳ 28-30 days</li><li>↳ 28-30 days</li><li>↳ 28-30 days</li><li>↳ Stages found in peripheral blood Trophozoite, schizonts, gametocytes As in vivax Ring form, accole form, gametocytes Band forms</li><li>↳ Stages found in peripheral blood</li><li>↳ Stages found in peripheral blood</li><li>↳ Stages found in peripheral blood</li><li>↳ Trophozoite, schizonts, gametocytes</li><li>↳ Trophozoite, schizonts, gametocytes</li><li>↳ As in vivax</li><li>↳ As in vivax</li><li>↳ Ring form, accole form, gametocytes</li><li>↳ Ring form, accole form, gametocytes</li><li>↳ Band forms</li><li>↳ Band forms</li><li>↳ Infected erythrocyte Enlarged pale with Schuffner's dots Pear-shaped, fimbriated, Schuffner's dots (Jame's dots) Normal size, Maurer's cleft Normal size, Ziemann's stippling</li><li>↳ Infected erythrocyte</li><li>↳ Infected erythrocyte</li><li>↳ Infected erythrocyte</li><li>↳ Enlarged pale with Schuffner's dots</li><li>↳ Enlarged pale with Schuffner's dots</li><li>↳ Pear-shaped, fimbriated, Schuffner's dots (Jame's dots)</li><li>↳ Pear-shaped, fimbriated, Schuffner's dots (Jame's dots)</li><li>↳ Normal size, Maurer's cleft</li><li>↳ Normal size, Maurer's cleft</li><li>↳ Normal size, Ziemann's stippling</li><li>↳ Normal size, Ziemann's stippling</li><li>↳ Gametocyte Spherical, fills the cell Similar to but smaller than vivax Crescent, Banana shaped Similar to but smaller than vivax</li><li>↳ Gametocyte</li><li>↳ Gametocyte</li><li>↳ Gametocyte</li><li>↳ Spherical, fills the cell</li><li>↳ Spherical, fills the cell</li><li>↳ Similar to but smaller than vivax</li><li>↳ Similar to but smaller than vivax</li><li>↳ Crescent, Banana shaped</li><li>↳ Crescent, Banana shaped</li><li>↳ Similar to but smaller than vivax</li><li>↳ Similar to but smaller than vivax</li><li>↳ Colour of pigment Yellowish-brown Yellowish-brown Black Dark brown</li><li>↳ Colour of pigment</li><li>↳ Colour of pigment</li><li>↳ Colour of pigment</li><li>↳ Yellowish-brown</li><li>↳ Yellowish-brown</li><li>↳ Yellowish-brown</li><li>↳ Yellowish-brown</li><li>↳ Black</li><li>↳ Black</li><li>↳ Dark brown</li><li>↳ Dark brown</li><li>↳ Prepatent period: The time from the entry of the parasite into the host until it is detectable in peripheral blood.</li><li>↳ Prepatent period:</li><li>↳ Incubation period: Time interval from the entry of the parasite until the appearance of the first clinical symptoms.</li><li>↳ Incubation period:</li><li>↳ Receptors on RBC:</li><li>↳ Receptors on RBC:</li><li>↳ Plasmodium vivax: Binds to Duffy antigen (also known as Duffy blood group antigen) on the surface of red blood cells (RBCs) Plasmodium falciparum: Binds to Basigin (also known as CD147) , a protein expressed on the surface of RBCs</li><li>↳ Plasmodium vivax: Binds to Duffy antigen (also known as Duffy blood group antigen) on the surface of red blood cells (RBCs)</li><li>↳ Plasmodium vivax:</li><li>↳ Plasmodium falciparum: Binds to Basigin (also known as CD147) , a protein expressed on the surface of RBCs</li><li>↳ Plasmodium falciparum:</li><li>↳ Basigin (also known as CD147)</li><li>↳ Options B, C, &amp; D are incorrect.</li><li>↳ Options B, C, &amp; D are incorrect.</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Properties</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>P.vivax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>P.ovale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>P.falciparum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>P.malariae</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Relapse (Hypnozoites)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Seen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Seen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not seen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not seen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Recrudescence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not seen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not seen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Seen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Seen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Preference</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Reticulocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Reticulocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Young erythrocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Old erythrocytes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Erythrocytic Cycle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>48 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>48 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>36–48 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>72 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prepatent Period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>8 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>9 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>5 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>13 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Incubation Period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>12- 17 days</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>14-17 days</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>12 days</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>28-30 days</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Stages found in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Trophozoite, schizonts, gametocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>As in vivax</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Ring form, accole form, gametocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Band forms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Infected erythrocyte</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Enlarged pale with Schuffner's dots</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pear-shaped, fimbriated, Schuffner's dots (Jame's dots)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Normal size, Maurer's cleft</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Normal size, Ziemann's stippling</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gametocyte</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Spherical, fills the cell</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Similar to but smaller than vivax</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Crescent, Banana shaped</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Similar to but smaller than vivax</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Colour of pigment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Yellowish-brown</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Yellowish-brown</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Black</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Dark brown</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55 year old man comes with complaints of fever and increasing fatigue for the past week. On examination, he is febrile at 40 degree C, hypotensive, and has tachycardia. The blood smear of this patient is given below. What is the causative agent?", "options": [{"label": "A", "text": "Plasmodium vivax", "correct": false}, {"label": "B", "text": "Plasmodium falciparum", "correct": true}, {"label": "C", "text": "Plasmodium ovale", "correct": false}, {"label": "D", "text": "Plasmodium malariae", "correct": false}], "correct_answer": "B. Plasmodium falciparum", "question_images": ["https://image.prepladder.com/content/mwJ3YualQIKG6UEemxCb1746710514.png"], "explanation_images": ["https://image.prepladder.com/content/0bnMQOF5VCESlXQ2cILC1746710597.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vivax </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Falciparum </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malariae </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ovale </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RBC size </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged with frayed margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pigments </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellowish brown</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dark brown</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schizont </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large (9-10 μm) Fills the RBC Contains 12-24 merozoite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not seen in the periphery</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small (6 μm), almost fills the RBC and contains 8 merozoites</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gametocytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spherical</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crescentic Larger than RBC</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spherical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ring <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5 μm</p>\n<p>Occupies ⅙ of RBC size</p>\n<p>It may be</p>\n<ul>\n<li>Multiple forms</li>\n<li>Accole (attached to RBC membrane)</li>\n<li>Double dot/headphone shaped with fragment nucleus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Band form</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In Plasmodium falciparum, only <span class=\"customMeta\" data-dictid=\"36514f2a4416927771881b27e74758\">gametocyte</span> and ring forms are demonstrated in the PBS, as later stages of the <span class=\"customMeta\" data-dictid=\"7d53fd92541692777187195e87ab70\">erythrocytic</span> cycle occur in deep vessels and not in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An unknown disease of suspected infectious origin has come up in your town. As a microbiologist, you collect the relevant samples and detect the etiological cause. Which of the following types of PCR would you do?", "options": [{"label": "A", "text": "Real time PCR", "correct": true}, {"label": "B", "text": "Nested PCR", "correct": false}, {"label": "C", "text": "Reverse transcriptase PCR", "correct": false}, {"label": "D", "text": "Multiplex", "correct": false}], "correct_answer": "A. Real time PCR", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A study was done to assess nutritional status among young children in rural and urban areas. 40 children in rural and 30 children in urban areas were malnourished. Which of the following tests of significance is the most appropriate in this case?", "options": [{"label": "A", "text": "Chi Square test", "correct": true}, {"label": "B", "text": "Paired T test", "correct": false}, {"label": "C", "text": "Standard error of the mean", "correct": false}, {"label": "D", "text": "ANOVA", "correct": false}], "correct_answer": "A. Chi Square test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/k3IQHpGhP2pkSdyIo3cU1746767743.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Parametric Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Paired Student's t-test <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Used to compare means (± SD) in paired data from the same group of individuals before and after an intervention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Unpaired Student's t-test</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Used to compare means (± SD) in two different groups of individuals. The<strong> Z-test is a <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> </strong>of the unpaired Student's t-test used when the sample size is &gt; 30.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>ANOVA <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Used to compare means (± SD) in more than two different groups of individuals.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Pearson correlation coefficient</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Measures the <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> association between two variables and can range from -1 (perfect negative correlation) to +1 (perfect positive correlation).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective method for graphically representing the fluctuations in disease occurrence within a specific geographical region?", "options": [{"label": "A", "text": "Line graph", "correct": true}, {"label": "B", "text": "Histogram", "correct": false}, {"label": "C", "text": "Ogive", "correct": false}, {"label": "D", "text": "Tree diagram", "correct": false}], "correct_answer": "A. Line graph", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/neblD38erMU5CdhNYvNi1746767994.png", "https://image.prepladder.com/content/pMnHUZMqPD9C6s5XWAxh1746768019.png", "https://image.prepladder.com/content/bxUKi4Ulbnq8KuMIprOB1746768059.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given logo below?", "options": [{"label": "A", "text": "AGMARK", "correct": false}, {"label": "B", "text": "Bureau of Indian standards", "correct": true}, {"label": "C", "text": "Food corporation of India", "correct": false}, {"label": "D", "text": "GST", "correct": false}], "correct_answer": "B. Bureau of Indian standards", "question_images": ["https://image.prepladder.com/content/JOYbiMlng6FpxyriYTHw1746768342.png"], "explanation_images": ["https://image.prepladder.com/content/njNIO7kRbSTCqmKAoVlL1746768469.png", "https://image.prepladder.com/content/qfLwr9X4BA6TObA4Prd91746768477.png", "https://image.prepladder.com/content/GUzahyqJ274xwUSybg6x1746768486.png", "https://image.prepladder.com/content/YtZnM4FwN3dgLp4rPFZd1746768500.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>LOGO</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>DESCRIPTION</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"508\" src=\"https://image.prepladder.com/content/njNIO7kRbSTCqmKAoVlL1746768469.png\" width=\"461\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p style=\"text-align:center\">(A)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Food Safety and Standards Authority of India (FSSAI)</strong></li>\n<li>Headquarters: New Delhi</li>\n<li>Ministry: <em>Health and Family Welfare</em></li>\n<li>Provides national food standards for products</li>\n<li>Adopts standards from CODEX ALIMENTARIUS by WHO and FAO (WHO Headquarters: Geneva; FAO Headquarters: Rome)</li>\n<li>Recently launched the Eat Right Campaign</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"346\" src=\"https://image.prepladder.com/content/qfLwr9X4BA6TObA4Prd91746768477.png\" width=\"417\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p style=\"text-align:center\">(B)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Bureau of Indian Standards</strong></li>\n<li>Ministry: <em>Ministry of Consumer affairs</em></li>\n<li>PFA (Prevention of Food Adulteration) provides the Minimum quality of food products.</li>\n<li>BIS provides quality above the minimum standards of food products.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"450\" src=\"https://image.prepladder.com/content/GUzahyqJ274xwUSybg6x1746768486.png\" width=\"461\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p style=\"text-align:center\">(C)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Fruit Product/Process Order.</strong></li>\n<li>The <em>Ministry of Food Processing Industries</em> has created an online system for licensing and monitoring all activities related to the enforcement and administration of FPO.</li>\n<li>Regulates the quality of tinned fruit juices and tinned fruit cans.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"413\" src=\"https://image.prepladder.com/content/YtZnM4FwN3dgLp4rPFZd1746768500.png\" width=\"461\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\">(D)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>This is administered by the Directorate of Marketing and Inspection (DMI) under the <em>Ministry of Agriculture and Farmers Welfare </em>for agricultural products.</li>\n<li><strong>AGMARK </strong>is a certification mark indicating that agricultural produce meets a <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> standard specified by DMI</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which type of variables is the following data representation used?", "options": [{"label": "A", "text": "Nominal", "correct": false}, {"label": "B", "text": "Discrete", "correct": false}, {"label": "C", "text": "Continuous", "correct": true}, {"label": "D", "text": "All the above", "correct": false}], "correct_answer": "C. Continuous", "question_images": ["https://image.prepladder.com/content/8B4iyU3F9RdzD63rTksA1746768764.png"], "explanation_images": ["https://image.prepladder.com/content/eFPPGeZqhijYQgrFgYnX1746768815.png", "https://image.prepladder.com/content/rpsEsB07WmMatVBsPFcm1746768843.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A healthy person got in contact with an infected case, and they have to separate him as he is sick now. This is:", "options": [{"label": "A", "text": "Absolute quarantine", "correct": false}, {"label": "B", "text": "Isolation", "correct": true}, {"label": "C", "text": "Interruption of transmission", "correct": false}, {"label": "D", "text": "Serial interval", "correct": false}], "correct_answer": "B. Isolation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Isolation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Quarantine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For people who are sick</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For well people who may have been exposed to a <span class=\"customMeta\" data-dictid=\"6f6ef8bf7c1692777184dfdf8cf45d\">communicable</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Separates people who are sick from those who are not sick</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Applies to people who may or may not become sick</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Restricts movement of people with an <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> disease to stop the spread of the Illness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Restricts the movement of healthy people who may develop a disease after possible exposure to an <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> agent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allows for appropriate treatment in a hospital type/setting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires people to stay in a designated location, e.g. their home. For a specified period of time</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires appropriate personal protective equipment (ppe) for those coming into contact with the person who is sick</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires active monitoring including taking temperature twice daily and checking for other symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires proper infection control, <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> and waste management</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PPE not required for contact with people who are not ill</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A researcher who was studying on plasmodium species decided to visit the malaria-endemic place in Odisha after 2 days to do his clinical study for 5 weeks. Which of the following drugs need to be taken as prophylaxis before visiting the malaria-endemic place?", "options": [{"label": "A", "text": "Artesunate", "correct": false}, {"label": "B", "text": "Mefloquine", "correct": false}, {"label": "C", "text": "Doxycycline", "correct": true}, {"label": "D", "text": "Chloramphenicol", "correct": false}], "correct_answer": "C. Doxycycline", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Short-term prophylaxis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Long-term prophylaxis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duration of Rx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 6 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 6 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DOC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Doxycycline 100 mg daily <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mefloquine 250 mg weekly <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prophylaxis period</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Before travel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-2 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2-3 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>After travel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 weeks</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old primigravida presents with painful vaginal bleeding in the first trimester. On USG, a well-formed gestation ring with central echoes from the embryo indicates a healthy fetus, and there is observation of fetal cardiac motion. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Inevitable abortion", "correct": false}, {"label": "B", "text": "Threatened abortion", "correct": true}, {"label": "C", "text": "Incomplete abortion", "correct": false}, {"label": "D", "text": "Complete abortion", "correct": false}], "correct_answer": "B. Threatened abortion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Threatened</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Inevitable</strong></p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Incomplete</strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complete</strong></p>\n<p style=\"text-align: center;\"><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Missed</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vaginal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in &lt; 20 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vaginal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> or <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> in &lt; 20 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Expulsion of some products of conception</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cervix closed after conception product expulsion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cervical OS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>USG Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> pregnancy with <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heartbeat</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilated <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> with <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> low in the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> or <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> canal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Empty <span class=\"customMeta\" data-dictid=\"9d49967fdb1692777188c0acbd701a\">gestational sac</span> or retained products of conception</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Empty <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> with no retained products of conception</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absence of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"bf4c28aebb1692777188074f2facbb\">heartbeat</span> and/or absent growth of gestational sac</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rest, monitor <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> viability</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prepare for inevitable expulsion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evacuation of retained products of conception</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Observation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> or expectant management</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 30-year-old woman who previously had dilatation and curettage, and now presents with amenorrhea, a negative urine pregnancy test, and a honeycomb appearance in the uterine cavity on HSG?", "options": [{"label": "A", "text": "Asherman syndrome", "correct": true}, {"label": "B", "text": "Kallman syndrome", "correct": false}, {"label": "C", "text": "Sheehan syndrome", "correct": false}, {"label": "D", "text": "Stein-Leventhal syndrome", "correct": false}], "correct_answer": "A. Asherman syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the quickest method for laboratory diagnosis of pulmonary tuberculosis?", "options": [{"label": "A", "text": "CB-NAAT", "correct": true}, {"label": "B", "text": "Sputum microscopy", "correct": false}, {"label": "C", "text": "Sputum culture", "correct": false}, {"label": "D", "text": "Radiometric BACTEC method", "correct": false}], "correct_answer": "A. CB-NAAT", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Modality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Usage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sputum Smear Microscopy (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Microscopic examination of <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> samples to detect <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used for initial screening and diagnosis, especially in resource-limited settings.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imaging done to identify abnormalities suggestive of TB.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used to support diagnosis when clinical suspicion is high; not <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> for TB diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TruNAAT/CBNAAT (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Molecular tests that detect Mycobacterial DNA and <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recommended for initial diagnosis due to high sensitivity and specificity; rapid results.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Line Probe Assay (LPA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Molecular test to detect specific genetic mutations associated with <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> (e.g., rifampicin, isoniazid).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used for detecting <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> in confirmed TB cases, not for initial diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tuberculin Skin Test (TST)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A skin test to measure <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> to <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> <span class=\"customMeta\" data-dictid=\"0fe92012341692777201bab3db39b1\">tuberculin</span> protein.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primarily used for screening <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> TB infection; not specific for active TB diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Interferon-Gamma Release Assays (IGRAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood <span class=\"customMeta\" data-dictid=\"0ac01cc0c31692777185cae5f28175\">cytokine</span> analysis test that measures <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> to TB antigens.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used for detecting <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> TB infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sputum Culture (Option C ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Growing Mycobacteria from <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> samples to confirm TB and test for drug susceptibility.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gold standard for TB diagnosis; takes several weeks to obtain results.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">Susceptibility</span> Testing (DST)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Testing TB bacteria from patient samples to determine resistance to TB drugs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used to guide treatment by identifying <span class=\"customMeta\" data-dictid=\"d4c88fcae71692777186aa1c32423a\">drug-resistant</span> strains in confirmed TB cases.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old woman comes for emergency contraception within 8 hours after engaging in sexual intercourse. She expresses a preference for a single pill rather than multiple pills. What would be your recommendation in this situation?", "options": [{"label": "A", "text": "Levonorgestrel 0.75 mg", "correct": false}, {"label": "B", "text": "Ethinyl estradiol + levonorgestrel", "correct": false}, {"label": "C", "text": "Levonorgestrel 1.5 mg", "correct": true}, {"label": "D", "text": "Desogestrel 3 mg", "correct": false}], "correct_answer": "C. Levonorgestrel 1.5 mg", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug(s)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dosage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Schedule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Time Period for Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pills</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Levonorgestrel</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5 mg (single dose)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 dose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 72 hours after unprotected sex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Combination Pills (Yuzpe Regimen)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Levonorgestrel + <span class=\"customMeta\" data-dictid=\"e4bcd9fe2c1692777187df0dbb0ddc\">Ethinyl</span> estradiol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Levonorgestrel 0.75 mg + <span class=\"customMeta\" data-dictid=\"e4bcd9fe2c1692777187df0dbb0ddc\">Ethinyl</span> <span class=\"customMeta\" data-dictid=\"d8cc09346f16927771878d48ba1ce8\">estradiol</span> 0.1 mg per tablet</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 doses, 12 hours apart</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 72 hours after unprotected sex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Levonorgestrel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Levonorgestrel</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.75 mg per <span class=\"customMeta\" data-dictid=\"508e14a7ca16927772002140ece8fb\">tablet</span> (take 2 tablets)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 dose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 72 hours after unprotected sex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulipristal Acetate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulipristal acetate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30 mg (single dose)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 dose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 120 hours (5 days) after unprotected sex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Copper IUD (Best)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copper IUD</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N/A (inserted by healthcare provider)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insertion by a healthcare provider</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 5 days after unprotected sex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mifepristone (Less Common)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mifepristone (in combination with misoprostol)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>200 mg (single dose)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 dose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 72 hours after unprotected sex</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following food items contains the lowest amount of iron?", "options": [{"label": "A", "text": "Liver", "correct": false}, {"label": "B", "text": "Spinach", "correct": false}, {"label": "C", "text": "Beans", "correct": false}, {"label": "D", "text": "Milk", "correct": true}], "correct_answer": "D. Milk", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a middle-aged woman who complains of dysmenorrhea, dyspareunia, and infertility, and exhibits a retroverted uterus that is fixed, tender, and accompanied by tender nodularity of the uterosacral ligaments?", "options": [{"label": "A", "text": "PID", "correct": false}, {"label": "B", "text": "Endometriosis", "correct": true}, {"label": "C", "text": "Pelvic TB", "correct": false}, {"label": "D", "text": "Leiomyoma", "correct": false}], "correct_answer": "B. Endometriosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/39HiX6dQdPZArxX2GHzi1746770096.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fertility-related</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Infertility</strong></li>\n<li>Increased risk of <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain-related</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain</strong></li>\n<li><strong>Dysmenorrhea</strong></li>\n<li><strong>Dyspareunia</strong></li>\n<li>Dyschezia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Organ-specific</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrointestinal:</strong></p>\n<ul>\n<li>Bowel obstruction</li>\n<li>Rectal bleeding</li>\n</ul>\n<p><strong>Ovarian:</strong></p>\n<ul>\n<li>Endometriomas</li>\n<li>Ovarian torsion</li>\n<li>Rupture of chocolate cyst</li>\n</ul>\n<p><strong>Urinary:</strong></p>\n<ul>\n<li>Ureteral obstruction</li>\n<li>Hydronephrosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structural</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Adhesions</strong></li>\n<li>Frozen pelvis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended duration for quarantine for the 30 individuals who had contact with a 28-year-old male who is tested positive for SARS-COV-2, but are currently asymptomatic?", "options": [{"label": "A", "text": "Minimum incubation period", "correct": false}, {"label": "B", "text": "Maximum incubation period", "correct": true}, {"label": "C", "text": "Period of communicability", "correct": false}, {"label": "D", "text": "Median incubation period", "correct": false}], "correct_answer": "B. Maximum incubation period", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely cause of the irregular periods in a 20-year-old female, based on the ultrasound scan findings shown in the image?", "options": [{"label": "A", "text": "PCOD", "correct": true}, {"label": "B", "text": "Obesity", "correct": false}, {"label": "C", "text": "Hirsutism", "correct": false}, {"label": "D", "text": "Turner’s syndrome", "correct": false}], "correct_answer": "A. PCOD", "question_images": ["https://image.prepladder.com/content/eZk2YL8NdlAxUwC9F2Yo1746770224.png"], "explanation_images": ["https://image.prepladder.com/content/XVS6EFml7njCiCQIZd9X1746770416.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As a medical officer posted in rural service, you have been asked to supervise the various preventive measures being taken in your region against malaria. According to the program whose logo is shown below, you would be correct to advise all of the following except:", "options": [{"label": "A", "text": "Two rounds of spraying with DDT should be done to provide protection during the entire transmission season.", "correct": false}, {"label": "B", "text": "Long lasting insecticide nest (LLIN) should be provided in areas with annual parasite Index 25.", "correct": false}, {"label": "C", "text": "Indoor residual sprays are not suitable for vector control in rural areas.", "correct": true}, {"label": "D", "text": "In case of DDT resistance, 3 rounds of spraying with Malathion should be done to provide protection during the entire transmission season.", "correct": false}], "correct_answer": "C. Indoor residual sprays are not suitable for vector control in rural areas.", "question_images": ["https://image.prepladder.com/content/wRyH9gptvH6tbVHLVy7n1746770370.png"], "explanation_images": ["https://image.prepladder.com/content/7aJLQ2ND8BYYifnJZAe91746770635.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vector</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Anopheles</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malaria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Aedes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dengue &amp; chikungunya</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Culex</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Japanese encephalitis: Culex quinquefasciatus/ Culex fatigans</li>\n<li>Filariasis: Culex tritaeniorhynchus, Culex vishnui</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Sandfly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Kala-azar</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please determine the study design based on the following information:", "options": [{"label": "A", "text": "Prospective cohort study", "correct": false}, {"label": "B", "text": "Retrospective cohort study", "correct": false}, {"label": "C", "text": "Case control study", "correct": true}, {"label": "D", "text": "Nested case control study", "correct": false}], "correct_answer": "C. Case control study", "question_images": ["https://image.prepladder.com/notes/1n4QprikxGSk24jpnmqI1747988580.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the duration after which the polymorphic rash of Varicella is no longer contagious?", "options": [{"label": "A", "text": "4 days after appearance of lesions", "correct": false}, {"label": "B", "text": "7 days after appearance of lesions", "correct": false}, {"label": "C", "text": "14 days after appearance of lesions", "correct": false}, {"label": "D", "text": "After crust formation over lesions", "correct": true}], "correct_answer": "D. After crust formation over lesions", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Agent</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Varicella-zoster virus (HHV 3- Human Herpes Virus 3)</li>\n<li>Double-stranded DNA virus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Source of infection</strong><br/>\n\t\t\t </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Scabs are not infectious, but the <span class=\"customMeta\" data-dictid=\"4b0fee14c816927772016e67cf3a13\">vesicular</span> fluid is infectious.<strong> (Option D)</strong></li>\n<li>Airborne- spreads via both <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> infection and <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> nuclei</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Period of communicability</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>1-2 days before and 4-5 days after the onset of the <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> (crust formation)</li>\n<li>Secondary attack rate- 85%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Host factors</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age: &lt;10 years</li>\n<li>Very common in school-going children</li>\n<li>One attack gives lifelong immunity</li>\n<li>Reactivation can occur as <span class=\"customMeta\" data-dictid=\"cf329b8cef169277720107b1efa15b\">Varicella</span> <span class=\"customMeta\" data-dictid=\"03350c16f71692777202dbca70976e\">zoster</span> infection in later age</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Environmental factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>More common in winter and early spring</li>\n<li>The virus can survive outside the body for 24-48 hours.</li>\n<li>Disinfectants easily kill the virus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>More common in winter and early spring</li>\n<li>The virus can survive outside the body for 24-48 hours.</li>\n<li>Disinfectants easily kill the virus.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A researcher is studying the difference in the incidence of asthma in children who are exposed to second-hand smoke and those who are not. If he wishes to express the additional incidence of asthma in the exposed children as a percentage, which of the following should he use?", "options": [{"label": "A", "text": "Attributable risk", "correct": false}, {"label": "B", "text": "Relative risk", "correct": false}, {"label": "C", "text": "Population attributable risk", "correct": true}, {"label": "D", "text": "Odds ratio", "correct": false}], "correct_answer": "C. Population attributable risk", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Measure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Calculation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Attributable Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proportion of disease <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> attributable to a specific exposure or risk factor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk in exposed group - Risk in unexposed group</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Relative Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk of a particular outcome in the exposed group compared to the unexposed group</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk in exposed group/Risk in unexposed group</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Population Attributable Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proportion of disease cases in a population attributable to a specific exposure or risk factor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(Prevalence of exposure) x (Relative risk-1)/(1+ (Prevalence of exposure) x (Relative risk - 1))</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Odds Ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Strength of association between exposure and outcome in case-control or <span class=\"customMeta\" data-dictid=\"7b9b60f7e016927771978a4311da4f\">retrospective</span> studies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(Exposure odds in cases/Non-exposure odds in cases) / (Exposure odds in controls/Non- exposure odds in controls)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The USG given below is seen in:", "options": [{"label": "A", "text": "Ectopic pregnancy", "correct": false}, {"label": "B", "text": "Ovarian pregnancy", "correct": false}, {"label": "C", "text": "Anencephaly", "correct": false}, {"label": "D", "text": "Hydatidiform mole", "correct": true}], "correct_answer": "D. Hydatidiform mole", "question_images": ["https://image.prepladder.com/content/SrOX9ata9fZdtS5kJnSo1746771267.png"], "explanation_images": ["https://image.prepladder.com/content/fkZyJcVJnAVTWMqyaftr1746771371.png", "https://image.prepladder.com/notes/SXb1SoqhE5gZnDhOOxL61747984505.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Molar Pregnancy (Benign)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gestational Trophoblastic Neoplasia (Malignant)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Partial Mole</li>\n<li>Complete Mole</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Invasive Mole</li>\n<li>Choriocarcinoma</li>\n<li>Placental Site Trophoblastic Tumor (PSTT)</li>\n<li>Epithelial Trophoblastic Tumor (ETT)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complete Mole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Partial Mole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Karyotype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>46 XX or 46 XY</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>69 XYY or 69 XXY (triploid)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Molar pregnancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Missed abortion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All paternal (empty egg + <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> duplication)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 paternal sets + 1 <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> set</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fetal Tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be present but abnormal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>β-hCG Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extremely high (&gt;1,00,000 mIU/mL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated, but lower than complete mole</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of Persistent GTD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-20%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of Choriocarcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-3%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-4%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Theca Lutein Cysts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common (25-30% of cases)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uterus Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Larger than expected for gestational age</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smaller than expected for gestational age</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaginal Bleeding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common (80-90%), dark and intermittent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less prominent, often associated with missed abortion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperemesis Gravidarum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common due to high hCG levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperthyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible due to hCG/TSH similarity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Products of Conception</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete molar tissue (grape-like vesicles)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less advanced <span class=\"customMeta\" data-dictid=\"7c7412c552169277718978073c8c85\">hydatidiform</span> changes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Villous Edema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse, widespread</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trophoblastic Proliferation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marked <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> trophoblastic hyperplasia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Focal to mild</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trophoblast Atypia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prominent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>p57KIP2 Immunostaining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely cause of hepatocellular carcinoma in a factory worker employed in a groundnut factory who does not consume alcohol and has had a prolonged duration of employment?", "options": [{"label": "A", "text": "Beta oxalyl amino alanine", "correct": false}, {"label": "B", "text": "Smoke from factory", "correct": false}, {"label": "C", "text": "Sanguinarine", "correct": false}, {"label": "D", "text": "Aflatoxins", "correct": true}], "correct_answer": "D. Aflatoxins", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Features of <span class=\"customMeta\" data-dictid=\"cbc7c810ce1692777188e6eaf3eba2\">hepatotoxicity</span> (jaundice, hepatomegaly)</li>\n<li>Hepatocellular carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infestation of <strong>Aspergillus flavus</strong> and <strong>Aspergillus parasiticus </strong>over stored rice, wheat, and corn</li>\n<li>Produce mycotoxins: <span class=\"customMeta\" data-dictid=\"4435e6aa0e1692777180e2f819ad80\">aflatoxin</span> B1 &amp; G1 (both are <span class=\"customMeta\" data-dictid=\"aad52f4a541692777188bfd2c5830b\">hepatotoxic</span> &amp; carcinogenic)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Storage temperature of 11 to 37 degree Celsius</li>\n<li>Moisture content &gt;16%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Educating people</li>\n<li>Moisture content &lt;10% during storage</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What observation can be made from this hysterosalpingogram?", "options": [{"label": "A", "text": "Bilateral hydrosalpinx", "correct": true}, {"label": "B", "text": "Extravasation into the venous system", "correct": false}, {"label": "C", "text": "Normal HSG", "correct": false}, {"label": "D", "text": "Bilateral cornual block", "correct": false}], "correct_answer": "A. Bilateral hydrosalpinx", "question_images": ["https://image.prepladder.com/content/pHFm01i0mLmpBRUAfLwZ1746771523.png"], "explanation_images": ["https://image.prepladder.com/notes/qJ3OVGWNZUhuSxvNQ8SS1747984589.png", "https://image.prepladder.com/notes/PUnhBWTDXPg3pDzErrDe1747984659.png", "https://image.prepladder.com/notes/wTUPiQdDDSqcV7iTLbal1747984709.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preparation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>NSAID 30 minutes before to prevent <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">tubal</span> spasm.</li>\n<li><strong>Paracervical block</strong> in patients with <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> stenosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4 phases of radiographic images taken</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pre-contrast preliminary.</li>\n<li>During contrast filling.</li>\n<li>Contrast spillage into peritoneum.</li>\n<li>During deflation and withdrawal.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> infections.</li>\n<li>Active <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> bleeding.</li>\n<li>Allergic to iodine.</li>\n<li>Pregnancy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Doxycycline can be given</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>If dilated tubes are identified (indicating previous <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> infection).</li>\n<li>As <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> to prevent infections post-HSG.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pelvic discomfort.</li>\n<li>Uterine perforation.</li>\n<li>Vasovagal reactions.</li>\n<li>Dye allergy.</li>\n<li>Intravascular dissemination of the dye.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of gestation is observed in the sonographic evaluation of a 26-year-old woman who has reported amenorrhea for 12 weeks, as shown in the image provided?", "options": [{"label": "A", "text": "Monochorionic diamniotic", "correct": false}, {"label": "B", "text": "Dichorionic diamniotic", "correct": true}, {"label": "C", "text": "Monochorionic monoamniotic", "correct": false}, {"label": "D", "text": "Conjoined twins", "correct": false}], "correct_answer": "B. Dichorionic diamniotic", "question_images": ["https://image.prepladder.com/notes/bmBdFcL38UBREYNKKspz1747984783.png"], "explanation_images": ["https://image.prepladder.com/content/i89OeQIBGhFwc3jHOby61746771832.png", "https://image.prepladder.com/content/ESNODb00dg57TMxJk04m1746771849.png", "https://image.prepladder.com/notes/YFClf1hgiaBMjh0Zs58j1747984839.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Timing of Cleavage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Placenta &amp; <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">Membrane</span> Status</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 72 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dichorionic-Diamniotic twins each have their own separate placenta/chorion and <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> sac.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Days 4–7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monochorionic-Diamniotic twins share one <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> (chorion) but have separate <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> sacs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Days 8–12</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monochorionic-Monoamniotic twins share both the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> and the <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> sac.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day &gt; 13</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conjoined (Siamese) are physically connected and may share organs or tissues, resulting from a very late and incomplete split.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Komal, a 2-year-old girl is brought to the clinic with a high fever, cough, red eyes, and rash. Parents say that the rash started on the forehead and behind the ears, then subsequently spread to the neck and body. On examination, a confluent maculopapular rash is noted as shown below. Which of the following is false regarding this child's condition?", "options": [{"label": "A", "text": "The period of infectivity is 3 days before and 5 days after the appearance of rash", "correct": false}, {"label": "B", "text": "The most common cause of death is subacute sclerosing panencephalitis", "correct": true}, {"label": "C", "text": "Warthin-Finkeldey giant cells are associated with the disease", "correct": false}, {"label": "D", "text": "Koplik spots are pathognomonic", "correct": false}], "correct_answer": "B. The most common cause of death is subacute sclerosing panencephalitis", "question_images": ["https://image.prepladder.com/content/6BKtIi2C1m3RDkkc9mv81746771773.png"], "explanation_images": ["https://image.prepladder.com/content/2JSOmGWS5t5su8JEacnS1746771881.png", "https://image.prepladder.com/content/CVFh2OnLDSAUTnPqFBIR1746771871.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Measles</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>ssRNA paramyxovirus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>10 days from exposure to onset of fever and 14 days to the appearance of rash</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Source of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Person with measles</li>\n<li>Infective material</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Period of communicability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Roughly 4 days before and 4 days after the appearance of <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prodromal stage</strong>:</p>\n<ul>\n<li>Fever</li>\n<li>Cough</li>\n<li>Coryza with sneezing</li>\n<li>Conjunctivitis with lacrimation</li>\n<li><strong>Koplik’s spots-</strong><em> </em><strong>grayish-white spots on the <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">buccal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (Pathognomonic feature) (Option D ruled out)</strong></li>\n</ul>\n<p> </p>\n<p><strong>Eruptive stage</strong>:</p>\n<ul>\n<li>Dusky red macular/maculopapular rash, which<strong> starts behind the ears</strong> and progresses to the face, neck and then to trunks and limbs.</li>\n<li>In the absence of complications, the lesions and fever disappear after 3-4 days.</li>\n</ul>\n<p> </p>\n<p><strong>Post <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> stage:</strong></p>\n<ul>\n<li>After the <span class=\"customMeta\" data-dictid=\"8d4614c31316927771874f34d090a9\">eruptive</span> stage, it leads to weight loss, weakness, fatigue, diarrhea.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Isolation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>7 days from the onset of rash</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Difference between <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> and <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Both rashes are maculopapular</li>\n<li>The <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> is <strong>more <span class=\"customMeta\" data-dictid=\"8793eea96e169277718446e2ea701a\">confluent</span> </strong>and botchy, whereas the <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> is <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> or non-confluent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinically diagnosed based on <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> and koplik’s spots</li>\n<li>Gold standard: <strong>PCR</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>No specific treatment</li>\n<li>Symptomatic management only</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:1px solid #333438; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complications of Measles</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Otitis Media </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p>M/c <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> in young children. Covered under <strong>IMNCI programme.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Subacute <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">Sclerosing</span> <span class=\"customMeta\" data-dictid=\"871ad2a8051692777194a3f7cd0309\">Panencephalitis</span> (SSPE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p>A rare, fatal brain disease that occurs years after <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> infection, causing neurological damage and mortality.<strong> </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Pneumonia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p>Most common fatal <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> &amp; cause of death.<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Persistent Diarrhea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p>Long-lasting diarrhea, potentially leading to <strong>protein-losing enteropathy</strong>.</p>\n<p>Prevalent in developing countries, impacting infants significantly.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Keratomalacia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p>Measles causes <strong>acute vitamin A <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> </strong>in children.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Giant Cell Pneumonia, <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">Measles</span> Inclusion-body Encephalitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p>Primarily affects <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> individuals.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Other complications: </strong>Laryngotracheobronchitis (Croup), Encephalitis, Spontaneous abortion, Premature delivery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the obstetric grip being depicted in the image?", "options": [{"label": "A", "text": "Fourth Leopold manoeuvre", "correct": true}, {"label": "B", "text": "Hudson’s grip", "correct": false}, {"label": "C", "text": "Fundal grip", "correct": false}, {"label": "D", "text": "Umbilical grip", "correct": false}], "correct_answer": "A. Fourth Leopold manoeuvre", "question_images": ["https://image.prepladder.com/notes/WkWXAwW925QcakqxwA0N1747987912.png"], "explanation_images": ["https://image.prepladder.com/content/xyHEACRJPI4UIr4dLQPM1746772076.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Maneuver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Purpose</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fundal Grip</strong></p>\n<p><strong>(First Leopold)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facing the patient’s face</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palpate the <span class=\"customMeta\" data-dictid=\"651c76a8c91692777203be09fa3dd6\">fundal</span> area with both hands</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To determine which <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> pole is in the fundus:</p>\n<ul>\n<li>Broad, soft, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> mass: Breech</li>\n<li>Smooth, hard, <span class=\"customMeta\" data-dictid=\"7fb01b5ad51692777188c3cb1733f9\">globular</span> mass: Head</li>\n<li>Transverse lie: Neither pole palpable</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral or Umbilical Grip</strong></p>\n<p><strong>(Second Leopold)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facing the patient’s face</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Place hands flat on either side of the umbilicus, <span class=\"customMeta\" data-dictid=\"5aabcb1ee8169277719447f2dd6c2c\">palpate</span> one side at a time</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To identify the position of the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> back, limbs, and <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> shoulder:</p>\n<ul>\n<li>Back: Smooth, curved, resistant</li>\n<li>Limb side: Comparatively empty with small, knob-like parts</li>\n<li>Anterior shoulder: Prominent in the lower part of the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> above the head</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pawlik’s Grip</strong></p>\n<p><strong>(Third Leopold)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facing the patient’s face</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Place thumb and four fingers over the lower pole of the uterus, <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> border on the upper <span class=\"customMeta\" data-dictid=\"48b6a0a5fb1692777199da12372b14\">symphysis</span> pubis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To grasp the presenting part if not engaged and test its mobility:</p>\n<p>Transverse lie: Pawlik’s grip is empty</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pelvic Grip</strong></p>\n<p><strong>(Fourth Leopold)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facing the patient’s feet</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Place four fingers of both hands on either side of the midline in the lower pole of the uterus, pressing downward and backward</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>To identify the part in the lower pole, its attitude, and engagement:</li>\n</ul>\n<p><strong>Head Characteristics:</strong></p>\n<ol>\n<li>Precise presenting area</li>\n<li>Attitude (position of <span class=\"customMeta\" data-dictid=\"5716872c671692777198a3cc032718\">sinciput</span> and occiput)</li>\n<li>Engagement (noted by the presence/absence of <span class=\"customMeta\" data-dictid=\"5716872c671692777198a3cc032718\">sinciput</span> and occiput, convergence/divergence of finger tips)</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the anteroposterior diameters of the pelvic inlet, the true conjugate is?", "options": [{"label": "A", "text": "The distance from the midpoint of the sacral promontory to the uppermost margin of the symphysis pubis", "correct": true}, {"label": "B", "text": "The shortest distance between the sacral promontory and the symphysis pubis", "correct": false}, {"label": "C", "text": "The distance from the lowest margin of the symphysis to the sacral promontory", "correct": false}, {"label": "D", "text": "The distance from the posterior margin of the sacral promontory to the symphysis pubis", "correct": false}], "correct_answer": "A. The distance from the midpoint of the sacral promontory to the uppermost margin of the symphysis pubis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rxqNHbk41dCNFxxo3c3R1746772283.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>True <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">Conjugate</span> (Conjugata Vera)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The shortest distance between the sacral <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> and the superior margin of the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Determines <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"42380fc2fb169277719066eff35739\">inlet</span> <span class=\"customMeta\" data-dictid=\"fc82a39c2a16927771807cea91e4a6\">adequacy</span> for <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> delivery; &lt;9.5 cm suggests possible <span class=\"customMeta\" data-dictid=\"6de56c3bcf1692777184daa7eb9660\">cephalopelvic</span> <span class=\"customMeta\" data-dictid=\"f7ebe196ca1692777186158cd2b01c\">disproportion</span> (CPD).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagonal Conjugate</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The distance between the sacral <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> and the lower margin of the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis, measured via the <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> exam.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Estimates true conjugate; &lt;12 cm may indicate a narrow <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> inlet.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obstetric <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">Conjugate</span> </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The shortest distance between the sacral <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> surface of the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> <span class=\"customMeta\" data-dictid=\"fc82a39c2a16927771807cea91e4a6\">adequacy</span> for <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head passage; inadequate may lead to obstructed labor.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Within what time frame should Cholera, a disease that requires notification, be reported to the World Health Organization?", "options": [{"label": "A", "text": "72 hours", "correct": false}, {"label": "B", "text": "24 hours", "correct": true}, {"label": "C", "text": "12 hours", "correct": false}, {"label": "D", "text": "2 days", "correct": false}], "correct_answer": "B. 24 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primigravida presents with labor pain, and on per vaginal examination, her cervix is 7 cm dilated and fully effaced. What stage of labor is she in?", "options": [{"label": "A", "text": "Acceleration phase", "correct": true}, {"label": "B", "text": "Latent phase", "correct": false}, {"label": "C", "text": "Deceleration phase", "correct": false}, {"label": "D", "text": "The phase of maximum slope", "correct": false}], "correct_answer": "A. Acceleration phase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contractions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Onset of labor to full <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> (10 cm).</p>\n<ul>\n<li><strong>Latent Phase: </strong>Early <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> changes with slower progress.</li>\n<li><strong>Active Phase: </strong>Faster <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> (≥5 cm) with regular contractions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cervical <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> and <span class=\"customMeta\" data-dictid=\"dc0035cd191692777187b9b8b2af69\">effacement</span> occur.</li>\n<li>Intermittent painful <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions.</li>\n<li>\"Show\" (blood-stained mucus) is common.</li>\n<li>Active labor starts at <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> ≥5 cm with regular contractions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Latent Phase: </strong>Irregular and mild.</p>\n<p><strong>Active Phase:</strong> Regular; 3–5 min apart, lasting ~45 seconds.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Second Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>From complete <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> (10 cm) to <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> delivery.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Begins after complete <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> dilation.</li>\n<li>Ends with the delivery of the baby.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strong and frequent; 2–3 minutes apart.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Third Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>From <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> delivery to <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> expulsion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Placental separation and expulsion occur.</li>\n<li>Average duration: 5–15 minutes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions to aid <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> expulsion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fourth Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Observation for at least 1 hour after <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> expulsion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Monitoring for <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> and <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contraction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uterine contractions continue, aiding hemostasis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the genetic disorder mentioned in the text.", "options": [{"label": "A", "text": "Testicular feminizing syndrome", "correct": false}, {"label": "B", "text": "Kallmann syndrome", "correct": false}, {"label": "C", "text": "Turner’s syndrome", "correct": true}, {"label": "D", "text": "Klinefelter syndrome", "correct": false}], "correct_answer": "C. Turner’s syndrome", "question_images": ["https://image.prepladder.com/content/qzOYa4JSpqHpvNdpklPv1746773889.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most reliant part of a female body among the following choices?", "options": [{"label": "A", "text": "Rectouterine pouch", "correct": true}, {"label": "B", "text": "Ovarian fossa", "correct": false}, {"label": "C", "text": "Posterior fornix", "correct": false}, {"label": "D", "text": "Vesicouterine pouch", "correct": false}], "correct_answer": "A. Rectouterine pouch", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of a patient scheduled for dilatation and curettage, if a Sim's sound is inserted into the uterus but no resistance is felt, what is the next step in management according to the available options?", "options": [{"label": "A", "text": "Continue the procedure", "correct": false}, {"label": "B", "text": "Do planned evacuation", "correct": false}, {"label": "C", "text": "Immediate laparoscopy", "correct": true}, {"label": "D", "text": "Mifepristone and Misoprostol", "correct": false}], "correct_answer": "C. Immediate laparoscopy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old female patient visits the outpatient department (OPD) with a case of primary absence of menstrual periods and recurring pain. During the examination of the perineal area, a visible protrusion is observed from the vagina. Please identify the underlying cause for this particular presentation.", "options": [{"label": "A", "text": "Transverse septum in the proximal vagina", "correct": false}, {"label": "B", "text": "Complete vaginal atresia", "correct": false}, {"label": "C", "text": "Imperforate hymen", "correct": true}, {"label": "D", "text": "Cervical agenesis", "correct": false}], "correct_answer": "C. Imperforate hymen", "question_images": ["https://image.prepladder.com/content/UWciib59rn4OWKXektsq1746774283.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Obstruction of <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> blood outflow due to <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> malformations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Imperforate hymen, <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> septum, <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> agenesis, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> stenosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Symptoms/</strong></p>\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Primary amenorrhea, <span class=\"customMeta\" data-dictid=\"1d84248e9f16927771850f8b75c26a\">cyclic</span> <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> mass, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention, endometriosis, <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Bulging hymen, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> mass, possible <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> on <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> examination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Pelvic <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> (shows collection of blood), MRI (detailed anatomy), examination under anesthesia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Surgical intervention to remove the <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (hymenectomy, <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of septum)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy weighing 30 kg has been posted for surgical resection of a tumor. What is the daily maintenance fluid required for this child while he's NPO?", "options": [{"label": "A", "text": "1000 mL", "correct": false}, {"label": "B", "text": "1700 mL", "correct": true}, {"label": "C", "text": "2500 mL", "correct": false}, {"label": "D", "text": "3000 mL", "correct": false}], "correct_answer": "B. 1700 mL", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- 1700 mL</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Body weight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Maintenance fluid (mL/kg/day)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;10 kg</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100 mL/kg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10-20 kg</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1000 + 50 for each kg in <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> of 10kg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;20 kg</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1500 + 20 for each kg in <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> of 20kg</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with an IQ of 55 comes under:", "options": [{"label": "A", "text": "Mild intellectual disability", "correct": true}, {"label": "B", "text": "Moderate intellectual disability", "correct": false}, {"label": "C", "text": "Severe intellectual disability", "correct": false}, {"label": "D", "text": "Profound intellectual disability", "correct": false}], "correct_answer": "A. Mild intellectual disability", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Mild intellectual disability</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IQ level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IQ range</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Mild intellectual disability</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">51-70</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Moderate intellectual disability</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">36-50</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Severe intellectual disability</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">21-35</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Profound intellectual disability</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0-20</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with continuing seizures for the past 30 minutes. The relatives say that there had been no seizure-free intervals in the past 30 minutes. After stabilizing the vitals, what is the first drug that should be administered?", "options": [{"label": "A", "text": "Diazepam", "correct": true}, {"label": "B", "text": "Phenytoin", "correct": false}, {"label": "C", "text": "Phenobarbital", "correct": false}, {"label": "D", "text": "Thiopentone sodium", "correct": false}], "correct_answer": "A. Diazepam", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Diazepam</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management of Status Epilepticus: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Status epilepticus is a <strong>medical emergency</strong> characterized by continuous <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> activity or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> seizures without recovery of consciousness between episodes. The definition has evolved to recognize the importance of early intervention:</p>\n<ul>\n<li>\n<p><strong>Traditional definition:</strong> seizures lasting &gt;30 minutes</p>\n</li>\n<li>\n<p><strong>Current definition:</strong> continuous seizures lasting ≥5 minutes, or two or more seizures without full recovery between them</p>\n</li>\n</ul>\n<p>Early intervention is critical as neuronal damage can begin to occur after <strong>5-30 minutes of continuous <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> activity.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial Assessment and Stabilization (0-5 minutes)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>\n<p><strong>Stabilize airway, breathing, and circulation</strong></p>\n<ul>\n<li>\n<p>Position patient appropriately to maintain open airway</p>\n</li>\n<li>\n<p>Assess <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> and provide oxygen via <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cannula/mask</p>\n</li>\n<li>\n<p>Monitor vital signs continuously</p>\n</li>\n<li>\n<p>Consider <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> if <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> assistance is needed</p>\n</li>\n</ul>\n</li>\n<li>\n<p><strong>Initial assessment</strong></p>\n<ul>\n<li>\n<p>Perform quick neurological exam if possible</p>\n</li>\n<li>\n<p>Check blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels (treat if &lt;60 mg/dl)</p>\n</li>\n<li>\n<p>Secure IV access</p>\n</li>\n</ul>\n</li>\n<li>\n<p><strong>Laboratory tests to obtain</strong></p>\n<ul>\n<li>\n<p>Electrolytes, hematology, <span class=\"customMeta\" data-dictid=\"c951767a31169277720004b3ec0817\">toxicology</span> screen</p>\n</li>\n<li>\n<p>Anticonvulsant drug levels (if on medication)</p>\n</li>\n</ul>\n</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First-Line Treatment (5-20 minutes)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <strong>benzodiazepine is the initial therapy of choice:</strong></p>\n<ul>\n<li>\n<p><strong>Intravenous lorazepam</strong>: 0.1 mg/kg up to maximum of 4 mg, may repeat in 5-10 min</p>\n</li>\n<li>\n<p><strong>Intravenous midazolam</strong>: 0.2 mg/kg up to 10 mg total dose, may repeat in 5-10 min</p>\n</li>\n<li>\n<p><strong>Intramuscular midazolam</strong>: 0.2 mg/kg (if IV access not available)</p>\n</li>\n<li>\n<p><strong>Rectal diazepam</strong>: 0.5 mg/kg (if IV access not available)</p>\n</li>\n<li>\n<p><strong>Buccal midazolam</strong>: 0.5 mg/kg (if IV access not available)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Second-Line Treatment (20-40 minutes)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>If seizures continue after <span class=\"customMeta\" data-dictid=\"020ca042e51692777182e5ffb60944\">benzodiazepine</span> administration, proceed to one of these options:</p>\n<ul>\n<li>\n<p><strong>Intravenous fosphenytoin</strong>: 20 mg PE/kg <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose (maximum 1500 mg/dose)</p>\n</li>\n<li>\n<p><strong>Intravenous valproate</strong>: 40 mg/kg <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose (maximum 3000 mg/dose)</p>\n</li>\n<li>\n<p><strong>Intravenous levetiracetam</strong>: 30-60 mg/kg <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose (maximum 4500 mg/dose)</p>\n</li>\n<li>\n<p><strong>Intravenous phenobarbital</strong>: 15-20 mg/kg <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose (if not given initially)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Third-Line Treatment (40-60 minutes)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>If seizures still continue (refractory status epilepticus):</p>\n<ul>\n<li>\n<p>Consider repeating second-line therapy</p>\n</li>\n<li>\n<p>Consider <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> doses of:</p>\n<ul>\n<li>\n<p>Thiopental</p>\n</li>\n<li>\n<p>Midazolam</p>\n</li>\n<li>\n<p>Pentobarbital</p>\n</li>\n<li>\n<p>Propofol (with caution in children due to <span class=\"customMeta\" data-dictid=\"3511f2654c1692777196ee7d048722\">propofol</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> syndrome risk)</p>\n</li>\n</ul>\n</li>\n</ul>\n<p>Continuous EEG monitoring is recommended at this stage.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 1-year-old male child who arrives at the hospital with fever and neck stiffness, the suspected diagnosis is meningitis. Among the options provided, which pathogen is the leading cause of meningitis in this particular age group?", "options": [{"label": "A", "text": "Klebsiella", "correct": false}, {"label": "B", "text": "Streptococcus pneumoniae", "correct": true}, {"label": "C", "text": "Staphylococcus aureus", "correct": false}, {"label": "D", "text": "Mycobacterium tuberculosis", "correct": false}], "correct_answer": "B. Streptococcus pneumoniae", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- Streptococcus pneumoniae</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>In India</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Overall</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neonates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gram negative organisms</p>\n<p>(<em>E.Coli</em> &gt; Acinetobacter &gt; Klebsiella)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><em>Group B <span class=\"customMeta\" data-dictid=\"8876d7c56816927771999e61073f60\">streptococci</span> </em></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infants and older children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><em>Streptococcus pneumoniae</em> &gt;</p>\n<p>Neisseria meningitidis &gt; Haemophilus Influenzae.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><em>Streptococcus pneumoniae</em></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Children with T-cell defect</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Listeria monocytogenes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Children with CSF shunts</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Staphylococci</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Children with Complement System Defects</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Meningococcal infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Children with Splenic Dysfunction or Asplenia</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Streptococcus pneumoniae,</li>\n<li>Neisseria Meningitidis Haemophilus Influenzae. <strong>(Encapsulated organisms)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following congenital heart disease presents with split-second heart sounds? Atrial Septal Defect (ASD) Ventricular Septal Defect (VSD) Patent Ductus Arteriosus (PDA) Tetralogy of Fallot (TOF)", "options": [{"label": "A", "text": "Only 1,2,3 is correct", "correct": true}, {"label": "B", "text": "Only 2,3,4 is correct", "correct": false}, {"label": "C", "text": "Only 1,2,4 is correct", "correct": false}, {"label": "D", "text": "All are correct", "correct": false}], "correct_answer": "A. Only 1,2,3 is correct", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Only 1,2,3 is correct</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examination findings in TOF</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiac Auscultation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Heart Sounds</strong>: <strong>Typically normal <span class=\"customMeta\" data-dictid=\"88aee35cd4169277720320bf5b05b6\">first heart sound</span> with a</strong> <strong>single <span class=\"customMeta\" data-dictid=\"ddbe945c10169277719841fa6a7fa2\">second heart sound</span> </strong>(pulmonic component usually inaudible)</li>\n<li><strong>Murmur</strong>: Harsh <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur, crescendo-decrescendo in quality\n\t\t\t\t<ul>\n<li>Best heard at the left <span class=\"customMeta\" data-dictid=\"75b57d54f21692777192dc01883ad1\">mid</span> to upper sternal border</li>\n<li>Radiates posteriorly</li>\n<li>The severity of the <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> correlates with the degree of right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> outflow <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction</li>\n<li>May occasionally have a <span class=\"customMeta\" data-dictid=\"00f5a32045169277719710bd9dd167\">regurgitant</span> quality</li>\n</ul>\n</li>\n<li><strong>Early <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> click</strong>: Sometimes heard along the left sternal border (attributed to flow through a dilated <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> aorta)</li>\n<li><strong>Continuous murmur</strong>: Present over the back and axillary regions in patients with <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> and <span class=\"customMeta\" data-dictid=\"f85253385d1692777181291012fc02\">aortopulmonary</span> collaterals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Palpation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prominent <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> impulse</li>\n<li>Systolic <span class=\"customMeta\" data-dictid=\"7deb9070e81692777200227c178c2f\">thrill</span> may be <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> along the left sternal border</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Wide Splitting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Occurs in conditions like <strong>right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block (RBBB)</strong> due to delayed <span class=\"customMeta\" data-dictid=\"5ebe3b1fbd1692777196b3ced12100\">pulmonic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> closure.</li>\n<li>Seen in <strong>severe <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> (MR)</strong> due to <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the aortic valve- Wide and variable split is seen.</li>\n<li>Seen in <strong>VSD</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Narrow Splitting or Singular S2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Narrow Splitting- E.g. <strong>Aortic stenosis</strong> or <strong>Patent Ductus Arteriosus</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wide Fixed Splitting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The A2-P2 interval is wide and does not change during the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> cycle. E.g.- <strong>ASD, TAPVC, RVF</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reversed or Paradoxical Splitting- P2 before A2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seen in conditions such as <strong>left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> branch block (LBBB).</strong></li>\n<li><strong>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> pacing.</strong></li>\n<li><strong>Severe <span class=\"customMeta\" data-dictid=\"b0c55e5f1916927771820b0864074e\">aortic stenosis</span> (AS).</strong></li>\n<li><strong>Hypertrophic obstructive <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> (HOCM), </strong></li>\n<li><strong>Acute myocardial ischemia.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Loud P2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Considered loud when its intensity exceeds A2 at the base or can be palpated in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> main <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> area. E.g.- <strong>Pulmonary arterial hypertension.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Decreased Intensity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A2 intensity decreases with <span class=\"customMeta\" data-dictid=\"b0c55e5f1916927771820b0864074e\">aortic stenosis</span> (AS) and P2 intensity decreases with <span class=\"customMeta\" data-dictid=\"5ebe3b1fbd1692777196b3ced12100\">pulmonic</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> (PS), potentially resulting in a single S2.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common cause of jaundice in this newborn presenting with conjugated hyperbilirubinemia, intrahepatic cholestasis, high alkaline phosphatase, and the presence of eosinophilic, PAS-positive cytoplasmic granules in liver biopsy specimens, suggestive of Alpha 1 AT deficiency?", "options": [{"label": "A", "text": "Hypoplasia of the biliary tract", "correct": false}, {"label": "B", "text": "Neonatal hepatitis", "correct": true}, {"label": "C", "text": "Choledochal cyst", "correct": false}, {"label": "D", "text": "Physiological", "correct": false}], "correct_answer": "B. Neonatal hepatitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\"&gt;Neonatal&lt;/span&gt; h\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neonatal Hepatitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inflammation of the liver in <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> infants</li>\n<li>Characterized by liver dysfunction</li>\n<li>Presents with jaundice, hepatomegaly, and <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> liver function tests</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infectious Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">Hepatitis</span> viruses (A, B, C, D, E)</p>\n<ul>\n<li>Transmitted from mother to baby during pregnancy/childbirth</li>\n</ul>\n<p>2. Other viruses:</p>\n<ul>\n<li>Cytomegalovirus (CMV)</li>\n<li>Herpes simplex virus (HSV)</li>\n<li>Rubella virus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Bilirubin <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> disorders:</p>\n<ul>\n<li>Gilbert syndrome</li>\n<li>Crigler-Najjar syndrome</li>\n</ul>\n<p>2. Carbohydrate <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> defects:</p>\n<ul>\n<li>Galactosemia</li>\n</ul>\n<p>3. Amino acid <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> disorders:</p>\n<ul>\n<li>Tyrosinemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immune-mediated Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoimmune hepatitis</li>\n<li>Neonatal lupus</li>\n<li>Immune system attacks and damages the liver</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug-induced Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maternal medications that can cause liver damage:</p>\n<ul>\n<li>Anticonvulsants</li>\n<li>Antibiotics</li>\n<li>NSAIDs</li>\n</ul>\n<p>Transfer occurs during pregnancy or breastfeeding</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Clinical presentation</p>\n<p>2. Physical examination</p>\n<p>3. Blood tests:</p>\n<ul>\n<li>Liver function tests</li>\n<li>Viral serology</li>\n</ul>\n<p>4. Imaging studies:</p>\n<ul>\n<li>Ultrasound</li>\n<li>MRI</li>\n</ul>\n<p>5. Liver <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (in some cases)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Approaches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">Viral</span> hepatitis:</p>\n<ul>\n<li>Supportive care</li>\n<li>Antiviral medications (specific cases)</li>\n</ul>\n<p>2. <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> disorders:</p>\n<ul>\n<li>Dietary modifications</li>\n<li>Enzyme replacement therapy</li>\n<li>Specific treatments for <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> defects</li>\n</ul>\n<p>3. Immune-mediated hepatitis:</p>\n<ul>\n<li>Immunosuppressive medications</li>\n</ul>\n<p>4. Drug-induced hepatitis:</p>\n<ul>\n<li>Discontinuation of offending medication</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options listed below does not represent an absolute contraindication for the use of the device depicted?", "options": [{"label": "A", "text": "Undiagnosed vaginal bleeding", "correct": false}, {"label": "B", "text": "Suspected pregnancy", "correct": false}, {"label": "C", "text": "HIV-infected women", "correct": true}, {"label": "D", "text": "PID", "correct": false}], "correct_answer": "C. HIV-infected women", "question_images": ["https://image.prepladder.com/content/5yRZ1dqTi6bRbTNp2UC41746778442.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid\">\n<p style=\"text-align: center;\"><strong>Absolute Contraindications</strong></p>\n</td>\n<td style=\"border-color:#000000; border-style:solid\">\n<p style=\"text-align: center;\"><strong>Relative Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid\">\n<ul>\n<li>Pregnancy <strong>(Option B)</strong></li>\n<li>Current Pelvic Infection <strong>(Option D)</strong></li>\n<li>Unexplained Vaginal Bleeding <strong>(Option A)</strong></li>\n<li>Active Cervical or <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">Uterine</span> Cancer</li>\n<li>Distorted <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">Uterine</span> Cavity</li>\n</ul>\n</td>\n<td style=\"border-color:#000000; border-style:solid\">\n<ul>\n<li>History of Ectopic Pregnancy</li>\n<li>Immunocompromised States</li>\n<li>History of Pelvic Inflammatory Disease (PID)</li>\n<li>Severe Menstrual Pain or Heavy Periods</li>\n<li>Postpartum Women</li>\n<li>Trophoblastic disease</li>\n<li>Previous <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">Intrauterine</span> Device (IUD) Expulsion</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The earliest indication of sexual maturation in females:", "options": [{"label": "A", "text": "Maturation", "correct": false}, {"label": "B", "text": "Thelarche", "correct": true}, {"label": "C", "text": "Pubarche", "correct": false}, {"label": "D", "text": "Menarche", "correct": false}], "correct_answer": "B. Thelarche", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- Thelarche</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pubertal Changes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Girls</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Boys</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Onset of Puberty</p>\n<ul>\n<li>Age: Around 10 years (range 8-12 years)</li>\n<li>Duration: 3-5 years</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Onset of Puberty</p>\n<ul>\n<li>Age: Around 11.5 years (range 9-14 years)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Sequence of Pubertal Changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Sequence of Pubertal Changes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Breast Development<strong>(Thelarche)</strong></p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Pubic Hair Growth <strong>(Pubarche)</strong></p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Growth Spurt</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Onset of <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">Menstrual</span> Cycles<strong>(Menarche)</strong></p>\n<p style=\"text-align:center\">2 years after Thelarche</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Final Breast Development<strong>(Adult Breast Maturation)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Testicular Enlargement</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Penile Enlargement</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Pubic Hair Growth (Pubarche)</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Growth Spurt</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Spermarche</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 29-year-old G2P1 came to the physician at 32 weeks of gestation. She underwent OGTT (75 g of glucose) and her values were fasting 110 mg/dl and 2 hours glucose at 180 mg/dl. Which of the following is the next step regarding the management of this patient?", "options": [{"label": "A", "text": "Start oral hypoglycemics", "correct": false}, {"label": "B", "text": "Reassurance", "correct": false}, {"label": "C", "text": "Admit and start insulin", "correct": true}, {"label": "D", "text": "Induce labor due to risk of fetal macrosomia", "correct": false}], "correct_answer": "C. Admit and start insulin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In an asymptomatic woman aged 35 years, an ultrasound scan reveals a single-chamber cyst measuring 6 cm in the ovary. Serology results are negative. The recommended approach for this condition includes treatment measures such as:", "options": [{"label": "A", "text": "Laparotomy", "correct": false}, {"label": "B", "text": "Follow-up after 1-2 cycles of OCPs", "correct": true}, {"label": "C", "text": "Ovariotomy", "correct": false}, {"label": "D", "text": "Follow-up with CA-125", "correct": false}], "correct_answer": "B. Follow-up after 1-2 cycles of OCPs", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How is the contraceptive shown in the below image inserted?", "options": [{"label": "A", "text": "Hysteroscopic", "correct": true}, {"label": "B", "text": "Abdominal", "correct": false}, {"label": "C", "text": "Laparoscopic", "correct": false}, {"label": "D", "text": "Oral", "correct": false}], "correct_answer": "A. Hysteroscopic", "question_images": ["https://image.prepladder.com/content/heegHyPkIIaQ0oH6XIdR1746778859.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most suitable course of action for managing a one and a half year old child who was brought to the hospital presenting symptoms of breathlessness, fever, cough, and cold, and upon examination has a respiratory rate of 46 breaths per minute, chest retractions, but no danger signs were present?", "options": [{"label": "A", "text": "Give IV antibiotics and observe", "correct": false}, {"label": "B", "text": "Give IV antibiotics and refer to higher centre", "correct": false}, {"label": "C", "text": "Oral antibiotics, warn of danger signs, and send home", "correct": true}, {"label": "D", "text": "No need of treatment only home remedies", "correct": false}], "correct_answer": "C. Oral antibiotics, warn of danger signs, and send home", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- Oral antibiotics, warn of danger signs, and send home</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pneumonia Classification: WHO IMNCI Guidelines</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Classify as</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of any general danger sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> or very severe disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Give 1 dose of inj <span class=\"customMeta\" data-dictid=\"e1a1f4fa35169277718150f74fa895\">ampicillin</span> &amp; gentamycin &amp; refer urgently to hospital</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of either chest indrawing &amp;/or fast breathing but no general danger sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Start oral <span class=\"customMeta\" data-dictid=\"d1e73ea72b1692777181fe0162bd92\">Amoxicillin</span> x 5 days.</li>\n<li>The child is sent home and assessed after 48 hours.</li>\n<li>If the child has improved, continue the same treatment.</li>\n<li>If the child has worsened, refer to a higher center.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No fast breathing, no chest indrawing, no general danger signs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No pneumonia: <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> or cold only</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Home-based supportive care</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fast Breathing Criteria:</strong></p>\n<ul>\n<li>&lt; 2 months: &gt; 60/min</li>\n<li>2-12 months: &gt; 50/min</li>\n<li>1-5 years: &gt; 40/min</li>\n</ul>\n<p><strong>General Danger signs:</strong></p>\n<ol>\n<li>Convulsions</li>\n<li>Lethargy</li>\n<li>Inability to drink or breastfeed</li>\n<li>Persistent vomiting</li>\n<li>Unconsciousness</li>\n<li>Stridor in a calm child</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Home-based Management of Pneumonia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Give oral antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provide antibiotics to treat a possible <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infection (<strong>Oral Amoxicillin</strong> 40-50 mg/kg/day in 2-3 divded doses for 5 days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Warn of danger signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Educate parents about specific warning signs to watch out for, such as worsening <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> or persistent high fever</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Send the child home</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Discharge the child from the hospital and instruct parents to monitor the child's condition and seek prompt medical help if needed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 45-year-old female patient who experiences bleeding after sexual intercourse, and upon per vaginal examination, a lesion is observed that bleeds when touched?", "options": [{"label": "A", "text": "Hemorrhagic cyst", "correct": false}, {"label": "B", "text": "Cervical polyp", "correct": true}, {"label": "C", "text": "Cervical cancer", "correct": false}, {"label": "D", "text": "Cervical fibroid", "correct": false}], "correct_answer": "B. Cervical polyp", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/2vYv8FdXXkwFehsXzZ9o1747985030.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5 year old child brought to the hospital with a history of loose stools. The mother says he is irritable and drinks water hastily when given. On examination, eyes are sunken and during the skin pinch test, the skin retracted after a few seconds but not immediately. What is the treatment for the child?", "options": [{"label": "A", "text": "Administer the first dose of IV antibiotic and immediately refer to a higher center", "correct": false}, {"label": "B", "text": "Give oral fluids and ask the mother to continue the same and visit again the next day", "correct": false}, {"label": "C", "text": "Give zinc supplementation and oral rehydration solution only and ask mother to come back if some danger signs develop", "correct": false}, {"label": "D", "text": "Consider severe dehydration, start intravenous (IV) fluids, IV antibiotics, and refer to a higher centre", "correct": true}], "correct_answer": "D. Consider severe dehydration, start intravenous (IV) fluids, IV antibiotics, and refer to a higher centre", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D- Consider severe dehydration, start &lt;span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\"&gt;intravenous&lt;/span&gt; (IV) fluids, IV antibiotics, and refer to a higher centre</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Degree of Dehydration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Slightly increased thirst</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</li>\n<li>Normal skin turgor</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"ffe9347bcc169277719793b2de1c6d\">rehydration</span> therapy (ORT) with a solution containing electrolytes and glucose</li>\n<li>Encourage the child to drink small, frequent amounts of the ORT solution</li>\n<li>Continue regular <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> if the child is not <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> or unable to tolerate oral intake</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increased thirst</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</li>\n<li>Decreased tears</li>\n<li>Dry <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes</li>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> refill (&gt;2 seconds)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"ffe9347bcc169277719793b2de1c6d\">rehydration</span> therapy (ORT) with a solution containing electrolytes and glucose</li>\n<li>Administer ORT in larger amounts and more frequently</li>\n<li>Monitor vital signs (heart rate, blood pressure), <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, and mental status</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"b676cf039416927771814f87114511\">antiemetic</span> medication if <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> is present</li>\n<li>If unable to tolerate oral <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> or deteriorating clinical status, consider <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> fluids</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Markedly increased thirst</li>\n<li>Minimal or no <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</li>\n<li>Sunken eyes, lethargy, irritability</li>\n<li>Cool extremities, <span class=\"customMeta\" data-dictid=\"66f4e1c35716927771929959483274\">mottled</span> or pale skin</li>\n<li>Altered mental status, decreased consciousness</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initiate <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> fluids with a <span class=\"customMeta\" data-dictid=\"8d138d554c16927771835be732558c\">bolus</span> of <span class=\"customMeta\" data-dictid=\"28f696d61216927771904dbe51b33b\">isotonic</span> <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> or lactated Ringer's solution</li>\n<li>Administer maintenance <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> fluids and correct <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> imbalances as necessary</li>\n<li>Monitor vital signs closely, including heart rate, blood pressure, oxygen saturation</li>\n<li>Address underlying causes, such as infections or other medical conditions</li>\n<li>Consider transfer to a higher level of care if there are signs of severe or life-threatening dehydration</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5 year old boy presented with hematemesis and was found to have splenomegaly, on examination. There was a past history of exchange transfusion in this child for neonatal jaundice. What is the probable diagnosis?", "options": [{"label": "A", "text": "Splenic vein thrombosis", "correct": false}, {"label": "B", "text": "Portal vein thrombosis", "correct": true}, {"label": "C", "text": "Budd chiari syndrome", "correct": false}, {"label": "D", "text": "Liver cirrhosis", "correct": false}], "correct_answer": "B. Portal vein thrombosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\"&gt;Portal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\"&gt;vein&lt;/span&gt; th\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Partial or complete <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of the <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, which carries blood from the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> tract, spleen, and <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> to the liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cirrhosis or liver fibrosis</li>\n<li>Hypercoagulable states (e.g., prothrombine gene mutation)</li>\n<li>Infections (e.g., <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> sepsis)</li>\n<li>Abdominal malignancies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abdominal pain, often in the right upper quadrant</li>\n<li>Enlarged <span class=\"customMeta\" data-dictid=\"6a4861c8d71692777199aeb1d55c85\">spleen</span> (splenomegaly)</li>\n<li>Ascites (fluid accumulation in the abdomen)</li>\n<li>Gastrointestinal bleeding</li>\n<li>Jaundice (yellowing of the skin and eyes)</li>\n<li>Fever and chills</li>\n<li>Altered mental status (in severe cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Imaging studies: Doppler ultrasound, <span class=\"customMeta\" data-dictid=\"44b07c254816927771855a12777513\">computed tomography</span> (CT), magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> (MRI)</li>\n<li>Laboratory tests: Liver function tests, <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> profile, complete blood count</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Treatment of underlying cause (e.g., <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> for hypercoagulable states)</li>\n<li>Symptomatic management: Analgesics for pain relief, diuretics for ascites, management of complications</li>\n<li>Surgical intervention (in selected cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> depends on the underlying cause, extent of thrombosis, and response to treatment.</li>\n<li>Complications can include <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension, <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding, liver failure, and sepsis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The Pearl index is used to calculate which of the following?", "options": [{"label": "A", "text": "Accidental pregnancies", "correct": true}, {"label": "B", "text": "Population", "correct": false}, {"label": "C", "text": "Fertility rate", "correct": false}, {"label": "D", "text": "Abortions", "correct": false}], "correct_answer": "A. Accidental pregnancies", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Gz9YPab0G0xHD9IFDQlH1748235947.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Contraceptive Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pearl Index (Failure Rate per 100 Woman-Years)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pills (OCPs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Women with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycles or <span class=\"customMeta\" data-dictid=\"8b61bc6e361692777180695ac33e91\">acne</span> seeking contraception</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.3 - 9</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intrauterine Device (IUD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long-term contraception; contraindications to estrogen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.1 - 0.8 (Copper)</p>\n<p>0.1 - 0.2 (Hormonal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condoms (Male)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevention of STIs and contraception</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 - 18</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condoms (Female)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-hormonal, barrier method</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 - 21</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraceptive Implant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long-term contraception; high efficacy, minimal user intervention</li>\n<li>Considered in women with seizures or sickle cell disorder</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.05 - 0.3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraceptive Injection (e.g., Depo-Provera)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long-term, non-daily hormonal contraception; those who cannot use estrogen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.2 - 6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaginal Ring (e.g., NuvaRing)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monthly <span class=\"customMeta\" data-dictid=\"988bd8e7c71692777197b9f1d5d5ca\">regimen</span> with local hormone delivery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.3 - 9</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sterilization (Female Tubal Ligation)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Permanent contraception</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5 - 0.1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sterilization (Vasectomy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Permanent contraception; more effective than female sterilization</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.1 - 0.15</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Natural Family Planning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Natural method, often for religious or personal reasons</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 - 25</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emergency <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">Contraception</span> Pills</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Post-coital contraception</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 - 2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lactational <span class=\"customMeta\" data-dictid=\"5d8a1011e31692777181375a96c9c8\">Amenorrhea</span> Method (LAM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breastfeeding women, within first 6 months <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> with exclusive <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> and amenorrhea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5 - 2</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does NOT represent a characteristic feature of bacterial vaginosis?", "options": [{"label": "A", "text": "Presence of clue cells", "correct": false}, {"label": "B", "text": "Thick white discharge", "correct": true}, {"label": "C", "text": "Vaginal pH &amp;gt; 4.5", "correct": false}, {"label": "D", "text": "Fishy odor", "correct": false}], "correct_answer": "B. Thick white discharge", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qYGJl76TVyTZLgpeTEV51746780618.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin, gray-white discharge</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogeneous <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> discharge, often malodorous.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>pH &gt; 4.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vaginal pH greater than 4.5 is indicative.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive Whiff Test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fishy <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> when 10% KOH is added to the discharge.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clue cells on microscopy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vaginal epithelial cells coated with bacteria, giving a <span class=\"customMeta\" data-dictid=\"3d7836b47f1692777199a5bbfc749f\">stippled</span> appearance.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>BV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Normal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colposcopic findings (A, B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogeneous, milk-like secretions observed.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogeneous, clear secretions seen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopic findings (C, D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gardnerella-like microbes and presence of clue cells on microscopy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lactobacillus-like microbes observed with no clue cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microbial composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Overgrowth of anaerobes (e.g., Gardnerella vaginalis).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dominance of Lactobacillus species, maintaining <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> acidity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical significance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with fishy <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> and elevated <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> pH (&gt;4.5), characteristic of BV.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Represents a healthy <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> microbiome with stable pH (≤4.5) and protective lactobacilli.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Bacterial Vaginosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Candidiasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Trichomoniasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Overgrowth of Gardnerella vaginalis and others</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Candida <span class=\"customMeta\" data-dictid=\"ec6a29c167169277718195e3b531cf\">albicans</span> or other Candida species</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trichomonas vaginalis (protozoan)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Discharge appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin, gray-white, homogeneous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thick, white, \"cottage cheese-like\"</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellow-green, frothy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Odor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fishy (especially post-coital or with KOH)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None or mild</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Foul-smelling</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaginal pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 4.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≤ 4.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt; 4.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Whiff Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (fishy <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> with KOH)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clue cells, few lactobacilli</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyphae or pseudohyphae, spores</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Motile trichomonads, many WBCs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often asymptomatic, may have <span class=\"customMeta\" data-dictid=\"8f179d376f16927771905338bc9387\">itching</span> or irritation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intense itching, burning, dyspareunia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Itching, burning, erythema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metronidazole or clindamycin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluconazole or <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> antifungals</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metronidazole or tinidazole</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male infant was brought to the emergency pediatric unit with abdominal distention. There was a history of recurrent urinary tract infections. On examination, he was found to have urinary retention. Imaging showed bilateral hydronephrosis. What could be the probable diagnosis of his condition?", "options": [{"label": "A", "text": "Vesicoureteric reflux", "correct": false}, {"label": "B", "text": "Posterior urethral valves", "correct": true}, {"label": "C", "text": "Horseshoe kidney", "correct": false}, {"label": "D", "text": "Pelviureteric junction obstruction", "correct": false}], "correct_answer": "B. Posterior urethral valves", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\"&gt;Posterior&lt;/span&gt; urethral valves</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal flaps of tissue in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> that obstruct the flow of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> in male infants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Developmental <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> during <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> symptoms, such as poor <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> stream, dribbling, or difficulty urinating</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections (UTIs) with fever, irritability, and poor feeding</li>\n<li>Enlarged <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> (palpable <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> mass)</li>\n<li>Hydronephrosis (swelling of the kidneys due to <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> backup)</li>\n<li>Poor weight gain and growth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Voiding <span class=\"customMeta\" data-dictid=\"7d3833cfbf1692777185c44c246cf4\">cystourethrogram</span> (VCUG): Radiographic <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> and identify the valves</li>\n<li>Ultrasound of the kidneys and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> to assess for hydronephrosis</li>\n<li>Blood tests: <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> function tests and <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> levels</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Endoscopic <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> or <span class=\"customMeta\" data-dictid=\"e06e32271216927772030141e67a00\">fulguration</span> to remove or destroy the obstructing valves</li>\n<li>Surgical intervention: <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> or <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> in severe cases</li>\n<li>Management of <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections and associated complications</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> varies depending on the severity of the <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and associated <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage</li>\n<li>Early diagnosis and intervention can lead to better outcomes and improved <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function</li>\n<li>Long-term monitoring and follow-up are necessary to monitor <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function and manage any potential complications</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a woman presenting with amenorrhea, headache, blurred vision, and galactorrhea, the appropriate investigation is:", "options": [{"label": "A", "text": "Prolactin level", "correct": true}, {"label": "B", "text": "LH", "correct": false}, {"label": "C", "text": "FSH", "correct": false}, {"label": "D", "text": "hCG", "correct": false}], "correct_answer": "A. Prolactin level", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During infancy, what is the most prevalent causative agent of acute bronchiolitis?", "options": [{"label": "A", "text": "Influenza virus", "correct": false}, {"label": "B", "text": "Parainfluenza virus", "correct": false}, {"label": "C", "text": "Rhinovirus", "correct": false}, {"label": "D", "text": "Respiratory syncytial virus", "correct": true}], "correct_answer": "D. Respiratory syncytial virus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D- &lt;span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\"&gt;Respiratory&lt;/span&gt; syncytial virus</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bronchiolitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infants between 1 and 6 months, but can affect children up to 2 years old.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Seasonality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs primarily in winter and spring.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Respiratory syncytial virus (RSV) (Most common)</strong></li>\n<li>Others include:\n\t\t\t\t<ul>\n<li>Parainfluenza virus <strong>(Option B)</strong></li>\n<li>Adenovirus</li>\n<li>Influenza virus <strong>(Option A)</strong></li>\n<li>Rarely Mycoplasma pneumoniae.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>M/c in male infants.</li>\n<li>Infants exposed to tobacco smoke, not breastfed, or living in crowded conditions.</li>\n<li>Maternal smoking</li>\n<li>Older family members/siblings (common source of infection)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Protection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>IgG3 antibodies (short half-life, limited <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> transfer)</li>\n<li>Breastfeeding provides IgA antibodies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bronchiolar <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> with edema, <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> and <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> debris.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> resistance during both inspiration and exhalation.</li>\n<li>Leads to <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> wheezing, air trapping, lung <span class=\"customMeta\" data-dictid=\"301f9a675d16927771892fb39029d3\">hyperinflation</span> and possible atelectasis.</li>\n<li>Hypoxemia due to ventilation-perfusion mismatch.</li>\n<li>With severe obstructive disease <span class=\"customMeta\" data-dictid=\"1f0bd058f91692777189f9a7c1992e\">hypercapnia</span> develops.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>First develop upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> symptoms: Sneezing and clear rhinorrhea.</li>\n<li>Fever (±)</li>\n<li>Diminished appetite</li>\n<li>Persistent Cough</li>\n<li>Dyspnea</li>\n<li>Irritability</li>\n<li>Respiratory distress</li>\n<li>Cyanosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> time</li>\n<li>Wheezing</li>\n<li>Increased work of breathing with <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> flaring and retractions</li>\n<li>Accessory muscles of <span class=\"customMeta\" data-dictid=\"aea081ceb416927771976e2c17be74\">respiration</span> are working</li>\n<li>Auscultation: Fine crepitations and rhonchi</li>\n<li>Faint or inaudible <span class=\"customMeta\" data-dictid=\"baa424d2de16927771836afd73785b\">breath sounds</span> in severe disease</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The FIGO stage of endometrial carcinoma with metastasis to the vagina is:", "options": [{"label": "A", "text": "Stage III a", "correct": false}, {"label": "B", "text": "Stage III b", "correct": true}, {"label": "C", "text": "Stage III c", "correct": false}, {"label": "D", "text": "Stage IV a", "correct": false}], "correct_answer": "B. Stage III b", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SLjL9kRzoEV7lxTwDOKC1746780921.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>FIGO STAGING OF ENDOMETRIAL CANCER (2023)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>STAGE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>DESCRIPTION</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Confined to the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> and ovary</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IA </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confined to endometrium; invasion of &lt;50% of myometrium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confined to endometrium; invasion of &gt;50% of myometrium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aggressive <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> types are limited to a <span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\">polyp</span> or Confined to endometrium</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cervical stromal invasion</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IIA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-aggressive <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> types</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IIB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Substantial LVSI (lymphovascular space involvement)<em> </em>of non-aggressive <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> types</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IIC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aggressive <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> types<em> </em>with any myometrial involvement</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local and/or regional spread of the tumor </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IIIA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invasion of <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"8fc2f5e23316927771989ab10ac305\">serosa</span> &amp;/or adnexa<strong> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IIIB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vagina &amp;/or the parametria or <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IIIC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pelvic &amp;/or <span class=\"customMeta\" data-dictid=\"b83fd0c2a5169277719403617c9fdd\">para-aortic</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement<strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spread to the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> &amp;/or intestinal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> &amp;/or distance metastasis.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IVA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invasion of the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and/or the intestinal/bowel <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> <strong> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IVB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominal peritoneal metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IVC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant metastasis, including <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> to any extra- or <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes above the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vessels, lungs, liver, brain, or bone</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is NOT associated with fibroids?", "options": [{"label": "A", "text": "Pelvic mass", "correct": false}, {"label": "B", "text": "Amenorrhoea", "correct": true}, {"label": "C", "text": "Infertility", "correct": false}, {"label": "D", "text": "Menstrual irregularity", "correct": false}], "correct_answer": "B. Amenorrhoea", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s7T7BvH6ZGNj1kFM4JkD1746781114.png", "https://image.prepladder.com/content/zdLCeLZlY5BKrzJ9luCn1746781098.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>FIGO <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Fibroids</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Name</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Submucosal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pedunculated, Intracavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;50% <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">Intramural</span> and rest in cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 50% <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">Intramural</span> and a part in cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100% <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">intramural</span> but contacts endometrium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intramural</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intramural</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subserosal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 50% <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">Intramural</span> and partly in serosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;50% <span class=\"customMeta\" data-dictid=\"5a2c3ec4ab1692777190af5b350865\">Intramural</span> and rest in serosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subserosal Pedunculated</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Others</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Other - Cervical, Parasitic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">2-5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hybrid - Present both in the <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> (type 2) and in the <span class=\"customMeta\" data-dictid=\"8fc2f5e23316927771989ab10ac305\">serosa</span> (type 5)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a characteristic of tetralogy of Fallot?", "options": [{"label": "A", "text": "Ventricular septal defect", "correct": false}, {"label": "B", "text": "Right ventricular hypertrophy", "correct": false}, {"label": "C", "text": "Atrial septal defect", "correct": true}, {"label": "D", "text": "Pulmonic stenosis", "correct": false}], "correct_answer": "C. Atrial septal defect", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rNSfwo6khZ6eGb7cQyK11746781202.png"], "explanation": "<p>Correct Answer C- A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the ferning pattern of drying cervical mucus indicate in terms of its mechanism?", "options": [{"label": "A", "text": "Estrogen", "correct": true}, {"label": "B", "text": "Progesterone", "correct": false}, {"label": "C", "text": "Prolactin", "correct": false}, {"label": "D", "text": "17-ketosteroids", "correct": false}], "correct_answer": "A. Estrogen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Organ/System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Estrogen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Progesterone</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proliferates endometrium.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Has a <span class=\"customMeta\" data-dictid=\"9e7aec9ff416927771984a1e3100b7\">secretory</span> effect on the endometrium.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upregulates <span class=\"customMeta\" data-dictid=\"183d374ac91692777196c63c850299\">progesterone</span> receptors on endometrium.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Downregulates <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> receptors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leads to the growth of the non-pregnant uterus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Promotes the growth of the pregnant <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> (in estrogen-primed endometrium).</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cervix</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cervical <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> is thin, watery, copious, and elastic.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cervical <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> is thick, scanty, viscous, and non-elastic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Permeable to sperm.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impermeable to sperm.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fern-like appearance on <span class=\"customMeta\" data-dictid=\"51df8cdfc91692777192aa76f4de51\">microscopy</span> (day 8 of cycle).</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ferning <strong>disappears by day 18</strong> of the cycle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vagina</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superficial cells (eosinophilic, <span class=\"customMeta\" data-dictid=\"7f335c6cf7169277719606ce29fdbd\">pyknotic</span> nucleus) predominate in the first half of the cycle.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate cells (basophilic, small nucleus) predominate in the second half of the cycle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breast</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Promotes ductal growth.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Promotes <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> growth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salt &amp; Water Regulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> of salt and water.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Promotes <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of salt and water.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fallopian Tube</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> and decreases secretions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreases <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> and increases secretions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lipid Profile</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases HDL, LDL, and triglycerides.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases HDL but lowers LDL and triglycerides (3rd/4th <span class=\"customMeta\" data-dictid=\"b5576958c81692777188fa476f3053\">gen</span> progesterones are cardioprotective).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient undergoing treatment for eclampsia at present. When should the subsequent administration of MgSO 4 be skipped?", "options": [{"label": "A", "text": "Absence of knee jerk reflex", "correct": true}, {"label": "B", "text": "Urine output of more than 45 mL/hr", "correct": false}, {"label": "C", "text": "Respiratory rate of more than 14/min", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Absence of knee jerk reflex", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Serum <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">Magnesium</span> Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>5–9 mg/dL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Therapeutic range</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>9 mg/dL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Loss of knee <span class=\"customMeta\" data-dictid=\"b88c1802e21692777190700ee5b998\">jerk</span> reflex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>12 mg/dL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Respiratory depression occurs at ~12 mEq/L (14.4 mg/dL) due to muscle paralysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>30 mg/dL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Cardiac arrest</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old boy, as shown in the image, presents with fever and painful sores in the mouth, along with a rash on his hand. Which of the following is the causative agent?", "options": [{"label": "A", "text": "Pox virus", "correct": false}, {"label": "B", "text": "Coxsackie virus", "correct": true}, {"label": "C", "text": "HHV 7 virus", "correct": false}, {"label": "D", "text": "HIV virus", "correct": false}], "correct_answer": "B. Coxsackie virus", "question_images": ["https://image.prepladder.com/content/VIxq5fF4smYHeXrnpZtG1746781375.png"], "explanation_images": ["https://image.prepladder.com/content/b0yx4F2MkQnblOQOLlMa1746781428.png", "https://image.prepladder.com/content/NkI27bDjT4IJ2FO5bDLR1746781467.png"], "explanation": "<p>Correct Answer B- Coxsackie virus</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hand Foot Mouth Disease (HFMD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causative organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coxsackie A16 virus, Enterovirus 71</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Age group </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;5 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> fever, feeling of being unwell, <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> throat are commonly observed.</li>\n<li>Characterized by <span class=\"customMeta\" data-dictid=\"e07244e7a2169277719434f2398467\">papulovesicular</span> skin <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> commonly on buttocks, knees, elbows and <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> area.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"MidgleyDJ \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hand,_foot,_and_mouth_disease#/media/File:Hand_Foot_Mouth_Disease.png\" data-tags=\"\" height=\"535\" src=\"https://image.prepladder.com/content/NkI27bDjT4IJ2FO5bDLR1746781467.png\" width=\"573\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Ulcers/blisters are also seen in the oral cavity, mostly on the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> aspect.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Resolves on its own in 5-7 days, till then <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> and <span class=\"customMeta\" data-dictid=\"c65831e9cb1692777185d546421397\">conservative treatment</span> is given.</li>\n<li>Isolation of affected children at home and promotion of hand <span class=\"customMeta\" data-dictid=\"15fa752a4f1692777189fe275abf3f\">hygiene</span> to prevent disease spread is important. </li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be a potential cause for a child with short stature who is brought to the pediatrician and has high growth hormone levels and low insulin-like growth factor (IGF-1) levels?", "options": [{"label": "A", "text": "Turner syndrome", "correct": false}, {"label": "B", "text": "Pituitary dwarfism", "correct": false}, {"label": "C", "text": "Laron dwarfism", "correct": true}, {"label": "D", "text": "Maternal deprivation dwarfism", "correct": false}], "correct_answer": "C. Laron dwarfism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a 10-year-old boy who was brought for psychiatric evaluation due to intellectual disability and exhibits an IQ of 45? The boy also presents with physical characteristics such as a long face, large ears, and large testes, along with a cardiac murmur. Additionally, there is a history of poor intellectual function in the paternal family.", "options": [{"label": "A", "text": "Cushing's syndrome", "correct": false}, {"label": "B", "text": "Rett syndrome", "correct": false}, {"label": "C", "text": "Fragile X syndrome", "correct": true}, {"label": "D", "text": "William syndrome", "correct": false}], "correct_answer": "C. Fragile X syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- Fragile X syndrome</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fragile X Syndrome:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic Basis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CGG repeats on <strong>FMR-1 (Familial mental retardation) gene</strong> on X chromosome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CGG Repeat Numbers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Normal population: </strong>5-55 repeats</li>\n<li><strong>Carriers (premutation):</strong> 55-200 repeats</li>\n<li><strong>Fragile X Syndrome:</strong> &gt;200 repeats</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gender Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>More common in <strong>males (X-Linked Dominant Inheritance)</strong></li>\n<li>Females mostly carriers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Long face &amp; large ears</li>\n<li>Large mandible/Prominent jaw</li>\n<li>High arched palate</li>\n<li>Hyperextensible joints</li>\n<li>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> prolapse</li>\n<li>Macroorchidism/large <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> (seen in adolescent age group)</li>\n<li>Intellectual disability</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features of female carriers </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>May be associated with <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> ovarian failure</li>\n<li>10% may have an intellectual disability/low IQ</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-month-old child was brought by her mother with complaints of diarrhoea and mucocutaneous lesions, as shown in the image. The symptoms have been present since weaning was started. What is the diagnosis?", "options": [{"label": "A", "text": "Wiskott-Aldrich syndrome", "correct": false}, {"label": "B", "text": "Acrodermatitis enteropathica", "correct": true}, {"label": "C", "text": "Pediatric epidermolysis bullosa", "correct": false}, {"label": "D", "text": "Atopic dermatitis", "correct": false}], "correct_answer": "B. Acrodermatitis enteropathica", "question_images": ["https://image.prepladder.com/content/cHzQRTeAVOhWGwXV8QzC1746782170.png"], "explanation_images": ["https://image.prepladder.com/content/CkQ1IFHYKwbSffUHjTbR1746782235.png"], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"0d3d27b6a0169277718078ff30967f\"&gt;Acrodermatitis&lt;/span&gt; enteropath\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old mother presented with her 2-week-old newborn who had a large tongue and an umbilical hernia. Which of the following investigations has to be done in view of congenital hypothyroidism?", "options": [{"label": "A", "text": "A fresh blood sample and screen first for TSH levels", "correct": false}, {"label": "B", "text": "A fresh blood sample and screen first for T4 levels", "correct": false}, {"label": "C", "text": "A dried blood sample and screen first for TSH levels", "correct": true}, {"label": "D", "text": "A dried blood sample and screen first for T4 levels", "correct": false}], "correct_answer": "C. A dried blood sample and screen first for TSH levels", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- A dried blood sample and screen first for TSH levels</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Congenital Hypothyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common preventable cause of intellectual disability</li>\n<li>Prevalence of 1 in 2,000 newborns</li>\n<li>Results from defects in hypothalamic-pituitary <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> or <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> gland</li>\n<li>Can be <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> or acquired</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thyroid <span class=\"customMeta\" data-dictid=\"2eb190da1c169277718620d9fd1b4a\">dysgenesis</span> (75% of cases)</li>\n<li>Spectrum ranging from <span class=\"customMeta\" data-dictid=\"133b86a0a516927771809ea08682e8\">agenesis</span> to <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> thyroid</li>\n<li>Biosynthetic defects affecting <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> transport, peroxidation, <span class=\"customMeta\" data-dictid=\"6336dd684316927772004a39add73d\">thyroglobulin</span> synthesis</li>\n<li>Pendred syndrome (associated with decreased <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> transport of <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> and deafness)</li>\n<li>Genetic defects associated with TSHR, PAX8, and TSHB genes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Congenital Signs:</strong></p>\n<ul>\n<li>Open <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fontanel</li>\n<li>Umbilical hernia</li>\n<li>Delayed neurodevelopment</li>\n<li>Large tongue</li>\n</ul>\n<p><strong>Common Features:</strong></p>\n<ul>\n<li>Growth retardation</li>\n<li>Sallow edematous facies</li>\n<li>Delayed skeletal maturation</li>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> eruption</li>\n<li>Delayed puberty</li>\n<li>Constipation</li>\n<li>Myopathy and pseudohypertrophy</li>\n<li>Hypothermia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Screening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dried blood spot (DBS) sample at age 2-4 days</strong></li>\n<li><strong>Screen first for TSH levels</strong></li>\n<li>TSH thresholds for treatment:\n\t\t\t\t<ul>\n<li>&gt;20 mU/L in first week</li>\n<li>&gt;10 mU/L between 7-21 days</li>\n<li>&gt;6 mU/L beyond 21 days</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>I<strong>nitial Tests:</strong></p>\n<ul>\n<li>Serum TSH and FT4 levels</li>\n<li>TSH &gt; 20 mU/L in first week needs evaluation</li>\n</ul>\n<p><strong>Further Evaluation:</strong></p>\n<ul>\n<li>Radionuclide scan</li>\n<li>Ultrasound of thyroid</li>\n<li>Children with undetectable <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> may need testing for:</li>\n<li>Defects in <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> transport</li>\n<li>TSH <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> abnormalities</li>\n<li>TSH <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> antibody</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immediate <span class=\"customMeta\" data-dictid=\"22d375381416927772009663d54998\">thyroxine</span> replacement after diagnosis</li>\n<li>Dosage: 10-15 μg/kg/day</li>\n<li>In central hypothyroidism, <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> replacement should precede <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> replacement</li>\n<li>Monitor FT4 and TSH levels every 2 months in first year</li>\n<li>Long-term follow-up required</li>\n<li>Most children require lifelong therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The artery that is palpated between the medial malleolus and the calcaneal tendon is?", "options": [{"label": "A", "text": "Anterior tibial artery", "correct": false}, {"label": "B", "text": "Posterior tibial artery", "correct": true}, {"label": "C", "text": "Dorsalis pedis artery", "correct": false}, {"label": "D", "text": "Popliteal artery", "correct": false}], "correct_answer": "B. Posterior tibial artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/79PnTxS5f198iXbVyn4c1747982168.png"], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\"&gt;Posterior&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\"&gt;tibial&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has lost sensation over the dorsum of the foot and medial four toes. There is the associated difficulty of eversion of the foot. Which nerve injury is likely to be the reason for this?", "options": [{"label": "A", "text": "Deep peroneal nerve", "correct": false}, {"label": "B", "text": "Superficial peroneal nerve", "correct": true}, {"label": "C", "text": "Common peroneal nerve", "correct": false}, {"label": "D", "text": "Posterior tibial nerve", "correct": false}], "correct_answer": "B. Superficial peroneal nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\"&gt;Superficial&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\"&gt;peroneal&lt;/span&gt; nerve</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Injury of <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">Tibial</span> Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Injury of <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">Superficial</span> <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">Peroneal</span> Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Injury of Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">Peroneal</span> Nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> flexion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Eversion completely affected</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"5c4883591b16927771863aa94323f0\">dorsiflexion</span> – foot drop</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li>No loss of complete <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> (because of <span class=\"customMeta\" data-dictid=\"7d3a7e876e1692777200a1e15f025f\">tibialis</span> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> supplied by deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve is intact)</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of great toe</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> four toes</li>\n<li>Paralysis of all muscles of sole</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> supply over sole</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sensory loss on major part of <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> except <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> side of foot and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side of foot and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side of little finger</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Inversion not completely affected because <span class=\"customMeta\" data-dictid=\"7d3a7e876e1692777200a1e15f025f\">tibialis</span> <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> functional</li>\n<li>Loss of extension of great toe</li>\n<li>Loss of extension of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> four toes</li>\n<li>Sensory loss on the area between great and second toe</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of joint is seen in the labeled structure?", "options": [{"label": "A", "text": "Syndesmosis", "correct": false}, {"label": "B", "text": "Primary cartilaginous joints", "correct": false}, {"label": "C", "text": "Fibrous joint", "correct": false}, {"label": "D", "text": "Secondary cartilaginous joint", "correct": true}], "correct_answer": "D. Secondary cartilaginous joint", "question_images": ["https://image.prepladder.com/content/EJLd4rEPNq0NwYLl8uGv1746783880.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Primary <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">Cartilaginous</span> Joint (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Secondary <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">Cartilaginous</span> Joint</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Sutures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Syndesmoses</strong></p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Gomphosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Joint between <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> and diaphysis</li>\n<li>Between basiocciput and basisphenoid</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Symphysis menti</li>\n<li>Symphysis pubis</li>\n<li>Manubrio sternal</li>\n<li>Joint between vertebral bodies, xiphisternal joint, midline <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> joint</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Serrate</strong>: Sagittal</li>\n<li><strong>Denticulate</strong>: Lambdoid</li>\n<li><strong>Squamous</strong>:Temporoparietal</li>\n<li><strong>Plane</strong>: Between <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> process of maxillae</li>\n<li><strong>Schindylesis</strong>: Between <span class=\"customMeta\" data-dictid=\"bd22f326b11692777197600574cc70\">rostrum</span> of <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> and upper margin of vomer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Inferior <span class=\"customMeta\" data-dictid=\"fecef2f7c41692777200740aa13322\">tibiofibular</span> joint</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Tooth fit in the socket</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The below image is of a femur bone. Which muscles are attached to \"A\"?", "options": [{"label": "A", "text": "Gluteus maximus", "correct": false}, {"label": "B", "text": "Iliopsoas", "correct": true}, {"label": "C", "text": "Quadriceps femoris", "correct": false}, {"label": "D", "text": "Adductor magnus", "correct": false}], "correct_answer": "B. Iliopsoas", "question_images": ["https://image.prepladder.com/notes/a37U6wJK7mhI9ZUcs1Vh1747982253.png"], "explanation_images": [], "explanation": "<p>Correct Answer B- I\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image showed a normal elbow. What is the structure marked in the image called?", "options": [{"label": "A", "text": "Capitulum", "correct": true}, {"label": "B", "text": "Trochlea", "correct": false}, {"label": "C", "text": "Olecranon", "correct": false}, {"label": "D", "text": "Head of radius", "correct": false}], "correct_answer": "A. Capitulum", "question_images": ["https://image.prepladder.com/notes/nmvmPZqpf4ojpDX58WOI1747982315.png"], "explanation_images": ["https://image.prepladder.com/notes/LcCf9D33jtKqGqereXhd1747982366.png"], "explanation": "<p>Correct Answer A- Capitulu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the labelled tarsal bone in the image below.", "options": [{"label": "A", "text": "Calcaneus", "correct": false}, {"label": "B", "text": "Cuboid", "correct": false}, {"label": "C", "text": "Navicular", "correct": true}, {"label": "D", "text": "Talus", "correct": false}], "correct_answer": "C. Navicular", "question_images": ["https://image.prepladder.com/notes/YDFHxxEuzuBga7UD5gQw1747982424.png"], "explanation_images": ["https://image.prepladder.com/notes/qMou6JgLx4goQQfb5zTF1747982510.png", "https://image.prepladder.com/content/bhR6vmrIUEjxZ2FC5ML31746784497.png", "https://image.prepladder.com/content/AXBhxQuPk6agl5XAIv551746784504.png", "https://image.prepladder.com/content/uSsf6sQa2aZc2gK16aw91746784700.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Bone Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Bones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Description &amp; Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Tarsals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Provide mechanical support and structure to the foot.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"18\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Proximal Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Talus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Transmits body weight to the foot.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Articulates at three joints:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Superiorly: Ankle joint (tibia/fibula)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Inferiorly: Subtalar joint (calcaneus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Anteriorly: Talonavicular joint (navicular)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Calcaneus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Largest <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> bone, forms the heel.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Articulates at two joints:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Superiorly: Subtalar joint (talus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Anteriorly: Calcaneocuboid joint (cuboid)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Intermediate Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Navicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Boat-shaped; articulates with talus, cuneiforms, and cuboid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Has a <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> for <span class=\"customMeta\" data-dictid=\"7d3a7e876e1692777200a1e15f025f\">tibialis</span> <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> attachment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Distal Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Cuboid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lateral; articulates with <span class=\"customMeta\" data-dictid=\"c8b77c76861692777183e8bcbc3c5a\">calcaneus</span> and fourth/fifth metatarsals.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Features a <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> for <span class=\"customMeta\" data-dictid=\"c3aedca1e41692777202041463429b\">fibularis</span> <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> tendon.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Cuneiforms (3)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Medial, intermediate, lateral; wedge-shaped.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Help <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> arch; attach to various muscles.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Metatarsals</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>I-V (1-5)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Connect tarsals to phalanges; numbered <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to lateral.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Have a head, neck, shaft, and base; facilitate movement and support.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Phalanges</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Great Toe: 2 (proximal, distal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Toes 2-5: 3 each (proximal, intermediate, distal).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Each <span class=\"customMeta\" data-dictid=\"e9451cd23d1692777195fe471f486e\">phalanx</span> has a base, shaft, and head; provide structure to toes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the labeled structure, what kind of joint is present?", "options": [{"label": "A", "text": "Sutures", "correct": false}, {"label": "B", "text": "Primary cartilaginous joints", "correct": false}, {"label": "C", "text": "Fibrous joint", "correct": false}, {"label": "D", "text": "Secondary cartilaginous joint", "correct": true}], "correct_answer": "D. Secondary cartilaginous joint", "question_images": ["https://image.prepladder.com/content/ENClKVVhvdG0y2j4aPPT1746784797.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Primary <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">Cartilaginous</span> Joint (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Secondary <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">Cartilaginous</span> Joint</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Sutures (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Syndesmoses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Gomphosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Joint between <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> and diaphysis</li>\n<li>Between basiocciput and basisphenoid</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Symphysis menti</li>\n<li>Symphysis pubis</li>\n<li>Manubrio sternal</li>\n<li>Joint between vertebral bodies, xiphisternal joint, midline <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> joint</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Serrate:</strong> Sagittal</li>\n<li><strong>Denticulate:</strong> Lambdoid</li>\n<li><strong>Squamous:</strong>Temporoparietal</li>\n<li><strong>Plane:</strong> Between <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> process of maxillae</li>\n<li><strong>Schindylesis:</strong> Between <span class=\"customMeta\" data-dictid=\"bd22f326b11692777197600574cc70\">rostrum</span> of <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> and upper margin of vomer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Inferior <span class=\"customMeta\" data-dictid=\"fecef2f7c41692777200740aa13322\">tibiofibular</span> joint</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Tooth fit in the socket</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old female patient visits you with symptoms of finger swelling, heartburn, and occasional joint pain. During the examination, her hands appeared shiny, tight, and thickened with non-pitting oedema. Additionally, she has interstitial lung disease and tests positive for ANA antibodies, topoisomerase I antibodies, and anti-RNA polymerase III antibodies. What is the likely diagnosis?", "options": [{"label": "A", "text": "Limited cutaneous systemic sclerosis", "correct": false}, {"label": "B", "text": "Diffuse cutaneous systemic sclerosis", "correct": true}, {"label": "C", "text": "Raynaud's phenomenon", "correct": false}, {"label": "D", "text": "Peutz-jeghers syndrome", "correct": false}], "correct_answer": "B. Diffuse cutaneous systemic sclerosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6RoGO7hp91A5d3M1AAmJ1746784859.png", "https://image.prepladder.com/content/r2spFRZIBa3tuR7hkBds1746784876.png", "https://image.prepladder.com/content/IE973bltaGSa4Jh4f52y1746784891.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male patient presented with chest pain, exertional dyspnea and syncope. He was diagnosed with a case of aortic stenosis and his chest x-ray was taken which is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Dilated aortic root", "correct": false}, {"label": "B", "text": "Widening of aortic knob", "correct": false}, {"label": "C", "text": "Widening of the vascular pedicle", "correct": false}, {"label": "D", "text": "Post stenotic dilatation of aorta", "correct": true}], "correct_answer": "D. Post stenotic dilatation of aorta", "question_images": ["https://image.prepladder.com/notes/hekuzzrrKmeDIay2kSqE1747999803.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Deep inguinal ring is a defect in", "options": [{"label": "A", "text": "External oblique aponeurosis", "correct": false}, {"label": "B", "text": "Internal oblique aponeurosis", "correct": false}, {"label": "C", "text": "Fascia transversalis", "correct": true}, {"label": "D", "text": "Rectus sheath", "correct": false}], "correct_answer": "C. Fascia transversalis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KYN4pv287ojoCexdJnwU1746785201.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Parietal peritoneum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Most <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> structure.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Transversalis fascia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Has a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> called the deep inguinal ring, through which the <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> and <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord pass. Site for <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> inguinal hernias. <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> to <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> peritoneum. Forms the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> in the whole extent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Lateral <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> fold</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Formed by the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Median <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Remnant of the <span class=\"customMeta\" data-dictid=\"cb43e65f8d16927772010a28d74bb4\">urachus</span> (from the allantois).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Medial <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Remnant of the obliterated <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> artery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Pyramidalis muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Small muscle attaching to the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> bone. <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">Rectus</span> abdominis lies above it. Covered by the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> and supplied by the <span class=\"customMeta\" data-dictid=\"46ff8ef1ee16927771996bb1697129\">subcostal</span> nerve (T12).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Rectus abdominis muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Receives <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> from T6–T12.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Transversus abdominis muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Does not <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> wall of the inguinal canal. Contributes to the roof and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> wall. Combines with <span class=\"customMeta\" data-dictid=\"50a310ef2e16927771907de8547137\">internal oblique</span> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the conjoint tendon.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Internal <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> muscle (Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Forms parts of the <strong>anterior, roof, and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> walls of the inguinal canal.</strong> Contributes to <span class=\"customMeta\" data-dictid=\"5003148c5116927771853277f6839a\">cremasteric</span> muscle and fascia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>External <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> muscle (Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Aponeurosis forms the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> wall of the inguinal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> and the <strong>superficial inguinal ring</strong>. Forms external <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> fascia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Internal <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> fascia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Derived from the <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> fascia.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on the clinical image below, what is the most probable nerve to be injured?", "options": [{"label": "A", "text": "Thoracodorsal nerve", "correct": false}, {"label": "B", "text": "Axillary nerve", "correct": false}, {"label": "C", "text": "Intercostal nerve", "correct": false}, {"label": "D", "text": "Long thoracic nerve", "correct": true}], "correct_answer": "D. Long thoracic nerve", "question_images": ["https://image.prepladder.com/content/InBxmib54wtYrmfwwMt71746785305.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Long <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C5 - C7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Insertion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serratus <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> muscle</strong>, which is responsible for <strong>scapular protraction</strong> and <strong>upward rotation</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nerve actions</strong></p>\n<p>(Motor function)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Protracts the scapula</strong> (pulls it forward around the thorax).</li>\n<li><strong>Assists in arm anteversion</strong> (moving the arm forward).</li>\n<li><strong>Lifts the ribs</strong>, aiding in respiration.</li>\n<li>Responsible for the <strong>anterolateral motion of the scapula</strong>, which is necessary for <strong>arm elevation</strong>.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The device seen in the following image is?", "options": [{"label": "A", "text": "Cardiac pacemaker", "correct": true}, {"label": "B", "text": "Chemo port device", "correct": false}, {"label": "C", "text": "Travel tract for accessory", "correct": false}, {"label": "D", "text": "Chest X-ray artefact", "correct": false}], "correct_answer": "A. Cardiac pacemaker", "question_images": ["https://image.prepladder.com/notes/DW5fjLqndM22Ihynjxmt1747999860.png"], "explanation_images": ["https://image.prepladder.com/notes/ITI5qb5QBo5Wx7COX4KK1747999917.png", "https://image.prepladder.com/content/2ncXbxzwkjSw86VeArXl1746785476.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following develops from the dorsal mesogastrium?", "options": [{"label": "A", "text": "Falciform ligament", "correct": true}, {"label": "B", "text": "Spleen", "correct": false}, {"label": "C", "text": "Lesser omentum", "correct": false}, {"label": "D", "text": "Liver", "correct": false}], "correct_answer": "A. Falciform ligament", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pUW4BJDuABExFxrIG2Zy1746785576.png", "https://image.prepladder.com/content/lMdxQZdeI51gbrXDMlIs1746785603.png"], "explanation": "<p>Correct Answer A- &lt;span class=\"customMeta\" data-dictid=\"4495d21f7716927772028e313cdedc\"&gt;Falciform&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\"&gt;ligament&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>From</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Contains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Dorsal mesentery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Greater omentum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Greater <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of stomach (and spleen)</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Transverse colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>right and left <span class=\"customMeta\" data-dictid=\"4a2f01d90816927771883e2bc0844f\">gastroepiploic</span> vessels and fat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Gastrosplenic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Spleen</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Short <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery, Left <span class=\"customMeta\" data-dictid=\"4a2f01d90816927771883e2bc0844f\">gastroepiploic</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Gastrophrenic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">phrenic</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Gastrocolic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Transverse colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Right <span class=\"customMeta\" data-dictid=\"4a2f01d90816927771883e2bc0844f\">gastroepiploic</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Splenorenal ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Spleen</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Kidney</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Splenic artery, Tail of pancreas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Ventral mesentery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Lesser omentum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Lesser <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of the stomach (and duodenum)</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>The right free margin-hepatic artery, <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, and <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct,lymph nodes and the <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> vessels,hepatic <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> of nerve,all enclosed in <span class=\"customMeta\" data-dictid=\"a606b55b4316927771956c3cb0d383\">perivascular</span> <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> sheath. Along the lesser <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of the stomach-left and right <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery,the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> group of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes and lymphatics, branches from the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> nerve.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Hepatogastric ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Right and left <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Hepatoduodenal ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Duodenum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Hepatic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> proper, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nerves</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>From</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Contains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Dorsal mesentery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Mesentery proper</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> (jejunum and ileum)</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Superior mesenteric artery, accompanying veins, <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nerve plexuses, lymphatics, 100–200 <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes and <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue with fat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Transverse mesocolon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Transverse colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Middle colic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Sigmoid mesocolon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Sigmoid colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Pelvic wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Sigmoid arteries and superior rectal artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Mesoappendix</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Mesentery of ileum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Appendix</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Appendicular artery</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>From</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Contains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ventral mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Falciform ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Thoracic diaphragm, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Round <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of liver, <span class=\"customMeta\" data-dictid=\"a68186fa3d1692777194d7b1b06fdc\">paraumbilical</span> vein</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> vein</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Round <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of liver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Umbilicus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ventral mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Coronary ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Thoracic diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ductus venosus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Ligamentum venosum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Phrenicocolic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Left colic flexure</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Thoracic diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ventral mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Left triangular ligament, right triangular ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Umbilical folds</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Urinary bladder</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Ileocecal fold</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ileum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Cecum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Broad <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of the uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Uterus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Pelvic wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Mesovarium, mesosalpinx, mesometrium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Round <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Uterus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Inguinal canal</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Suspensory <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of the ovary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ovary</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Pelvic wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ovarian artery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male patient came to the hospital complaining of palpitations. During the examination, a diastolic murmur is detected in the left third intercostal space, along with the presence of a pistol shot sound over the femoral arteries. What is the diagnosis here?", "options": [{"label": "A", "text": "Aortic regurgitation", "correct": true}, {"label": "B", "text": "Aortic stenosis", "correct": false}, {"label": "C", "text": "Tricuspid regurgitation", "correct": false}, {"label": "D", "text": "Mitral regurgitation", "correct": false}], "correct_answer": "A. Aortic regurgitation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Signs of Aortic Regurgitation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muller Sign </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is a visible <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <strong>pulsation of the uvula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rosenbach sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic pulsations of the Liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gerhardt's sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic pulsations of the Spleen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quincke's sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repeatedly <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> blushing and blanching of capillaries in the nail folds upon <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">palpation</span> (Capillary Pulsations)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Landolphi sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alternating <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"4880e9b3761692777185e64eba797c\">constriction</span> and diastolic <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of pupils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Traube Sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is <strong>pistol shot sounds</strong> that are heard while auscultating <strong>over the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Water-Hammer pulse</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strong pulse that rises quickly and then drops off suddenly.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duroziez Sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is a to-and-fro <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> heard while auscultating the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>De-Musset sign</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The jarring motion of the head with each heartbeat</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> pressure and decreased <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">diastolic pressure</span> result in <strong>increased arterial pulse pressure</strong>.</li>\n<li><strong>Atrio-ventricular malformation</strong> and <strong>Atrio-ventricular fistula</strong> also show low diastolic BP due to continuous Korotkoff sounds.</li>\n<li><strong>Positive Hill’s sign</strong> is an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> difference in BP in the <span class=\"customMeta\" data-dictid=\"0bc1ae5070169277720193a2852d9c\">upper limb</span> and lower limb.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>On Palpation</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Heaving LV impulse</strong> is noted, which is displaced laterally and inferiorly</li>\n<li><strong>Diastolic and <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> Thrills</strong> were noticed at the left lower sternal border and <span class=\"customMeta\" data-dictid=\"751ea5589f1692777199db9f2ec233\">suprasternal</span> notch, respectively.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>On Auscultation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Heart Sounds</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A2 is absent</li>\n<li>In the Bicuspid aortic valve, <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> sound is present</li>\n<li>Sometimes, A4 is also heard</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Murmurs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>A decrescendo diastolic murmur</strong><strong>, </strong>best heard when sitting up and leaning forward,<strong> </strong>is<strong> </strong>an early <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> that becomes holo-diastolic as the condition progresses to a severe stage.</li>\n<li><strong>Musical <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> </strong>is aortic <span class=\"customMeta\" data-dictid=\"390b319abc16927771852902093fde\">cusp</span> fluttering in the <span class=\"customMeta\" data-dictid=\"00f5a32045169277719710bd9dd167\">regurgitant</span> flow.</li>\n<li><strong>Mid-diastolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> </strong></li>\n<li><strong>Austin Flint murmur</strong> is a soft, low-pitched, mid- to end-diastolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> caused by <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> due to AR.</li>\n<li><strong>Ejection <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> </strong>is commonly heard in AR along with AS<strong>.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person with dyspnea has a slight limitation in physical activity and doing ordinary activity causes symptoms but he is asymptomatic at rest. To which class does he belong, based on the New York Heart Association functional classification?", "options": [{"label": "A", "text": "Class I", "correct": false}, {"label": "B", "text": "Class II", "correct": true}, {"label": "C", "text": "Class III", "correct": false}, {"label": "D", "text": "Class IV", "correct": false}], "correct_answer": "B. Class II", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>New York Heart Association (NYHA) <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No limitation of physical activity.</li>\n<li>No symptoms with ordinary exertion (e.g. shortness of breath when walking, climbing stairs etc).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Slight limitation of physical activity.</li>\n<li>Ordinary activity causes symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Marked limitation of physical activity.</li>\n<li>Less than ordinary activity causes symptoms.</li>\n<li>Asymptomatic at rest.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inability to carry out any physical activity without discomfort.</li>\n<li>Symptoms at rest.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient presented with chronic projectile vomiting and weight loss. What is the expected metabolic abnormality to be seen here?", "options": [{"label": "A", "text": "Hypokalemic hypochloremic metabolic alkalosis with hyponatremia", "correct": true}, {"label": "B", "text": "Hypokalemic hypochloremic metabolic alkalosis with hypernatremia", "correct": false}, {"label": "C", "text": "Hypokalemic hypochloremic metabolic alkalosis with hypercalcemia", "correct": false}, {"label": "D", "text": "Hypokalemic hypochloremic metabolic acidosis with hyponatremia", "correct": false}], "correct_answer": "A. Hypokalemic hypochloremic metabolic alkalosis with hyponatremia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male came to the physician with complaints of chronic back pain, easy fatigability and a history of multiple urinary tract infections in the last 3 months. His ESR is elevated, and an x-ray of his skull is shown below. Which of the following investigations is useful for diagnosis?", "options": [{"label": "A", "text": "MRI brain", "correct": false}, {"label": "B", "text": "PET scan", "correct": false}, {"label": "C", "text": "Head CT scan with contrast", "correct": false}, {"label": "D", "text": "Serum electrophoresis", "correct": true}], "correct_answer": "D. Serum electrophoresis", "question_images": ["https://image.prepladder.com/content/hDEJLeEOPdkakQ7hMg1J1746786391.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old woman who had a heart attack 2 years ago is currently experiencing a cough and difficulty breathing while walking short distances. Physical examination revealed dullness upon percussion and reduced breath sounds on the right side. A chest x-ray indicated the presence of moderate pleural effusion. Thoracocentesis, guided by ultrasound, was performed and the laboratory results are provided below. Pleural fluid findings: Appearance: turbid pH: 7.1 Protein: 3.2 g/dL Lactate dehydrogenase: 80 U/L (normal serum LDH- 50-150 U/L) Pleural fluid protein/serum protein ratio: 0.34 Pleural fluid LDH /serum LDH: 0.3 Glucose: 54 mg/dL WBC count: 4000 cells/µL with &amp;gt;50% lymphocytes Adenosine deaminase: 30 U/L AFB smear microscopy: Negative Gram staining and microscopy: No organisms, no pus cells", "options": [{"label": "A", "text": "Parapneumonic pleural effusion", "correct": false}, {"label": "B", "text": "Malignant pleural effusion", "correct": false}, {"label": "C", "text": "Congestive heart failure", "correct": true}, {"label": "D", "text": "Tubercular pleural effusion", "correct": false}], "correct_answer": "C. Congestive heart failure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features of Left-Sided vs. Right-Sided <span class=\"customMeta\" data-dictid=\"b0eb48bbf6169277718568c051e6ad\">Congestive Heart Failure</span> (CHF)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Left-Sided Heart Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Right-Sided Heart Failure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong>:</p>\n<ul>\n<li>Ischemic heart disease (myocardial infarction).</li>\n<li>Hypertension</li>\n<li>Dilated cardiomyopathy.</li>\n<li>Aortic or <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disease.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong>:</p>\n<ul>\n<li>Left-sided <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> (<strong>most common cause</strong>).</li>\n<li>Chronic lung diseases (COPD, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension).</li>\n<li>Pulmonary embolism.</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> infarction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In left-sided heart failure, the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> cannot effectively pump blood to the body, leading to a backup of blood into the lungs.</p>\n<p><strong>Clinical features:</strong></p>\n<p>This primarily results in <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> symptoms.</p>\n<ul>\n<li>Dyspnea</li>\n<li>Exertional dyspnea).</li>\n<li>Orthopnea</li>\n<li>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> dyspnea</li>\n</ul>\n<p><strong>Pulmonary Congestion:</strong></p>\n<ul>\n<li>Crackles (rales) heard on <span class=\"customMeta\" data-dictid=\"b2f0dbabe516927771821b0ec5ba85\">auscultation</span> due to fluid in the alveoli.</li>\n<li>Cough</li>\n<li>Wheezing (cardiac asthma).</li>\n<li>Fatigue and Weakness</li>\n<li>Decreased Exercise Tolerance</li>\n<li>Limited physical activity due to breathlessness and fatigue.</li>\n<li>S3 Gallop</li>\n<li><strong>Cool Extremities: </strong>Reduced <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output may cause poor <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> circulation, leading to cold, pale skin.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In right-sided heart failure, the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> fails to pump blood effectively into the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> circulation, leading to <strong>systemic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion. </strong>It is often secondary to left-sided <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> or conditions affecting the lungs <strong>(cor pulmonale).</strong></p>\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>Peripheral Edema</li>\n<li>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Distension (JVD)</li>\n<li>Hepatomegaly</li>\n<li>B/L <span class=\"customMeta\" data-dictid=\"a8c53e6875169277719588cd709854\">pitting</span> <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> oedema</li>\n<li><strong>Kussmaul sign: </strong>JVP <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> on inspiration</li>\n<li>Ascites</li>\n<li>Nocturia</li>\n<li>Weight Gain</li>\n<li>Anorexia and Nausea</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pleural fluid Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Light's Criteria</strong></p>\n</td>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Differentiates transudative from <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> pleural effusions based on LDH and protein levels in pleural fluid.</p>\n<ul>\n<li>An <strong>exudative pleural effusion</strong> meets at least<strong> one</strong> of the following:\n\n\t\t\t\t<ol>\n<li>Pleural fluid protein/serum protein &gt; 0.5</li>\n<li>Pleural fluid LDH/serum LDH &gt; 0.6</li>\n<li>Pleural fluid LDH exceeds two-thirds of the normal upper limit for serum.</li>\n</ol>\n</li>\n<li>~25% of transudates may be misidentified as exudates.</li>\n<li>If <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> criteria are <span class=\"customMeta\" data-dictid=\"fffe8d8cdd169277719212053c343d\">met</span> but a transudative condition is suspected, measure protein difference; if &gt;31 g/L (3.1 g/dL), likely transudative.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the best confirmatory method to ensure the central line is in the jugular vein?", "options": [{"label": "A", "text": "Chest X-ray", "correct": true}, {"label": "B", "text": "Blood pH", "correct": false}, {"label": "C", "text": "Blood color", "correct": false}, {"label": "D", "text": "ETCO2", "correct": false}], "correct_answer": "A. Chest X-ray", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a 45-year-old man who experiences chest pain and difficulty breathing that worsens when lying down but improves when sitting upright, and has muffled heart sounds during examination?", "options": [{"label": "A", "text": "Pericardial effusion", "correct": true}, {"label": "B", "text": "Tetralogy of Fallot", "correct": false}, {"label": "C", "text": "Transposition of great arteries", "correct": false}, {"label": "D", "text": "Pulmonary hypertension", "correct": false}], "correct_answer": "A. Pericardial effusion", "question_images": ["https://image.prepladder.com/content/HSL60n66H8ZzWd3kfwtj1746787616.png"], "explanation_images": ["https://image.prepladder.com/content/LUKfLQC5UR0oNk1y48y41746787705.png", "https://image.prepladder.com/content/R6oKD88WumZiaYfs3Nrb1746787726.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the tachycardia depicted in the given ECG.", "options": [{"label": "A", "text": "Atrial fibrillation", "correct": false}, {"label": "B", "text": "Atrial flutter", "correct": true}, {"label": "C", "text": "Ventricular tachycardia", "correct": false}, {"label": "D", "text": "Ventricular fibrillation", "correct": false}], "correct_answer": "B. Atrial flutter", "question_images": ["https://image.prepladder.com/content/GGa9MFEpc1C9XJ73RiEm1746787957.png"], "explanation_images": ["https://image.prepladder.com/content/r0FZTzDTRc0EWSWBq0uA1746788030.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Atrial Flutter</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> is characterized by a large re-entry circuit, usually within the right atrium, encircling the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"2889a63cdd1692777181f9102ed608\">annulus</span> originating from the cavotricuspid isthmus.</li>\n<li>The atrial rate is approximately <strong>300 beats per minute</strong>.</li>\n<li>It is typically associated with 2:1, 3:1, or 4:1 AV block, resulting in <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> rates of 150, 100, or 75 beats per minute.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The ECG shows<strong> saw-tooth <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves</strong>, often <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as <strong>\"F-waves.\"</strong></li>\n<li>With a 2:1 AV block, <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves may be buried in QRS complexes and T waves, making them difficult to identify.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ewingdo\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ECG_Atrial_Flutter_294_bpm.jpg\" data-tags=\"\" height=\"490\" src=\"https://image.prepladder.com/content/r0FZTzDTRc0EWSWBq0uA1746788030.png\" width=\"814\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> should be suspected in narrow-complex <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> at a rate of 150 beats per minute.</li>\n<li>Carotid <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> pressure or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"d3f6a49b7416927771802124ccddf0\">adenosine</span> may help reveal <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves by temporarily increasing the degree of AV block.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Rhythm Control:</strong></p>\n<ul>\n<li><strong>Acute Management:</strong>\n<ul>\n<li>Hemodynamically <strong>Unstable</strong> Patients: Synchronized cardioversion.</li>\n<li><strong>Stable </strong>Patients:\n\t\t\t\t\t<ul>\n<li>Electrical <span class=\"customMeta\" data-dictid=\"f6c133a4ba1692777183c42bc77b81\">cardioversion</span> (if no <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> thrombus).</li>\n<li>Pharmacological cardioversion:\n\t\t\t\t\t\t<ul>\n<li>Antiarrhythmic drugs:\n\t\t\t\t\t\t\t<ul>\n<li>Amiodarone</li>\n<li>Class IA: Procainamide, Quinidine, Disopyramide</li>\n<li>Class IC: Flecainide, Propafenone</li>\n</ul>\n</li>\n<li>Calcium Channel Blockers: Verapamil, Diltiazem</li>\n<li>Beta-Blockers: Metoprolol, Carvedilol, Esmolol</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</li>\n<li><strong>Long-Term Management:</strong>\n<ul>\n<li>Radiofrequency <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> of the cavotricuspid isthmus.</li>\n</ul>\n</li>\n</ul>\n<p><strong>2. Rate Control:</strong></p>\n<ul>\n<li>First-Line Agents:\n\t\t\t\t<ul>\n<li>Calcium Channel Blockers (e.g., Verapamil, Diltiazem)</li>\n<li>Beta-blockers (e.g., Metoprolol, Carvedilol, Esmolol)</li>\n<li>Digoxin (use cautiously due to toxicity).</li>\n</ul>\n</li>\n<li>Goal: Heart rate &lt; 110 beats per minute.</li>\n</ul>\n<p><strong>3. Anticoagulation:</strong></p>\n<ul>\n<li>Assess stroke risk using the CHADS2-VASC score:</li>\n<li>Anticoagulation Recommendations:\n\t\t\t\t<ul>\n<li>2 or more points: Strong recommendation for anticoagulation.</li>\n<li>1 point: Consider either <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> or full anticoagulation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for an adult patient with a pulsatile swelling in the neck below the jaw angle that causes an outward expansile impulse, based on the findings of an MRI angiography?", "options": [{"label": "A", "text": "Grave’s disease", "correct": false}, {"label": "B", "text": "Branchial cyst", "correct": false}, {"label": "C", "text": "Thymic cyst", "correct": false}, {"label": "D", "text": "Carotid body tumour", "correct": true}], "correct_answer": "D. Carotid body tumour", "question_images": ["https://image.prepladder.com/content/oLQVQdbr5vDLu8pCEqB21746788191.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the diagnosis:", "options": [{"label": "A", "text": "Normal ECG", "correct": false}, {"label": "B", "text": "Ventricular fibrillation", "correct": false}, {"label": "C", "text": "Ventricular tachycardia", "correct": true}, {"label": "D", "text": "Misplaced leads", "correct": false}], "correct_answer": "C. Ventricular tachycardia", "question_images": ["https://image.prepladder.com/content/wSoW7SB6DSMlt3KfzUbV1746788476.png"], "explanation_images": ["https://image.prepladder.com/content/lmp6ay4fbTOUDKO9KRqG1746788603.png", "https://image.prepladder.com/content/eIXjOynKUcLNCQCRHihY1746788619.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition in the following X-ray.", "options": [{"label": "A", "text": "Hydropneumothorax", "correct": true}, {"label": "B", "text": "Pleural effusion", "correct": false}, {"label": "C", "text": "Pericardial effusion", "correct": false}, {"label": "D", "text": "Pneumothorax", "correct": false}], "correct_answer": "A. Hydropneumothorax", "question_images": ["https://image.prepladder.com/content/8EXkkWxMNGIBz4xT9JZC1746788822.png"], "explanation_images": ["https://image.prepladder.com/content/b2QO2aJae6Frr97t6FfR1746788890.png", "https://image.prepladder.com/content/tvByJcv97r0ND6uHir8D1746788917.png", "https://image.prepladder.com/content/KgQJnDQGfs1yAUNW8nrl1746788932.png", "https://image.prepladder.com/content/xum8xZExUVhZbnBg6POv1746788949.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed delayed symptom of radiation therapy for the head and neck?", "options": [{"label": "A", "text": "Dysphagia", "correct": false}, {"label": "B", "text": "Xerostomia", "correct": true}, {"label": "C", "text": "Myelopathy", "correct": false}, {"label": "D", "text": "Dysgeusia", "correct": false}], "correct_answer": "B. Xerostomia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Late symptoms of radiation therapy for head and neck tumours </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Permanent <span class=\"customMeta\" data-dictid=\"e3afd7f63b1692777186b9a6e7824d\">dry mouth</span> (xerostomia) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dry mouth, difficulty in eating, swallowing, and speaking</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maintain adequate oral hygiene, salivary substitutes’ <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> stimulation, low-level laser treatment of the salivary gland, chlorhexidine, <span class=\"customMeta\" data-dictid=\"c929a2b71516927771812a8b7b7ec3\">antifungal</span> therapy, adequate hydration, acupuncture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Burning mouth syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Burning or scalded of mouth; dryness, increased thirst; loss of taste</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral rinses, lidocaine, <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> substitutes, capsaicin, <span class=\"customMeta\" data-dictid=\"48e85a38f21692777184dbb46a0dc0\">clonazepam</span> or Klonopin, antidepressants, pain medications, low-level laser therapy, cognitive behavioural therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dental caries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dental caries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral hygiene, management of xerostomia, <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> fluorides and/or remineralizing agents</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteoradionecrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain, bad breath, dysgeusia, numbness, trismus, <span class=\"customMeta\" data-dictid=\"7beec9567a1692777191ec123e0989\">mastication</span> and speech difficulties</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Debridement, <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> treatment and prophylaxis, <span class=\"customMeta\" data-dictid=\"1b1cc7f2861692777189c9bd7d9b81\">hyperbaric</span> oxygen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fibrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Woody texture and limited neck enhance lymphedema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Physiotherapy, <span class=\"customMeta\" data-dictid=\"ff4da5559b169277719349b30b2f82\">myofascial</span> release, external laser</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Physiotherapy, <span class=\"customMeta\" data-dictid=\"ff4da5559b169277719349b30b2f82\">myofascial</span> release, external laser</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mastication muscles fibrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral appliances, diet modification, pharyngeal strengthening, swallow retraining</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The dropped head syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"cae8dbebe516927771911eb08960d5\">kyphotic</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of the <span class=\"customMeta\" data-dictid=\"f140a27e12169277718407f79367c2\">cervicothoracic</span> spine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supportive care, external orthotic devices</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pharyngoesophageal stenosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysphagia <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilation, surgery and stents</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin changes and skin cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> reaction in an area previously exposed to radiation after a chemotherapeutic agent or other medication</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of skin cancer, maintaining proper skin hygiene, <span class=\"customMeta\" data-dictid=\"db283047011692777189a869dbce07\">hydrophilic</span> or <span class=\"customMeta\" data-dictid=\"5a456ffb2d1692777191b507ca2fb0\">lipophilic</span> barrier creams with or without <span class=\"customMeta\" data-dictid=\"b43f30abaa1692777189a062e2e3e4\">hydrogel</span> or <span class=\"customMeta\" data-dictid=\"a8781ce464169277718906adfc4e69\">hydrocolloid</span> dressings</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphedema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neck and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> swelling, heaviness, achiness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Manual <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> drainage, <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> bandages and garments, <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> pump</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypothyroidism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slowing of <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> processes symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thyroxine replacement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperparathyroidism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excessive urination, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, <span class=\"customMeta\" data-dictid=\"a3af5237fd1692777200f706d79cc1\">tiring</span> weakness, depression. bone and joint pain, nausea, <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> and loss of appetite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcimimetics, hormone replacement therapy, bisphosphonates</p>\n<p>Surgical removal of the <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> adenoma(s) is <span class=\"customMeta\" data-dictid=\"0968038e2a1692777185ed087c7fd8\">curative</span> in most patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brachial plexopathy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paresthesia, dysesthesia, decreased sensitivity, movement loss, <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> atrophy, <span class=\"customMeta\" data-dictid=\"f0cdc42a0c1692777198f54a380826\">shoulder joint</span> dislocation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Physical and occupational therapies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eye damage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cataract, retinopathy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monoclonal antibody, triamcinolone, laser, <span class=\"customMeta\" data-dictid=\"04082a0a281692777195d88f87e245\">photodynamic</span> therapy, <span class=\"customMeta\" data-dictid=\"1b1cc7f2861692777189c9bd7d9b81\">hyperbaric</span> oxygen, pentoxifylline</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following organisms is most likely to be the cause of the leg lesion shown in the image below, as presented by a young man? The lesions exhibit pain, well-defined raised edges, and the patient also reports blisters on his body. Furthermore, the patient is in good health with no co-existing medical conditions.", "options": [{"label": "A", "text": "Group B streptococcus", "correct": false}, {"label": "B", "text": "Group A streptococcus", "correct": true}, {"label": "C", "text": "Staphylococcus aureus", "correct": false}, {"label": "D", "text": "Haemophilus influenza type B", "correct": false}], "correct_answer": "B. Group A streptococcus", "question_images": ["https://image.prepladder.com/content/w6VwBXI2SdtUaYxTpDvz1746789298.png"], "explanation_images": ["https://image.prepladder.com/content/L44hlWP6Mg4jxsi3LiwN1746789300.png"], "explanation": "<p>Correct Answer B- Group A streptococcu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female comes with complaints of pain in her fingernail. On examination, nail folds were seen to be red and with erythema as shown in the picture. The most likely diagnosis is.", "options": [{"label": "A", "text": "Paronychia", "correct": true}, {"label": "B", "text": "Yellow-nail syndrome", "correct": false}, {"label": "C", "text": "Psoriasis", "correct": false}, {"label": "D", "text": "Alopecia areata", "correct": false}], "correct_answer": "A. Paronychia", "question_images": ["https://image.prepladder.com/content/Xy26XQpZ3Ey91EwCTPAw1746789691.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with the given rash after he had taken NSAIDs for his knee pain. He reported that he developed the same rash in the same location 6 months ago when he took the same drugs for back pain. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Drug hypersensitivity", "correct": false}, {"label": "B", "text": "Post inflammatory hyperpigmentation", "correct": false}, {"label": "C", "text": "Fixed drug eruption", "correct": true}, {"label": "D", "text": "Drug-induced hyper melanosis", "correct": false}], "correct_answer": "C. Fixed drug eruption", "question_images": ["https://image.prepladder.com/content/eJUQCoMdrjY4VsUZQ6rS1746789937.png"], "explanation_images": ["https://image.prepladder.com/content/6VQynDYvJFJYMvLziV631746789996.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the distinctive finding shown in the image below, which is pathognomonic for Psoriasis?", "options": [{"label": "A", "text": "Nail pitting", "correct": false}, {"label": "B", "text": "Subungual oil drop sign", "correct": true}, {"label": "C", "text": "Thinning of nails", "correct": false}, {"label": "D", "text": "Pterygium", "correct": false}], "correct_answer": "B. Subungual oil drop sign", "question_images": ["https://image.prepladder.com/content/lftSzfihfddD98l2oKiT1746790263.png"], "explanation_images": ["https://image.prepladder.com/content/hAdhraWArGsEVpBk7kuV1746790301.png", "https://image.prepladder.com/content/CnixUYYQ9Cd0Vc6ocjC61746790315.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the clinical sign shown in the picture below?", "options": [{"label": "A", "text": "Dermographism", "correct": true}, {"label": "B", "text": "Nikolsky sign", "correct": false}, {"label": "C", "text": "Koebner's phenomenon", "correct": false}, {"label": "D", "text": "Auspitz sign", "correct": false}], "correct_answer": "A. Dermographism", "question_images": ["https://image.prepladder.com/content/iqYwkCQ3l7WZaPbeh6ky1746790527.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Type of Physical Urticaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Eliciting Factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Urticaria <span class=\"customMeta\" data-dictid=\"d459a8b3ad1692777202137ee8d53b\">factitial</span> / Dermographism</strong></p>\n<ul>\n<li>Most common type, red, itchy, <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <span class=\"customMeta\" data-dictid=\"e5af50c97116927772022c9af96a3c\">wheal</span> appearing immediately after light stroking of the skin.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Mechanical shearing forces (wheals arising within 1-5 mins)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Cold contact urticaria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cold objects, air, fluids, wind</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Heat contact urticaria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Localized heat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Solar urticaria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>UV and/or visible light</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Delayed <span class=\"customMeta\" data-dictid=\"c7da23f45d1692777196fd4eb985e4\">pressure urticaria</span> (poor prognosis)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Vertical pressure (wheals arise with 3-12 hours latency)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Aquagenic urticaria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Water</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Cholinergic urticaria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Increase in core <span class=\"customMeta\" data-dictid=\"4a7581c8b01692777183819f38c633\">body temperature</span> by exercise or spicy food</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents to the OPD with palpitation and weight loss. On examination of her legs the following lesion was found which on applying pressure, the indentation does not persist on release. ECG shows sinus rhythm. What is the probable cause of the oedema?", "options": [{"label": "A", "text": "Myxedema", "correct": false}, {"label": "B", "text": "Nephrotic syndrome", "correct": true}, {"label": "C", "text": "Chronic lymphangitis", "correct": false}, {"label": "D", "text": "Dilated cardiomyopathy", "correct": false}], "correct_answer": "B. Nephrotic syndrome", "question_images": ["https://image.prepladder.com/content/l0EfSFDEiq8fyKh0FjpW1746791038.png"], "explanation_images": ["https://image.prepladder.com/content/N6GdjNeNOMz3no5pa9Iy1746791107.png", "https://image.prepladder.com/content/vaLPjxJ4VSnuMkMKLr9s1746791121.png", "https://image.prepladder.com/content/WHwc9sGjhs5eJ3uqXSzm1746791137.png", "https://image.prepladder.com/content/FA87StRmTwp6FmT3sNu31746791150.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Nephrotic Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical manifestations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Proteinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The damage to the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> barrier leads to <strong>increased <span class=\"customMeta\" data-dictid=\"1c7103a9b516927771955682b6aaa4\">permeability</span> to proteins</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Odema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"330\" src=\"https://image.prepladder.com/content/N6GdjNeNOMz3no5pa9Iy1746791107.png\" width=\"866\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypoalbuminemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> loss of <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> being more than its <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by the liver.</li>\n<li>Muehrcke's lines (linear white lines in the <span class=\"customMeta\" data-dictid=\"b343d5e0891692777193df04031c03\">nail bed</span> seen in hypoalbuminemia)</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Lyrl\" data-hash=\"\" data-license=\"OPEN ACCESS \" data-source=\"https://en.wikipedia.org/wiki/Muehrcke%27s_nails\" data-tags=\"\" height=\"269\" src=\"https://image.prepladder.com/content/vaLPjxJ4VSnuMkMKLr9s1746791121.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperlipidemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"540\" src=\"https://image.prepladder.com/content/WHwc9sGjhs5eJ3uqXSzm1746791137.png\" width=\"801\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li>Xanthoma and <span class=\"customMeta\" data-dictid=\"10bddad16c16927772022ef59afac7\">xanthelasma</span> can be appreciated.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Klaus D. Peter, Wiehl, Germany\" data-hash=\"\" data-license=\"CC BY 3.0 de\" data-source=\"https://en.wikipedia.org/wiki/Xanthelasma\" data-tags=\"\" height=\"256\" src=\"https://image.prepladder.com/content/FA87StRmTwp6FmT3sNu31746791150.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypercoagulability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This can be due to factors like:</p>\n<ul>\n<li>Due to the loss of <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">anticoagulant</span> proteins like Protein C/ Protein S/ Antithrombin III</li>\n<li>Ferritin deficiency</li>\n<li>History of factor V Leiden mutation</li>\n<li>Increased production of <span class=\"customMeta\" data-dictid=\"ff2094828c1692777196941a65e6eb\">procoagulant</span> factors by the liver.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of immunoglobulins in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> causes <strong>hypogammaglobulinemia</strong>, increasing <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> to infections.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnostic criteria for <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Essential findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Proteinuria of &gt; 3.5 g/day</li>\n<li>Urine PCR &gt; 2g protein/g of creatinine</li>\n<li>Hypoalbuminemia - <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">Albumin</span> &lt; 2.5 gm%</li>\n<li><strong>Oedema due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"5d369be246169277719451754ab37a\">oncotic</span> pressure</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypercholesterolemia,</li>\n<li>Lipiduria\n\t\t\t\t<ul>\n<li>Urine microscopy: Oval fat bodies/Maltese cross bodies</li>\n</ul>\n</li>\n<li>Low eGFR</li>\n<li>Hypercoagulability</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "HV interval in the below given His bundle electrogram is for conduction:", "options": [{"label": "A", "text": "Through the His-Purkinje system", "correct": false}, {"label": "B", "text": "From AV node to bundle of His", "correct": false}, {"label": "C", "text": "Purkinje to ventricular fibres", "correct": false}, {"label": "D", "text": "From a bundle of His and bundle branches to ventricles", "correct": true}], "correct_answer": "D. From a bundle of His and bundle branches to ventricles", "question_images": ["https://image.prepladder.com/content/rjnkBsSD49nVn2mypGhM1746791299.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man presents with recurrent episodes of chest pain which is seen only on exertion or exercise and lasts 2-5 minutes. He was assessed and was diagnosed with a case of stable angina however his BP was consistently elevated. What is the most appropriate antihypertensive for this patient", "options": [{"label": "A", "text": "Atenolol", "correct": false}, {"label": "B", "text": "Thiazides", "correct": false}, {"label": "C", "text": "Enalapril", "correct": false}, {"label": "D", "text": "Amlodipine", "correct": true}], "correct_answer": "D. Amlodipine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medication Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Function/Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nitrates</strong></p>\n<p>Sublingual <span class=\"customMeta\" data-dictid=\"7cfca041201692777193da668f40be\">nitroglycerin</span> (0.4 or 0.6 mg)</p>\n<p>Long-acting forms (oral, transdermal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic venodilation</li>\n<li>Reduces LV <span class=\"customMeta\" data-dictid=\"437bfd6ffb1692777187b5a7a706d5\">end-diastolic volume</span> and pressure</li>\n<li>Releases <span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\">nitric</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> (NO) to relax <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> smooth muscle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina relief</li>\n<li>Preemptive use before activities</li>\n<li>Improves exercise tolerance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-Blocker</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduces heart rate, arterial pressure, and myocardial contractility</li>\n<li>Improves survival post-MI</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina relief</li>\n<li>Reduces mortality<strong> </strong>and reinfarction rates</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Channel Blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Coronary vasodilators</li>\n<li><strong>Reduces myocardial oxygen demand and arterial pressure</strong></li>\n<li>Dihydropyridines (e.g., <strong>amlodipine</strong>) and non-dihydropyridines (e.g., verapamil)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina treatment when beta-blockers are ineffective</li>\n<li>Variant angina</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiplatelet Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Aspirin</strong>: inhibits <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> activation</li>\n<li><strong>Clopidogrel 75mg</strong>: blocks <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> aggregation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> events in high-risk populations</li>\n<li>Stent placement</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 46-year-old chronic alcoholic male presents to the OPD with fever, headache, shortness of breath, chest pain, and productive cough with red currant jelly sputum for the last two days. On examination, there was bronchial breathing on the right side, increased vocal fremitus, increased vocal resonance, and a dull note on percussion. The patient’s plain radiograph is shown below. Which is the most likely causative agent?", "options": [{"label": "A", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "B", "text": "Klebsiella pneumoniae", "correct": true}, {"label": "C", "text": "Pseudomonas aeruginosa", "correct": false}, {"label": "D", "text": "Haemophilus influenza", "correct": false}], "correct_answer": "B. Klebsiella pneumoniae", "question_images": ["https://image.prepladder.com/content/HhbpqL68lRH92jkT1bph1746791573.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman complains of dryness in her mouth and eyes and has positive anti-Ro and anti-La antibodies. The image below shows a positive test result with a score of less than 5 mm in 5 minutes without anaesthesia. What is the probable diagnosis?", "options": [{"label": "A", "text": "Scleroderma", "correct": false}, {"label": "B", "text": "Dehydration", "correct": false}, {"label": "C", "text": "Lacrimal duct stones", "correct": false}, {"label": "D", "text": "Sjogren syndrome", "correct": true}], "correct_answer": "D. Sjogren syndrome", "question_images": ["https://image.prepladder.com/content/246FctK0etnEp3xkhrgz1746791714.png"], "explanation_images": ["https://image.prepladder.com/content/F80p7spBJ5eaAaoEvY8u1746791767.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 21-year-old woman with no comorbidities presented with numbness and paraesthesia of the fingers of both hands along with the characteristic finding as shown in the image below. She has no other illnesses and she says these episodes occur when she is under excess stress or during cold climates. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Primary Raynaud’s phenomenon", "correct": true}, {"label": "B", "text": "Secondary Raynaud’s phenomenon", "correct": false}, {"label": "C", "text": "Cold sores", "correct": false}, {"label": "D", "text": "Scleroderma", "correct": false}], "correct_answer": "A. Primary Raynaud’s phenomenon", "question_images": ["https://image.prepladder.com/content/xeU7NIuzbvDJetxdXEcT1746792282.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The flow-volume curve of a patient after spirometry is given below. The most likely diagnosis in this patient is:", "options": [{"label": "A", "text": "Asbestosis", "correct": false}, {"label": "B", "text": "COPD", "correct": true}, {"label": "C", "text": "Myasthenia gravis", "correct": false}, {"label": "D", "text": "Vocal cord paralysis", "correct": false}], "correct_answer": "B. COPD", "question_images": ["https://image.prepladder.com/content/TRgds4DVLdshbGr02Ud31746792453.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spirometry/PFTs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Best initial test</li>\n<li>IOC</li>\n<li>Obstructive pattern\n\t\t\t\t<ul>\n<li>Reversible with short-acting β2-agonists (SABAs)</li>\n</ul>\n</li>\n<li>Findings:\n\t\t\t\t<ul>\n<li>FEV1/FVC &lt; 70%</li>\n<li>↓ FEV1</li>\n<li>Normal or ↓ FVC</li>\n<li><strong>↑ Residual Volume (RV) </strong></li>\n<li><strong>↑ Total Lung Capacity (TLC)</strong></li>\n<li>Normal or ↑ Diffusing Capacity of Lung for Carbon Monoxide (DLCO)</li>\n</ul>\n</li>\n<li>Reversibility:\n\t\t\t\t<ul>\n<li>Increase in FEV1 ≥ 12% and &gt;200 mL with SABA (albuterol)</li>\n</ul>\n</li>\n<li>PFTs between exacerbations: Often normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Methacholine Challenge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Tests for bronchial hyperresponsiveness</li>\n<li>Positive if ≥20% decrease in FEV1</li>\n<li>Sensitive but not specific</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Arterial blood gas </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Early\n\t\t\t\t<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> (↓ PaCO2, ↑ pH) due to hyperventilation</li>\n</ul>\n</li>\n<li>Late\n\t\t\t\t<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> due to muscle fatigue (normalizing PaCO2, normalizing pH, ↓ PaO2)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Normal appearance to <span class=\"customMeta\" data-dictid=\"301f9a675d16927771892fb39029d3\">hyperinflation</span> with <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">flattening</span> of the diaphragm</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A postoperative cardiac surgery patient developed sudden hypotension, raised central venous pressure, and pulsus paradoxus at the 4 th postoperative hour. The most probable diagnosis is.", "options": [{"label": "A", "text": "Ventricular dysfunction", "correct": false}, {"label": "B", "text": "Cardiac tamponade", "correct": true}, {"label": "C", "text": "CHF", "correct": false}, {"label": "D", "text": "Excessive mediastinal effusion", "correct": false}], "correct_answer": "B. Cardiac tamponade", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiac Tamponade</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A condition where the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> chambers are compressed by a <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">tense</span> <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion, limiting <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> inflow. Fluid accumulation of as little as 200 ml to upwards of 2 L may lead to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beck's triad</strong></p>\n<ul>\n<li><strong>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Distension</strong>: Due to increased central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure. <strong>Prominent x <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> and an absent y descent.</strong></li>\n<li><strong>Hypotension</strong>: Resulting from impaired <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</li>\n<li><strong>Muffled Heart Sounds</strong>: Caused by fluid accumulation in the <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> space, dampening heart sounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus paradoxus</strong>: A drop in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP during inspiration, greater than 10 mm Hg.</p>\n<p>Causes of <span class=\"customMeta\" data-dictid=\"a507417e891692777196a900bd7993\">Pulsus</span> paradoxus:</p>\n<ul>\n<li><strong>Lung Conditions:</strong> <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> asthma, COPD, tension pneumothorax, pleural effusion, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism.</li>\n<li><strong>Heart Conditions:</strong> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> tamponade, <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">constrictive</span> pericarditis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Low-Pressure <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Tamponade</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This occurs when lower <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> pressure leads to tamponade, often in cases of <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> fluid <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> (e.g., hypovolemia).</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Distension: Often absent</p>\n<p>Pulsus Paradoxus: Rare</p>\n<p>Requires a high degree of suspicion due to the absence of typical signs like <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> distension and <span class=\"customMeta\" data-dictid=\"a507417e891692777196a900bd7993\">pulsus</span> paradoxus.</p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A hepatitis B-positive person came to your OPD on routine urine massive proteinuria (&amp;gt; 3.5 g/day). Further renal biopsy was performed as below. Identify the disease.", "options": [{"label": "A", "text": "Focal segmental glomerulosclerosis", "correct": false}, {"label": "B", "text": "Membranous glomerulonephritis", "correct": true}, {"label": "C", "text": "Membranoproliferative glomerulonephritis", "correct": false}, {"label": "D", "text": "Minimal change disease", "correct": false}], "correct_answer": "B. Membranous glomerulonephritis", "question_images": ["https://image.prepladder.com/content/4lQjkA1DJ0i52C02YaYd1746792742.png"], "explanation_images": ["https://image.prepladder.com/content/nzsX9IlwQVNjYwFA717f1746792818.png", "https://image.prepladder.com/content/64rffmZYbAIIGTmgVEZY1746792831.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male was brought to the emergency room with a history of RTA. GCS progressively declines over hours and axial T2 MRI shows multiple small hypointense lesions at the corticomedullary junction and basal ganglia. What is the diagnosis?", "options": [{"label": "A", "text": "Diffuse axonal injury", "correct": true}, {"label": "B", "text": "Extensive subarachnoid haemorrhage", "correct": false}, {"label": "C", "text": "Hypoxic cerebral injury", "correct": false}, {"label": "D", "text": "Multiple haemorrhagic contusion", "correct": false}], "correct_answer": "A. Diffuse axonal injury", "question_images": ["https://image.prepladder.com/content/tkw3i5GtgaN31KpeAFMn1746792977.png"], "explanation_images": ["https://image.prepladder.com/content/4MXWHw01wm7twIMoUWrv1746793091.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old man collapsed in his house and was rushed to the hospital. On arrival, his ECG tracing was as shown below. Which of the following is the best intervention for this patient?", "options": [{"label": "A", "text": "Use of automated external defibrillator", "correct": false}, {"label": "B", "text": "Injection of vasopressin 40 IU", "correct": false}, {"label": "C", "text": "Injection of Adrenaline 1mg IV", "correct": true}, {"label": "D", "text": "Injection of Atropine 0.5mg IV", "correct": false}], "correct_answer": "C. Injection of Adrenaline 1mg IV", "question_images": ["https://image.prepladder.com/content/iIWthQBAC5LFbNEqHBgL1746793257.png"], "explanation_images": ["https://image.prepladder.com/content/NlhOnVoL0Lzc33xUKrfO1746793322.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Resuscitation Steps for Asystole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1133\" src=\"https://image.prepladder.com/content/NlhOnVoL0Lzc33xUKrfO1746793322.png\" width=\"650\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Visual field testing of a patient revealed the following type of loss. Where is the likely site of lesion in the optic pathway?", "options": [{"label": "A", "text": "Frontal visual field", "correct": false}, {"label": "B", "text": "Occipital lobe", "correct": true}, {"label": "C", "text": "Optic radiation", "correct": false}, {"label": "D", "text": "Optic chiasma", "correct": false}], "correct_answer": "B. Occipital lobe", "question_images": ["https://image.prepladder.com/content/wkWIthvjJUaPpFfKn6ak1746793412.png"], "explanation_images": ["https://image.prepladder.com/content/VfXZEfetmmIq7F5VpNOW1746793477.png", "https://image.prepladder.com/content/rc1uXYhGolmu8yQm7rCS1746793497.png", "https://image.prepladder.com/content/iGvkdjnEfuBrTM3Y7FbW1746793507.png", "https://image.prepladder.com/content/SPf6YkVXhANEMinK9jjp1746793531.png", "https://image.prepladder.com/content/XmnSWm46dbztN7C8mv9Y1746793541.png", "https://image.prepladder.com/content/ohuYAjdKivkLOawVZOdh1746793594.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Visual Pathway Lesions and Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Site of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fibers Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Field Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> + Nasal Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/rc1uXYhGolmu8yQm7rCS1746793497.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Anopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Chiasma</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral Nasal Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"307\" src=\"https://image.prepladder.com/content/iGvkdjnEfuBrTM3Y7FbW1746793507.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Bitemporal Hemianopia</strong></p>\n<p><strong>(Heteronymous Hemianopia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Optic Tract</strong></li>\n<li><strong>Lateral Geniculate Body (LGB Lesion)</strong></li>\n<li><strong>Optic Radiation </strong><strong>(Option C)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + Contralateral Nasal Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"149\" src=\"https://image.prepladder.com/content/SPf6YkVXhANEMinK9jjp1746793531.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Homonymous Hemianopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">Cortex</span> without the involvement of tip</strong></p>\n<p><strong>(Post. Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + Contralateral Nasal Fibers except for <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> representation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/XmnSWm46dbztN7C8mv9Y1746793541.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Homonymous <span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\">Hemianopia</span> with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">Macular</span> Sparing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tip of Visual Cortex</strong></p>\n<p><strong>(Middle Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Macular Representation of Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> and Contralateral Nasal Fibers.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/ohuYAjdKivkLOawVZOdh1746793594.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Macular <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">Homonymous</span> Hemianopia</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a copper-containing enzyme?", "options": [{"label": "A", "text": "Mitochondrial superoxide dismutase", "correct": true}, {"label": "B", "text": "Cytosolic superoxide dismutase", "correct": false}, {"label": "C", "text": "Tyrosinase", "correct": false}, {"label": "D", "text": "Lysyl oxidase", "correct": false}], "correct_answer": "A. Mitochondrial superoxide dismutase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for a 45-year-old male patient with a history of chronic alcoholism, who is currently experiencing symptoms of confusion, ataxia, and diplopia?", "options": [{"label": "A", "text": "Vitamin B1 injection followed by glucose infusion", "correct": true}, {"label": "B", "text": "Glucose infusion followed thiamine injection", "correct": false}, {"label": "C", "text": "Glucose infusion alone", "correct": false}, {"label": "D", "text": "Thiamine infusion alone", "correct": false}], "correct_answer": "A. Vitamin B1 injection followed by glucose infusion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>WERNICKE-KORSAKOFF SYNDROME (CEREBRAL BERI-BERI)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wernicke Encephalopathy:</strong></p>\n<p>Symptoms: Ophthalmoplegia, nystagmus, cerebellar ataxia, global confusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Korsakoff Psychosis:</strong></p>\n<p>Symptoms: Anterograde and <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> amnesia, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> agnosia, and confabulation. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">Thiamine</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> in Alcoholics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> requirements due to alcohol consumption. Alcohol is a source of empty calories.</li>\n<li>Inhibition of intestinal <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> by alcohol.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Implications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Impaired conversion of <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> to acetyl-CoA.</li>\n<li>Accumulation of <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> and <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> in the blood.</li>\n<li>Potential for life-threatening <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progression and Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Progression from Wernicke <span class=\"customMeta\" data-dictid=\"b37b211cbc169277718725f07b5473\">encephalopathy</span> to Korsakoff <span class=\"customMeta\" data-dictid=\"1cb2d1482916927771964c2890313e\">psychosis</span> if untreated.</li>\n<li>Associated with severely compromised nutritional status, often due to chronic alcoholism.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symmetrical T2/FLAIR signal increase in the <span class=\"customMeta\" data-dictid=\"06d33302e016927771911f7ef71255\">mammillary</span> bodies, dorsomedial thalami, tectal plate, <span class=\"customMeta\" data-dictid=\"c51baf41771692777195b4b3432d4b\">periaqueductal</span> area, and around the third ventricle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Phase (Wernicke Encephalopathy)</strong>:</p>\n<ul>\n<li><strong>Intravenous thiamine</strong> (100 mg) for <strong>3-7 days</strong> is standard; however, <strong>higher doses (500 mg TID)</strong> may be required if symptoms persist.</li>\n<li><strong>Glucose</strong> should be administered <strong>after</strong> <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> to prevent exacerbating symptoms.</li>\n</ul>\n<p><strong>Chronic Phase (Korsakoff’s Psychosis)</strong>:</p>\n<ul>\n<li>Continue <strong>oral thiamine</strong> indefinitely, especially in alcohol-dependent patients.</li>\n<li>Address <strong>co-occurring deficiencies</strong>, provide <strong>nutritional support</strong>, and consider <strong>rehabilitation</strong> or <strong>residential care</strong> if needed.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with mental retardation, blindness, and muscle weakness was investigated and was found to be deficient for Hexosaminidase-A enzyme. She is most likely suffering from ..", "options": [{"label": "A", "text": "Krabbe's disease", "correct": false}, {"label": "B", "text": "Fabry's disease", "correct": false}, {"label": "C", "text": "Tay-sachs disease", "correct": true}, {"label": "D", "text": "Gaucher's disease", "correct": false}], "correct_answer": "C. Tay-sachs disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Enzyme deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tay-Sachs disease</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hexosaminidase A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mental retardation</li>\n<li>Blindness</li>\n<li>Muscular weakness</li>\n<li>Cherry red spots in the macula</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fabry disease</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>α-Galactosidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Skin rash</li>\n<li>Kidney failure (full symptoms only in males</li>\n<li>X-linked recessive)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Krabbe disease</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>β-Galactosidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mental retardation</li>\n<li>Near absence of myelin</li>\n<li>Predominant neurological manifestation and <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves causing <span class=\"customMeta\" data-dictid=\"696dd98be71692777185b10993da3e\">deafness</span> and blindness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gaucher disease</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>β-Glucosidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Enlarged liver and spleen</li>\n<li>Erosion of long bones</li>\n<li>Mental <span class=\"customMeta\" data-dictid=\"680dfbc5a5169277719748281f877e\">retardation</span> in infants</li>\n<li>Anemia</li>\n<li>Thrombocytopenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Niemann-Pick disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphingomyelinase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Enlarged liver and spleen</li>\n<li>Mental retardation</li>\n<li>Fatal in early life</li>\n<li>Cherry red spot in macula</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Farber disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ceramidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hoarseness</li>\n<li>Dermatitis</li>\n<li>Skeletal deformation</li>\n<li>Mental retardation</li>\n<li>Fatal in early life</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 14-year-old male, a medical condition has been identified as a result of a defect in a gene responsible for DNA repair. The individual is experiencing increased pigmentation on the skin and is at a heightened risk of developing skin cancers, according to the physician. Which of the following mechanisms is most likely to be impaired in this particular condition?", "options": [{"label": "A", "text": "Nonhomologous end joining repair defect", "correct": false}, {"label": "B", "text": "Nucleotide excision repair defect", "correct": true}, {"label": "C", "text": "DNA base excision repair defect", "correct": false}, {"label": "D", "text": "DNA mismatch repair defect", "correct": false}], "correct_answer": "B. Nucleotide excision repair defect", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ju4qdtjL0Mnz0ahjUFK61746795173.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What diagnostic tool is used to determine the cause of chest pain at rest for 6 hours and an electrocardiogram indicating myocardial ischemia in a patient?", "options": [{"label": "A", "text": "LDH 2", "correct": false}, {"label": "B", "text": "LDH 3", "correct": false}, {"label": "C", "text": "LDH 1", "correct": true}, {"label": "D", "text": "LDH 4", "correct": false}], "correct_answer": "C. LDH 1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Isoenzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Activity at 60°C for 30 minutes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Electrophoretic Mobility at pH 8.6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Tissue of Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Percentage in Human Serum (Mean)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>LDH-1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Not destroyed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Fastest</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Heart muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">30%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>LDH-2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Not destroyed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Faster</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">RBC <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">35%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>LDH-3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Partially destroyed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Fast</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Brain <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>LDH-4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Destroyed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Slow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Liver <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>LDH-5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Destroyed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Slowest</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">Skeletal muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">5%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has come in with bleeding gums and the examination results are as follows. This particular condition can be observed in the case of a deficiency in", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin B12", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": true}, {"label": "D", "text": "Vitamin D", "correct": false}], "correct_answer": "C. Vitamin C", "question_images": ["https://image.prepladder.com/notes/PSn1ysqQItdy14tSwTXQ1747982775.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man presents with a gradual onset of swallowing difficulties for both solid and liquid foods, persisting for 8 months. The barium swallow test results are presented below. The patient undergoes upper gastrointestinal endoscopy and manometry. Which of the following statements is not true regarding this condition?", "options": [{"label": "A", "text": "Loss of lower esophageal sphincter pressure causing reflux", "correct": true}, {"label": "B", "text": "&amp;lt;75% relaxation of the lower esophageal sphincter", "correct": false}, {"label": "C", "text": "It is a primary motility disorder", "correct": false}, {"label": "D", "text": "Esophageal peristalsis is absent", "correct": false}], "correct_answer": "A. Loss of lower esophageal sphincter pressure causing reflux", "question_images": ["https://image.prepladder.com/content/4y3yp49d1lZC9VfxxApT1746975818.png"], "explanation_images": ["https://image.prepladder.com/content/VFPDmBxrNcTSD4sZvN0Q1746975875.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Achalasia cardia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a primary <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> disorder <strong>(Option B ruled out) </strong>characterised by the progressive <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall, which leads to a loss of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the lower <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> and failure of the lower <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> (LES) to relax during swallowing</p>\n<p><strong>(Option A &amp; D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dysphagia: May initially affect liquids more than solids.</li>\n<li>Regurgitation</li>\n<li>Halitosis</li>\n<li>Chest Pain</li>\n<li>Weight Loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Esophageal Manometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gold Standard</strong>: This is the <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test for achalasia. It measures the pressure and pattern of muscle contractions in the esophagus.</p>\n<ul>\n<li>Elevated resting LES pressure (typically &gt; 45 mmHg).</li>\n<li>Incomplete LES relaxation.</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> body.</li>\n<li>Periodic contractions with normal <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> or high <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> contractions (type I and II achalasia).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Swallow (Esophagram)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with a narrowing at the LES (Bird <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">beak</span> appearance/ Pencil tip appearance/ Rat tail appearance).</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Achalasie_Stadium_2.jpg\" data-tags=\"\" height=\"522\" src=\"https://image.prepladder.com/content/VFPDmBxrNcTSD4sZvN0Q1746975875.png\" width=\"281\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endoscopy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> but may show dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with possible food debris. It is important to rule out other causes of dysphagia, such as tumours.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to GCS, a verbal score of 1 indicates:", "options": [{"label": "A", "text": "No Verbal response", "correct": true}, {"label": "B", "text": "Inappropriate words", "correct": false}, {"label": "C", "text": "Incomprehensible sounds", "correct": false}, {"label": "D", "text": "Oriented response", "correct": false}], "correct_answer": "A. No Verbal response", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Simplified Glasgow <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">Coma</span> Scale (GCS) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5 <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the subsequent course of action for managing a 35-year-old woman who has been experiencing swelling in her right groin for the past six months, as determined during her arrival at the emergency department? Upon examination, a reducible hernia is observed in the right groin without any signs of strangulation.", "options": [{"label": "A", "text": "Exploratory laparotomy", "correct": false}, {"label": "B", "text": "Reduce the swelling and later observe", "correct": false}, {"label": "C", "text": "Reduce the swelling and do elective surgery", "correct": true}, {"label": "D", "text": "Do a CT abdomen", "correct": false}], "correct_answer": "C. Reduce the swelling and do elective surgery", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment Approaches for <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lockwood's </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open, Low</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incision below <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> crease, directly over hernia; Elective repair</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>McEvedy's </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open, High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oblique <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> above inguinal ligament</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lotheissen's</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open, High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Access through the inguinal canal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>McVay </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suturing <span class=\"customMeta\" data-dictid=\"c9ac184b521692777185f5b6c8e958\">conjoint tendon</span> to Cooper's ligament</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TEP (Totally Extraperitoneal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Laparoscopic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesh placement without entering the peritoneal cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TAPP (Transabdominal Preperitoneal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Laparoscopic</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesh placement after entering the peritoneal cavity</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the appropriate course of action for managing a 25-year-old male patient who was brought to the emergency department after a road traffic accident (RTA)? The patient has a respiratory rate of 25 breaths per minute and a blood pressure of 80/45 mmHg. During examination, hyper-resonance is detected over the left side of the chest. The provided chest x-ray is shown below.", "options": [{"label": "A", "text": "Wide bore needle insertion in the right 5th ICS", "correct": false}, {"label": "B", "text": "Wide bore needle insertion in the left 5th ICS followed by an intercostal drain", "correct": true}, {"label": "C", "text": "Aspiration of the pleural fluid", "correct": false}, {"label": "D", "text": "No intervention is needed", "correct": false}], "correct_answer": "B. Wide bore needle insertion in the left 5th ICS followed by an intercostal drain", "question_images": ["https://image.prepladder.com/content/h1I8ia9RY9L36DjNKarW1746976251.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:743px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of pneumothoraces:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Spontaneous Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs<strong> without underlying lung disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often due to <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> pleural blebs</li>\n<li>Seen commonly in smokers</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple aspiration</li>\n<li>Thoracoscopy if recurrent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary Spontaneous <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated with <strong>pre-existing lung conditions </strong>(e.g., COPD)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More life-threatening due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> reserve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tube thoracostomy</li>\n<li>Thoracoscopy or <span class=\"customMeta\" data-dictid=\"8126bfda4a1692777195ede6823750\">pleurodesis</span> if needed</li>\n<li>Thoracoscopy with <span class=\"customMeta\" data-dictid=\"3b4c96c9d01692777199d56349e8d8\">stapling</span> of blebs and pleural <span class=\"customMeta\" data-dictid=\"2ff3cc6c8a16927771802154170e4f\">abrasion</span> if surgery is contraindicated</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Traumatic <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs during <strong>mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> or resuscitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It can be <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> (from medical procedures)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tube thoracostomy</li>\n<li>Manage <span class=\"customMeta\" data-dictid=\"4be129c8311692777188780148e955\">hemopneumothorax</span> with dual chest tubes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tension <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">Pneumothorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Results from <strong>physical injury</strong> (blunt or penetrating)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Positive pressure in pleural space</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> compromise</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Emergency treatment with large bore needle <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> followed by thoracostomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man presented to his primary care physician with a 3-month history of increasing urinary frequency without burning and nocturia four times each day. He has limited his fluid consumption and caffeine intake in the evening without much benefit. On prostate examination, the swelling was palpated with a smooth surface, and a firm, non-tender rubber-like consistency was found. The physician thinks of benign prostate hypertrophy. All are characteristic features of benign prostate hypertrophy except:", "options": [{"label": "A", "text": "Increased trabeculations in the bladder", "correct": true}, {"label": "B", "text": "J-shaped/ fish hook proximal ureter", "correct": false}, {"label": "C", "text": "J-shaped/ fish hook distal ureters", "correct": false}, {"label": "D", "text": "Bilateral hydronephrosis", "correct": false}], "correct_answer": "A. Increased trabeculations in the bladder", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Benign <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">Hyperplasia</span> (BPH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age affected: <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">Men</span> over 50 years</li>\n<li>After 60 years, 50% of <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> have <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> evidence of BPH.</li>\n<li>Common cause of significant lower <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> symptoms (LUTS) in men: BPH</li>\n<li>Common cause of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outflow <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (BOO) in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> more than 70 years of age: BPH</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Role of hormones in BPH:</strong>\n<ul>\n<li><strong>DHT (Dihydrotestosterone)</strong>\n<ul>\n<li>DHT, derived from <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> via 5-alpha reductase, binds to <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> receptors in the prostate, promoting <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> and contributing to prostatic enlargement.</li>\n</ul>\n</li>\n<li><strong>Estrogen</strong>\n<ul>\n<li>Estrogen levels increase relative to <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> in ageing men, influencing <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> growth through the <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> receptors, particularly ER-α, in the prostatic tissue.</li>\n</ul>\n</li>\n</ul>\n</li>\n<li>Affects both <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> and <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> to variable degrees.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common site of origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Submucosal glands of the <span class=\"customMeta\" data-dictid=\"9f0c1a99081692777195efa0fd76d0\">periurethral</span> <strong>transitional zone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary changes in the bladder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is due to increased force of <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of <span class=\"customMeta\" data-dictid=\"80d318a6701692777186805934d86a\">detrusor</span> muscles):</p>\n<ul>\n<li>Collagen deposition</li>\n<li>Detrusor muscle hyperplasia</li>\n<li>Detrusor muscle hypertrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Obstructive symptoms:</strong>\n<ul>\n<li>Poor flow/stream</li>\n<li>Hesitancy</li>\n<li>Intermittency</li>\n<li>Incomplete voiding-High post-void <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> urine</li>\n<li>Dribbling of urine</li>\n</ul>\n</li>\n<li><strong>Irritative symptoms:</strong>\n<ul>\n<li>Frequency</li>\n<li>Urgency</li>\n<li>Nocturia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Retention</li>\n<li>Haematuria</li>\n<li>Urinary infection</li>\n<li>Stone formation</li>\n<li>Hydronephrosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient experiencing excessive bleeding, with limbs displaying low temperature and reduced central venous pressure (CVP), what type of shock is observed?", "options": [{"label": "A", "text": "Cardiogenic shock", "correct": false}, {"label": "B", "text": "Hypovolemic shock", "correct": true}, {"label": "C", "text": "Obstructive shock", "correct": false}, {"label": "D", "text": "Hypo adrenal shock", "correct": false}], "correct_answer": "B. Hypovolemic shock", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6nTSx6ZBX659oD8ShHHt1746976815.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:415px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathophysiology of Hypovolemic shock</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"602\" src=\"https://image.prepladder.com/content/6nTSx6ZBX659oD8ShHHt1746976815.png\" width=\"602\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Physiological Hemodynamic Characteristics of Shock</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiac Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Vascular Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Central Venous Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mean Arterial Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distributive(Septic, anaphylactic, neurogenic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ or N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Obstructive (pulmonary embolism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, tension pneumothorax)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common site of peripheral aneurysm?", "options": [{"label": "A", "text": "Brachial artery", "correct": false}, {"label": "B", "text": "Popliteal artery", "correct": true}, {"label": "C", "text": "Radial artery", "correct": false}, {"label": "D", "text": "Femoral artery", "correct": false}], "correct_answer": "B. Popliteal artery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is absent in cases of massive blood transfusion?", "options": [{"label": "A", "text": "DIC", "correct": false}, {"label": "B", "text": "Febrile transfusion reaction", "correct": false}, {"label": "C", "text": "Hypercalcemia", "correct": true}, {"label": "D", "text": "Thrombocytopenia", "correct": false}], "correct_answer": "C. Hypercalcemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complications of massive blood transfusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypothermia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transfusion of cold blood (stored at 4°C).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Body temperature drops, leading to impaired <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> mechanisms (coagulopathy), and worsening bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coagulopathy</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilution of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors and platelets due to transfusion; consumption of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors by ongoing haemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired blood clotting, prolonged <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> time, thrombocytopenia, and increased risk of continued bleeding.</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DIC</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to the release of <span class=\"customMeta\" data-dictid=\"ff2094828c1692777196941a65e6eb\">procoagulant</span> substances</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leads to haemorrhage due to depleted <span class=\"customMeta\" data-dictid=\"7414bd02f216927771889b3e159ef4\">hemostatic</span> components, tissue hypoxia, and <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> due to microthrombi, or both.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Citrate Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large volumes of transfused blood contain citrate, which binds to calcium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypocalcemia leads to muscle cramps, seizures, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypocalcemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Packed red blood cells (PRBCs) and other blood products are preserved with <strong>citrate</strong>, an anticoagulant.</li>\n<li>Citrate binds to <strong>ionised calcium</strong> (Ca²⁺) in the recipient's blood, reducing the free <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> level - <strong>hypocalcemia</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presents as muscle spasms, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, and decreased myocardial contractility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium leaks from stored red blood cells into <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels (hyperkalemia) can cause <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, potentially leading to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypokalemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium may shift intracellularly once transfused red blood cells are metabolically revived.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypokalemia causes muscle weakness, paralysis, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> of <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> into bicarbonate.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased pH (alkalosis) can lead to muscle twitching, irritability, and impaired oxygen release from haemoglobin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inadequate tissue <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> leads to <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acid accumulation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lowered blood pH (acidosis) leads to confusion, fatigue, rapid breathing, and worsened <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Lung Injury (TRALI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibodies in transfused blood <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> the recipient's immune response, causing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fluid buildup in the lungs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema, presenting as <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> with <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> within 6 hours of transfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Associated Circulatory <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">Overload</span> (TACO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Volume of transfused blood exceeds the patient’s capacity to manage, leading to fluid overload.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary oedema, shortness of breath, hypertension, and signs of heart failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iron Overload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repeated transfusions lead to excessive accumulation of iron.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iron deposits in organs (e.g., liver, heart, pancreas), lead to organ damage and failure over time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemolytic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ABO or Rh incompatibility.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid destruction of red blood cells (hemolysis), causes fever, chills, hemoglobinuria, and potentially <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure or shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Allergic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reaction to proteins in transfused blood products.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms range from mild itching, rash, or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> to severe <span class=\"customMeta\" data-dictid=\"d6d717efa216927771819fee139235\">anaphylaxis</span> (airway constriction, low blood pressure, shock).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bacterial Contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood products are contaminated during collection or storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sepsis, characterized by fever, chills, low blood pressure, and possibly <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Febrile <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> reaction</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a non-hemolytic condition that is not completely understood but is believed to be caused by <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> white blood cells in the blood unit or cytokines that accumulate during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fever, rigour, chills</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a hypotensive patient with a head injury, which of the subsequent fluids should be avoided?", "options": [{"label": "A", "text": "0.9% NS", "correct": false}, {"label": "B", "text": "5% Dextrose", "correct": true}, {"label": "C", "text": "Ringer lactate", "correct": false}, {"label": "D", "text": "3% saline", "correct": false}], "correct_answer": "B. 5% Dextrose", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The likely diagnosis for a newborn infant presenting with signs of intestinal obstruction, as indicated by the x-ray image and CT abdomen showing an annular pancreas, is:", "options": [{"label": "A", "text": "Jejunoileal atresia", "correct": false}, {"label": "B", "text": "Esophageal atresia", "correct": false}, {"label": "C", "text": "Duodenal atresia", "correct": true}, {"label": "D", "text": "Colonic atresia", "correct": false}], "correct_answer": "C. Duodenal atresia", "question_images": ["https://image.prepladder.com/content/Q6bErUC36xNmsINRI6Wl1746982676.png"], "explanation_images": ["https://image.prepladder.com/content/cBSeIGAyPNgQrNKTBZc01746982718.png", "https://image.prepladder.com/notes/pkRanHgtOVTzL1yR4reL1747998288.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Duodenal Atresia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Failed recanalisation of intestinal <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> during gestation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prematurity (50%)</li>\n<li>Congenital anomalies (heart disease, malrotation, <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> pancreas, etc.)</li>\n<li>Chromosomal abnormalities (e.g., <span class=\"customMeta\" data-dictid=\"5e54fdc4d3169277720003f231621d\">trisomy</span> 21)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bilious <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> without <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distention.</li>\n<li>Symptoms typically present within the first few days of life.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Confirmed by the<strong> double bubble sign</strong> on the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> and <span class=\"customMeta\" data-dictid=\"d554413593169277719693b8e38638\">prenatal</span> ultrasonography.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial:</strong> Nasogastric <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> and IV fluids</li>\n<li><strong>Definitive:</strong> Surgical repair<strong> (Duodenoduodenostomy)</strong></li>\n<li><strong>Postoperative care:</strong> Gastrostomy tube, nutritional support</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A factory worker working in a plastic pipe factory presented to the OPD with weight loss and right upper quadrant abdominal pain for 6 months duration. He had hepatomegaly. Further investigation revealed that most of the liver was replaced by a hemorrhagic tumour with extensive necrosis. What can be the likely diagnosis in this case?", "options": [{"label": "A", "text": "Cavernous hemangioma", "correct": false}, {"label": "B", "text": "Metastatic carcinoma of the liver", "correct": false}, {"label": "C", "text": "Angiosarcoma of the liver", "correct": true}, {"label": "D", "text": "Primary hepatocellular carcinoma", "correct": false}], "correct_answer": "C. Angiosarcoma of the liver", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hepatic Angiosarcoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is a <strong>high-grade <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> </strong>that arises from the endothelial cells lining blood vessels or <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> channels.</li>\n<li>It is the <strong>most common sarcoma</strong> arising in the liver, especially in those with significant exposure to <strong>Vinyl chloride.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Men and elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Arsenic,</li>\n<li>Radiation,</li>\n<li>Thorium <span class=\"customMeta\" data-dictid=\"0bd01a042116927771868e3482910e\">dioxide</span> (Thorotrast)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It can spread through <strong>lymphatic and <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> routes</strong>, but due to the tumour's <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> nature, <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> spread (via blood vessels) is more common.</li>\n<li>The<strong> liver and lungs</strong> are common sites of metastasis, reflecting the tumour's aggressive nature</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It presents as a <strong>red-brown, indurated, and ulcerated skin lesion. </strong></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who underwent Nissen’s fundoplication was seen in the ward during evening rounds. He is asymptomatic at present and has stable vitals. What is the next line of management for this patient?", "options": [{"label": "A", "text": "Nasogastric tube to prevent gas bloat syndrome", "correct": false}, {"label": "B", "text": "Insert chest tube to prevent pneumothorax", "correct": false}, {"label": "C", "text": "Monitor vitals", "correct": true}, {"label": "D", "text": "Imaging to rule out perforation", "correct": false}], "correct_answer": "C. Monitor vitals", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management of GERD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lifestyle Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevate the head of the bed</li>\n<li>Avoid lying down after meals</li>\n<li>Quit smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Antacids: </strong>Neutralize stomach acid</li>\n<li><strong>H2-receptor antagonists: </strong>Ranitidine, Famotidine</li>\n<li><strong>Proton pump inhibitors (PPIs): </strong>Omeprazole, Esomeprazole</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antireflux operation: </strong>3 components</p>\n<ul>\n<li>Restoration of the <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> segment of the esophagus</li>\n<li>Crural repair</li>\n<li>Reinforcement of the <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> by the upper stomach or prosthesis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fundoplication: </strong>A <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedure to wrap the top of the stomach around the lower <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> to strengthen the sphincter.</p>\n<ul>\n<li><strong>Complete <span class=\"customMeta\" data-dictid=\"5ef90c9b94169277720333361d520e\">fundoplication</span> (Nissen)</strong></li>\n<li><strong>Partial fundoplication: Posteriorly (Toupet) or Anteriorly(Dor, Watson)</strong> has few short-term side effects but has a higher long-term failure rate.</li>\n<li><strong>Transoral Incisionless <span class=\"customMeta\" data-dictid=\"5ef90c9b94169277720333361d520e\">Fundoplication</span> (TIF): </strong>An <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> procedure performed through the mouth but may be less effective for severe GERD and not suitable for all patients.</li>\n<li><strong>Magnetic <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">Sphincter</span> Augmentation (LINX Device): </strong>Involves implanting a ring of magnetic beads around the lower oesophagal <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> to enhance its function and prevent reflux.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following do not require instruments to examine?", "options": [{"label": "A", "text": "Acute anal fissure", "correct": true}, {"label": "B", "text": "Carcinoma rectum", "correct": false}, {"label": "C", "text": "Hemorrhoids", "correct": false}, {"label": "D", "text": "Rectal polyp", "correct": false}], "correct_answer": "A. Acute anal fissure", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rectal exam findings on external and internal inspection:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>External Inspection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Internal Inspection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anal fissures</li>\n<li>Anal fistula</li>\n<li>Genital warts</li>\n<li>External haemorrhoids</li>\n<li>Pilonidal sinus</li>\n<li>Skin disease (seborrhoeic eczema, skin cancer, natal <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> dermatitis)</li>\n<li>Skin tags</li>\n<li>Skin discoloration with Crohn's disease</li>\n<li>Rectal prolapse</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Internal haemorrhoids</li>\n<li>Rectal carcinoma</li>\n<li>Rectal polyps</li>\n<li>Tenderness with <span class=\"customMeta\" data-dictid=\"bf8668fa0e16927771965fbed47263\">prostatitis</span> or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> appendicitis</li>\n<li>Malignant or <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions of the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> with <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> palpation</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the incision marked as B", "options": [{"label": "A", "text": "Gridiron incision", "correct": false}, {"label": "B", "text": "Lanz incision", "correct": true}, {"label": "C", "text": "Rutherford - Morison incision", "correct": false}, {"label": "D", "text": "Rockey-Davis incision", "correct": false}], "correct_answer": "B. Lanz incision", "question_images": ["https://image.prepladder.com/content/0u6r7dcuV0qKd3hIuKGA1746983253.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of Incisions used for appendicectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Name of the incision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incision area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of incision</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>McBurney's incision</strong></p>\n<p>(A in the image)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Centered on McBurney's point, perpendicular to the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> ASIS line</li>\n<li>Junction of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 1/3 from <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> &amp; <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> 2/3 from ASIS</li>\n<li>McBurney's point corresponds to the base of the appendix</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> incision</li>\n<li>Aka Grid iron <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> / McArthur <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lanz incision</strong></p>\n<p>(B in the image)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placed transversely 2 cm below the <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> on the line joining the midpoint of the <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> to the midpoint of the inguinal ligament</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscle <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> incision</li>\n<li>Cosmetically better incision</li>\n<li>Aka Modified McBurney's <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> / Rocky Davis <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> <strong>(Option D ruled out)</strong> / Bikini <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> (good <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rutherford-Morrison incision</strong></p>\n<p>(C in the image)</p>\n<p><strong>(Option C ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extension of McBurney's <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> for retrocecal appendicitis.</li>\n<li>Upward &amp; laterally by cutting the conjoint tendon.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscle cutting incision</li>\n<li>Preferred for retrocecal appendix</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about carcinoid tumours in the appendix is false?", "options": [{"label": "A", "text": "Size appears to be the best predictor of malignant behaviour and metastatic potential", "correct": false}, {"label": "B", "text": "Arise from Kulchitsky cells of the crypts of Leiberkuhn", "correct": false}, {"label": "C", "text": "Most common location is the base of the appendix", "correct": true}, {"label": "D", "text": "Most common tumor of the appendix", "correct": false}], "correct_answer": "C. Most common location is the base of the appendix", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Carcinoid tumor of the <span class=\"customMeta\" data-dictid=\"b790a83bb41692777181cc3c0232af\">appendix</span> (aka Argentaffinoma)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n<p><strong>(Options A &amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>They are <strong>neuroendocrine tumours</strong> that originate from the <strong>enterochromaffin cells</strong> (also known as<strong> Kulchitsky cells</strong>) of the <strong>crypts of Lieberkuhn</strong>.</li>\n<li>They are considered the most common tumours of the appendix.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MC Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tip of the appendix</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mostly discovered incidentally during surgery</p>\n<p>Larger tumours may cause <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, flushing, and diarrhoea due to hormone secretion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormone Secretion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Secretes <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> and other <span class=\"customMeta\" data-dictid=\"1059a0d9031692777201a8d8debd5e\">vasoactive</span> substances.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk of Metastasis</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low for tumours &lt;2 cm</li>\n<li>Higher for tumours&gt;2 cm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confirmed by histopathological examination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>&lt;2 cm</strong>: Appendectomy</li>\n<li><strong>&gt;2 cm</strong>: Right hemicolectomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young sheep farmer presents to the OPD with pain in the right upper part of the abdomen. Upon examination, there was tenderness and enlargement of the liver. Blood investigations show eosinophilia, elevated liver enzymes, and abdominal ultrasound, as shown below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Amoebic liver abscess", "correct": false}, {"label": "B", "text": "Hydatid cyst", "correct": true}, {"label": "C", "text": "Pyogenic liver abscess", "correct": false}, {"label": "D", "text": "Hepatocellular carcinoma", "correct": false}], "correct_answer": "B. Hydatid cyst", "question_images": ["https://image.prepladder.com/content/9vf2nMRm75wHpTuO2cyP1746983419.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hydatid cyst</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Echinococcus granulosus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Commonly Affected Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Liver (most common site, about 60-70% of cases)</li>\n<li>Lungs (second most common site)</li>\n<li>Other organs (rare but possible): Brain, spleen, kidneys, bones, and peritoneum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asymptomatic Phase: </strong>Common due to slow <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> growth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptomatic Phase:</strong></p>\n<ul>\n<li>Liver Involvement: Mostly right lobe; Abdominal pain, hepatomegaly, obstructive jaundice, <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> hypertension.</li>\n<li>Lung Involvement: Cough, chest pain, dyspnea, hemoptysis, pneumothorax.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging Studies:</strong></p>\n<ul>\n<li><strong>USG</strong> is the first-line <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> modality, particularly for liver involvement.\n\n\t\t\t\t<ul>\n<li><strong>Features: </strong>Echinococcal <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> wall shows double <span class=\"customMeta\" data-dictid=\"91b98150ea169277718629280d911c\">echogenic</span> lines separated by a <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> layer (double contour)</li>\n</ul>\n</li>\n<li><strong>CT Scan</strong></li>\n<li><strong>MRI</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serological Tests:</strong></p>\n<ul>\n<li>ELISA</li>\n<li>Immunoblotting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other tests:</strong></p>\n<ul>\n<li>Casoni Intradermal Test</li>\n<li>ARC5 Immunoelectrophoresis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:582px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>WHO Classification of Hydatid cyst</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cyst Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilocular Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> and no visible <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CE1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Simple Active Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Double-line sign</strong>; well-defined <span class=\"customMeta\" data-dictid=\"acb59b05f31692777181d2df5f618b\">anechoic</span> cyst</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CE2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multivesicular Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Honeycomb appearance: </strong>Visible <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> wall and internal septations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CE3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transitional Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Have detached <span class=\"customMeta\" data-dictid=\"60871f0132169277719130bf2568f0\">laminar</span> membranes or may be partially collapsed and floating within the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> (<strong>Water-lily sign</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CE4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactive Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-homogenous mass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CE5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactive Cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cyst with a thick calcified wall</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A car driver was brought into the A &amp;amp; E following a RTA with complaints of breathlessness. On examination, his vitals are PR-112/min, BP-100/70, SpO2-90 %, and there is extensive bruising on his chest. What is the management of this patient?", "options": [{"label": "A", "text": "Chest tube drainage", "correct": true}, {"label": "B", "text": "24% oxygen", "correct": false}, {"label": "C", "text": "IPPV", "correct": false}, {"label": "D", "text": "Internal operative fixation of the fracture’s segments", "correct": false}], "correct_answer": "A. Chest tube drainage", "question_images": ["https://image.prepladder.com/content/JvtCrMXOc4WSXSsc3FWi1746983600.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:633px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Flail chest </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It occurs when<strong> three or more consecutive ribs</strong> are fractured in at least <strong>two places</strong>, creating a <span class=\"customMeta\" data-dictid=\"3dec14fe921692777202dc55958a46\">flail</span> segment that moves independently.</li>\n<li>It exhibits <strong>paradoxical chest movement</strong> (inwards during <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> &amp; outwards during exhalation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypoventilation: Reduced lung <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> leads to low oxygen and high CO₂ levels.</li>\n<li>Mediastinal Flutter: Abnormal <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> movement risks sudden <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</li>\n<li>Pendular Air Movement: Inefficient air exchange between lungs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hemothorax: Blood in the chest cavity.</li>\n<li>Pneumothorax: Air in the chest cavity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ventilation Support:\n\t\t\t\t<ul>\n<li><strong>Oxygen supplementation and Analgesics- </strong>Initial management</li>\n<li><strong>IPPV</strong> is the preferred TOC.</li>\n<li><strong>Tracheostomy</strong> if support exceeds 10 days.</li>\n</ul>\n</li>\n<li>Injury Management:\n\t\t\t\t<ul>\n<li><strong>Intercostal Tube Drainage</strong>: Removes air/fluids from the pleural space.</li>\n<li><strong>Rib Fixation</strong>: Stabilises the chest wall.</li>\n</ul>\n</li>\n<li>Supportive Care:\n\t\t\t\t<ul>\n<li><strong>Blood Transfusions</strong>: For blood loss.</li>\n<li><strong>IV Fluids</strong>: For hydration.</li>\n<li><strong>Antibiotics</strong>: To prevent infection.</li>\n<li><strong>Medications</strong>: Bronchodilators and steroids.</li>\n</ul>\n</li>\n<li>Thoracotomy:\n\t\t\t\t<ul>\n<li>Considered in severe cases</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following tests would a surgeon advise first in a patient with a large thyroid swelling?", "options": [{"label": "A", "text": "Ultrasound of the neck", "correct": true}, {"label": "B", "text": "FNAC", "correct": false}, {"label": "C", "text": "Biopsy", "correct": false}, {"label": "D", "text": "Radioiodine uptake", "correct": false}], "correct_answer": "A. Ultrasound of the neck", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NfwDhGcurpb9NR63k0fZ1746983730.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a tumour marker of pancreatic cancer?", "options": [{"label": "A", "text": "NSE", "correct": false}, {"label": "B", "text": "Alpha-Fetoprotein", "correct": false}, {"label": "C", "text": "Ca 15-3", "correct": false}, {"label": "D", "text": "CA 19-9", "correct": true}], "correct_answer": "D. CA 19-9", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tumor markers</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor marker</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha-fetoprotein</strong></p>\n<p><strong>(AFP)</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hepatocellular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (HCC)</li>\n<li>Hepatoblastoma</li>\n<li>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> tumour (endodermal <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tumour)</li>\n<li>Nonseminomatous <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumour of testis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>↑ AFP: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall defects, <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects</li>\n<li>↓ AFP: associated with <span class=\"customMeta\" data-dictid=\"5e54fdc4d3169277720003f231621d\">trisomy</span> 21, 18, and 13</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>β-HCG</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nonseminomatous testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumours (choriocarcinoma, embryonal cell carcinoma, mixed <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumour, seminoma)</li>\n<li>Ovarian cancer: <span class=\"customMeta\" data-dictid=\"209abd0cee16927771843bab0de87c\">choriocarcinoma</span> (gestational trophoblastic disease)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (CEA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Colorectal cancer</li>\n<li>Pancreatic cancer</li>\n<li>Breast cancer</li>\n<li>Lung cancer (especially in non-small cell cancers)</li>\n<li>Gastric cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prostate-specific <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (PSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prostate cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Benign prostatic hyperplasia</li>\n<li>Prostatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcitonin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer (both <span class=\"customMeta\" data-dictid=\"a325d0c14e16927771992fe8a96758\">sporadic</span> and associated with MEN 1 and MEN 2)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alkaline phosphatase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastases to bone or liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paget disease of the bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Placental <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seminoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lactate dehydrogenase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovarian cancer (dysgerminoma)</li>\n<li>Testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumours (both <span class=\"customMeta\" data-dictid=\"0b7129b26c16927771988bb64b78ef\">seminoma</span> and nonseminoma)</li>\n<li>Lymphomas</li>\n<li>Ewing's sarcoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuron specific <span class=\"customMeta\" data-dictid=\"92417be2b316927771877be984d041\">enolase</span> (NSE)</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neuroendocrine tumors</li>\n<li>Small cell lung cancer</li>\n<li>Carcinoid tumour</li>\n<li>Neuroblastoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CA 19–9 (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pancreatic adenocarcinoma</li>\n<li>Colon cancer</li>\n<li>Cholangiocarcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CA 15–3 and CA 27–29 (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breast cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CA 125 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovarian carcinoma</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"29c037b45616927771886c286ed45b\">gynecologic</span> malignancies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S-100 protein (S100A) and (S100B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malignant melanoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>SMRP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesothelioma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man presents to OPD with a low backache. His PSA level is 100 ng/ml. Which of the following drugs is indicated for treatment?", "options": [{"label": "A", "text": "Somatostatin", "correct": false}, {"label": "B", "text": "Terlipressin", "correct": false}, {"label": "C", "text": "Goserelin", "correct": true}, {"label": "D", "text": "Testosterone", "correct": false}], "correct_answer": "C. Goserelin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CA <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Strategy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Active Surveillance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For low-risk cases; regular monitoring</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radical Prostatectomy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery for <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> cancer; potentially curative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiation Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-energy rays; external or brachytherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormone Therapy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduces/block testosterone; for advanced/metastatic cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systemic drug treatment; for advanced/metastatic cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common primary source of metastasis to the brain is:", "options": [{"label": "A", "text": "Thyroid", "correct": false}, {"label": "B", "text": "Lung", "correct": true}, {"label": "C", "text": "Liver", "correct": false}, {"label": "D", "text": "Breast", "correct": false}], "correct_answer": "B. Lung", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What kind of thyroid cancer is frequently linked to prior radiation exposure, elevated RET/PTC rearrangements, and BRAF mutations?", "options": [{"label": "A", "text": "Follicular carcinoma", "correct": false}, {"label": "B", "text": "Papillary carcinoma", "correct": true}, {"label": "C", "text": "Anaplastic carcinoma", "correct": false}, {"label": "D", "text": "Medullary carcinoma", "correct": false}], "correct_answer": "B. Papillary carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gVk5ZzzZRApuS5GHmqV51746984072.png", "https://image.prepladder.com/content/yAhfUzPeMqqZDrLrQitD1746984072.png", "https://image.prepladder.com/content/iaqXf3BHa234DAQa0ocq1746984073.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:753px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Papillary </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Follicular</strong></p>\n<p><strong>(Option A ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Medullary </strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anaplastic</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follicular cells</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follicular cells</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Para <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> cells</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follicular cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Radiation </strong></li>\n<li>Thyroglossal cyst</li>\n<li>Hashimoto’s thyroiditis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Iodine deficiency</li>\n<li>Multinodular goitre</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BRAF, RET-PTC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PAX-8,/PPAR-1, PTEN, P-53, RAS</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>RET, <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>P53</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seen in the 3rd to 4th decade.</li>\n<li>Midline <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of the neck</li>\n<li>Occasionally, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> is seen.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seen in the 5th to 6th decade.</li>\n<li>A sudden increase in the size of the swelling</li>\n<li>Minimal or no pain</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Raised calcitonin.</li>\n<li>History of diarrhoea</li>\n<li>Family history of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> or hyperparathyroidism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphatic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hematogenous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both and Direct invasion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Optically clear <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> (Orphan Annie eye nuclei)</li>\n<li>Dystrophic <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> (Psammoma bodies)</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"KGH \" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Thyroid_papillary_carcinoma_histopathology_%282%29.jpg\" data-tags=\"\" height=\"180\" src=\"https://image.prepladder.com/content/gVk5ZzzZRApuS5GHmqV51746984072.png\" width=\"239\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follicles (multiple <span class=\"customMeta\" data-dictid=\"e2071f8f891692777203982b3fa0f5\">foci</span> are seen)</p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Follicular_thyroid_cancer#/media/File:Follicular_thyroid_carcinoma_2_--_low_mag.jpg\" data-tags=\"\" height=\"179\" src=\"https://image.prepladder.com/content/yAhfUzPeMqqZDrLrQitD1746984072.png\" width=\"264\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Amyloid deposition</p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Medullary_thyroid_carcinoma_-_2_-_high_mag.jpg#/media/File:Medullary_thyroid_carcinoma_-_low_mag.jpg\" data-tags=\"\" height=\"177\" src=\"https://image.prepladder.com/content/iaqXf3BHa234DAQa0ocq1746984073.png\" width=\"261\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Highly <span class=\"customMeta\" data-dictid=\"d391ed597c1692777195574de6cc11\">pleomorphic</span> cells, <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> cells, giant cells, often areas of <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and mitotic figures.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent a laparoscopic cholecystectomy for cholelithiasis. A picture of the resected gall bladder is shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Gall bladder carcinoma", "correct": true}, {"label": "B", "text": "Mixed stone in gallbladder", "correct": false}, {"label": "C", "text": "Cholecystitis", "correct": false}, {"label": "D", "text": "Choledocholithiasis", "correct": false}], "correct_answer": "A. Gall bladder carcinoma", "question_images": ["https://image.prepladder.com/notes/AcNnhAngRLRwGNGbXQoW1747998454.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gall <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gallstones, (The risk of developing <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> disease is 7-10 times higher than in the general population)</li>\n<li>Porcelain gallbladder,</li>\n<li>PSC,</li>\n<li>Abnormal pancreatic-biliary junction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often indistinguishable from <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> diseases</li>\n<li>Symptoms include:\n\t\t\t\t<ul>\n<li>Biliary colic</li>\n<li>Cholecystitis (especially in older individuals)</li>\n<li>Jaundice (late-stage)</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"d4a253810c1692777181f708ba3dc6\">appetite</span> (late-stage)</li>\n<li>Palpable mass (late-stage)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Non-specific indicators:\n\t\t\t\t<ul>\n<li>Anemia</li>\n<li>Leukocytosis</li>\n<li>Slight increase in transaminases</li>\n</ul>\n</li>\n<li>Tumor markers:\n\t\t\t\t<ul>\n<li>Elevated CA19-9</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"11b3cfa9a31692777183e48dccbc39\">carcinoembryonic</span> <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (in ~80% of patients)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasonography (USG):</strong> Initial diagnosis</li>\n<li><strong>CT Scans:</strong> Thorax, abdomen, and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> for confirmation and staging</li>\n<li><strong>MRI/MRCP:</strong> For accurate <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">preoperative</span> staging</li>\n<li><strong>PET Scans:</strong> To identify metastatic disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Staging &amp; Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Preoperative Staging: </strong>Crucial to assess local disease extent and rule out distant metastases</li>\n<li><strong>Percutaneous Biopsy:</strong> Guided by radiological <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for unresectable tumours</li>\n<li><strong>Laparoscopic Examination:</strong> Detects peritoneal or liver <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> that preclude surgery</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old morbidly obese male patient presented with complaints of severe abdominal pain and urinary disturbances. His urine microscopy shows the following type of crystals, and an ultrasound of the kidney revealed a renal stone of size 2.5 cm. What is the treatment of choice?", "options": [{"label": "A", "text": "Extracorporeal shockwave lithotripsy (ESWL)", "correct": false}, {"label": "B", "text": "Percutaneous nephrolithotomy (PCNL", "correct": true}, {"label": "C", "text": "Open surgery", "correct": false}, {"label": "D", "text": "Ureteroscopy-assisted removal", "correct": false}], "correct_answer": "B. Percutaneous nephrolithotomy (PCNL", "question_images": ["https://image.prepladder.com/content/CRSE7iYKkoQg7He2UqDu1746984644.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Analgesics</strong> like diclofenac, ketorolac, tramadol</li>\n<li><strong>Fluid therapy:</strong> IVF (intravenous fluids) are administered to prevent dehydration</li>\n<li><strong>Alpha 1 blocker:</strong> Tamsulosin (relaxes <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> and expels the stone).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Extracorporeal shock wave <span class=\"customMeta\" data-dictid=\"6713a50e721692777191903bb2160c\">lithotripsy</span> (ESWL): </strong>Indicated if the size of the calculi<strong> &lt;2 cm</strong>. <strong>(Contraindicated in pregnancy and <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> diathesis)</strong>.<strong> (Option A ruled out)</strong></li>\n<li><strong>PCNL (Percutaneous nephrolithotomy): </strong>If the size is <strong>&gt;2 cm</strong>. <strong>(Option B)</strong></li>\n<li><strong>Ureteroscopy </strong></li>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"544d770dfc1692777190622242d004\">intrarenal</span> surgery</strong></li>\n<li>Pyelolithotomy and <span class=\"customMeta\" data-dictid=\"5dda24df28169277719383e298df18\">nephrolithotomy</span> (rarely used).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most common type of gastric sarcoma:", "options": [{"label": "A", "text": "GIST", "correct": true}, {"label": "B", "text": "Liposarcoma", "correct": false}, {"label": "C", "text": "Leiomyosarcoma", "correct": false}, {"label": "D", "text": "Epithelioid sarcoma", "correct": false}], "correct_answer": "A. GIST", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gastrointestinal stromal tumour (GIST)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mutations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common-<strong> c-KIT/CD117</strong></li>\n<li>Others:\n\t\t\t\t<ul>\n<li>PDGFR- beta</li>\n<li><strong>S</strong>uccinate <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> (SDH)- <strong>S</strong>mall baby( Pediatric GIST)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mechanism</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>KIT (c-kit) </strong>is a <span class=\"customMeta\" data-dictid=\"07aa4138b11692777196389334280a\">proto-oncogene</span> <span class=\"customMeta\" data-dictid=\"b989cb3b0d1692777187dd7965b4d3\">encoding</span> a<strong> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> tyrosine kinase. </strong>Mutations result in constant <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of KIT signalling, driving tumour growth and survival.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common Locations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Stomach:</strong> 60-70% of cases.</li>\n<li><strong>Small Intestine:</strong> 20-30%.</li>\n<li><strong>Other Areas:</strong> Colon, rectum, and <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> (less common).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">Kinase</span> inhibitors <strong>- Imatinib</strong></li>\n<li>Surgical management</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to Weigert Meyer’s rule of duplication of the ureter, the lower pole ureter in the urinary bladder is:", "options": [{"label": "A", "text": "Lateral and cephalad to the upper pole ureter", "correct": true}, {"label": "B", "text": "Lateral and caudal to the upper pole ureter", "correct": false}, {"label": "C", "text": "Medial and cephalad to the upper pole ureter", "correct": false}, {"label": "D", "text": "Medial and caudal to the upper pole ureter", "correct": false}], "correct_answer": "A. Lateral and cephalad to the upper pole ureter", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man suffered a blow on a distended bladder ,following which he developed sudden severe pain in the hypogastrium associated with syncope. Later on, as the pain subsided, the abdomen began to distend. However, he had no desire to micturate. Which among the following is true regarding his condition?", "options": [{"label": "A", "text": "This is a typical case of extraperitoneal bladder rupture", "correct": true}, {"label": "B", "text": "MRI is the ideal investigation to diagnose bladder rupture", "correct": false}, {"label": "C", "text": "Repair is done by suturing edges with single-layer 2/0 absorbable suture", "correct": false}, {"label": "D", "text": "Laparoscopic method is avoided as it can be done only on laparotomy", "correct": false}], "correct_answer": "A. This is a typical case of extraperitoneal bladder rupture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0Wrut7Mp5YHjNS8t9JWb1747024432.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Extra peritoneal <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> rupture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It occurs when the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> wall is disrupted, but the peritoneal lining remains intact, often due to trauma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CT cystography</strong> reveals characteristic features like a <strong>flame-shaped appearance, pear sign &amp; teardrop appearance.</strong></li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ali Nourian\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/bladder-rupture-5\" data-tags=\"\" height=\"722\" src=\"https://image.prepladder.com/content/0Wrut7Mp5YHjNS8t9JWb1747024432.png\" width=\"520\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li><strong>Retrograde cystography</strong> is the <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> of choice for diagnosing <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> ruptures, including <span class=\"customMeta\" data-dictid=\"1f0a3237f21692777187669004cf0a\">extraperitoneal</span> injuries.</li>\n<li><strong>Extravasation of contrast limited to the <span class=\"customMeta\" data-dictid=\"a8676d7c5116927771959fe0c9087b\">perivesical</span> space is a key finding</strong> that helps <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> <span class=\"customMeta\" data-dictid=\"1f0a3237f21692777187669004cf0a\">extraperitoneal</span> from <span class=\"customMeta\" data-dictid=\"e47e248094169277719000b0ed02ea\">intraperitoneal</span> ruptures, where contrast would outline <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial management:</strong>\n<ul>\n<li>Urethral catheterisation with free <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> for 10-14 days.</li>\n<li>Followed by a <span class=\"customMeta\" data-dictid=\"b933eec07e1692777185b18d537acd\">cystogram</span> to confirm <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> before <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> removal.</li>\n</ul>\n</li>\n<li><strong>If the injury is iatrogenic:</strong>\n<ul>\n<li>Repair during the same procedure (open or laparoscopic).</li>\n<li>Repair done in <strong>two layers using 2/0 <span class=\"customMeta\" data-dictid=\"5292eb7fdc16927772020ce135cbdc\">vicryl</span> <span class=\"customMeta\" data-dictid=\"330e2bf7d216927771804326d05181\">absorbable</span> sutures (Option C ruled out)</strong></li>\n</ul>\n</li>\n<li><strong>Bladder injury with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fracture:</strong>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> should be repaired at the same time during the surgery for <strong>pelvic fracture.</strong></li>\n<li><strong>Immediate <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> repair is indeed indicated</strong> in cases where there are <strong>complicating factors like <span class=\"customMeta\" data-dictid=\"7651a08a051692777190d0e439f450\">intravesical</span> bone spicules, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> neck injuries</strong>, or associated <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> or rectal lacerations.</li>\n<li><strong>Laparoscopy</strong> can be used in the management of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> rupture, particularly in cases where less <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> approaches are preferred <strong>(Option D ruled out)</strong>.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 11-month-old boy had a recent urinary tract infection that was resolved with antibiotics. Vital signs are within normal limits. Physical examination revealed an empty scrotum on the right side with normal left testis. However, a mass was palpable on the right inguinal canal. The USG revealed the right testicle under the subcutaneous fat near the right inguinal canal, as shown in the image below. What is the next best step in management?", "options": [{"label": "A", "text": "Observation", "correct": false}, {"label": "B", "text": "Laparoscopy", "correct": false}, {"label": "C", "text": "Orchidopexy", "correct": false}, {"label": "D", "text": "Surgical exploration", "correct": true}], "correct_answer": "D. Surgical exploration", "question_images": ["https://image.prepladder.com/notes/LG8bH4asDFJdwtPaVzu51747998560.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> (Cryptorchidism)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a condition where one or both <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> fail to descend into the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> from the abdomen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inguinal/Palpable</strong> undescended testis: 80%</li>\n<li><strong>Abdominal/Non-Palpable </strong>undescended testis: 20%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Palpable undescended testis:</strong> Inguinal exploration. <strong>(Option D)</strong></li>\n<li><strong>Non-Palpable undescended testis:</strong> Diagnostic laparoscopy. <strong>(Option B ruled out)</strong></li>\n<li><strong>Imaging:</strong> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> or MRI may be utilised to locate the testis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Repositioning (Orchidopexy):</strong> Usually performed when the child is between 6-12 months old. <strong>(Option C ruled out)</strong></p>\n<p> </p>\n<p><strong>Types of Orchidopexy</strong></p>\n<ul>\n<li>Ombridannes</li>\n<li>Keetley-Torek</li>\n<li>Stephen-Fowler</li>\n<li>Ladd &amp; Gross</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old lady presented with a 1.5 cm pigmented lesion on her face that was growing rapidly in size and associated with itching. The lesion is shown below. Which of the following is likely the diagnosis?", "options": [{"label": "A", "text": "Dysplastic nevus", "correct": false}, {"label": "B", "text": "Congenital melanocytic nevus", "correct": false}, {"label": "C", "text": "Acquired melanocytic nevus", "correct": false}, {"label": "D", "text": "Malignant melanoma", "correct": true}], "correct_answer": "D. Malignant melanoma", "question_images": ["https://image.prepladder.com/content/iUhO3Jr4DTx72m5fVEjD1747024520.png"], "explanation_images": ["https://image.prepladder.com/content/9W4uO3VA9rmvjzxlmOht1747024806.png", "https://image.prepladder.com/content/ztxq7udSu14sJaRKtZ1N1747024833.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Malignant melanoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Melanoma is a <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tumour arising from <strong>melanocytes at the epidermal-dermal junction.</strong> Though it is a rare skin cancer, it has a high mortality rate. It presents as a <span class=\"customMeta\" data-dictid=\"85dafbf32f1692777195b9d9f035d8\">pigmented</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> that enlarges, ulcerates, or bleeds.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Positive family history.</li>\n<li>Fair skin.</li>\n<li>Genetics: <strong>CDKN2A </strong>(chromosome <strong>9p21</strong>), MC1R, and TYR genes.</li>\n<li>Nevus:\n\t\t\t\t<ul>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"f23fb27bcf169277719237a433653d\">melanocytic</span> nevi.</li>\n<li>Junctional nevi.</li>\n<li>Atypical nevi.</li>\n<li>Dysplastic nevi.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(P</strong>neumonic<strong>: ABCDE)</strong></p>\n<ul>\n<li>Asymmetry: <strong>Irregular shapes.</strong></li>\n<li>Border:<strong> Irregular. </strong></li>\n<li>Colour: <strong>Various colours present or uneven distribution.</strong></li>\n<li>Diameter: <strong>&gt; 6 mm</strong>.</li>\n<li>Evolution:<strong> Changes in <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> over time</strong> (size, shape, itching, or bleeding)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical examination.</li>\n<li>Dermoscopy.</li>\n<li>Biopsy.</li>\n<li>Immunohistochemistry: The markers are <strong>S-100, HMB-45</strong> (the most specific), <strong>Melan-A</strong> (MART-1), and <strong>MITF.</strong></li>\n<li>CT scan.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> (with margins measured before <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and determined by Breslow depth, <span class=\"customMeta\" data-dictid=\"f08132bdfb16927771986a66c5d7b6\">sentinel</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> indicated for tumours with a depth of &gt;1.0 mm).</li>\n<li>If the tumour is aggressive:\n\t\t\t\t<ul>\n<li>Immunotherapy.</li>\n<li>Chemotherapy.</li>\n<li>Targeted therapy.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Interferon-𝛼</strong> is the only <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">adjuvant</span> treatment that has documented beneficial effects on overall survival.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents with a lesion over his left ear. It slowly grew in size over the past 3 months, and he is a chronic smoker with 20 pack years. Vitals are within normal limits, and his physical examination is otherwise unremarkable. The histopathologic evaluation shows keratin pearls. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Nodular melanoma", "correct": false}, {"label": "B", "text": "Basal cell carcinoma", "correct": false}, {"label": "C", "text": "Squamous cell carcinoma", "correct": true}, {"label": "D", "text": "Malignant melanom", "correct": false}], "correct_answer": "C. Squamous cell carcinoma", "question_images": ["https://image.prepladder.com/notes/ny3YuQd8BZWYNzZoNalS1747998668.png"], "explanation_images": ["https://image.prepladder.com/content/xu3zCu9U1C3eq68J0CnH1747024902.png", "https://image.prepladder.com/content/zBRLEgadyZkyIZikgLwu1747024902.png", "https://image.prepladder.com/content/LX9ySO0piJZJDepZVlgG1747024902.png", "https://image.prepladder.com/content/HxzHkGntrGsKPuhHutxZ1747024902.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:669px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Squamous cell carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a type of <strong>skin cancer</strong> that arises from the <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cells, which are the flat cells found in the epidermis, <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes &amp; tissues lining your organs. It is the second most common type of skin cancer after <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cell carcinoma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High sunlight exposure</li>\n<li><strong>Arsenic </strong>exposure.</li>\n<li>Immunosuppression (organ transplant, HIV)</li>\n<li>Chronic lymphocytic leukemia</li>\n<li><strong>Human <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">papilloma</span> virus.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It commonly presents as papules, nodules, or plaques with <span class=\"customMeta\" data-dictid=\"7a14c26a7816927771904fb670c6da\">induration</span> and signs of <span class=\"customMeta\" data-dictid=\"4fcf84d1741692777195f8562d0ada\">photodamage</span> like crusting and scaling.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Dermanonymous\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Squamous_Cell_Carcinoma,_Right_Upper_Cheek.png\" data-tags=\"\" height=\"291\" src=\"https://image.prepladder.com/content/xu3zCu9U1C3eq68J0CnH1747024902.png\" width=\"387\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It involves <span class=\"customMeta\" data-dictid=\"27ac5e3413169277719548c1b36288\">physical examination</span> and biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reveals characteristic <span class=\"customMeta\" data-dictid=\"d0e68b82ed1692777190fa10f7d4ba\">keratin</span> pearls.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primary treatment involves wide <strong>surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with margins. </strong></li>\n<li><strong>Mohs micrographic surgery (MMS)</strong> aids in <span class=\"customMeta\" data-dictid=\"a489e669011692777190af3dd98ed4\">intraoperative</span> histopathological examination.</li>\n<li>Advanced cases may require <strong>radiation or chemotherapy.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about ranula is FALSE?", "options": [{"label": "A", "text": "Mucus extravasation cyst", "correct": false}, {"label": "B", "text": "Arises from submandibular salivary gland", "correct": true}, {"label": "C", "text": "Bluish, translucent cystic swelling on the floor of the mouth", "correct": false}, {"label": "D", "text": "Marsupialization or excision is the treatment", "correct": false}], "correct_answer": "B. Arises from submandibular salivary gland", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/akYmkU4Zg2U6E2ZO9wmY1747024988.png", "https://image.prepladder.com/content/GNogQfMmb7mub03r2GvM1747024988.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Ranula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition</strong></p>\n<p><strong>(Options A &amp; C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Ranulas are a type of <strong>extravasation mucocele</strong>, caused by the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the main <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> or obstructed <span class=\"customMeta\" data-dictid=\"4e0948603216927771801829c2c085\">acini</span> of the <strong>sublingual gland</strong>.</li>\n<li>They appear as <strong>bluish, translucent, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> on the floor of the mouth</strong> and resemble the belly of a frog.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ph0t0happy\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ranula_human_09.jpg\" data-tags=\"\" height=\"513\" src=\"https://image.prepladder.com/content/akYmkU4Zg2U6E2ZO9wmY1747024988.png\" width=\"573\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Commonly found in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> floor of the mouth.</li>\n<li>When it extends through the <span class=\"customMeta\" data-dictid=\"d0922475bc1692777193d420470423\">mylohyoid</span> muscle, it presents as a <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> known as a<strong> \"plunging ranula.\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Typically soft, fluctuant, and painless unless infected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Confirmed through Magnetic Resonance Imaging (MRI)</li>\n<li>Ultrasound</li>\n<li>Aspiration of thick, sticky <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> differentiates it from a lymphangioma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Excision of the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> is preferred. </strong></li>\n<li>Incision, drainage, and marsupialisation have low success rates. Although <strong>marsupialisation</strong> is often adequate, it has a higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate compared to <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> excision.</li>\n<li>OK-432 injection</li>\n<li>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> injections</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"534\" src=\"https://image.prepladder.com/content/GNogQfMmb7mub03r2GvM1747024988.png\" width=\"534\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who is taking steroids for psoriasis and is experiencing a low-grade fever only at night, weight loss, and an ulcer on her neck with undermined edges, as depicted in the provided image?", "options": [{"label": "A", "text": "Psoriasis flare-up", "correct": false}, {"label": "B", "text": "Tubercular lymphadenitis", "correct": true}, {"label": "C", "text": "Lymphosarcoma", "correct": false}, {"label": "D", "text": "Syphilis", "correct": false}], "correct_answer": "B. Tubercular lymphadenitis", "question_images": ["https://image.prepladder.com/notes/1TH1dju86skmeaqbBBxB1747998760.png"], "explanation_images": ["https://image.prepladder.com/content/fEc4u0perN8HZQL6yWkS1747025426.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> TB (Tuberculous Lymphadenitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Most common</strong> <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB presentation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Groups</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HIV-positive individuals, Immunosuppressive individuals, children, and non-Caucasian women.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Previously M. bovis; now mainly M. tuberculosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Painless </strong>swelling in <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, usually <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> or <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> (historically called scrofula).</li>\n<li><strong>Early disease: Discrete nodes</strong></li>\n<li>Advanced disease: Matted, nontender mass, possible <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> draining <span class=\"customMeta\" data-dictid=\"99368d5fef1692777183ea405bed67\">caseous</span> material.</li>\n<li>Pulmonary disease in &lt;50% of cases.</li>\n<li>Systemic symptoms are uncommon except in HIV-positive patients.</li>\n<li>Non-specific reaction → Matting → Cold <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> → Collar stud <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> → Sinus formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fine-needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (80% yield) or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> biopsy.</strong></li>\n<li>Granulomatous lesions may or may not contain AFBs.</li>\n<li>Cultures are positive in 70–80% of cases.</li>\n<li>HIV-positive patients: Poorly organised or absent granulomas; higher bacterial loads increase <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> yield.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infectious diseases</li>\n<li>Lymphomas</li>\n<li>Metastatic carcinomas</li>\n<li>Rare disorders: Kikuchi’s disease, Kimura’s disease, Castleman’s disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for the unconscious patient brought to the casualty department following a road accident, as depicted in the provided CT scan image?", "options": [{"label": "A", "text": "Extradural hematoma (EDH)", "correct": false}, {"label": "B", "text": "Subdural hematoma (SDH)", "correct": true}, {"label": "C", "text": "Intraparenchymal bleed", "correct": false}, {"label": "D", "text": "Subarachnoid hemorrhage (SAH)", "correct": false}], "correct_answer": "B. Subdural hematoma (SDH)", "question_images": ["https://image.prepladder.com/content/QutGHiTYgyOq71lTKKTA1747025534.png"], "explanation_images": ["https://image.prepladder.com/content/DrXBeUhm2vXb4EmWK1Yo1747025566.png", "https://image.prepladder.com/content/GTRAxAWgVacxutb1zvrT1747025566.png", "https://image.prepladder.com/content/2IJsmc0EABb47lH7Igwr1747025566.png", "https://image.prepladder.com/content/U4dZz2NnU2hLgfBsZO9g1747025566.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of brain haemorrhage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidural or Extradural Hematoma</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"EpiduralHematoma - Epidural hematoma - Wikipedia\" data-tags=\"\" height=\"394\" src=\"https://image.prepladder.com/content/DrXBeUhm2vXb4EmWK1Yo1747025566.png\" width=\"332\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Biconvex/lentiform shape</li>\n<li>Does not cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</li>\n<li>Cross-dural <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> sinuses</li>\n<li>Hyperdense</li>\n<li>Usually unilateral</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Typically, meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> injury (especially middle meningeal)</li>\n<li><strong>High-velocity trauma</strong></li>\n<li>Young patient</li>\n<li>Always traumatic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subdural Hematoma</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"Subduralandherniation - Subdural hematoma - Wikipedia\" data-tags=\"\" height=\"411\" src=\"https://image.prepladder.com/content/GTRAxAWgVacxutb1zvrT1747025566.png\" width=\"331\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Crescent-shaped</li>\n<li>Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</li>\n<li>Can be bilateral</li>\n<li>Don't cross <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> sinuses</li>\n<li>Follows brain surface</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bridging <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> tears</li>\n<li>Can be <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">Traumatic</span> or non-traumatic</li>\n<li>Elderly patients</li>\n<li>Extent of brain injury more in SDH than in EDH</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intraparenchymal Hematoma</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"OpenStax College\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"File:1602 The Hemorrhagic Stroke-02.jpg - Wikimedia Commons\" data-tags=\"\" height=\"255\" src=\"https://image.prepladder.com/content/2IJsmc0EABb47lH7Igwr1747025566.png\" width=\"347\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Irregular shape within brain tissue</li>\n<li>May have surrounding oedema</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Direct tissue damage or coagulopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subarachnoid Haemorrhage</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subarachnoid_hemorrhage#/media/File:SubarachnoidP.png\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/U4dZz2NnU2hLgfBsZO9g1747025566.png\" width=\"260\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood in sulci/cisterns</li>\n<li>Follows CSF spaces</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trauma or <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> rupture</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with inflammatory bowel disease presents with the following lesion. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Erythema nodosum", "correct": false}, {"label": "B", "text": "Pyoderma gangrenosum", "correct": true}, {"label": "C", "text": "Diabetic ulcer", "correct": false}, {"label": "D", "text": "Venous ulcer", "correct": false}], "correct_answer": "B. Pyoderma gangrenosum", "question_images": ["https://image.prepladder.com/content/OTaVM6eLMetcC6W0OZKK1747027692.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who is a tour guide of Mount Everest presented with blisters on her hand as shown in the figure below. She has severe pain and on examination is erythematous and tender. Which of the following is used in the management of this patient?", "options": [{"label": "A", "text": "Oxygen", "correct": false}, {"label": "B", "text": "Apply heat to the area and cast it as soon as possible", "correct": false}, {"label": "C", "text": "Pentoxyphylline", "correct": false}, {"label": "D", "text": "NSAID’s", "correct": true}], "correct_answer": "D. NSAID’s", "question_images": ["https://image.prepladder.com/notes/FnExofW8tR564TxQ6ol61748000413.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which type/s of cancer/s is prophylactic cranial radiation administered? Lung cancer Liver cancer Prostate cancer Breast cancer", "options": [{"label": "A", "text": "1 and 2", "correct": false}, {"label": "B", "text": "1, 2, and 3", "correct": false}, {"label": "C", "text": "1 and 4", "correct": true}, {"label": "D", "text": "2 and 4", "correct": false}], "correct_answer": "C. 1 and 4", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the false statement among the following for the condition given in the picture?", "options": [{"label": "A", "text": "Retention cyst of major salivary glands", "correct": false}, {"label": "B", "text": "Most common site is lower lip", "correct": true}, {"label": "C", "text": "Retention cyst of minor salivary glands", "correct": false}, {"label": "D", "text": "Treatment is surgical excision", "correct": false}], "correct_answer": "B. Most common site is lower lip", "question_images": ["https://image.prepladder.com/notes/2zFBp6qYtLWWNoi7RNMO1747983383.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blockage or damage to the <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> system of the salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> leads to <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major salivary glands</strong> (parotid, submandibular, and <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> glands) for <strong>major</strong> <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> cysts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor Salivary Glands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most often found on the <strong>lower lip</strong>, <strong>buccal mucosa</strong>, or <strong>palate</strong> for <strong>minor salivary glands</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> is the standard treatment to remove the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> and prevent recurrence.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical examination and <strong>ultrasound or sialography</strong> for confirmation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which laser is most commonly used for performing a laser iridotomy?", "options": [{"label": "A", "text": "Argon laser", "correct": false}, {"label": "B", "text": "Nd:YAG laser", "correct": true}, {"label": "C", "text": "Excimer laser", "correct": false}, {"label": "D", "text": "CO₂ laser", "correct": false}], "correct_answer": "B. Nd:YAG laser", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/na0egv2MCMrZsyDpIw381747035978.png"], "explanation": "<p>Correct Answer B - Nd:YAG\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Laser</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Wavelength </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Applications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Nd: YAG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1064</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Posterior capsulotomy, iridotomy, vitreolysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Frequency-doubled Nd:YAG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">532</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Retinal photocoagulation, cyclophotocoagulation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about pterygium?", "options": [{"label": "A", "text": "Inflammation of cornea", "correct": false}, {"label": "B", "text": "Fatty deposition of sclera", "correct": false}, {"label": "C", "text": "Conjunctival invasion making a flap over cornea", "correct": true}, {"label": "D", "text": "Dead epithelial debris accumulation", "correct": false}], "correct_answer": "C. Conjunctival invasion making a flap over cornea", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UN0nMO9miuExwvFWw9RN1747036490.png", "https://image.prepladder.com/content/L2TwxPDQzzct8uH8rDl71747036499.png", "https://image.prepladder.com/content/tz42Q2c1NagK5lGqIo8H1747036508.png", "https://image.prepladder.com/content/0yeBA7srm03MooaJmmpb1747036519.png", "https://image.prepladder.com/content/MTAXEOmFBRa4FDauCCBO1747036415.png"], "explanation": "<p>Correct Answer C - Conjunctival invasion making a &lt;span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\"&gt;flap&lt;/span&gt; over cornea</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pterygium/Surfer’s eye</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pterygium is a triangular encroachment of vascularized <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue covered by <span class=\"customMeta\" data-dictid=\"d168af6e7f1692777185683fea5e7f\">conjunctiva</span> in the<strong> <span class=\"customMeta\" data-dictid=\"f2a86bcac91692777190f5db6b96ca\">interpalpebral</span> area</strong>.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jmvaras José Miguel Varas, MD\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Pterygium#/media/File:Pterygium_Slitlamp.jpg\" data-tags=\"\" height=\"423\" src=\"https://image.prepladder.com/content/UN0nMO9miuExwvFWw9RN1747036490.png\" width=\"630\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Parts: Cap, head, neck, body</li>\n<li><strong>Degenerative </strong>process</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common in dry, sunny climates with sandy soils</li>\n<li><strong>Ultraviolet light </strong>is a probable factor</li>\n<li>Usually elderly persons</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://librepathology.org/wiki/File:Pterygium_-_high_mag.jpg\" data-tags=\"\" height=\"458\" src=\"https://image.prepladder.com/content/L2TwxPDQzzct8uH8rDl71747036499.png\" width=\"684\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Histology shows <strong>collagenous degenerative changes in the vascularized <span class=\"customMeta\" data-dictid=\"94aff4fd141692777199a78b5ed2eb\">subepithelial</span> stroma.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Degenerative <span class=\"customMeta\" data-dictid=\"335f16a33c16927771992f5c55bc4d\">subconjunctival</span> proliferation</li>\n<li>Granulation tissue proliferates as avascularized tissue encroaches on the cornea.</li>\n<li>Destroys the <strong>superficial layers of the <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> and Bowman’s membrane</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Frequently follows a pinguecula</li>\n<li>Often bilateral</li>\n<li>Usually on the <strong>nasal side</strong> <strong> </strong></li>\n<li>Impairment of vision due to:\n\t\t\t\t<ul>\n<li>Progression into the pupillary area of the cornea</li>\n<li>Induced <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> by corneal <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">flattening</span> in the <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> of pterygium</li>\n</ul>\n</li>\n<li><strong>Progressive </strong>pterygium: thick and vascular</li>\n<li><strong>Regressive </strong>pterygium: thin, pale, and atrophic</li>\n<li>Ceases to grow but never disappears</li>\n<li>A <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> can be passed under the lesion</li>\n<li>Can present as <strong>inflammed pterygium</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jonathan Trobe, M.D\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Pterygium_(eye)#/media/File:Pterygium_(from_Michigan_Uni_site,_CC-BY).jpg\" data-tags=\"\" height=\"444\" src=\"https://image.prepladder.com/content/tz42Q2c1NagK5lGqIo8H1747036508.png\" width=\"583\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Signs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> cannot be passed under the lesion</li>\n<li><strong>Fusch’s spots/Islets of Vogt:</strong> small <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> whitish flecks made of pterygial epithelial cells seen in progressive <span class=\"customMeta\" data-dictid=\"9571debfbe1692777196de3e804df2\">pterygium</span> and are also called the <strong>cap </strong>of the pterygium.</li>\n<li><strong>Stocker line: </strong>linear epithelial iron deposition, seen in <span class=\"customMeta\" data-dictid=\"531cf746021692777197c135fbce82\">regressive</span> pterygium.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Tae Seen Kang, Jong Joo Lee, Si Hwan Choi\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/Stockers-line-slit-lamp-photo-A-A-64-year-old-male-diagnosed-with-pteygium_fig2_304027779\" data-tags=\"\" height=\"357\" src=\"https://image.prepladder.com/content/0yeBA7srm03MooaJmmpb1747036519.png\" width=\"838\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Best left alone</li>\n</ul>\n<p><strong>Medical treatment: </strong></p>\n<ul>\n<li>Tear substitutes for small <span class=\"customMeta\" data-dictid=\"531cf746021692777197c135fbce82\">regressive</span> <span class=\"customMeta\" data-dictid=\"9571debfbe1692777196de3e804df2\">pterygium</span> with dry eye</li>\n<li>Topical steroids for associated inflammation</li>\n<li>Protection from UV rays with sunglasses</li>\n</ul>\n<p><strong>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for:</strong></p>\n<ul>\n<li>Progression of <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> towards the pupillary area causing excessive <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> and visual impairment</li>\n<li>Restricted <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> movements</li>\n<li>Disfiguring</li>\n<li>Diplopia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><strong>Procedures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bare <span class=\"customMeta\" data-dictid=\"3e4400809d16927771983252fc08b1\">sclera</span> technique:\n\t\t\t\t<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"9571debfbe1692777196de3e804df2\">pterygium</span> is excised from the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> and conjunctiva, leaving a bare sclera</li>\n<li>Associated with a high <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate</li>\n</ul>\n</li>\n<li>Autoconjunctival graft\n\t\t\t\t<ul>\n<li>A piece of <span class=\"customMeta\" data-dictid=\"71928251b41692777191a31e57c47f\">limbal</span> conjunctival tissue from <strong>the same or the other eye </strong>or</li>\n<li>An<strong> <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> </strong>is used to cover the bare sclera</li>\n<li>Sutured at the <span class=\"customMeta\" data-dictid=\"799979f3bc169277719134cd535c7c\">limbus</span> to cover the defect</li>\n</ul>\n</li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with <span class=\"customMeta\" data-dictid=\"95dc7047f41692777191f225afb261\">lamellar</span> <span class=\"customMeta\" data-dictid=\"8a6b591d1d16927771900a3c620d92\">keratectomy</span> and <span class=\"customMeta\" data-dictid=\"95dc7047f41692777191f225afb261\">lamellar</span> <span class=\"customMeta\" data-dictid=\"9810f0dbdb16927771908a955add6d\">keratoplasty</span> for deeply infiltrating <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> recalcitrant pterygia</li>\n<li>Old methods (not used now):\n\t\t\t\t<ul>\n<li>McRaynold’s operation</li>\n<li>Postoperative use of <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> irradiations</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p><strong>Post-operative therapy and care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prevent recurrence:\n\t\t\t\t<ul>\n<li>Mitomycin C 0.02% drops</li>\n<li>Complications like scleral necrosis, cataracts, and <span class=\"customMeta\" data-dictid=\"0b673ec1e31692777190e88b9898af\">iritis</span> <strong> </strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pseudopterygium</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pterygium like lesion</li>\n<li>Due to cicatrizing conjunctival <strong>inflammatory </strong>overgrowth</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" Facundo Urbinati, Davide Borroni, Marina Rodríguez-Calvo-de-Mora, José-María Sánchez-González, María García-Lorente, Francisco Zamorano-Martín, Rahul Rachwani-Anil, Santiago Ortiz-Pérez, Vito Romano and Carlos Rocha-de-Lossada \" data-hash=\"\" data-license=\"open access\" data-source=\"https://www.mdpi.com/2075-4418/12/8/1843\" data-tags=\"\" height=\"588\" src=\"https://image.prepladder.com/content/MTAXEOmFBRa4FDauCCBO1747036415.png\" width=\"712\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seen at any age</li>\n<li>Caused by\n\t\t\t\t<ul>\n<li>Trauma</li>\n<li>Chronic conjunctivitis</li>\n<li>Thermochemical burn</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Non-progressive</strong></li>\n<li>Can be at <strong>any quadrant</strong> of the corneal limbus</li>\n<li>Located away from the horizontal</li>\n<li>Attached to the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> due to <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue</li>\n<li>Adhered to the adjacent lid</li>\n<li>Always <strong>stationary</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Signs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> can be passed under the neck.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In Dacryocystorhinostomy (DCR), the point of opening of the lacrimal sac is into which nasal meatus?", "options": [{"label": "A", "text": "Inferior meatus", "correct": false}, {"label": "B", "text": "Middle meatus", "correct": true}, {"label": "C", "text": "Supreme meatus", "correct": false}, {"label": "D", "text": "Superior meatus", "correct": false}], "correct_answer": "B. Middle meatus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3a8L9vTN6uW4BUbyWUnN1747036761.png", "https://image.prepladder.com/content/dEcqo9CZlz7bR04X9zYV1747036790.png"], "explanation": "<p>Correct Answer B - Middle meatu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the average degree of hypermetropia in a newborn?", "options": [{"label": "A", "text": "+2.5 D", "correct": true}, {"label": "B", "text": "+5 D", "correct": false}, {"label": "C", "text": "+10 D", "correct": false}, {"label": "D", "text": "+1 D", "correct": false}], "correct_answer": "A. +2.5 D", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - +2.5 D</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Hypermetropia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Axial Hypermetropia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shortening of the eyeball's <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> length. Commonest form.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Curvatural Hypermetropia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flatter <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of the cornea, lens, or both.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Index Hypermetropia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> index of the lens, usually due to <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> in old age or in treated diabetics.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Positional Hypermetropia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"35b1a3c6191692777185a1e2376fc0\">crystalline</span> lens.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aphakia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absence of the <span class=\"customMeta\" data-dictid=\"35b1a3c6191692777185a1e2376fc0\">crystalline</span> lens, either <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> or <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> (e.g., after surgery), leads to high hypermetropia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Consecutive Hypermetropia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Overcorrected <span class=\"customMeta\" data-dictid=\"619b89f28f16927771936b1ade010c\">myopia</span> after <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> surgery (e.g., LASIK, ICL) or underpowered <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> lens (IOL) after <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">cataract</span> surgery.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the embryological origin of the corneal endothelium?", "options": [{"label": "A", "text": "Neuroectoderm", "correct": false}, {"label": "B", "text": "Neural crest cells", "correct": true}, {"label": "C", "text": "Mesoderm", "correct": false}, {"label": "D", "text": "Surface ectoderm", "correct": false}], "correct_answer": "B. Neural crest cells", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\"&gt;Neural&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"48528974ed1692777185cd29753db5\"&gt;crest&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 308 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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Chloride", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pulmonary capillary wedge pressure increases in which of the following?", "options": [{"label": "A", "text": "Hypovolemic shock", "correct": false}, {"label": "B", "text": "Septic shock", "correct": false}, {"label": "C", "text": "Cardiogenic shock", "correct": true}, {"label": "D", "text": "Anaphylactic shock", "correct": false}], "correct_answer": "C. Cardiogenic shock", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient exhibits symptoms depicted in the image provided below. Shows the site of the lesion Experiences decreased proprioception, vibration, and discriminative touch on the affected side. Has loss of pain and temperature beginning one or two segments below the side of the lesion on the contralateral side. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Weber’s syndrome", "correct": false}, {"label": "B", "text": "Dejerine syndrome", "correct": false}, {"label": "C", "text": "Brown Sequard syndrome", "correct": true}, {"label": "D", "text": "Wallenberg syndrome", "correct": false}], "correct_answer": "C. Brown Sequard syndrome", "question_images": ["https://image.prepladder.com/notes/kIv01vEbsJomlVYldXjk1747999064.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable outcome for a patient who has undergone complete ileal and partial jejunal resection?", "options": [{"label": "A", "text": "Folic acid deficiency", "correct": false}, {"label": "B", "text": "Vitamin B12 deficiency", "correct": true}, {"label": "C", "text": "Gastric ulcer", "correct": false}, {"label": "D", "text": "Constipation", "correct": false}], "correct_answer": "B. Vitamin B12 deficiency", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions will shift the oxygen-Hb dissociation curve to the left?", "options": [{"label": "A", "text": "Hypoxia", "correct": false}, {"label": "B", "text": "Hypercarbia", "correct": false}, {"label": "C", "text": "Alkalosis", "correct": true}, {"label": "D", "text": "Increase in 2,3-DPG", "correct": false}], "correct_answer": "C. Alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the duration for which sperm stays in the epididymis?", "options": [{"label": "A", "text": "24hours", "correct": false}, {"label": "B", "text": "48 hours", "correct": false}, {"label": "C", "text": "20 days", "correct": true}, {"label": "D", "text": "96hours", "correct": false}], "correct_answer": "C. 20 days", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sperm Changes in epididymis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Motility Acquisition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sperm leaving the <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> are not fully mobile.</li>\n<li>They <strong>gain progressive <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> in the epididymis.</strong></li>\n<li>Inhibitory proteins suppress <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> until ejaculation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cation Channel Activation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Activation of CatSper family <span class=\"customMeta\" data-dictid=\"299c6a693916927771832f0615b65d\">cation</span> channels occurs. Alkaline-sensitive Ca2+ channels become active as <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> move to more <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> mucus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chemotaxis Development</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Develop the <strong>ability to sense chemical signals</strong> from the ovaries, helping guide them toward the ovary.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Concentration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Become concentrated due to fluid reabsorption.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epididymal Fluid Contribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Epididymis and Sertoli cells <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> nutrient-rich fluid containing hormones, enzymes, and nutrients essential for maturation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sperm Storage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Epididymis serves as the primary storage site (for 2-4 weeks). (Option C)</strong></li>\n<li>Sperm can maintain <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">fertility</span> for at least a month.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Timeframe for Motility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sperm gain the capability for <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> after 18 to 24 hours in the epididymis.</li>\n<li>Full <span class=\"customMeta\" data-dictid=\"76948f718016927771924774ade7e9\">maturation</span> and <span class=\"customMeta\" data-dictid=\"67bb86d8a416927771894a2507530c\">hypermotility</span> occur in the female <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> tract.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acrosome Maturation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The acrosome, located at the <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> head and containing enzymes for fertilization, matures while <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> are stored in the epididymis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zona Pellucida Binding Ability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sperm acquire receptors <strong>during epididymal transit</strong> that enable them to bind to the <span class=\"customMeta\" data-dictid=\"ce703232dd1692777202121148f8ee\">zona</span> pellucida, facilitating <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> and <span class=\"customMeta\" data-dictid=\"2a8e411e2116927772022dd4b365bc\">fertilization</span> of the egg. Therefore this occurs before ejaculation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Capacitation Post-Epididymis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Full <span class=\"customMeta\" data-dictid=\"2a8e411e2116927772022dd4b365bc\">fertilization</span> capacity (capacitation) occurs after <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> leave the epididymis. This involves the removal of <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> factors and changes to the <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> membrane.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In case a small pain stimulus causes more pain, it is called?", "options": [{"label": "A", "text": "Hypersensitivity", "correct": false}, {"label": "B", "text": "Causalgia", "correct": false}, {"label": "C", "text": "Hyperalgesia", "correct": true}, {"label": "D", "text": "Allodynia", "correct": false}], "correct_answer": "C. Hyperalgesia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:712px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criteria </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hyperalgesia (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Allodynia (Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe pain from a stimulus that normally causes pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pain from a stimulus that normally wouldn't cause pain,</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sensitivity </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both increases sensitivity of nociceptive <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> fibers</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Primary hyperalgesia:</strong> Excessive sensitivity of the pain receptors.<br/>\n\t\t\t\tEg : Extreme sensitivity of sunburned skin (results from <span class=\"customMeta\" data-dictid=\"4fe92aaac71692777198234aaa055a\">sensitization</span> of pain receptors due to local tissue products like histamine, prostaglandins)<br/>\n\t\t\t\t </li>\n<li><strong>Secondary hyperalgesia:</strong> It is the <span class=\"customMeta\" data-dictid=\"eb1d0cae18169277720258152c1896\">facilitation</span> of <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> transmission .<br/>\n\t\t\t\tEg: Lesions in the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord or thalamus</li>\n</ol>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The exact cause is unknown. Likely involves error in neuronal conduction.</p>\n<p>Eg:Painful sensation from a light touch which is never painful</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Association </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both types of pain is seen in <span class=\"customMeta\" data-dictid=\"f14d4173d816927771937aaa53dc91\">neuropathic pain</span> and <span class=\"customMeta\" data-dictid=\"c5b75e91c61692777183b2ec0110da\">causalgia</span> (severe burning pain in a specific part of the body)<strong> (Option B ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which hormone binds to tyrosine kinase receptors and has 4 subunits and 2 units for receptor binding?", "options": [{"label": "A", "text": "Insulin", "correct": true}, {"label": "B", "text": "Glucagon", "correct": false}, {"label": "C", "text": "T3", "correct": false}, {"label": "D", "text": "AD", "correct": false}], "correct_answer": "A. Insulin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the active form of Vitamin D3?", "options": [{"label": "A", "text": "Calcitriol", "correct": true}, {"label": "B", "text": "Calciferol", "correct": false}, {"label": "C", "text": "Calcidiol", "correct": false}, {"label": "D", "text": "Ergocalciferol", "correct": false}], "correct_answer": "A. Calcitriol", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/6jtlIIHWS0Rpf7iImK651747917606.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What specific region of the thalamus is associated with the regulation of motor control?", "options": [{"label": "A", "text": "Ventrolateral thalamus", "correct": true}, {"label": "B", "text": "Ventral posteromedial", "correct": false}, {"label": "C", "text": "Ventral posterolateral", "correct": false}, {"label": "D", "text": "Superior and inferior colliculi", "correct": false}], "correct_answer": "A. Ventrolateral thalamus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Thalamic <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">Nucleus</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventral <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">Posterolateral</span> (VPL) <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Relays <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> information from the body to the primary <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> cortex</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventral <span class=\"customMeta\" data-dictid=\"b1b0b6b9c716927771966dfdac754d\">Posteromedial</span> (VPM) <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Relays <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> information from the face to the primary <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> cortex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">Geniculate</span> (LGN)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Relays visual information from the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> tracts to the primary visual cortex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">Geniculate</span> (MGN)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Relays <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> information from the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"1bbc05a9c216927771844ff032232d\">colliculus</span> to the primary <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> cortex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventral <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> (VA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contributes to <span class=\"customMeta\" data-dictid=\"098b60fa37169277719232147d5fb7\">motor control</span> by receiving input from the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventral <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> (VL) <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contributes to <span class=\"customMeta\" data-dictid=\"098b60fa37169277719232147d5fb7\">motor control</span> by receiving input from the cerebellum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior (AN)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involved in memory, emotion, and regulation of the <span class=\"customMeta\" data-dictid=\"fae243395d16927771917dbd1992e9\">limbic</span> system</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intralaminar Nuclei</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involved in arousal, attention, and <span class=\"customMeta\" data-dictid=\"6c0c4e41b31692777192be0fbfce62\">modulation</span> of pain perception</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are Glucogenic hormones except?", "options": [{"label": "A", "text": "ADH", "correct": true}, {"label": "B", "text": "Glucagon", "correct": false}, {"label": "C", "text": "Thyroxine", "correct": false}, {"label": "D", "text": "Glucocorticoids", "correct": false}], "correct_answer": "A. ADH", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What mediates the Inverse stretch reflex?", "options": [{"label": "A", "text": "Golgi tendon", "correct": true}, {"label": "B", "text": "Muscle spindle", "correct": false}, {"label": "C", "text": "Unmyelinated C fibres", "correct": false}, {"label": "D", "text": "Dorsal Column", "correct": false}], "correct_answer": "A. Golgi tendon", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reflex arc</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Receptor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Golgi <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">Tendon</span> Organs (GTOs).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location of Receptors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Found at the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of muscles and tendons.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Afferent Fiber</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type Ib <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> fibers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stimulus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased tension within the muscle-tendon unit.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibition of the <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> motor neurons leading to muscle relaxation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prevents damage to muscles and tendons from excessive force or tension.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male who met with a road traffic accident is brought to the emergency department. His left leg is shortened, internally rotated, and adducted. On examination, femoral artery pulsation is not felt. A plain radiograph of his lower limb was taken which is shown below. What is your diagnosis?", "options": [{"label": "A", "text": "Intertrochanteric fracture of the femur", "correct": false}, {"label": "B", "text": "Fracture neck of femur with injury to femoral vessels", "correct": false}, {"label": "C", "text": "Anterior dislocation of hip with femoral artery injury", "correct": false}, {"label": "D", "text": "Posterior dislocation of hip", "correct": true}], "correct_answer": "D. Posterior dislocation of hip", "question_images": ["https://image.prepladder.com/notes/0rEql9HtkNjpZD7AmOIN1747914651.png"], "explanation_images": ["https://image.prepladder.com/notes/0rEql9HtkNjpZD7AmOIN1747914651.png", "https://image.prepladder.com/notes/lh1ylf1Sw02wyttJjfB81747914712.png", "https://image.prepladder.com/notes/pAYQVP3UXPNhJMMoqSDc1747914763.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:722px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong><br/>\n\t\t\tCaused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nerve injury: <strong>common</strong>, <strong>sciatic nerve</strong> is injured.</li>\n<li>Arterial injury: rare</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nerve injury: rare</li>\n<li><strong>Arterial injury:</strong> relatively more <strong>common</strong>, <strong>Femoral artery</strong> is injured</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"posterior dislocation of the hip.\" data-author=\"James Heilman, MD\" data-hash=\"13179\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/0rEql9HtkNjpZD7AmOIN1747914651.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Anterior dislocation of hip\" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"13180\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/lh1ylf1Sw02wyttJjfB81747914712.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Central fracture dislocation of hip\" data-author=\"Samir Benoudina\" data-hash=\"13181\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/central-fracture-dislocation-of-the-acetabulum-2\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/pAYQVP3UXPNhJMMoqSDc1747914763.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What will be the diagnosis of the following image of a 1-year old infant’s hand?", "options": [{"label": "A", "text": "Syndactyly", "correct": true}, {"label": "B", "text": "Symphalangism", "correct": false}, {"label": "C", "text": "Polydactyly", "correct": false}, {"label": "D", "text": "Brachydactyly", "correct": false}], "correct_answer": "A. Syndactyly", "question_images": ["https://image.prepladder.com/notes/TkJJo1rTqqvr8bBB4oCU1747914836.png"], "explanation_images": ["https://image.prepladder.com/notes/TkJJo1rTqqvr8bBB4oCU1747914836.png", "https://image.prepladder.com/notes/aejYfYNFoZ55bvR6iue01747914910.png", "https://image.prepladder.com/notes/JHvsUCwPY5kicac2lbHr1747914972.png", "https://image.prepladder.com/notes/V2TWbUcySgyoFwya1arl1747915013.png", "https://image.prepladder.com/notes/ZFt8WOuEM43u9AVdhuq61747915061.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Simple Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Only soft tissue is fused</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complex Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both skin and bone are fused</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complete Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Webbing along the entire length of affected digits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incomplete Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Webbing along only part of the length of the affected digits.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complicated Syndactyly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Accessory <span class=\"customMeta\" data-dictid=\"27cd397275169277719513776c38c8\">Phalanges</span> or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> bones involved in fusion.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Syndactyly Classification\" data-author=\"\" data-hash=\"13183\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/aejYfYNFoZ55bvR6iue01747914910.png\"/></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nonoperative Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Mild or <span class=\"customMeta\" data-dictid=\"1d993016c316927771904ccbd56fdd\">incomplete syndactyly</span> and <span class=\"customMeta\" data-dictid=\"3a5454de16169277719918f0097320\">syndactyly</span> of toes are often managed non-operatively, especially when the function is unaffected.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Operative Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Surgical Timing:</strong>\n<ul>\n<li>Performed around 12-18 months of age to reduce <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> contractures.</li>\n<li>Early surgery (around 6 months) is advised for border digits (thumb, little finger) to prevent deformity.</li>\n</ul>\n</li>\n<li><strong>Surgical Technique:</strong>\n<ul>\n<li><strong>Zigzag incisions</strong> (e.g., the <strong>Cronin technique</strong>) are used to separate digits and minimise <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> contracture.</li>\n<li>Avoid simultaneous separation of both sides of a <span class=\"customMeta\" data-dictid=\"02e6b5c95316927771867eba7818b1\">digit</span> to protect blood supply.</li>\n</ul>\n</li>\n<li>Complex Syndactyly: May require bone separation (synostosis) with techniques like closing <span class=\"customMeta\" data-dictid=\"b3c25aa68616927772025ab4ff7a11\">wedge</span> osteotomies/ amputation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 9-year-old boy who is experiencing pain, limping, and has had worsening symptoms for the past 6 months? The child seems to be in good overall health, with normal height and weight. Upon examination, there is slight muscle loss on the right side, limited ability to move the hip outwards (especially when flexed), and internal rotation is restricted due to pain.", "options": [{"label": "A", "text": "DDH (developmental dysplasia of hip)", "correct": false}, {"label": "B", "text": "Slipped capital femoral epiphysis", "correct": false}, {"label": "C", "text": "Perthes disease", "correct": true}, {"label": "D", "text": "Congenital coxa vara", "correct": false}], "correct_answer": "C. Perthes disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/yexetOna2xG0kkup9COm1747915147.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Idiopathic <span class=\"customMeta\" data-dictid=\"ffadabff021692777194c8ebe87262\">osteonecrosis</span> or <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of the capital <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Idiopathic or <span class=\"customMeta\" data-dictid=\"4711a65634169277718737b781005d\">etiology</span> that would disrupt the <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> epiphysis.</li>\n<li>Coagulopathy and <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use.</li>\n</ul>\n<p>Includes 4 phases</p>\n<ul>\n<li><strong>Necrosis:</strong> Disruption of the blood supply leads to <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> capital epiphysis.</li>\n<li><strong>Fragmentation:</strong> The body reabsorbs the infarcted bone.</li>\n<li><strong>Reossification:</strong> Osteoblastic activity takes over, and the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> reestablishes.</li>\n<li><strong>Remodeling: </strong>The new <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head may be enlarged or flattened. It reshapes during growth.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Familial ~ 10%</li>\n<li><strong>Factor V Leiden</strong>/Thrombophilias (increased clotting)</li>\n<li>Hypofibrinolysis (decreased ability to dissolve clots)</li>\n<li>Low socioeconomic status</li>\n<li>Birth weight less than 2.5 kg in boys</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Limp of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> or <span class=\"customMeta\" data-dictid=\"fc73a9e10016927771905d69184c24\">insidious</span> onset, usually painless.</li>\n<li>If pain is present, it is <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the hip or knee.</li>\n<li>Decreased internal <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> and <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> of hip.</li>\n<li>Atrophy of thighs and buttocks.</li>\n<li>Limb length discrepancy.</li>\n<li>Antalgic <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> cases and Trendelenburg <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> in chronic cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Standard <span class=\"customMeta\" data-dictid=\"c12a40cc401692777181852b507764\">anteroposterior</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and frog-leg <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> (Lauenstein) X-ray views.</li>\n<li>Bone scan or MRI</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"perthes disease x ray\" data-author=\"Mohammad Taghi Niknejad\" data-hash=\"13187\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/perthes-disease-19\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/yexetOna2xG0kkup9COm1747915147.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<p><strong>Early findings:</strong></p>\n<ul>\n<li>Widening of joint space (epiphyseal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> hypertrophy)</li>\n<li>Changes in the epiphysis.</li>\n<li>Crescent sign: Subchondral <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> zone of the <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> epiphysis</li>\n</ul>\n<p><strong>Late signs:</strong></p>\n<ul>\n<li>Flattening of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n<li>Bone scan shows decreased <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> to the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non operative:</strong></p>\n<ul>\n<li>Indicated for children with <span class=\"customMeta\" data-dictid=\"627954967a1692777183a81869cece\">bone age</span> less than 6 or <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"711a7039b116927771952962024d86\">pillar</span> A involvement.</li>\n<li>Activity restriction and protective weight-bearing are recommended until <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> is complete.</li>\n</ul>\n<p><strong>Operative treatment:</strong></p>\n<ul>\n<li>Femoral or Pelvic Osteotomy indicated in children older than 8 years.</li>\n<li>Valgus or Shelf Osteotomies indicated in children with hinge abduction</li>\n<li>Hip replacement procedures: if Arthritis has developed</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 74-year-old man, who was previously a weightlifter, presented with lower back pain that was radiating to his legs. On examination , a palpable step was felt in the lumbosacral region of the spine. The x-ray of the spine is given below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Spondylolysis", "correct": false}, {"label": "B", "text": "Spondylolisthesis", "correct": true}, {"label": "C", "text": "Disc prolapse", "correct": false}, {"label": "D", "text": "Spondylosis", "correct": false}], "correct_answer": "B. Spondylolisthesis", "question_images": ["https://image.prepladder.com/notes/2tGP5c5jRw8rLUV7cNlD1747915232.png"], "explanation_images": ["https://image.prepladder.com/notes/yQUjNaWdDw4UrtPR3Y4h1747915429.png", "https://image.prepladder.com/notes/6nF45HF8Uf2ckgo5Ko3R1747915526.png", "https://image.prepladder.com/notes/8kFlnYq48Eerw5clMQId1747915575.png", "https://image.prepladder.com/notes/yXITopyApTQOH1KnngPX1747915619.png", "https://image.prepladder.com/notes/9gcFjKdj6VstefxZfFGi1747915674.png", "https://image.prepladder.com/notes/v06r61hU5uQPpaNesGrw1747915739.png", "https://image.prepladder.com/notes/U0FCUEgnl8MqcJrZMgmG1747915816.png", "https://image.prepladder.com/notes/n7UOcoeRhd46uxe8RxqN1747915863.png", "https://image.prepladder.com/content/pU8OQ9RNvQy0EzAzmWey1745837567.png", "https://image.prepladder.com/notes/J5sbwI2OrOnbHt3wPbiv1747915971.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Spondylolisthesis</strong></p>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"Spondylolisthesis\" data-author=\"\" data-hash=\"13189\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/yQUjNaWdDw4UrtPR3Y4h1747915429.png\"/></p>\n<ul>\n<li>It refers to the forward <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of a <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> over the one beneath it</li>\n<li>Commonly occurring at the L5-S1 and L4-L5 levels.</li>\n<li><strong>Spondylolysis </strong>refers to a<strong> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> without</strong> the<strong> <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> slipping forward</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Dysplastic\" data-author=\"\" data-hash=\"13190\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/6nF45HF8Uf2ckgo5Ko3R1747915526.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dysplastic </strong></p>\n<ul>\n<li>Least common type</li>\n<li>Caused by <strong>congenital anomalies in the upper <span class=\"customMeta\" data-dictid=\"d7ea5b85641692777198096c6c80c2\">sacrum</span> or L5</strong> arch, facilitating the slip.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Isthmic\" data-author=\"\" data-hash=\"13191\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/8kFlnYq48Eerw5clMQId1747915575.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Isthmic </strong></p>\n<ul>\n<li>The most common type</li>\n<li>Involving a <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> in the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis, which can be further divided into three subtypes:</li>\n</ul>\n<ul>\n<li><strong>Lytic</strong>: A fatigue <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis.</li>\n<li><strong>Intact but elongated</strong>: The <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis remains intact but is elongated.</li>\n<li><strong>Acute fracture</strong>: A recent <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis. The <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> causes the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> half of the <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> to slip forward while the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> half remains with the lower vertebra.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Degenerative\" data-author=\"\" data-hash=\"13192\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/yXITopyApTQOH1KnngPX1747915619.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Degenerative </strong></p>\n<ul>\n<li>Results from<strong> long-term <span class=\"customMeta\" data-dictid=\"52e6e2a0a11692777190b145ae5dc0\">intersegmental</span> instability</strong>, where the <strong>pars remains intact,</strong> but degenerative changes in the <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> joints permit forward slipping.</li>\n<li>Common in older adults, where <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"25d29169e3169277720246b37b93ef\">facet</span> joints due to <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> can lead to displacement, occasionally backwards (retrolisthesis).</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and neurological issues are rare.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Type IV Traumatic Spondylolisthesis\" data-author=\"\" data-hash=\"13193\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/9gcFjKdj6VstefxZfFGi1747915674.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Traumatic </strong></p>\n<p>This results from<strong> fractures</strong> in other parts of the<strong> bony structure</strong> <strong>rather </strong>than in the<strong> <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> interarticularis.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Pathological\" data-author=\"\" data-hash=\"13194\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/v06r61hU5uQPpaNesGrw1747915739.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathological</strong></p>\n<p>Caused by <strong>generalized</strong> or<strong> <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> bone diseases</strong> that weaken the vertebral articulations.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3><strong>Normal appearance</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3><strong>Spondylolysis</strong> <strong>(Option A)</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3><strong>Spondylolisthesis </strong><strong>(Option B)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Resembles a<strong> Scottish dog</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Collar Appearance</strong>: Indicates a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> (pars interarticularis)</li>\n<li>Defect without vertebral displacement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Separated Head and Neck</strong></li>\n<li>Defect with vertebral displacement</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Normal appearance\" data-author=\"Frank Gaillard\" data-hash=\"13195\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/scottie-dog-sign-spine\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/U0FCUEgnl8MqcJrZMgmG1747915816.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Collar Appearance\" data-author=\"Lucien Monfils\" data-hash=\"13196\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:SpondylolisthesisL5S1.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/n7UOcoeRhd46uxe8RxqN1747915863.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\" Jojo assumed\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Spondylolisthesis.jpg\" data-tags=\"\" height=\"233\" src=\"https://image.prepladder.com/content/pU8OQ9RNvQy0EzAzmWey1745837567.png\" width=\"283\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<h3><img alt=\"Normal appearance\" data-author=\"\" data-hash=\"13197\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/J5sbwI2OrOnbHt3wPbiv1747915971.png\"/></h3>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The type of splint shown in the image is known as?", "options": [{"label": "A", "text": "Wrist splint", "correct": false}, {"label": "B", "text": "Cock-up splint", "correct": true}, {"label": "C", "text": "Knuckle bender splint", "correct": false}, {"label": "D", "text": "Dynamic finger splint", "correct": false}], "correct_answer": "B. Cock-up splint", "question_images": ["https://image.prepladder.com/notes/ZK8mirresjSYMOvWkELn1747916074.png"], "explanation_images": ["https://image.prepladder.com/notes/ZK8mirresjSYMOvWkELn1747916074.png", "https://image.prepladder.com/notes/RvYG03pvtUA07zKTBGiP1747916149.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Treatment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Open Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immediate exploration and nerve repair or grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Closed Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wait 12 weeks for recovery before exploring</li>\n<li>Use EMG if no improvement; if <span class=\"customMeta\" data-dictid=\"c35382d7d61692777185a1eeeb333c\">denervation</span> is detected, perform nerve exploration and repair or grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fractures of Humerus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Assess for nerve injury on admission</li>\n<li>If the injury appears post-manipulation or internal fixation, explore and repair or <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> immediately</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Recovery Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Perform <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> hand movements</li>\n<li>Splint the wrist in extension-cock up splint:<img alt=\" Extension cock up splint\" data-author=\"\" data-hash=\"13199\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/RvYG03pvtUA07zKTBGiP1747916149.png\"/></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Long-term Disability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tendon transfers: <span class=\"customMeta\" data-dictid=\"51d02ec7e5169277719693f472fa48\">pronator</span> <span class=\"customMeta\" data-dictid=\"8ad930500b1692777200545684a556\">teres</span> to short <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> extensor, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> carpi <span class=\"customMeta\" data-dictid=\"282d33f842169277719716e285a377\">radialis</span> or <span class=\"customMeta\" data-dictid=\"d4cb28e3e91692777201b2085b4f79\">ulnaris</span> to finger extensors, <span class=\"customMeta\" data-dictid=\"2a7c79c3d01692777194c9e71d569b\">palmaris</span> <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> to thumb abductor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the fracture shown in the image, which occurred due to a fall from a significant height?", "options": [{"label": "A", "text": "Open book fracture", "correct": true}, {"label": "B", "text": "Chauffeur fracture", "correct": false}, {"label": "C", "text": "Malgaigne fracture", "correct": false}, {"label": "D", "text": "Bucket handle fracture", "correct": false}], "correct_answer": "A. Open book fracture", "question_images": ["https://image.prepladder.com/notes/JN1KqVWoNNZkSU19gKYA1747916290.png"], "explanation_images": ["https://image.prepladder.com/notes/JN1KqVWoNNZkSU19gKYA1747916290.png", "https://image.prepladder.com/notes/FRTyE5cWiTQxTeXOKYI51747916418.png", "https://image.prepladder.com/notes/NKvJFFQtSYhQHrm2u3OR1747916514.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type A: Stable (Intact <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arch)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Avulsion injury</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iliac-wing or <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> fracture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transverse <span class=\"customMeta\" data-dictid=\"c5e0f80e7e1692777198edc686a232\">sacrococcygeal</span> fracture</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type B: Partially stable (incomplete <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arch)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Open-book</strong> injury <strong>(external rotation) (Option A)</strong></p>\n<p><img alt=\"Open book fracture of Pelvis\" data-author=\"\" data-hash=\"13200\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/JN1KqVWoNNZkSU19gKYA1747916290.png\"/></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral-compression injury <strong>(internal rotation)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B2-1:</strong> Ipsilateral <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> injuries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B2-2:</strong> Contralateral <strong>(bucket-handle)</strong> injuries <strong>(Option D)</strong></p>\n<p> </p>\n<p><img alt=\"Diametric or Bucket Handle Injury.\" data-author=\"\" data-hash=\"13201\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/FRTyE5cWiTQxTeXOKYI51747916418.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type C: Unstable (complete <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arch)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral, with one side type B, one side type C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While examining a patient with a right forearm fracture, you ask him to make a fist. The following finding is noted during this procedure. What is the sign called?", "options": [{"label": "A", "text": "Froment’s sign", "correct": false}, {"label": "B", "text": "Pointing index sign", "correct": true}, {"label": "C", "text": "Benediction sign", "correct": false}, {"label": "D", "text": "Policeman tip deformity", "correct": false}], "correct_answer": "B. Pointing index sign", "question_images": ["https://image.prepladder.com/notes/c6UfQTKeG1p3RByX9gjp1747916572.png"], "explanation_images": ["https://image.prepladder.com/notes/c6UfQTKeG1p3RByX9gjp1747916572.png", "https://image.prepladder.com/notes/D22k6mkj0I5m2anTgBTz1747916624.png", "https://image.prepladder.com/notes/OoWy3Q8eB5glCj3Zw5491747916659.png", "https://image.prepladder.com/notes/b03yVaw5iLbpqOnaOudy1747916703.png", "https://image.prepladder.com/notes/WDngOwAWP5LhrvgH87ua1747916926.png", "https://image.prepladder.com/notes/JzWtOUmHTTapn6cD1WRu1747917000.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Muscle tested and action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pen test:</strong></p>\n<p><img alt=\"Pen test\" data-author=\"\" data-hash=\"13204\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/D22k6mkj0I5m2anTgBTz1747916624.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> Abductor pollicis brevis</li>\n<li><strong>Action:</strong> <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">Abduction</span> of thumb</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oschner <span class=\"customMeta\" data-dictid=\"7d9fedb3a5169277718426c475e8e8\">clasp</span> test:</strong><img alt=\"Oschner clasp test\" data-author=\"\" data-hash=\"13205\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/OoWy3Q8eB5glCj3Zw5491747916659.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> digitorum <span class=\"customMeta\" data-dictid=\"d3c34e683916927771998a3426c3a6\">superficialis</span> &amp; <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum profundus</li>\n<li><strong>Action:</strong> Flexion of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2 digits</li>\n<li><strong>Pointing index</strong> sign seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thumb opposition:</strong></p>\n<p><img alt=\"Thumb opposition\" data-author=\"\" data-hash=\"13206\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/b03yVaw5iLbpqOnaOudy1747916703.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> Opponens pollcis</li>\n<li><strong>Action: </strong>Opposition of thumb</li>\n<li><strong>O-sign</strong> is seen in normal patients</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female patient presented with complaints of a gradually progressive swelling around her wrist joint for 3 months. Given below is the image of the X-ray film. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing’s Sarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": true}, {"label": "D", "text": "Osteochondroma", "correct": false}], "correct_answer": "C. Osteoclastoma", "question_images": ["https://image.prepladder.com/notes/YxwBhktcXIxPgGjzk2jF1747917083.png"], "explanation_images": ["https://image.prepladder.com/notes/YxwBhktcXIxPgGjzk2jF1747917083.png", "https://image.prepladder.com/notes/YNeH66s71VqBNuPmSlXZ1747917154.png", "https://image.prepladder.com/notes/XY1AAof8xyRDju43cabT1747917215.png", "https://image.prepladder.com/notes/6u4qopbUwMg9bzIEmvOX1747917276.png", "https://image.prepladder.com/notes/L0jQL6YtYmg9vhVEU8Ln1747917351.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Benign but locally aggressive tumor of bone.<strong> </strong></li>\n<li>It commonly arises from epiphysis.</li>\n<li>MC Age: 20 and 45 years of age.</li>\n<li>Females &gt; males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sites affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> &gt; <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> &gt; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> &gt; sacrum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malignant transformation in &lt;1% of cases.</li>\n<li>Lungs are the most common site for metastases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Swelling, vague pain.</li>\n<li>Pathological fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: Expansile <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on epiphysis</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Osteoclastoma Xray\" data-author=\"Amini B, MacManus D, Le L, et al.\" data-hash=\"13209\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/giant-cell-tumour-of-bone\" data-tags=\"May2025\" height=\"522\" src=\"https://image.prepladder.com/notes/YxwBhktcXIxPgGjzk2jF1747917083.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histo- pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Multinucleated giant cells and a background network of spindle-shaped <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> stromal cells.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Osteoclastoma Histopathology\" data-author=\"Nephron\" data-hash=\"13210\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Giant_cell_tumour_of_bone_-_very_high_mag.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/YNeH66s71VqBNuPmSlXZ1747917154.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extended <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with Bone grafting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was diagnosed with supraspinatus tendinitis. What degree of movement of the shoulder would present with pain in this patient?", "options": [{"label": "A", "text": "0-60 degrees", "correct": false}, {"label": "B", "text": "60-120 degrees", "correct": true}, {"label": "C", "text": "More than 120 degrees", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. 60-120 degrees", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Pain in the shoulder and upper arm during the <strong>mid-range (60-120 degrees) </strong>of gleno-humeral abduction. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Minor <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> of the supraspinatus tendon</li>\n<li><strong>Supraspinatus tendinitis</strong></li>\n<li>Calcification of supraspinatus tendon</li>\n<li><strong>Subacromial bursitis</strong></li>\n<li>Fracture of the greater tuberosity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The space between the upper end of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> and the <span class=\"customMeta\" data-dictid=\"7ce5726fb0169277718072972038ca\">acromion</span> gets compromised, leading to the <span class=\"customMeta\" data-dictid=\"78dfa6942216927771971d0733476f\">rotator</span> <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> being pinched between the greater <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> and the <span class=\"customMeta\" data-dictid=\"7ce5726fb0169277718072972038ca\">acromion</span> during mid-abduction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain during mid-range of gleno-humeral abduction</li>\n<li>Tenderness at the supraspinatus <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> or <span class=\"customMeta\" data-dictid=\"e5fd8aa603169277719924d16bc34c\">subacromial</span> space</li>\n<li>Restriction of shoulder movements</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ultrasound therapy to the tender point</li>\n<li>Anti-inflammatory drugs</li>\n<li>Injection of <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">hydrocortisone</span> into the <span class=\"customMeta\" data-dictid=\"e5fd8aa603169277719924d16bc34c\">subacromial</span> space</li>\n<li>Excision of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of the acromion</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary source of reducing equivalents for liver fatty acid synthesis?", "options": [{"label": "A", "text": "Hexose monophosphate shunt pathway", "correct": true}, {"label": "B", "text": "Glycolysis", "correct": false}, {"label": "C", "text": "Tricarboxylic acid cycle", "correct": false}, {"label": "D", "text": "Uronic acid pathway", "correct": false}], "correct_answer": "A. Hexose monophosphate shunt pathway", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qEFeikvgkL9TZoTAht4B1745841482.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the cycles listed below is absent in muscle tissue?", "options": [{"label": "A", "text": "Glycogenolysis", "correct": false}, {"label": "B", "text": "Ketogenesis", "correct": true}, {"label": "C", "text": "Glycogenesis", "correct": false}, {"label": "D", "text": "Lipolysis", "correct": false}], "correct_answer": "B. Ketogenesis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vitamins is incorrectly paired with their respective enzymes?", "options": [{"label": "A", "text": "Vitamin B1 (Thiamine): RBC Trans-ketolase", "correct": false}, {"label": "B", "text": "Vitamin B2 (Riboflavin): RBC glutathione reductase", "correct": false}, {"label": "C", "text": "Vitamin B9 (Folic acid): FIGLU excretion/Histidine load test", "correct": false}, {"label": "D", "text": "Vitamin C: Serum methylmalonate level", "correct": true}], "correct_answer": "D. Vitamin C: Serum methylmalonate level", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the enzyme that is responsible for the defect causing Maple syrup urine disease?", "options": [{"label": "A", "text": "Branched-chain a-ketoacid dehydrogenase", "correct": true}, {"label": "B", "text": "Isovaleryl CoA dehydrogenase", "correct": false}, {"label": "C", "text": "Pyruvate carboxylase", "correct": false}, {"label": "D", "text": "Acetyl CoA carboxylase", "correct": false}], "correct_answer": "A. Branched-chain a-ketoacid dehydrogenase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old obese lady with diabetes, managed with oral hypoglycemic agents, now presents to the casualty with a hypoglycemic episode. Which of the following drugs is most likely responsible for her hypoglycemic episode?", "options": [{"label": "A", "text": "Metformin", "correct": false}, {"label": "B", "text": "Pioglitazone", "correct": false}, {"label": "C", "text": "Sitagliptin", "correct": false}, {"label": "D", "text": "Glimepiride", "correct": true}], "correct_answer": "D. Glimepiride", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/IY2K2D6ylFhToCCDEEPD1745842217.png"], "explanation": "<p>Correct Answer D - Glimepiride</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sulfonylureas</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Generation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Special Points</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First Generation</strong></p>\n<ul>\n<li>Higher risk of hypoglycemia</li>\n<li>Less commonly used</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tolbutamide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Short-acting</li>\n<li>Lower potency</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chlorpropamide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Long-acting</li>\n<li>Antidiuretic effects.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tolazamide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intermediate duration</li>\n<li>More potent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Second Generation</strong></p>\n<ul>\n<li>More potent than first-generation drugs</li>\n</ul>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glibenclamide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>longer duration</li>\n<li>There is a higher risk of <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> compared to other second-generation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glipizide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Shorter half-life</li>\n<li>Lower risk of hypoglycemia</li>\n<li>Preferable in elderly patients or those with <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glimepiride</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Once-daily dosing,</li>\n<li>Lower risk of hypoglycemia</li>\n<li>Most Potent In second-generation sulfonylureas.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gliclazide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Considered safer regarding hypoglycemia,</li>\n<li>Antioxidative properties may improve <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> outcomes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "10-year-old boy rapidly develops hypoglycemia after moderate activity. Blood examination reveals raised levels of ketone bodies, lactic acid, and triglycerides.On examination, the liver and kidneys are found to be enlarged.Which of the following deficiencies would be seen in the liver of this child?", "options": [{"label": "A", "text": "Glucose-6-phosphate", "correct": true}, {"label": "B", "text": "Glucose-1-phosphate", "correct": false}, {"label": "C", "text": "Glucose-1,6-diphosphate", "correct": false}, {"label": "D", "text": "Glycosaminoglycans", "correct": false}], "correct_answer": "A. Glucose-6-phosphate", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Von Gierke's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucose-6-phophatase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pompe's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acid maltase/ <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> glucosidase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cori's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Debranching enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anderson's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Branching enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>McArdle's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Muscle Phosphorylase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hers Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver phosphorylase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tarui's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Phosphoructokinase- I</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fat is stored in which form in tissue?", "options": [{"label": "A", "text": "Fatty acid", "correct": false}, {"label": "B", "text": "Cholesterol", "correct": false}, {"label": "C", "text": "TGs", "correct": true}, {"label": "D", "text": "Cholesterol esters", "correct": false}], "correct_answer": "C. TGs", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 66-year-old male presents with urinary difficulties, back pain, an elevated PSA blood test, two radiolucent lesions in the bony pelvis on X-ray, and enlarged lymph nodes in the lower abdomen on MRI. What medication is most appropriate for treating his condition?", "options": [{"label": "A", "text": "Anastrozole", "correct": false}, {"label": "B", "text": "Desogestrel", "correct": false}, {"label": "C", "text": "Goserelin", "correct": true}, {"label": "D", "text": "Oxandrolone", "correct": false}], "correct_answer": "C. Goserelin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Goserelin</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>GnRH antagonist</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>GnRH <span class=\"customMeta\" data-dictid=\"7d8d28cda71692777180c89a3c86ce\">agonist</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">GnRH antagonist</p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\"><strong>Blocks the GnRH <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> in the pituitary</strong></p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\">Decreased <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> and LH levels</p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\">Decreased <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">Estrogen</span> and Progesterone</p>\n<p> </p>\n<ul>\n<li>They have a lower risk of ovarian hyperstimulation.</li>\n<li>They offer complete <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> of <span class=\"customMeta\" data-dictid=\"2a7f0b780c1692777187fe83ec76b1\">endogenous</span> gonadotropins.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">GnRH agonist</p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\">Initial <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of <span class=\"customMeta\" data-dictid=\"514d28a1c21692777188703b64cfde\">gonadotropin</span> release</p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\"><strong>Downregulation of GnRH receptors</strong></p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\">Suppression of <span class=\"customMeta\" data-dictid=\"514d28a1c21692777188703b64cfde\">gonadotropin</span> release</p>\n<p> </p>\n<ul>\n<li>Recovery occurs after 2-3 months of the stoppage of medication.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid white; border-top:none; vertical-align:top\">\n<ul>\n<li>Cetrorelix</li>\n<li>Ganirelix</li>\n<li>Degarelix</li>\n<li>Abarelix</li>\n<li>Elagolix</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Leuprolide<strong> </strong></li>\n<li>Goserelin<strong> </strong></li>\n<li>Histrelin</li>\n<li>Buserelin</li>\n<li>Triptorelin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prostate cancer.</li>\n<li>Endometriosis.</li>\n<li>In Vitro <span class=\"customMeta\" data-dictid=\"2a8e411e2116927772022dd4b365bc\">Fertilization</span> (Suppression of <span class=\"customMeta\" data-dictid=\"2a7f0b780c1692777187fe83ec76b1\">endogenous</span> <span class=\"customMeta\" data-dictid=\"514d28a1c21692777188703b64cfde\">Gonadotropin</span> before administration of <span class=\"customMeta\" data-dictid=\"18a9d4c52716927771878ee08e63ee\">exogenous</span> hormones).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Delayed puberty</li>\n<li>Precocious puberty</li>\n<li>Anovulation</li>\n<li>Endometriosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Intermittent injection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Continuous injection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This is used when increased <span class=\"customMeta\" data-dictid=\"514d28a1c21692777188703b64cfde\">gonadotropin</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> is needed. As an agonist, its initial action <strong>stimulates the GnRH receptors</strong>, resulting in the release of gonadotropins.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This is preferred when decreased levels of gonadotropins or sex hormones are needed. Continuous <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> results in a <strong>negative feedback mechanism</strong> on the receptors, leading to their <strong>downregulation</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>DOC in Delayed puberty.</li>\n<li>Azoospermia (Male Infertility).</li>\n<li>Anovulation (Female Infertility).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>DOC in <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> carcinoma.</li>\n<li>DOC in<strong> <span class=\"customMeta\" data-dictid=\"58aedbfaa916927771960c11064ef0\">Precocious</span> puberty.</strong></li>\n<li>Endometriosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increased size of the <span class=\"customMeta\" data-dictid=\"7b1a7ff355169277719401475de6fb\">ovary</span> may lead to pain in the abdomen.</li>\n<li>Rupture of the ovary: Hemoperitoneum.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Postmenopausal symptoms include hot flashes, <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">Osteoporosis</span> and Depression.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the pattern of inheritance for hemophilia A?", "options": [{"label": "A", "text": "X linked recessive", "correct": true}, {"label": "B", "text": "X linked Dominant", "correct": false}, {"label": "C", "text": "Autosomal dominant", "correct": false}, {"label": "D", "text": "Autosomal recessive", "correct": false}], "correct_answer": "A. X linked recessive", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Hemophilia A is a genetic <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorder that affects the blood's ability to <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> properly due to a <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factor VIII.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hemophilia A is an <span class=\"customMeta\" data-dictid=\"dd35346fc716927772029e2f0bb10f\">X-linked</span> <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder, which means it primarily affects males.</li>\n<li>Females can be carriers of the condition.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Excessive or prolonged <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> after injuries or surgeries.</li>\n<li>Frequent nosebleeds.</li>\n<li>Easy bruising.</li>\n<li>Bleeding into joints, leading to pain and swelling.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood tests to measure the level of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factor VIII.</li>\n<li>Genetic testing to identify the specific mutation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Replacement therapy:</strong> Regular <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factor VIll concentrates.</li>\n<li>Desmopressin DDAVP): Stimulates the release of stored <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factor VIII.</li>\n<li><strong>Gene therapy:</strong> Emerging treatment option to introduce the missing <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factor gene.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Joint damage: </strong>Repeated <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> into the joints can cause permanent damage and limited mobility.</li>\n<li><strong>Intracranial bleeding:</strong> Severe cases may result in <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> inside the skull, which can be life-threatening.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the medications listed below is considered safe for the treatment of pregnancy-induced hypertension?", "options": [{"label": "A", "text": "Lisinopril", "correct": false}, {"label": "B", "text": "Propranolol", "correct": false}, {"label": "C", "text": "Alpha methyldopa", "correct": true}, {"label": "D", "text": "Losartan", "correct": false}], "correct_answer": "C. Alpha methyldopa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\"&gt;Alpha&lt;/span&gt; methyldopa</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Antihypertensives in Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>DOC: Labetaolol</strong> (Beta-blocker)</li>\n<li>If chronic <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> develops, <strong>Alpha methyldopa</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Safe antihypertensives during pregnancy</strong></li>\n<li>Labetalol, Hydralazine, Methyldopa, and <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> channel blockers like Nifedipine. (LHMC- Lady Hardinge Medical College)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Unsafe <span class=\"customMeta\" data-dictid=\"a9952795951692777181001d03753a\">antihypertensive</span> drugs during pregnancy:</strong></p>\n<ul>\n<li><strong>ACE inhibitors (Option A) &amp; ARBs (Option D):</strong> Can lead to <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"133b86a0a516927771809ea08682e8\">agenesis</span> in the fetus, causing <span class=\"customMeta\" data-dictid=\"41fc142ae61692777194c3f69d3d74\">oligohydramnios</span> and leading to POTTER sequence (Pulmonary hypoplasia, Oligohydramnios, Twisted/wrinkled skin, Twisted Potter faces, <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">Extremity</span> defects, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> agenesis).</li>\n<li><strong>Thiazides/Loop diuretics/Beta-blockers (Option B):</strong> Bear the risk of <strong>placental ischemia</strong>, which can be fatal to the fetus.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with complaints of slowly progressive difficulty hearing in the right ear. She also has pulsatile tinnitus. On examination, a reddish mass was seen behind the tympanic membrane, and an audible bruit was heard over the mastoid when auscultation with a stethoscope was performed. Her Rinne test was negative. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "CSOM", "correct": false}, {"label": "B", "text": "ASOM", "correct": false}, {"label": "C", "text": "Mastoiditis", "correct": false}, {"label": "D", "text": "Glomus tumor", "correct": true}], "correct_answer": "D. Glomus tumor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JraWuOxssPuJNbPINCg11745842662.png", "https://image.prepladder.com/content/yGe14XPFEuzrnyhZnbVt1745842670.png", "https://image.prepladder.com/content/LLX66sbejsMwFDyXCQNA1745842683.png", "https://image.prepladder.com/content/Lz3YAEFZtWtdoOZ1tLxw1745842700.png", "https://image.prepladder.com/content/41baNtty94g7XkMFRE0M1745842713.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Glomus Tympanicum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Glomus Jugulare</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours arise from the<strong> <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> of the middle ear. </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours originate from the <span class=\"customMeta\" data-dictid=\"48872daf681692777186072f36702a\">dome</span> of the <strong>jugular bulb </strong>and can extend into the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> and surrounding structures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulsatile tinnitus, hearing loss, and a reddish mass behind the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulsatile tinnitus, hearing loss, and may involve multiple <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves (IX, X, XI)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Otoscopy findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reddish, <span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\">pulsatile</span> mass behind the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</li>\n<li>This may lead to <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> and a feeling of fullness in the ear.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Masafumi Ohki, Shigeru Kikuchi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/a-A-red-mass-was-observed-under-the-anterior-quadrant-of-the-tympanic-membrane-b_fig1_334371255\" data-tags=\"\" height=\"328\" src=\"https://image.prepladder.com/content/JraWuOxssPuJNbPINCg11745842662.png\" width=\"328\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reddish mass behind the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane, often pulsatile.</li>\n<li>It is associated with neurological symptoms due to <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve involvement, including <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> nerve involvement.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Michael Hawke MD\" data-hash=\"\" data-license=\"CC-BY-4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Glomus_Jugulare_Tumor.jpg\" data-tags=\"\" height=\"373\" src=\"https://image.prepladder.com/content/yGe14XPFEuzrnyhZnbVt1745842670.png\" width=\"373\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations of <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">Glomus</span> Tumour</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CECT (contrast-enhanced computed tomography) </strong>is the <strong>investigation of choice to distinguish</strong> between <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tympanicum and <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> jugulare tumours and to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> them from an <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, a high <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb, or a dehiscent <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb.</li>\n<li><strong>Phelps sign: </strong>On the normal side, the carotico-jugular spine (a dense bone structure between the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> and mastoid) is intact. On the affected side, <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the carotico-jugular spine is observed.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"426\" src=\"https://image.prepladder.com/content/LLX66sbejsMwFDyXCQNA1745842683.png\" width=\"419\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI scan </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It demonstrates the extent of the tumour within the soft tissue.</li>\n<li><strong>Salt and pepper sign: </strong>Microhemorrhages within the tumour are visualized as white and gray dots on MRI, resulting in a <strong>\"salt-and-pepper\" appearance.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/Lz3YAEFZtWtdoOZ1tLxw1745842700.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Angiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is essential when CT indicates involvement of the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb, <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, or <span class=\"customMeta\" data-dictid=\"ebcba023d81692777190e9eef5bcc2\">intradural</span> extension. It also aids in identifying additional <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tumors, locating <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> vessels, and guiding embolization.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brain <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> and Flow Studies </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These are essential if the tumor compresses the internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n<li>They assess brain perfusion, <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> function, and may involve <span class=\"customMeta\" data-dictid=\"e3827ede5c1692777202c45715fc8e\">xenon</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and <span class=\"customMeta\" data-dictid=\"7cb1c220051692777190be13e8c7cc\">isotope</span> studies to <span class=\"customMeta\" data-dictid=\"7991fb415f16927771887b76483a71\">gauge</span> stroke risk and the need for <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> replacement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Histopathological studies show the<strong> Zell Ballen pattern,</strong> where <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> chief cells and <span class=\"customMeta\" data-dictid=\"d02faf3d3e16927771998a3442add3\">sustentacular</span> supporting cells <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> clusters (Zell Ballen) encircled by extensive <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> sinusoids.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elsharawy, Mohamed &amp; Alsaif, Hind &amp; Elsaid, Ayman &amp; Kredees, Ali. \" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Well-defined-nests-of-cuboidal-cells-zellballen-are-separated-by-highly-vascularized_fig5_259272100\" data-tags=\"\" height=\"310\" src=\"https://image.prepladder.com/content/41baNtty94g7XkMFRE0M1745842713.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Preoperative <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> of the tumour is not performed due to the risk of profuse <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from its highly <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> thin-walled blood sinusoids and potential injury to the high <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb or <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What medication is administered to prevent chemotherapy-induced nausea and vomiting in a 45-year-old woman with lung adenocarcinoma who has experienced these symptoms during her previous treatment visits?", "options": [{"label": "A", "text": "Metoclopramide", "correct": false}, {"label": "B", "text": "Ropinirole", "correct": false}, {"label": "C", "text": "Domperidone", "correct": false}, {"label": "D", "text": "Palonosetron", "correct": true}], "correct_answer": "D. Palonosetron", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Palonosetron</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>5HT-3 Antagonists (Anti-motility drugs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>5HT-4 Agonists (Prokinetic drugs)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Block 5HT-3 receptors</strong> in the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> and central nervous system.</li>\n<li><strong>Decrease</strong> <span class=\"customMeta\" data-dictid=\"6043ec42cf169277719044e8ee3234\">intestinal motility</span> and secretion.</li>\n<li>Inhibit the <span class=\"customMeta\" data-dictid=\"64f968d2251692777184286bce1af6\">chemoreceptor</span> trigger zone (CTZ) in the area postrema, reducing <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Activate 5HT-4 receptors</strong> in the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> tract.</li>\n<li><strong>Increase</strong> <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> and secretion.</li>\n<li>Enhances the release of <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> from <span class=\"customMeta\" data-dictid=\"85c304623c1692777187da4d1f1ee7\">enteric</span> neurons.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ondansetron</li>\n<li>Granisetron</li>\n<li>Dolasetron</li>\n<li><strong>Palonosetron</strong></li>\n<li>Alosetron</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metoclopramide</li>\n<li>Cisapride (withdrawn due to QT prolongation)</li>\n<li>Tegaserod (restricted use due to <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> risks)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (CINV)</strong></li>\n<li>Postoperative <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (PONV)</li>\n<li>Radiation-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (RINV)</li>\n<li>Irritable <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> syndrome with diarrhoea (IBS-D): Alosetron</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gastroparesis</li>\n<li>Gastroesophageal <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease (GERD)</li>\n<li>Functional dyspepsia</li>\n<li>Chronic constipation</li>\n<li>Postoperative ileus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Headache</li>\n<li>Constipation</li>\n<li>Dizziness</li>\n<li>Fatigue</li>\n<li>Prolonged QT interval (rare)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diarrhea</li>\n<li>Abdominal pain</li>\n<li>Nausea</li>\n<li>Headache</li>\n<li>Prolonged QT interval (Cisapride, Tegaserod)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the objective tests used to assess hearing ability? A. BERA (Brainstem evoked response audiometry) B. OAE (Otoacoustic emission) C. PTA (Pure tone audiometry) D. Tympanometry", "options": [{"label": "A", "text": "A, B and D", "correct": false}, {"label": "B", "text": "A, B and C", "correct": false}, {"label": "C", "text": "B, C and D", "correct": false}, {"label": "D", "text": "A, B, C and D", "correct": true}], "correct_answer": "D. A, B, C and D", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is considered a universal methyl group donor in various biochemical reactions?", "options": [{"label": "A", "text": "Glucose-6-phosphate", "correct": false}, {"label": "B", "text": "Acetyl CoA", "correct": false}, {"label": "C", "text": "S-Adenosyl Methionine", "correct": true}, {"label": "D", "text": "S-Adenosyl Serine", "correct": false}], "correct_answer": "C. S-Adenosyl Methionine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of doxycycline?", "options": [{"label": "A", "text": "Cell wall synthesis inhibitor", "correct": false}, {"label": "B", "text": "Protein synthesis inhibitor", "correct": true}, {"label": "C", "text": "DNA gyrase inhibitor", "correct": false}, {"label": "D", "text": "Leucyl-tRNA synthetase inhibitor", "correct": false}], "correct_answer": "B. Protein synthesis inhibitor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8H9qf0BDgVdvgWvHPtJQ1745842933.png"], "explanation": "<p>Correct Answer B - Protein &lt;span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\"&gt;synthesis&lt;/span&gt; inhibitor</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tetracycline </strong></p>\n<p style=\"text-align:center\"><strong>Oxytetracycline </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Demeclocycline </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Doxycycline </strong></p>\n<p style=\"text-align:center\"><strong>Minocycline </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Potency </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intermediate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plasma protein binding </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Half-life</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6 - 12 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 -16 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18- 24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alteration of gut flora</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Altered</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate alteration</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Least alteration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phototoxicity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Highest </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tooth discoloration is less marked</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diabetes insipidus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Doxycycline has low <strong>nephrotoxicity. </strong></li>\n<li>Minocycline has <strong>Ototoxicity.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses of Tetracyclines</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Chlamydial Infections</strong>: Urethritis, Endocervicitis, Lymphogranuloma venereum, <span class=\"customMeta\" data-dictid=\"2334b7498b1692777188fa8b2eee36\">granuloma</span> inguinale.</li>\n<li><strong>Atypical Pneumonia: </strong>Mycoplasma pneumonia, Psittacosis.</li>\n<li>Rickettsial Infections.</li>\n<li>Pleurodesis: <span class=\"customMeta\" data-dictid=\"d0f202322516927771863db87b76e7\">Doxycycline</span> for pneumothorax.</li>\n<li>H. pylori Infection: Part of quadruple therapy.</li>\n<li>Anthrax, Plague, Borrelia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the OPD with a chronic dry cough with no fever or other associated symptoms. He had recently been started on an antihypertensive for hypertension. Which among the following is most likely responsible for causing these symptoms?", "options": [{"label": "A", "text": "Bradykinin and renin", "correct": false}, {"label": "B", "text": "Angiotensin II and bradykinin", "correct": false}, {"label": "C", "text": "Only bradykinin", "correct": true}, {"label": "D", "text": "Histamine", "correct": false}], "correct_answer": "C. Only bradykinin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Only bradykinin</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adverse Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypotension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decrease in blood pressure, especially upon <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> of therapy or with <strong>dosage increases.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels due to <strong>reduced <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> secretion.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cough</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Persistent dry cough, possibly due to <span class=\"customMeta\" data-dictid=\"3c5739595d16927771839e61a5855c\">bradykinin</span> buildup in the lungs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Angioedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to <strong>increased <span class=\"customMeta\" data-dictid=\"3c5739595d16927771839e61a5855c\">bradykinin</span> levels,</strong> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of deeper layers of skin, particularly around the eyes and lips, can be life-threatening.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rashes/Urticaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin reactions like rashes or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> occur in a small percentage of users.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dysgeusia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reversible</strong> taste changes are <strong>more common with captopril</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rare Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Granulocytopenia</strong> (low white blood cells) and <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> (excess protein in urine) are more concerning in patients with <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Possible in patients with <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> due to decreased <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> filtration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fetal Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ACE inhibitors are <strong>contraindicated during pregnancy </strong>due to potential harm to the fetus, including <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage due to <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> renin-angiotensin system.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following enzymes is deficient in the autosomal recessive type of severe combined immunodeficiency?", "options": [{"label": "A", "text": "Ornithine transcarbamylase", "correct": false}, {"label": "B", "text": "Phosphomannose isomerase", "correct": false}, {"label": "C", "text": "Adenosine deaminase", "correct": true}, {"label": "D", "text": "Hypoxanthine-guanine phosphoribosyl transferase", "correct": false}], "correct_answer": "C. Adenosine deaminase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with chronic obstructive pulmonary disease (COPD) is already on inhaled salmeterol therapy, but they are currently experiencing no improvement and have presented to the outpatient department. Which of the following medications can be included in their treatment plan?", "options": [{"label": "A", "text": "Theophylline", "correct": false}, {"label": "B", "text": "Azithromycin", "correct": false}, {"label": "C", "text": "Oral glucocorticoids", "correct": false}, {"label": "D", "text": "Ipratropium", "correct": true}], "correct_answer": "D. Ipratropium", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Vg20tLxuydwWoVh0GiuK1745843191.png", "https://image.prepladder.com/content/5oJj2IFNmMtgR8uNq6fj1745843195.png"], "explanation": "<p>Correct Answer D - Ipratropiu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How should a patient with diphtheria and right vocal fold palsy be treated?", "options": [{"label": "A", "text": "Wait and watch", "correct": false}, {"label": "B", "text": "Gelfoam injection", "correct": false}, {"label": "C", "text": "Thyroplasty type 1", "correct": true}, {"label": "D", "text": "Fat injection", "correct": false}], "correct_answer": "C. Thyroplasty type 1", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old man presented with weight loss, decreased appetite, and iron deficiency anemia. Chest x-ray was done and given below. What is the diagnosis?", "options": [{"label": "A", "text": "Lung metastasis", "correct": true}, {"label": "B", "text": "Bronchogenic carcinoma", "correct": false}, {"label": "C", "text": "Miliary tuberculosis", "correct": false}, {"label": "D", "text": "Mesothelioma", "correct": false}], "correct_answer": "A. Lung metastasis", "question_images": ["https://image.prepladder.com/content/UKi7ohKDCwEOsCZy8JWv1745843277.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was brought to the hospital following a road traffic accident. The patient is disoriented, and a CT scan of the head shows no evidence of hemorrhage but features of cerebral edema and raised intracranial pressure. Which of the following drugs can be used for the initial management of raised intracranial pressure?", "options": [{"label": "A", "text": "Chlorthiazide", "correct": false}, {"label": "B", "text": "Mannitol", "correct": true}, {"label": "C", "text": "Acetazolamide", "correct": false}, {"label": "D", "text": "Glycerol", "correct": false}], "correct_answer": "B. Mannitol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Mannitol</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diuretic Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thiazide Diuretics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chlorothiazide<br/>\n\t\t\t(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension (effective in <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> HTN)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not suitable for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> fluid <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> but can be used as an adjunct.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">Anhydrase</span> Inhibitors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acetazolamide (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glaucoma</p>\n<p>Altitude sickness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>- Not recommended for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> or fluid overload.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Osmotic Diuretics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mannitol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reducing <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure</p>\n<p>Acute <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>- Not used for <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> management.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended course of action for managing a 6-year-old boy who fell from a bed and now has swelling in his nose, along with breathing difficulties? During examination, it was observed that there are smooth, rounded swellings on both sides of the septum, visible through both nostrils. On palpation, the swellings were found to be soft and fluctuant.", "options": [{"label": "A", "text": "Systemic antibiotics", "correct": false}, {"label": "B", "text": "Incision and drainage", "correct": true}, {"label": "C", "text": "High-resolution computerized tomography", "correct": false}, {"label": "D", "text": "Submucosal resection", "correct": false}], "correct_answer": "B. Incision and drainage", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cSkVk50IOvKfVHcporot1745843346.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Collection of blood under the <span class=\"customMeta\" data-dictid=\"f6fce4967b16927771956fcb228bb9\">perichondrium</span> or <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum.</li>\n<li>Commonly caused by:\n\t\t\t\t<ul>\n<li>Nasal trauma.</li>\n<li>Septal surgery.</li>\n<li>Spontaneous occurrence in <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorders.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (most common symptom).</li>\n<li>Frontal headache and pressure over the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bridge.</li>\n<li>Smooth, rounded, soft, and <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in both <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"919be7b0a31692777203eb1a856f99\">fossae</span> (or sometimes unilateral).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Small hematomas:</u> Aspirated with a wide-bore <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> needle.</li>\n<li><u>Larger hematomas:</u> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">Incision</span> and <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> via a septal <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> floor, excising a small piece of <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> for better drainage.</li>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"80273d93491692777194321d2f821b\">packing</span> on both sides to prevent reaccumulation.</li>\n<li>Systemic antibiotics to prevent septal abscess.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibrous tissue formation leads to permanent septal thickening if untreated.</li>\n<li>Secondary infection may lead to septal abscess, <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> necrosis, and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> depression.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary source of cholesterol synthesis?", "options": [{"label": "A", "text": "Malonyl-CoA", "correct": false}, {"label": "B", "text": "Pyruvate", "correct": false}, {"label": "C", "text": "Oxaloacetate", "correct": false}, {"label": "D", "text": "Acetyl-CoA", "correct": true}], "correct_answer": "D. Acetyl-CoA", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/gFT6JP9sdwZ8rDuqTFEQ1748236611.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man joins a pilgrimage to a shrine at a mountain peak. At the summit, he develops tightness in the chest, associated with breathlessness and altered sensorium. Which of the following can be given for symptomatic relief?", "options": [{"label": "A", "text": "Mannitol", "correct": false}, {"label": "B", "text": "Digoxin", "correct": false}, {"label": "C", "text": "Diltiazem", "correct": false}, {"label": "D", "text": "Acetazolamide", "correct": true}], "correct_answer": "D. Acetazolamide", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oTbp9Qc2COPoV0gpVOwq1745843494.png"], "explanation": "<p>Correct Answer D - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve is responsible for the syncopal episode that occurred during the syringing procedure for ear wax removal in a patient?", "options": [{"label": "A", "text": "Auriculotemporal nerve", "correct": false}, {"label": "B", "text": "Arnold’s nerve", "correct": true}, {"label": "C", "text": "Glossopharyngeal nerve", "correct": false}, {"label": "D", "text": "Jacobson’s nerve", "correct": false}], "correct_answer": "B. Arnold’s nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The parents of a 9-year-old girl have noticed their daughter often staring blankly, which is sometimes associated with chewing movements. There were also complaints of daydreaming and a decline in school performance. During the episodes, she did not have a problem with maintaining posture, nor were there generalised tonic and clonic movements. The child's EEG is given below. Which of the following is a first-line agent to treat this condition?", "options": [{"label": "A", "text": "Carbamazepine", "correct": false}, {"label": "B", "text": "Phenytoin", "correct": false}, {"label": "C", "text": "Sodium valproate", "correct": true}, {"label": "D", "text": "Clonazepam", "correct": false}], "correct_answer": "C. Sodium valproate", "question_images": ["https://image.prepladder.com/notes/19DnLPiIiK5wg7S0SCv51747899744.png"], "explanation_images": [], "explanation": "<p>Correct Answer C - Sodium v\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55 year old shipbuilding worker presents with dyspnea. He has been working in this industry for the past 25 years. Which is the most specific malignancy that we can expect in this patient?", "options": [{"label": "A", "text": "Bronchogenic carcinoma", "correct": false}, {"label": "B", "text": "Malignant mesothelioma", "correct": true}, {"label": "C", "text": "Small cell carcinoma of lung", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma of lung", "correct": false}], "correct_answer": "B. Malignant mesothelioma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wmjZSRSFJN0dvZHSLfU61745843643.png", "https://image.prepladder.com/content/GKd7WhC5zEVkx6AC2dFe1745843643.png", "https://image.prepladder.com/content/1gOAdXc21YEn3wxtT8x11745843643.png", "https://image.prepladder.com/content/KlXxAYvPdB1qqzaraO871745843643.png", "https://image.prepladder.com/content/I81xJDClQ669QLZJ8e9Q1745843643.png", "https://image.prepladder.com/content/S4pBggmOT6EslQyCzpQ61745843683.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:742px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mesothelioma</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A rare cancer arising from mesothelial cells that most commonly affects the pleura.</li>\n<li>It can also affect the peritoneum, <span class=\"customMeta\" data-dictid=\"56ab21797f16927771954b343891ef\">pericardium</span> and <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asbestos: <span class=\"customMeta\" data-dictid=\"9f56633f181692777192f07ed38b1a\">Mesothelioma</span> is the most specific asbestos-associated cancer .</li>\n<li>It is not associated with smoking.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Advanced pleural <span class=\"customMeta\" data-dictid=\"9f56633f181692777192f07ed38b1a\">mesothelioma</span> can cause extensive pleural <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and thickening, making the affected side rigid and immobile.</li>\n<li>Later stages fix the <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> in place due to pleural thickening and fibrosis.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift is not a characteristic feature of mesothelioma.</li>\n<li>M/C <span class=\"customMeta\" data-dictid=\"2878159c181692777185d495ce6244\">cytogenetic</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in mesothelioma: <strong>Homozygous <span class=\"customMeta\" data-dictid=\"cf1e8ec6121692777185eba2630061\">deletion</span> of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 9p</strong>, leading to <strong>loss</strong> of tumour <span class=\"customMeta\" data-dictid=\"92427347f51692777199a762a91d21\">suppressor</span> gene- <strong>CDKN2A.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Progressive dyspnea, chest pain, weight loss, chronic cough, hemoptysis.</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"baa424d2de16927771836afd73785b\">breath sounds</span> and <span class=\"customMeta\" data-dictid=\"e452a3bf5716927771867e7ea9b4da\">dullness</span> to <span class=\"customMeta\" data-dictid=\"4818bebdf31692777195cc835c12d4\">percussion</span> (due to pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> or thickening).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CT scan:</strong> <strong>Pleural thickening, effusion, or frozen hemithorax</strong> (not causing a <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift in the presence of effusion)</li>\n<li>Confirmed by <strong>biopsy:</strong>\n<ul>\n<li><strong>Epithelioid mesothelioma</strong> shows tubules, nests, or <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> structures with uniform round to <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> and <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm.</li>\n<li><strong>Sarcomatoid mesothelioma</strong> consists of spindle-shaped cells resembling fibrosarcoma.</li>\n<li><strong>Biphasic mesothelioma</strong> displays a mixture of both patterns.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Specific</strong> <strong>markers</strong> for mesothelioma:\n\n\t\t\t\t<ul>\n<li>Calretinin.</li>\n<li>Epithelial <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> antigen.</li>\n<li>Cytokeratin.</li>\n<li>Mesothelin.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Yale Rosen\" data-hash=\"\" data-license=\"CC BY SA 2.0\" data-source=\"https://www.flickr.com/photos/pulmonary_pathology/3954797985/in/photostream/\" data-tags=\"\" height=\"415\" src=\"https://image.prepladder.com/content/wmjZSRSFJN0dvZHSLfU61745843643.png\" width=\"266\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Mesothelioma- Gross</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Malignant_epithelioid_mesothelioma_2-2_-_high_mag.jpg#/media/File:Malignant_epithelioid_mesothelioma_-_high_mag.jpg\" data-tags=\"\" height=\"286\" src=\"https://image.prepladder.com/content/GKd7WhC5zEVkx6AC2dFe1745843643.png\" width=\"192\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Mesothelioma- H &amp; E stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Malignant_epithelioid_mesothelioma_2-2_-_high_mag.jpg#/media/File:Malignant_epithelioid_mesothelioma_-_calretinin_-_intermed_mag.jpg\" data-tags=\"\" height=\"207\" src=\"https://image.prepladder.com/content/1gOAdXc21YEn3wxtT8x11745843643.png\" width=\"335\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Mesothelioma- Calretinin stain</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Mesothelioma - sarcomatoid. Case study, Radiopaedia.org (Accessed on 06 Dec 2024) https://doi.org/10.53347/rID-8705\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/mesothelioma-sarcomatoid#image-317742\" data-tags=\"\" height=\"380\" src=\"https://image.prepladder.com/content/KlXxAYvPdB1qqzaraO871745843643.png\" width=\"460\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Coarse, partially calcified right pleural plaques, accompanied by massive right pleural effusion, causing total <span class=\"customMeta\" data-dictid=\"e9046e11bd1692777197e166e5418f\">right lung</span> collapse and mass effect.</p>\n</td>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Leong P, Mesothelioma. Case study, Radiopaedia.org (Accessed on 06 Dec 2024) https://doi.org/10.53347/rID-26805\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/mesothelioma-23#image-5530797\" data-tags=\"\" height=\"390\" src=\"https://image.prepladder.com/content/I81xJDClQ669QLZJ8e9Q1745843643.png\" width=\"549\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Lobulated pleural soft tissue mass encasing the right lung. Associated <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the right 3rd rib anteriorly.</p>\n<p>Calcified <span class=\"customMeta\" data-dictid=\"e9d028795c169277719520dc71ae4b\">pleural plaques</span> were noted bilaterally, indicating previous <span class=\"customMeta\" data-dictid=\"92cc1e1acb1692777182aee908c1fd\">asbestos</span> exposure.</p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The probable diagnosis for a 60-year-old diabetic patient who is experiencing intense ear pain and otorrhea that has not improved with antibiotics, along with the presence of granulation tissue in the ear canal and facial nerve paralysis, is:", "options": [{"label": "A", "text": "Otomycosis", "correct": false}, {"label": "B", "text": "Serous otitis media", "correct": false}, {"label": "C", "text": "Malignant otitis externa", "correct": true}, {"label": "D", "text": "Eczematous otitis externa", "correct": false}], "correct_answer": "C. Malignant otitis externa", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jnP5eGFvDM0HCk2XUnhO1745843643.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the potential diagnosis for a 34-year-old male who has been consuming maize as his main diet for an extended period and is now experiencing symptoms such as abdominal pain, decreased appetite, and diarrhea? Additionally, upon examination, glossitis (inflammation of the tongue) and a pigmented rash in sun-exposed areas were observed, along with a lesion on his neck.", "options": [{"label": "A", "text": "Pellagra", "correct": true}, {"label": "B", "text": "Scurvy", "correct": false}, {"label": "C", "text": "Megaloblastic anemia", "correct": false}, {"label": "D", "text": "Beriberi", "correct": false}], "correct_answer": "A. Pellagra", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pRnZX0AyUyG0AmDl9H6B1745843605.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male patient comes to your clinic with an 8-month history of shortness of breath and non-productive cough. He has smoked half a pack of cigarettes for the past 30 years. On physical examination, clubbing is seen and fine crackles are heard on both sides during inspiration. You perform pulmonary function tests and it shows an FEV1/FVC ratio of 92%. The CT scan of the chest is shown below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Bronchial asthma", "correct": false}, {"label": "B", "text": "Pulmonary fibrosis", "correct": true}, {"label": "C", "text": "Pulmonary tuberculosis", "correct": false}, {"label": "D", "text": "Chronic obstructive pulmonary disease", "correct": false}], "correct_answer": "B. Pulmonary fibrosis", "question_images": ["https://image.prepladder.com/notes/R6rsBFzzAMLvZkK1Tzei1747901834.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:603px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Histological Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Associated Clinical Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usual Interstitial Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Idiopathic Pulmonary Fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desquamative Interstitial Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desquamative Interstitial Pneumonia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute Interstitial Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hamman-Rich Syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bronchiolitis Obliterans Organizing Pneumonia (BOOP)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cryptogenic Organizing Pneumonia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Specific Interstitial Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Specific Interstitial Pneumonia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory Bronchiolitis-Associated Lung Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory Bronchiolitis-Associated Interstitial Lung Disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following medications can lead to the development of gynecomastia?", "options": [{"label": "A", "text": "Tamoxifen", "correct": false}, {"label": "B", "text": "Oxytocin", "correct": false}, {"label": "C", "text": "Spironolactone", "correct": true}, {"label": "D", "text": "Clomiphene citrate", "correct": false}], "correct_answer": "C. Spironolactone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of alteplase, a tissue plasminogen activator (tPA)?", "options": [{"label": "A", "text": "Inhibits Vitamin K-dependent factors", "correct": false}, {"label": "B", "text": "Inhibits factor X", "correct": false}, {"label": "C", "text": "Promotes fibrinolysis", "correct": true}, {"label": "D", "text": "Activation of thrombin", "correct": false}], "correct_answer": "C. Promotes fibrinolysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Promotes fibrinolysis</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<thead>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fibrinolytic Drugs (Thrombolytics)</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Activate <span class=\"customMeta\" data-dictid=\"bab1a0998e1692777195514ec82e5f\">plasminogen</span> to <span class=\"customMeta\" data-dictid=\"7e525df4331692777195cc62f0899a\">plasmin</span> via tissue <span class=\"customMeta\" data-dictid=\"bab1a0998e1692777195514ec82e5f\">plasminogen</span> <span class=\"customMeta\" data-dictid=\"a095f733351692777180a29940c98a\">activator</span> (t-PA)</strong>→ digests <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> →lyse <span class=\"customMeta\" data-dictid=\"fc23eb4c0a16927772003dff4101cd\">thrombi</span> to recanalize occluded blood vessels, primarily <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> arteries.</p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Examples </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Streptokinase (not in use)</li>\n<li>Urokinase (not in use)</li>\n<li><strong>Alteplase </strong></li>\n<li>Reteplase</li>\n<li>Tenecteplase</li>\n</ul>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">Infarction</span> (STEMI)\n\t\t\t\t<ul>\n<li>The chief indication is for STEMI.</li>\n<li>Not indicated for unstable <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> (UA) and low-risk NSTEMI.</li>\n<li>Alternative to emergency PCI.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">Vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">Thrombosis</span> (DVT)</li>\n</ul>\n<ul>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> (PE)\n\t\t\t\t<ul>\n<li>Indicated for large, life-threatening PE</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Peripheral Arterial Occlusion\n\t\t\t\t<ul>\n<li>Indicated when <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"b5771b30e816927772007c88fd4e29\">thrombectomy</span> is not possible.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Stroke (Ischemic Stroke)\n\t\t\t\t<ul>\n<li>Alteplase is approved</li>\n<li>Contraindicated after 4.5 hours of symptom onset due to increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> risk.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contraindications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>History of <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hemorrhage.</li>\n<li>History of <span class=\"customMeta\" data-dictid=\"bef027ba821692777190cb424e9554\">ischemic stroke</span> in the past 3 months.</li>\n<li>History of head injury in the past 3 months.</li>\n<li>Intracranial tumor/vascular abnormality/aneurysms.</li>\n<li>Active bleeding/bleeding disorders.</li>\n<li>Patients on anticoagulants.</li>\n<li>Peptic ulcer, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> varices.</li>\n<li>Recent wound, fracture, or tooth extraction.</li>\n<li>Major surgery within the past 3 weeks.</li>\n<li>Uncontrolled hypertension.</li>\n<li><strong>Pregnancy.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male who is a professional trumpet blower presented with a swelling on the left side of the neck. On examination, there is a gurgling sound compressing the swelling. X-ray of the neck is seen below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pharyngeal pouch", "correct": false}, {"label": "B", "text": "Laryngocele", "correct": true}, {"label": "C", "text": "Trachea-oesophageal fistula", "correct": false}, {"label": "D", "text": "Tonsillar cyst", "correct": false}], "correct_answer": "B. Laryngocele", "question_images": ["https://image.prepladder.com/notes/acoe6s4g05oHIEULfwxD1747897701.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In patients affected by COVID-19, which of the following patterns is frequently observed in chest CT scans?", "options": [{"label": "A", "text": "Interlobular septal thickening", "correct": false}, {"label": "B", "text": "Air bronchograms", "correct": false}, {"label": "C", "text": "Ground glass opacity", "correct": true}, {"label": "D", "text": "Crazy paving pattern", "correct": false}], "correct_answer": "C. Ground glass opacity", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/SJVXrCIjD1ishLASdXwr1747901941.png", "https://image.prepladder.com/content/QfbxUQG9YLve64ERM2ac1745843869.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CO-RADS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Suspicion Level </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CT findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically inadequate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or non-infectious abnormalities</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormalities consistent with infections other than Covid-19</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Indeterminate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unclear whether <span class=\"customMeta\" data-dictid=\"2d364aeaf7169277718529fa58f6ea\">covid-19</span> is present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormalities suspicious for covid-19</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 5 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very high</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typical covid-19</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CO-RADS 6 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PCR+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following choices does not represent a function of glucagon?", "options": [{"label": "A", "text": "Glycolysis", "correct": true}, {"label": "B", "text": "Gluconeogenesis", "correct": false}, {"label": "C", "text": "Glycogenolysis", "correct": false}, {"label": "D", "text": "Ketogenesis", "correct": false}], "correct_answer": "A. Glycolysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is not considered safe for a pregnant woman diagnosed with extensively drug-resistant TB?", "options": [{"label": "A", "text": "Amoxicillin", "correct": false}, {"label": "B", "text": "Clofazimine", "correct": false}, {"label": "C", "text": "Kanamycin", "correct": true}, {"label": "D", "text": "Linezolid", "correct": false}], "correct_answer": "C. Kanamycin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - K\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the subsequent course of treatment for a child with bilateral sensorineural hearing loss who did not experience any improvement after using hearing aids?", "options": [{"label": "A", "text": "Bone anchored hearing aid", "correct": false}, {"label": "B", "text": "Tympanoplasty", "correct": false}, {"label": "C", "text": "Normal hearing aid", "correct": false}, {"label": "D", "text": "Cochlear implant", "correct": true}], "correct_answer": "D. Cochlear implant", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male came to the physician with complaints of chronic back pain, easy fatigability, and a past history of multiple urinary tract infections in the last 3 months. His ESR is elevated, x-ray of his skull is shown below. Which of the following investigations is useful for diagnosis?", "options": [{"label": "A", "text": "MRI brain", "correct": false}, {"label": "B", "text": "PET scan", "correct": false}, {"label": "C", "text": "Head CT scan with contrast", "correct": false}, {"label": "D", "text": "Serum electrophoresis", "correct": true}], "correct_answer": "D. Serum electrophoresis", "question_images": ["https://image.prepladder.com/content/jZfAkDzMwHtBevArfcnq1745843973.png"], "explanation_images": ["https://image.prepladder.com/notes/iuXjibfVjcy46yyQPqjO1747902027.png", "https://image.prepladder.com/content/dA5F4ByrJJZwhTi6HP5F1745844028.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In patients with indications for warfarin usage, what is the recommended range of INR in a patient with mechanical heart valves?", "options": [{"label": "A", "text": "1.0-1.5", "correct": false}, {"label": "B", "text": "2.0-3.0", "correct": false}, {"label": "C", "text": "2.5-3.5", "correct": true}, {"label": "D", "text": "3.5-4.5", "correct": false}], "correct_answer": "C. 2.5-3.5", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - 2.5-3.5\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which enzyme is responsible for the deficiency causing classical galactosemia?", "options": [{"label": "A", "text": "Aldose reductase", "correct": false}, {"label": "B", "text": "Galactokinase", "correct": false}, {"label": "C", "text": "Galactose-1-phosphate uridyl transferase", "correct": true}, {"label": "D", "text": "UDP galactose-4-epimerase", "correct": false}], "correct_answer": "C. Galactose-1-phosphate uridyl transferase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent stages in the vitamin D metabolism necessitates exposure to sunlight?", "options": [{"label": "A", "text": "1,25 dihydroxy cholecalciferol to 7-dehydrocholesterol", "correct": false}, {"label": "B", "text": "Cholecalciferol to 25-hydroxycholecalciferol", "correct": false}, {"label": "C", "text": "7-dehydrocholesterol to cholecalciferol", "correct": true}, {"label": "D", "text": "25-hydroxycholecalciferol to 1,25 dihydroxycholecalciferol", "correct": false}], "correct_answer": "C. 7-dehydrocholesterol to cholecalciferol", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/eEHzxO598R03PIm7HOH61748236707.png", "https://image.prepladder.com/content/O21p24JJ3X9K5lAtVu3k1745844238.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient diagnosed with breast cancer, who is 53 years old and also has heart failure, which medication should be avoided?", "options": [{"label": "A", "text": "Methotrexate", "correct": false}, {"label": "B", "text": "Epirubicin", "correct": true}, {"label": "C", "text": "Cyclophosphamide", "correct": false}, {"label": "D", "text": "Cisplatin", "correct": false}], "correct_answer": "B. Epirubicin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Epiru\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the sinus marked in the image.", "options": [{"label": "A", "text": "Frontal sinus", "correct": false}, {"label": "B", "text": "Pyriform sinus", "correct": false}, {"label": "C", "text": "Ethmoid sinus", "correct": false}, {"label": "D", "text": "Maxillary sinus", "correct": true}], "correct_answer": "D. Maxillary sinus", "question_images": ["https://image.prepladder.com/notes/IX9qkOO816uP9A4XJXDl1747897786.png"], "explanation_images": ["https://image.prepladder.com/content/SswZBndAH97r86FvLGtx1745844147.png", "https://image.prepladder.com/content/ROsxZpvVarCL8HF8vJop1745844162.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a scorching summer afternoon, a man, who had been toiling in a field, unexpectedly collapsed. Upon examination, there were no apparent physical indications of dehydration, although his radial pulse was detectable. The doctor determined that the man's serum electrolyte levels were within the normal range. Shockingly, the man's body temperature measured 106 degrees Fahrenheit. Considering these circumstances, which of the following should be administered as an initial form of immediate assistance?", "options": [{"label": "A", "text": "Inject epinephrine immediately", "correct": false}, {"label": "B", "text": "Cover with hot damp sheets", "correct": false}, {"label": "C", "text": "Cover with cool damp sheets", "correct": true}, {"label": "D", "text": "Start CPR", "correct": false}], "correct_answer": "C. Cover with cool damp sheets", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Heat Exhaustion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Heat Stroke</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged strenuous activity with inadequate water/salt <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> in a hot environment.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Failure of <span class=\"customMeta\" data-dictid=\"f36a7c49d116927772002856c83dc1\">thermoregulation</span> in extreme heat exposure (Option C ruled out).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nausea, vomiting, malaise, myalgia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sudden collapse and loss of consciousness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CNS symptoms: dizziness, fatigue, impaired judgment, <span class=\"customMeta\" data-dictid=\"1cb2d1482916927771964c2890313e\">psychosis</span> (severe water depletion)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin initially wet, then dry</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moist skin, increased pulse</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperventilation, tachycardia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rectal temperature &gt; 37.8°C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Core temp &gt; 40.5°C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Other symptoms such as Constricted pupils, convulsions, unconsciousness, cerebral dysfunction, high fever, absence of sweating.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with the presence of a B tympanogram?", "options": [{"label": "A", "text": "Ossicular dislocation", "correct": false}, {"label": "B", "text": "Otosclerosis", "correct": false}, {"label": "C", "text": "Serous otitis media", "correct": true}, {"label": "D", "text": "Normal ear", "correct": false}], "correct_answer": "C. Serous otitis media", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/25NoTb3pCi5TRwNvJ0la1747897870.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a 50-year-old man who presents with symptoms of anemia, fever, and recurrent nosebleeds? The patient has hepatosplenomegaly and lab investigations indicate a hemoglobin level of 6g/dL, a total leukocyte count of 40,000/cu.mm with 10% blasts, and a platelet count of 12,000/cu.mm. Further investigation reveals the presence of t(8;21) in the blasts.", "options": [{"label": "A", "text": "Acute lymphoblastic leukemia", "correct": false}, {"label": "B", "text": "Acute myeloblastic leukemia", "correct": true}, {"label": "C", "text": "Preleukemia", "correct": false}, {"label": "D", "text": "Aleukemic leukemia", "correct": false}], "correct_answer": "B. Acute myeloblastic leukemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ol>\n<li>Idiopathic</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>25-50% cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> Failure</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fanconi Anemia</li>\n<li>Diamond-Blackfan Syndrome Diamond-Blackfan <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">Anemia</span> (DBA) is a rare inherited <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of macrocytic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> characterised by a failure of <span class=\"customMeta\" data-dictid=\"317dbdacdb16927771878c7860f69b\">erythropoiesis</span> in the bone marrow.</li>\n<li>Shwachman-Diamond Syndrome: An autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder involving <span class=\"customMeta\" data-dictid=\"938890efd616927771870f4a611546\">exocrine</span> pancreatic insufficiency.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Defective DNA Repair</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bloom Syndrome</li>\n<li>Ataxia Telangiectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Down Syndrome</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>AML is associated with Down syndrome, particularly the subtype known as <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Megakaryoblastic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (AML M7), which involves the GATA1 gene.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Exposure to Anticancer Drugs</li>\n</ol>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alkylating agents -&gt; <span class=\"customMeta\" data-dictid=\"93e077ee021692777192666a61cfbc\">Monosomy</span> 5 &amp; 7 -&gt; <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> (After 4-6 years).</li>\n<li>Anticancer drugs (Topoisomerase 2 inhibitors) -&gt; <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">Chromosome</span> 11 involvement -&gt; <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> (After 1-3 years).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Radiation Exposure</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exposure to radiation, benzene, phenylbutazone, and <span class=\"customMeta\" data-dictid=\"a1b9b992ca1692777184a69772eb33\">chloramphenicol</span> may increase the risk of developing <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> and <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>t(15:17)</li>\n</ol>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chromosomal <span class=\"customMeta\" data-dictid=\"8ba7332e86169277720060bd4507c8\">translocation</span> results in the PML-RARA <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> gene, which is associated with <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> promyelocytic leukaemia (APL), a subtype of AML.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>t(8:21)</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chromosomal <span class=\"customMeta\" data-dictid=\"8ba7332e86169277720060bd4507c8\">translocation</span> (RUNX1- RUNX1T1) is associated with <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">myeloid</span> sarcoma.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Inversion 16 or t(16;16).</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for an older diabetic woman,who received steroids and remdesivir for COVID, and is now experiencing a malodorous black discharge from her nose? On examination a necrotic black mass, filling the nasal cavity and causing erosion of the septum and hard palate is found.", "options": [{"label": "A", "text": "Aspergillosis", "correct": false}, {"label": "B", "text": "Mucormycosis", "correct": true}, {"label": "C", "text": "Foreign body", "correct": false}, {"label": "D", "text": "Rhinosporidiosis", "correct": false}], "correct_answer": "B. Mucormycosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mucormycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A severe fungal infection primarily affects the nose and sinuses but can quickly spread to the orbit, <span class=\"customMeta\" data-dictid=\"978aa37443169277718555206ddf9e\">cribriform</span> plate, meninges, and brain. The <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> invades arteries, causing endothelial damage, thrombosis, and rapid tissue destruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Black necrotic material in the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, eroding the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum, hard palate, and turbinates. <strong>Black <span class=\"customMeta\" data-dictid=\"0715afec83169277720196fd982691\">turbinate</span> sign</strong> is seen on contrast enhanced MRI.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uncontrolled diabetes, especially with ketoacidosis</li>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use (common in <span class=\"customMeta\" data-dictid=\"2d364aeaf7169277718529fa58f6ea\">COVID-19</span> treatment)</li>\n<li>Conditions causing immunosuppression: Neutropenia, HIV/AIDS, chemotherapy, organ transplants, and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> issues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Endoscopy:</strong> Shows pale <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> early, progressing to black crusts and sloughing.</li>\n<li><strong>Biopsy:</strong> Multiple sites should be sampled for fungal identification; <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"0a57b1bc5916927771895a4f4e60b4\">hydroxide</span> preparation is the <strong>gold standard</strong><strong> </strong>for confirming <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> features.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT</strong>: Detects bony destruction and initial assessment of <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> involvement.</li>\n<li><strong>CECT: </strong>CECT provides better delineation of soft tissue structures, allowing for <span class=\"customMeta\" data-dictid=\"55436411c216927771846e318f45ce\">clearer</span> identification of mucosal thickening, <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> opacification, and bony destruction.</li>\n<li><strong>MRI</strong>: Evaluates soft tissue invasion, assesses the extent of extra-sinus disease, and identifies complications, especially in the <strong>orbit and brain</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antifungal Therapy</strong>:</p>\n<ul>\n<li>Amphotericin B: 0.6 to 1 mg/kg/day IV or liposomal Amphotericin B: 5 mg/kg/day.</li>\n<li>Posaconazole: 300 mg twice daily orally on the first day, then 300 mg once daily.</li>\n</ul>\n<p><strong>Surgical Intervention</strong>:</p>\n<ul>\n<li>Endoscopic debridement of necrotic tissues.</li>\n<li>Severe cases: Total/Partial <span class=\"customMeta\" data-dictid=\"7e1612510d1692777192cfe698ecc1\">maxillectomy</span> or <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> <span class=\"customMeta\" data-dictid=\"b26b12affb16927771872ba42c137b\">exenteration</span> may be required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presented with a history of yellowing of the skin and eyes for 11 weeks, but he does not have any other symptoms. He had a viral infection 10 days ago and experienced a similar episode of yellowing 2 years ago for 2 weeks. Upon further questioning, he mentioned having long hours of basketball practice 2 years ago, which left him physically exhausted. His current blood tests show a serum bilirubin level of 2.4 mg/dL, with unconjugated bilirubin at 2.1 mg/dL and conjugated bilirubin at 0.3 mg/dL. His liver enzyme levels (AST and ALT) are normal. Based on these findings, what is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Dubin-Johnson syndrome", "correct": false}, {"label": "B", "text": "Crigler-Najjar type 1 syndrome", "correct": false}, {"label": "C", "text": "Gilbert syndrome", "correct": true}, {"label": "D", "text": "Rotor syndrome.", "correct": false}], "correct_answer": "C. Gilbert syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:603px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gilbert Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gilber <strong>Gilbert Syndrome </strong>(GS) is a common, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> condition with<strong> mild unconjugated <span class=\"customMeta\" data-dictid=\"cab274fa4f1692777189f9b6dad514\">hyperbilirubinemia</span> and normal liver function tests</strong>, affecting up to 8% of people, more common in males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Caused by<strong> <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> UGT1A1 enzyme</strong> <strong>activity </strong>(10–35% of normal), often due to a TA <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> in the UGT1A1 <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> (A[TA]7TAA).</li>\n<li>Inheritance is typically <strong>autosomal recessive</strong> with the <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> variant; some cases show <span class=\"customMeta\" data-dictid=\"18e7ddb7841692777186f7e78b2206\">dominant inheritance</span> with other mutations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Serum <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> &lt;51 μmol/L (&lt;3 mg/dL), fluctuating with stress, </strong>fasting, alcohol, or illness; <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> may occur during elevations.</li>\n<li>Most patients are asymptomatic, though <span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\">jaundice</span> can occur during episodes of elevated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels.</li>\n<li>Often diagnosed incidentally in <span class=\"customMeta\" data-dictid=\"98d9739e5f1692777180d7de404750\">adolescence</span> or adulthood.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Serum <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels are intermittently high, with Normal liver function tests and <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> histology.</li>\n<li>UGT1A1 gene testing may reveal the A[TA]7TAA <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> variant.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lifestyle adjustments, such as avoiding alcohol and maintaining regular <span class=\"customMeta\" data-dictid=\"5f526a682c16927771831cac5b3711\">calorie</span> intake, may help manage <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels.</li>\n<li><strong>Phenobarbital </strong>can normalize <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels if required.</li>\n<li>Caution with drugs metabolized by <strong>UGT1A1 </strong>(e.g., irinotecan, <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> <span class=\"customMeta\" data-dictid=\"fe13bbded1169277719694883c6ba4\">protease</span> inhibitors) due to risk of toxicity.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the view that provides the optimal visualization of the maxillary sinus?", "options": [{"label": "A", "text": "Water’s view", "correct": true}, {"label": "B", "text": "Towne’s view", "correct": false}, {"label": "C", "text": "Law’s view", "correct": false}, {"label": "D", "text": "Stenver’s view", "correct": false}], "correct_answer": "A. Water’s view", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Tj46zufMvR9KvXedG3uj1745844860.png", "https://image.prepladder.com/content/bxtLLsxdgA3aZXbIB70x1745844873.png", "https://image.prepladder.com/content/T8HGELed4qWsEYkqb6lI1745844886.png", "https://image.prepladder.com/content/jsKfqlDE2hJX3Y4Q3T961745844899.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>View</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Waters' View (Occipitomental View)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chin-up position.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best view to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the maxillary sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ng, Qi Xiong &amp; Lim, Xiao &amp; Chong, Jia &amp; Hanafi, Hanida &amp; Lim, Lik Thai. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Plain-skull-X-ray-occipitomental-view-Waters-view-showing-a-black-eyebrow-sign-as_fig2_375528241\" data-tags=\"\" height=\"356\" src=\"https://image.prepladder.com/content/Tj46zufMvR9KvXedG3uj1745844860.png\" width=\"419\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pierre’s View</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to Waters' view but with the <strong>mouth open</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best view to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Bálint Botz\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/normal-waters-view-skull-x-ray\" data-tags=\"\" height=\"367\" src=\"https://image.prepladder.com/content/bxtLLsxdgA3aZXbIB70x1745844873.png\" width=\"408\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caldwell View (Occipitofrontal View)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chin-down position.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best view to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hamed Ebrahimnejad, Seyed Hosein Hoseini Zarch,Adineh Javadian langaroodi\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/A-Caldwell-radiograph-showing-opacification-of-frontal-and-ethmoidal-sinuses_fig2_309859475\" data-tags=\"\" height=\"476\" src=\"https://image.prepladder.com/content/T8HGELed4qWsEYkqb6lI1745844886.png\" width=\"445\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral View</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral (as the name indicates)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allows <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of all sinuses (frontal, maxillary, sphenoid, and ethmoidal).</p>\n<p>Helps to understand the <span class=\"customMeta\" data-dictid=\"e80b9923cb1692777195fad978604a\">pneumatization</span> pattern of the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Murphy A, Er A, Bell D,\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/paranasal-sinuses-and-facial-bones-radiography/\" data-tags=\"\" height=\"334\" src=\"https://image.prepladder.com/content/jsKfqlDE2hJX3Y4Q3T961745844899.png\" width=\"445\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed adverse effect of orlistat among the options provided?", "options": [{"label": "A", "text": "Acute kidney injury", "correct": false}, {"label": "B", "text": "Osteoporosis", "correct": false}, {"label": "C", "text": "Steatorrhea", "correct": true}, {"label": "D", "text": "Colorectal cancer", "correct": false}], "correct_answer": "C. Steatorrhea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Steatorrh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with symptoms of psychosis is prescribed aripiprazole. Which of the following best describes this drug when compared to other antipsychotic drugs?", "options": [{"label": "A", "text": "No intrinsic activity, high affinity for D2 receptor, less extrapyramidal symptoms, andmore weight gain", "correct": false}, {"label": "B", "text": "High intrinsic activity, no affinity for D2 receptor, more extrapyramidal symptoms, and less weight gain", "correct": false}, {"label": "C", "text": "Low intrinsic activity, high affinity for D2 receptor, less extrapyramidal symptoms, and less weight gain", "correct": true}, {"label": "D", "text": "High intrinsic activity, high affinity for D2 receptor, less extrapyramidal symptoms, and less weight gain", "correct": false}], "correct_answer": "C. Low intrinsic activity, high affinity for D2 receptor, less extrapyramidal symptoms, and less weight gain", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Low &lt;span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\"&gt;intrinsic&lt;/span&gt; activity, high &lt;span class=\"customMeta\" data-dictid=\"227269f3ec1692777180d76a7898dd\"&gt;affinity&lt;/span&gt; for D2 receptor, less &lt;span class=\"customMeta\" data-dictid=\"e2952dfc311692777187fa773bcc9f\"&gt;extrapyramidal&lt;/span&gt; symptoms, and less weight g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gastric lavage, commonly known as stomach pumping or gastric irrigation, is a procedure performed to remove the contents of the stomach. It has been widely used since the early 19th century as a standard method to eliminate toxins from the stomach. This procedure is typically employed for individuals who have consumed poison or overdosed on substances like ethanol. Additionally, it may be performed prior to surgery to empty the digestive tract. In which of the following situations is gastric lavage not recommended?", "options": [{"label": "A", "text": "Organo-Phosphosphate poisoning", "correct": false}, {"label": "B", "text": "Hydrocarbons", "correct": true}, {"label": "C", "text": "Ethanol poisoning", "correct": false}, {"label": "D", "text": "PCM toxicity", "correct": false}], "correct_answer": "B. Hydrocarbons", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/RlpvYRx6p54vAKItkExi1747898015.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient Positioning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trendelenburg: Head down to prevent aspiration</p>\n<p>Left <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> decubitus: Reduces chance of <span class=\"customMeta\" data-dictid=\"b437be3f051692777196d06a1fa93d\">poison</span> entering the duodenum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tube Placement Confirmation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inject air and listen for <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> bubbling sounds</p>\n<p>Watch for coughing or bubbles (indicates misplacement in trachea)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid Administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluid is administered and aspirated using a <span class=\"customMeta\" data-dictid=\"29863704261692777199d30fdfa6fa\">syringe</span> attached to the tube</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid Selection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tap water for most cases</p>\n<p>Normal <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> for infants</p>\n<p>Specific solutions (e.g., <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> permanganate) may be used for certain poisons</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Residual Fluid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leave a small amount of fluid to <span class=\"customMeta\" data-dictid=\"9c60f7b6b81692777193976e7f1d8e\">neutralize</span> remaining poison</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspiration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs in ~10% of cases. Risk of lung injury</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal/Gastric Perforation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be life-threatening</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tube Misplacement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Misplaced into trachea, causing complications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bleeding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can occur with improper technique or pathology</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Alternative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Induce <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> in conscious patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dilution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large water <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> to <span class=\"customMeta\" data-dictid=\"e63a499e5716927771860681cef17d\">dilute</span> <span class=\"customMeta\" data-dictid=\"16a98a214c16927771852d7f6c344e\">corrosive</span> substances</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic/Surgical Removal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for toxic foreign bodies or drug packets</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with diffuse abdominal pain. He has a known history of chronic NSAID usage. Physical examination reveals rigidity. An X-ray of the abdomen is shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Intestinal obstruction", "correct": false}, {"label": "B", "text": "Pericarditis", "correct": false}, {"label": "C", "text": "Peptic ulcer perforation", "correct": true}, {"label": "D", "text": "Gallstones", "correct": false}], "correct_answer": "C. Peptic ulcer perforation", "question_images": ["https://image.prepladder.com/notes/HuvHNcUjaTfVYL0C7UGt1747899878.png"], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\"&gt;Peptic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\"&gt;ulcer&lt;/span&gt; perforation</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adverse effects of NSAIDs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Additional information</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastrointestinal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nausea and vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Selective COX-2 inhibitors:</strong> Less likely to cause GI side effects</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GI hemorrhage, erosion, <strong>Ulcers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to ↓prostaglandin synthesis, leading to loss of mucosal protection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hematological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Platelet <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> → Increased bruising and <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> risk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>From <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"96309dcb1c169277720072ad555473\">thromboxane</span> A2 activity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Renal dysfunction/failure</li>\n<li>Reduction in <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> of <span class=\"customMeta\" data-dictid=\"1848b160c11692777191b60caaf622\">loop diuretics</span> &amp; antihypertensives</li>\n<li>Salt and water retention</li>\n<li><strong>Hyperkalemia </strong></li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> necrosis</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> necrosis</li>\n<li>Interstitial nephritis</li>\n<li>Analgesic nephropathy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Analgesic nephropathy</strong> leads to <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure with <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and chronic <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> nephritis, which is less common since the ban of <strong>phenacetin.</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiovascular</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Precipitate heart failure</li>\n<li>Edema</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hepatic</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated liver enzymes</li>\n<li>Hepatic failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypersensitivity</strong></p>\n<p> </p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urticaria</li>\n<li>Flushing</li>\n<li>Anaphylaxis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dermatological</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Steven-Johnson syndrome</li>\n<li>Photosensitivity</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which confirmatory test is utilized by forensic experts to establish the presence of a bloodstain at a crime scene?", "options": [{"label": "A", "text": "Spectroscopic test", "correct": true}, {"label": "B", "text": "Kastle meyer test", "correct": false}, {"label": "C", "text": "Benzidine test", "correct": false}, {"label": "D", "text": "Orthotoluidine test", "correct": false}], "correct_answer": "A. Spectroscopic test", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/NJ57q3fOikCewh1E5ht81747898085.png", "https://image.prepladder.com/notes/NvkdORQGPzqrj1CvcXNN1747898123.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Takayama Test</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Takayama test\" data-author=\"Vanessa Stewart, Paul Deacon, Nathalie Zahra, Mari Uchimoto, Kevin Farrugia\" data-hash=\"13115\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://rke.abertay.ac.uk/ws/portalfiles/portal/15029667/Farrugia_TheEffectOfMarkEnhancementTechniquesOnThePresumptiveAndConfirmatoryTests_Author_2018.pdf\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/NJ57q3fOikCewh1E5ht81747898085.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> by forming red, feathery crystals of <span class=\"customMeta\" data-dictid=\"dcccae21671692777196dc33208a39\">pyridine</span> ferroprotoporphyrin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Teichmann Test</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PFM016 Teichmann Test\" data-author=\"NA\" data-hash=\"13116\" data-license=\"NA\" data-source=\"https://elearning.raghunathpurcollege.ac.in/files/CE08FC0816227718690.pdf\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/NvkdORQGPzqrj1CvcXNN1747898123.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Converts <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> to hemin, creating brownish-yellow <span class=\"customMeta\" data-dictid=\"0115afa2131692777197b45ae0d136\">rhomboid</span> crystals, confirming blood presence.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Precipitin Test </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identifies species origin through antibody-antigen reactions, using antisera specific to human blood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HemaTrace Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses <span class=\"customMeta\" data-dictid=\"b2b82438d6169277719287eb450079\">monoclonal</span> antibodies to detect human hemoglobin, showing a visible pink band for confirmation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options below acts as a selective alpha-1 receptor antagonist in medical practice?", "options": [{"label": "A", "text": "Phenoxybenzamine", "correct": false}, {"label": "B", "text": "Phentolamine", "correct": false}, {"label": "C", "text": "Prazosin", "correct": true}, {"label": "D", "text": "Idazoxan", "correct": false}], "correct_answer": "C. Prazosin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the scenario provided, what is the probable diagnosis for a patient who ceased drinking alcohol for three days and subsequently exhibited symptoms such as irritability, disorientation, paranoid delusions, agitation, visual hallucinations, and changes in consciousness?", "options": [{"label": "A", "text": "Delirium tremens", "correct": true}, {"label": "B", "text": "Wernicke’s encephalopathy", "correct": false}, {"label": "C", "text": "Korsakoff psychosis", "correct": false}, {"label": "D", "text": "Alcohol-induced psychosis", "correct": false}], "correct_answer": "A. Delirium tremens", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"74ef5626ab16927771855274381e00\"&gt;Delirium&lt;/span&gt; tremens</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features of Alcohol Withdrawal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Onset after last drink</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mild withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild anxiety</li>\n<li>Tremulousness</li>\n<li>Nausea</li>\n<li>Headache</li>\n<li>Palpitations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6-8 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderate (Alcoholic hallucinosis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visual, auditory, or <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> hallucinations</li>\n<li>Intact orientation</li>\n<li>Normal vital signs</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8- 12 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe (Withdrawal seizures)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> seizures</li>\n<li>Usually brief and self-limited</li>\n<li>Also known as rum fits</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>12-24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Life-threatening (Delirium tremens)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe agitation</li>\n<li>Confusion and disorientation</li>\n<li>Hallucinations (often visual)</li>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"2e780c7fd416927771895c61217c12\">hyperactivity</span> (tachycardia, hypertension, fever)</li>\n<li>Profound sweating</li>\n<li>Tremors</li>\n<li>Insomnia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within 72 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 20-year-old female who exhibits abrupt palpitations, sweating, breathlessness, and a sensation of being choked? She contracted COVID-19 a year ago and is worried about her life due to her prior positive status. All physical examinations, ECG, and laboratory tests have yielded no significant findings. This episode, lasting approximately 20 minutes, is the first occurrence of its kind.", "options": [{"label": "A", "text": "Post-traumatic stress disorder", "correct": false}, {"label": "B", "text": "Bipolar disorder", "correct": false}, {"label": "C", "text": "Depression", "correct": false}, {"label": "D", "text": "Panic attack", "correct": true}], "correct_answer": "D. Panic attack", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Panic attack.</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Panic attacks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Unexpected, i.e., not restricted to any particular situation.</li>\n<li>Usually last for 20 to 30 minutes, rarely, they may last more than one hour.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiopulmonary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Feeling short of breath</li>\n<li>Palpitations <strong>(Option A ruled out) </strong></li>\n<li>Chest discomfort <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastrointestinal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea</li>\n<li>GI discomfort</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin and systemic</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sweating</li>\n<li>Chills</li>\n<li>Feeling flushed</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurologic</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tremors</li>\n<li>Dizziness</li>\n<li>Numbness and <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> sensation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psychiatric</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Derealization</li>\n<li>Depersonalization</li>\n<li>Fear of losing control</li>\n<li>Fear of dying <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 43-year-old individual who arrives at the emergency department accompanied by the police, alleging that his daughter intends to harm him, but subsequent investigation by the police reveals it to be a false accusation? The patient's physical examination does not reveal any notable findings.", "options": [{"label": "A", "text": "Delusional disorder", "correct": true}, {"label": "B", "text": "Illusions", "correct": false}, {"label": "C", "text": "Cotard syndrome", "correct": false}, {"label": "D", "text": "Hallucinations", "correct": false}], "correct_answer": "A. Delusional disorder", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Delusional disorder</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of delusional disorders</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Persecutory </strong></p>\n<p><strong>(Delusion of persecution)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing others are trying to harm them</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Jealous </strong></p>\n<p><strong>(Delusion of infidelity or Othello syndrome)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing that a lover or partner is unfaithful</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erotomanic </strong></p>\n<p><strong>(Delusion of <span class=\"customMeta\" data-dictid=\"0edf763ccc1692777187772bc783fe\">erotomania</span> or <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">De</span> Clerambault’s syndrome) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing that another person (often of higher status) is in love with them</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Somatic type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing he or she has some physical disorder that includes:</p>\n<ul>\n<li><strong>Delusion of parasitosis</strong> (infested with parasites, such as bugs or worms)</li>\n<li><strong>Delusion of <span class=\"customMeta\" data-dictid=\"6f178b169b169277718682ed34971f\">dysmorphophobia</span> </strong>(body or appearance is distorted or altered in a negative way)</li>\n<li><strong>Delusion of <span class=\"customMeta\" data-dictid=\"47755c9e931692777188e07e343028\">halitosis</span> </strong>(bad breath)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grandiose </strong></p>\n<p><strong>(Delusion of grandeur)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing one has exceptional abilities, wealth, or fame</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Delusion of Guilt</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing that they are an evil person and have ruined their family</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nihilistic <span class=\"customMeta\" data-dictid=\"a57e3265851692777185e6f4f5b8bc\">delusion</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deny the existence of their body, mind, loved ones, or the world, claiming they have no intelligence, that parts of their body are absent, or even believing they are dead or that the world has ended</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Delusion of Poverty</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing they are impoverished and that destitution threatens them and their family.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mixed and unspecified type </strong></p>\n<p><strong>(Delusion of misidentification)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delusions that are a combination of types or not described by one of the categories:</p>\n<ul>\n<li>Capgras syndrome</li>\n<li>Fregoli syndrome</li>\n<li>Syndrome of metamorphosis</li>\n<li>Syndrome of <span class=\"customMeta\" data-dictid=\"d2a2319d681692777199792417b5e2\">subjective</span> doubles</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What diagnosis would you give to a 30-year-old woman who is brought to the psychiatric OPD by her friend, where she claims that her boss is in love with her and stalks her, but her friend denies these allegations?", "options": [{"label": "A", "text": "Megalomania", "correct": false}, {"label": "B", "text": "Delusion of reference", "correct": false}, {"label": "C", "text": "Delusion of control", "correct": false}, {"label": "D", "text": "Erotomania", "correct": true}], "correct_answer": "D. Erotomania", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Erotomania</p>\n<p><strong>References:</strong></p>\n<ul><li>↳ Delusion of reference (Option B)</li><li>↳ Delusion of control (Option C) : The patient believes others are trying to control their thoughts or behaviours. For example: ”My doctor is trying to plant thoughts inside my head.”</li><li>↳ Delusion of control (Option C)</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of delusional disorders</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Persecutory </strong></p>\n<p><strong>(Delusion of persecution)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing others are trying to harm them</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Jealous </strong></p>\n<p><strong>(Delusion of infidelity or Othello syndrome)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing that a lover or partner is unfaithful</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erotomanic </strong></p>\n<p><strong>(Delusion of <span class=\"customMeta\" data-dictid=\"0edf763ccc1692777187772bc783fe\">erotomania</span> or <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">De</span> Clerambault’s syndrome) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing that another person (often of higher status) is in love with them</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Somatic type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing he or she has some physical disorder that includes:</p>\n<ul>\n<li><strong>Delusion of parasitosis</strong> (infested with parasites, such as bugs or worms)</li>\n<li><strong>Delusion of <span class=\"customMeta\" data-dictid=\"6f178b169b169277718682ed34971f\">dysmorphophobia</span> </strong>(body or appearance is distorted or altered in a negative way)</li>\n<li><strong>Delusion of <span class=\"customMeta\" data-dictid=\"47755c9e931692777188e07e343028\">halitosis</span> </strong>(bad breath)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grandiose </strong></p>\n<p><strong>(Delusion of grandeur)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing one has exceptional abilities, wealth, or fame</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Delusion of Guilt</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing that they are an evil person and have ruined their family</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nihilistic <span class=\"customMeta\" data-dictid=\"a57e3265851692777185e6f4f5b8bc\">delusion</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deny the existence of their body, mind, loved ones, or the world, claiming they have no intelligence, that parts of their body are absent, or even believing they are dead or that the world has ended</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Delusion of Poverty</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Believing they are impoverished and that destitution threatens them and their family.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mixed and unspecified type </strong></p>\n<p><strong>(Delusion of misidentification)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delusions that are a combination of types or not described by one of the categories:</p>\n<ul>\n<li>Capgras syndrome</li>\n<li>Fregoli syndrome</li>\n<li>Syndrome of metamorphosis</li>\n<li>Syndrome of <span class=\"customMeta\" data-dictid=\"d2a2319d681692777199792417b5e2\">subjective</span> doubles</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a management approach used for a violent patient in psychiatry?", "options": [{"label": "A", "text": "BZD", "correct": false}, {"label": "B", "text": "CBT", "correct": true}, {"label": "C", "text": "ECT", "correct": false}, {"label": "D", "text": "Haloperidol", "correct": false}], "correct_answer": "B. CBT", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - CBT\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Double depression is:", "options": [{"label": "A", "text": "Major depressive disorder for 2 years", "correct": false}, {"label": "B", "text": "Depression with OCD", "correct": false}, {"label": "C", "text": "Depression with dysthymia", "correct": true}, {"label": "D", "text": "Depression with an anxiety attack", "correct": false}], "correct_answer": "C. Depression with dysthymia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Depression with dysth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following investigations should be conducted in a 7-month-old child who has a hemoglobin level of 6.3, a history of recurrent blood transfusions, an MCV of 70 fl, normal MCH, normal MCHC, and a peripheral smear indicating a hypochromic microcytic image?", "options": [{"label": "A", "text": "Serum iron", "correct": false}, {"label": "B", "text": "Direct coomb’s test", "correct": false}, {"label": "C", "text": "Osmotic fragility test", "correct": false}, {"label": "D", "text": "Hb electrophoresis", "correct": true}], "correct_answer": "D. Hb electrophoresis", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:449px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Hemoglobin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>At Birth (1st day)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>At Adult (6 months)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HbF (Fetal Hemoglobin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>95%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HbA (Adult Hemoglobin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>95% (α2β2)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HbA2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was admitted to the ICU 48 hours after an accident in which he sustained a fracture of the femur. The oxygen saturation in the rebreathing unit was 100% but his SpO2 remained at 60%. The patient is in a state of confusion. Diffuse petechiae are noted on examination. Chest radiograph showed lung fields to be clear. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pulmonary embolism", "correct": false}, {"label": "B", "text": "Fat embolism", "correct": true}, {"label": "C", "text": "ARDS", "correct": false}, {"label": "D", "text": "Occult pneumothorax", "correct": false}], "correct_answer": "B. Fat embolism", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/3TIfJH2acvVl8bt3hMf41747902191.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fat <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blunt trauma</strong>: Accounts for 90% of cases, especially involving <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> fractures.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong>:</p>\n<ul>\n<li>Acute pancreatitis</li>\n<li>Diabetes mellitus</li>\n<li>Burns</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> surgeries</li>\n<li>Liposuction</li>\n<li>Cardiopulmonary bypass</li>\n<li>Decompression sickness</li>\n<li>Parenteral <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> infusion</li>\n<li>Sickle cell crisis</li>\n<li>Pathologic fractures</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Increased risk factors</strong> (in trauma patients):</p>\n<ul>\n<li>Age 30 years or younger</li>\n<li>Closed <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> fracture</li>\n<li>Multiple long-bone fractures</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following imaging tests should be performed to confirm a diagnosis of pulmonary embolism in a patient?", "options": [{"label": "A", "text": "Doppler echocardiography", "correct": false}, {"label": "B", "text": "CT pulmonary angiography", "correct": true}, {"label": "C", "text": "Ventilation perfusion scan of lungs", "correct": false}, {"label": "D", "text": "MR pulmonary angiography", "correct": false}], "correct_answer": "B. CT pulmonary angiography", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/7mZQzYdjWQpJNcwpmz1X1747902284.png", "https://image.prepladder.com/content/PpDTCMHyrT9NDDgOdpS51745902837.png", "https://image.prepladder.com/content/dY8BgnvPkbUz6Ekh5x7T1745902837.png", "https://image.prepladder.com/notes/9a18lbkwDQnXUpC8hn581747902443.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Evaluation</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>PE symptoms are nonspecific, often leading to excessive use of CT <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> angiograms. Age-adjusted d-dimer testing is recommended for patients over 50 years with low-to-moderate PE probability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>D-Dimer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A sensitive but <span class=\"customMeta\" data-dictid=\"70d4f989c31692777193372189cfbb\">nonspecific</span> test for PE. Elevated levels indicate possible PE but can also occur with conditions like MI, pneumonia, or sepsis. Normal d-dimer helps rule out PE.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Electrocardiogram (ECG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common findings include <strong>sinus tachycardia(most common) </strong>and the <strong>S1Q3T3 sign (most specific)</strong> (S wave in lead I, Q wave in lead III, inverted T wave in lead III). T-wave <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> in V1 to V4 suggests RV strain or ischemia.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"IM596 Pulmonary Embolism ECG\" data-author=\"R.W.Koster\" data-hash=\"13140\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pulm_embolism.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/7mZQzYdjWQpJNcwpmz1X1747902284.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Venous Ultrasonography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uses <strong>loss of <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> compressibility</strong> as a key indicator for diagnosing DVT, which is associated with PE. Doppler <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> can assess <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> dynamics.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often normal but may show specific signs like Westermark’s sign (focal oligemia), Hampton’s <span class=\"customMeta\" data-dictid=\"cc997dd837169277718990ed8944ed\">hump</span> (wedge-shaped pleural density), or Palla’s sign (enlarged <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sleedaniel\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:AP_Chest_X-Ray.tif?page=1\" data-tags=\"\" height=\"381\" src=\"https://image.prepladder.com/content/PpDTCMHyrT9NDDgOdpS51745902837.png\" width=\"415\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Chest <span class=\"customMeta\" data-dictid=\"5c71603ac81692777197e2aa1e7fd3\">radiograph</span> demonstrating <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> oligemia<strong> (Westermark’s sign) </strong>in the <span class=\"customMeta\" data-dictid=\"e9046e11bd1692777197e166e5418f\">right lung</span> (area between white arrowheads) and a prominent right <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <strong>(Palla’s sign)</strong> (black arrow).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hampton_hump_bei_schwerer_Lungenembolie_-_Roe_Thorax.jpg\" data-tags=\"\" height=\"415\" src=\"https://image.prepladder.com/content/dY8BgnvPkbUz6Ekh5x7T1745902837.png\" width=\"498\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>The chest <span class=\"customMeta\" data-dictid=\"5c71603ac81692777197e2aa1e7fd3\">radiograph</span> demonstrates a wedge-shaped <span class=\"customMeta\" data-dictid=\"a8eadab50316927771948be0cc91ca\">opacity</span> (arrow) in the right middle <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> consistent with <strong>Hampton hump.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chest CT with Contrast</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The primary <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> test. It offers high-resolution visualisation of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> vasculature. RV <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> on CT indicates a higher risk of mortality.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lung Scanning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A second-line test, mostly for patients who can’t tolerate contrast. High-probability <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> scans (two or more <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> defects) strongly suggest PE.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Magnetic Resonance (MR) Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MR <span class=\"customMeta\" data-dictid=\"8a7362882e1692777201ef793c3fd4\">venography</span> with <span class=\"customMeta\" data-dictid=\"e3767003061692777187b931c6a08f\">gadolinium</span> can diagnose DVT when <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> is inconclusive, though <strong>MR <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">angiography</span> (Option D)</strong> is less reliable for smaller PEs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Echocardiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is <strong>not reliable (Option A)</strong> for directly diagnosing PE but useful for detecting mimicking conditions. <strong>McConnell’s sign</strong> (RV-free wall hypokinesis) is an <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> sign of PE.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PIM085 McConnell sign\" data-author=\"Gunjan Choudhary, Arushi A. Malik, Dwight Stapleton, Pratap c Reddy\" data-hash=\"13141\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/McConnell-sign-McConnell-sign-akinesis-of-the-free-wall-of-the-right-ventricle-with_fig6_309337048\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/9a18lbkwDQnXUpC8hn581747902443.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Angiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Identifies <span class=\"customMeta\" data-dictid=\"603b3d38051692777190701f192c2a\">intraluminal</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> defects or abrupt vessel occlusion.</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely cause of a young patient experiencing desaturation and bilateral basal crepitations shortly after undergoing surgery with general anesthesia using 02, Nitrous oxide, and Desflurane?", "options": [{"label": "A", "text": "ARDS", "correct": false}, {"label": "B", "text": "Pleural effusion", "correct": false}, {"label": "C", "text": "Negative pressure pulmonary oedema", "correct": true}, {"label": "D", "text": "Atelectasis", "correct": false}], "correct_answer": "C. Negative pressure pulmonary oedema", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Factors associated with increased risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Complications </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Airway risk factors</li>\n<li>Known difficult airway</li>\n<li>Airway deterioration (bleeding, edema, trauma)</li>\n<li>Restricted <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> access</li>\n<li>Obesity and obstructive sleep apnea</li>\n<li>Cardiovascular disease</li>\n<li>Respiratory disease</li>\n<li>Neuromuscular disease</li>\n<li>Special <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> requirements</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Laryngospasm</li>\n<li>Bronchospasm</li>\n<li>Negative pressure <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</li>\n<li>Hypoventilation</li>\n<li>Aspiration</li>\n<li>Paradoxical vocal cord motion</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction</li>\n<li>Laryngeal edema</li>\n<li>Arytenoid dislocation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old girl was rescued from a village in Bihar where she had been sold off by her father for Rs. 25000 to a 45-year-old man. On examination, she was found to be 12 weeks pregnant. She was granted permission to abort the pregnancy, taking into consideration the age of the girl and the circumstances of her pregnancy. A doctor who will be eligible to perform the abortion for this girl should have performed at least how many MTP prior to this?", "options": [{"label": "A", "text": "10", "correct": false}, {"label": "B", "text": "15", "correct": false}, {"label": "C", "text": "25", "correct": true}, {"label": "D", "text": "35", "correct": false}], "correct_answer": "C. 25", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with severe pain and swelling in his knee joint for 10 days. He also complains of pain and discomfort during urination. He says that he had diarrhea one month ago and he has been unwell since then. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Reactive arthritis", "correct": true}, {"label": "B", "text": "Enteropathic arthritis", "correct": false}, {"label": "C", "text": "Rheumatoid arthritis", "correct": false}, {"label": "D", "text": "Psoriatic arthritis", "correct": false}], "correct_answer": "A. Reactive arthritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Osteoarthritis (OA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Psoriatic Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gout</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reactive Arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Joint Involvement Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symmetrical involvement of small joints (MCP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, especially DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, often DIP joints</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically involves a single joint (e.g., big toe)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical involvement, often larger joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morning Stiffness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lasts over 1 hour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resolves within 30 minutes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varies, often significant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely significant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable often <strong>follows infection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling, tenderness, deformities (e.g., <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> deviation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pain and <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> with use</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dactylitis, nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sudden, severe pain and swelling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Joint pain following an infection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Affected Joints</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MCP, PIP, wrists, knees</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Knees, hips, hands (DIP, PIP)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MCP, PIP, and can include spine and tendons</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically big toe (1st <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> joint)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Larger joints ( knees, ankles)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiographic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soft tissue swelling, joint space narrowing</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Osteophytes, joint space narrowing</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erosions, possible nail changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erosions and <span class=\"customMeta\" data-dictid=\"23ed22c5821692777200820f6150ac\">tophi</span> possible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar to RA but typically larger joints</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20 year old male was brought for psychiatric evaluation for intellectual disability. On examination, his IQ was 45. He has a long face, large ears, large testis and a cardiac murmur and history of poor intellectual function is present in the paternal family. What is his diagnosis?", "options": [{"label": "A", "text": "Cushing’s syndrome", "correct": false}, {"label": "B", "text": "Rett syndrome", "correct": false}, {"label": "C", "text": "Fragile X syndrome", "correct": true}, {"label": "D", "text": "William syndrome", "correct": false}], "correct_answer": "C. Fragile X syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:575px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Genetic Basis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>CGG repeats on <strong>FMR-1 (Familial mental retardation) gene</strong> on X chromosome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CGG Repeat Numbers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Normal population: </strong>5-55 repeats</li>\n<li><strong>Carriers (premutation):</strong> 55-200 repeats</li>\n<li><strong>Fragile X Syndrome:</strong> &gt;200 repeats</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gender Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>More common in males</li>\n<li>Females mostly carriers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Long face and large ears</strong></li>\n<li>Large mandible/Prominent jaw</li>\n<li>High arched palate</li>\n<li>Hyperextensible joints</li>\n<li><strong>Mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> prolapse</strong></li>\n<li><strong>Macroorchidism </strong>(seen in adolescent age group)</li>\n<li><strong>Intellectual disability</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features of female carriers </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>May be associated with<strong> <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> ovarian failure</strong></li>\n<li>10% may have an intellectual disability/low IQ</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "From the dense vegetation near the highway, the police have found the remains of a burnt body. The location was discovered with the help of a sniffer dog, as they were tracing a 25-year-old IT worker who had gone missing the night before. To determine the identity of the victim, the team needs to gather a suitable sample. Which type of tissue from a charred body is most effective for identification purposes?", "options": [{"label": "A", "text": "Hair", "correct": false}, {"label": "B", "text": "Bone", "correct": false}, {"label": "C", "text": "Teeth", "correct": true}, {"label": "D", "text": "Blood", "correct": false}], "correct_answer": "C. Teeth", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the treatment of Grade I Meningioma?", "options": [{"label": "A", "text": "Reassurance", "correct": false}, {"label": "B", "text": "Surgical excision", "correct": true}, {"label": "C", "text": "Chemotherapy", "correct": false}, {"label": "D", "text": "Radiotherapy", "correct": false}], "correct_answer": "B. Surgical excision", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/tb7hCzU45sR2Swki0iUX1747902536.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following foods is not included in the DASH diet?", "options": [{"label": "A", "text": "Rich in potassium", "correct": false}, {"label": "B", "text": "Rich in calcium", "correct": false}, {"label": "C", "text": "Rich in sodium", "correct": true}, {"label": "D", "text": "Rich in magnesium", "correct": false}], "correct_answer": "C. Rich in sodium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Death registration in India done within?", "options": [{"label": "A", "text": "21 days", "correct": true}, {"label": "B", "text": "28 days", "correct": false}, {"label": "C", "text": "30 days", "correct": false}, {"label": "D", "text": "40 days", "correct": false}], "correct_answer": "A. 21 days", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The mask given below works on which of the following principles?", "options": [{"label": "A", "text": "Bohr effect", "correct": false}, {"label": "B", "text": "Boyle's principle", "correct": false}, {"label": "C", "text": "Bernoulli principle", "correct": true}, {"label": "D", "text": "Mapleson's circuit", "correct": false}], "correct_answer": "C. Bernoulli principle", "question_images": ["https://image.prepladder.com/notes/zU9IB60kb3wtae5BwXxW1747893247.png"], "explanation_images": ["https://image.prepladder.com/content/fIM5Jw2gdGxRM21DKSwX1745903075.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:539px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Color coding of Venturi mask</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>FiO2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Require Flow rate (L/min)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>24%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>White</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>28%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Orange</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>31%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>35%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>40%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Green</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>60%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>12</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"534\" src=\"https://image.prepladder.com/content/fIM5Jw2gdGxRM21DKSwX1745903075.png\" width=\"534\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has presented with features of cardiac tamponade. Which of the following is correct regarding this condition?", "options": [{"label": "A", "text": "Pulsus Paradoxus is always present", "correct": false}, {"label": "B", "text": "Kussmaul sign is always present", "correct": false}, {"label": "C", "text": "Tall A wave is present", "correct": false}, {"label": "D", "text": "Jugular veins column is visibly distended without pulsations", "correct": true}], "correct_answer": "D. Jugular veins column is visibly distended without pulsations", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cardiac Tamponade</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A condition where the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> chambers are compressed by a <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">tense</span> <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion, limiting <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> inflow. Fluid accumulation of as little as 200 ml to upwards of 2L may lead to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Beck's triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Distension:</strong> Due to increased central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure. Prominent x <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> and an absent y descent.</li>\n<li><strong>Hypotension</strong>: Resulting from impaired <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</li>\n<li><strong>Muffled Heart Sounds</strong>: Caused by fluid accumulation in the <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> space, dampening heart sounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulsus Paradoxus</strong>: A drop in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP during inspiration, greater than 10 mm Hg. It is present in most of the conditions but not always<strong>(Option A) </strong>and can vary depending on the severity of <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> and other factors.</p>\n<p>Causes of <span class=\"customMeta\" data-dictid=\"a507417e891692777196a900bd7993\">Pulsus</span> paradoxus:</p>\n<ul>\n<li><strong>Lung Conditions:</strong> <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> asthma, COPD, tension pneumothorax, pleural effusion, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism.</li>\n<li><strong>Heart Conditions:</strong> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> tamponade, <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">constrictive</span> pericarditis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most reliable criteria among Gustafson's criteria for age estimation is?", "options": [{"label": "A", "text": "Root resorption", "correct": false}, {"label": "B", "text": "Paradentosis", "correct": false}, {"label": "C", "text": "Translucency of root", "correct": true}, {"label": "D", "text": "Attrition", "correct": false}], "correct_answer": "C. Translucency of root", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the first postmortem change that occurs in a dead body?", "options": [{"label": "A", "text": "Maggot formation", "correct": false}, {"label": "B", "text": "Putrefaction", "correct": false}, {"label": "C", "text": "Greenish discoloration of right iliac fossa", "correct": true}, {"label": "D", "text": "Mummification", "correct": false}], "correct_answer": "C. Greenish discoloration of right iliac fossa", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Putrefaction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autolysis is the <span class=\"customMeta\" data-dictid=\"d0e42f22261692777198fe4b2d191f\">self-digestion</span> of tissues caused by the body’s own enzymes after death.</p>\n\t\t\t \n\n\t\t\t<p><strong>Characteristics of Autolysis:</strong></p>\n<ul>\n<li>Initiation: Begins immediately after death when <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> processes cease.</li>\n<li><strong>Mechanism:</strong> <span class=\"customMeta\" data-dictid=\"11d4157da4169277718762144a4fe7\">Enzymatic</span> action leads to cell lysis, altering tissue appearance and texture.</li>\n</ul>\n<p><strong>Examples of <span class=\"customMeta\" data-dictid=\"d69244457c1692777182592c8395cc\">Autolytic</span> Changes:</strong></p>\n<ul>\n<li><strong>Clouding of the Cornea:</strong> The first observable external change, losing transparency due to <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> breakdown.</li>\n<li><strong>Changes in Brain <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">Glandular</span> Tissue:</strong> The first internal change, where neuronal and glial cells undergo lysis.</li>\n</ul>\n<p><strong>Note:</strong></p>\n<p><strong>Aseptic Autolysis: </strong>Occurs in <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> demise, leading to <span class=\"customMeta\" data-dictid=\"4d6efde1841692777193721eb5f865\">mummification</span> without bacterial involvement.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Putrefaction is driven by bacterial activity, resulting in tissue <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> and gas production.</p>\n<p><strong>Characteristics of Putrefaction:</strong></p>\n<ul>\n<li><strong>Bacterial Involvement: </strong>Primarily caused by <span class=\"customMeta\" data-dictid=\"27791cc8181692777184b363360a3c\">Clostridium</span> perfringens.</li>\n<li><strong>Lytic Enzyme: </strong>The main <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> involved is lecithinase, which breaks down cell membranes.</li>\n</ul>\n<p><strong>Stages of Putrefaction:</strong></p>\n<ol>\n<li><strong>Color Change:</strong>\n<ul>\n<li>The<strong> first internal change</strong> is reddish-brown discoloration of the aortic intima.</li>\n<li>The <strong>first external change</strong> is green discoloration in the right <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> due to the <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of hemoglobin.</li>\n</ul>\n</li>\n<li><strong>Mechanism of Color Change:</strong>\n<ul>\n<li><strong>Hydrogen <span class=\"customMeta\" data-dictid=\"0e84bc8bb5169277719934af06eb80\">Sulfide</span> Production:</strong> Bacteria produce <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> sulfide, which forms a green compound with hemoglobin.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"7e536c2543169277718488f0a5bb37\">cecum</span> is the primary site of discoloration due to high bacterial activity.</li>\n</ul>\n</li>\n<li><strong>Gas Formation: </strong>\n<ul>\n<li>Gas production leads to bloating, with gases like carbon dioxide, methane, and <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> sulfide.</li>\n</ul>\n</li>\n<li><strong>Liquefaction of Tissue: </strong>\n<ul>\n<li>Tissues become liquefied, losing structural integrity, contributing to the characteristic <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> of decomposition.</li>\n</ul>\n</li>\n<li><strong>Timing of Discoloration:</strong>\n<ul>\n<li>Discoloration begins within 12-18 hours in summer and 1-2 days in winter, influenced by temperature and bacterial activity.</li>\n</ul>\n</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the clinical diagnosis for a young male who has no symptoms but is found to have a wide fixed split S2 during auscultation?", "options": [{"label": "A", "text": "ASD", "correct": true}, {"label": "B", "text": "VSD", "correct": false}, {"label": "C", "text": "TOF", "correct": false}, {"label": "D", "text": "BAV", "correct": false}], "correct_answer": "A. ASD", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:467px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of S2 split</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Conditions causing split</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Narrow split S2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Failure</li>\n<li>Early Aortic Stenosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>wide split fixed S2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Atrial Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (ASD)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wide split variable S2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ventricular Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (VSD)</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">Bundle</span> Branch Block (RBBB)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paradoxical split S2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Left <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">Bundle</span> Branch Block</li>\n<li>Severe Aortic Stenosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the association of Rhino-cerebral Mucor mycosis?", "options": [{"label": "A", "text": "Diabetic ketoacidosis", "correct": true}, {"label": "B", "text": "Pregnancy", "correct": false}, {"label": "C", "text": "Antibiotics", "correct": false}, {"label": "D", "text": "Inhaled steroids", "correct": false}], "correct_answer": "A. Diabetic ketoacidosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Overview</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe fungal infection affecting <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> passages, sinuses, and brain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primarily caused by <em>Rhizopus oryzae</em>, associated with uncontrolled DM and <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> <span class=\"customMeta\" data-dictid=\"27b295ed331692777190e5e04eaa18\">ketoacidosis</span> (DKA).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Begins in <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> turbinates; progresses rapidly due to <span class=\"customMeta\" data-dictid=\"c5ef9f5e371692777181b43f888174\">angioinvasive</span> nature, causing tissue <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fever, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> pain, swelling, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> discharge, necrotic eschar.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imaging studies and histopathological examination.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate <span class=\"customMeta\" data-dictid=\"c929a2b71516927771812a8b7b7ec3\">antifungal</span> therapy (e.g., amphotericin B) and aggressive <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> debridement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given disorder.", "options": [{"label": "A", "text": "Melanoma", "correct": true}, {"label": "B", "text": "Hyperpigmentation", "correct": false}, {"label": "C", "text": "Basal cell carcinoma", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma", "correct": false}], "correct_answer": "A. Melanoma", "question_images": ["https://image.prepladder.com/content/QIorxmfHQV2cAOfba9fF1745903778.png"], "explanation_images": ["https://image.prepladder.com/notes/O9tHlzVXyqtbxiiJDTAp1747895403.png", "https://image.prepladder.com/notes/XEA28HD040hDhqOKeLwl1747895615.png", "https://image.prepladder.com/content/aNpl3dRMi0Mv79g9npLU1745903884.png", "https://image.prepladder.com/notes/AeHFpIj8YzhQzyWNR3Jg1747895675.png", "https://image.prepladder.com/content/vygRwTSNmxrTR0yxqQSd1745903907.png"], "explanation": "<p>Correct Answer:A) Melanoma</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superficial <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> <strong>(M/C type)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any (more common on the upper back and, in women, lower legs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brown mixed with bluish-red, bluish-black, reddish brown, and often whitish pink. The <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> border is often visibly and/or palpably raised</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"PDM036 Superficial spreading\" data-author=\"Ivan Bristow, Jonathan Bowling\" data-hash=\"13105\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Superficial-spreading-melanoma-on-the-ankle_fig1_24420940\" data-tags=\"May2025\" height=\"291\" src=\"https://image.prepladder.com/notes/XEA28HD040hDhqOKeLwl1747895615.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lentigo maligna</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sun-exposed surfaces, particularly <span class=\"customMeta\" data-dictid=\"b5e3350aab16927771912aa39c71f5\">malar</span> region and temple</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In flat portions, brown and <span class=\"customMeta\" data-dictid=\"1aa3f03ae516927772007bdf930201\">tan</span> predominate, but whitish grey sometimes present; in nodules, reddish brown, bluish grey, bluish-black.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dermanonymous,\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Lentigo_maligna_melanoma\" data-tags=\"\" height=\"327\" src=\"https://image.prepladder.com/content/aNpl3dRMi0Mv79g9npLU1745903884.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acral lentiginous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palm, sole, nail bed, <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In flat portions, dark brown; in raised lesions (plaques), brown-black or blue-black.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PDM037 Acral lentiginous\" data-author=\"Ivan Bristow, Katharine Acland\" data-hash=\"13106\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/publication/23288903_Acral_lentiginous_melanoma_of_the_foot_and_ankle_A_case_series_and_review_of_the_literature\" data-tags=\"May2025\" height=\"348\" src=\"https://image.prepladder.com/notes/AeHFpIj8YzhQzyWNR3Jg1747895675.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nodular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reddish blue, purple, or bluish-black; can be uniform or mixed with brown and black.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"0x6adb015 \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Nodular_melanoma\" data-tags=\"\" height=\"350\" src=\"https://image.prepladder.com/content/vygRwTSNmxrTR0yxqQSd1745903907.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stage</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clarke</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Breslow</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Involvement of epidermis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">≤ 0.75 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Involvement of <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + dermis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">0.76-1.5 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Involvement of <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> papillae</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">1.5-4 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Involvement of <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> dermis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">&gt;4 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Involvement of <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the most suitable course of action for managing a 65-year-old male who presented with symptoms of weakness, lethargy, excessive cold intolerance, and slow ankle jerk? His thyroid function test (TFT) revealed a TSH level of 16 Mu/L (normal range: 0.4 - 4.0 mu / l), T4 level of 0.3 ng/dl (normal range: 0.6 - 1.6 ng / dl), and T3 level of 70 pg /dl.", "options": [{"label": "A", "text": "Start levothyroxine at 100 micrograms and decrease the dose gradually", "correct": false}, {"label": "B", "text": "Start levothyroxine at 25 micrograms and increase the dose gradually", "correct": true}, {"label": "C", "text": "Start levothyroxine at 25 micrograms and decrease the dose gradually", "correct": false}, {"label": "D", "text": "Give T3 and T4 drugs simultaneously", "correct": false}], "correct_answer": "B. Start levothyroxine at 25 micrograms and increase the dose gradually", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>TSH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Free T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Free T3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary hyperthyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ (&lt;0.1 mIU/L)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subclinical hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subclinical hyperthyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ or Approximately normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T3 thyrotoxicosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not done in W.P.W?", "options": [{"label": "A", "text": "Treadmill test", "correct": true}, {"label": "B", "text": "Electrophysiological studies", "correct": false}, {"label": "C", "text": "Oral beta blocker", "correct": false}, {"label": "D", "text": "Procainamide", "correct": false}], "correct_answer": "A. Treadmill test", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/5WnQG2L2Nm7OizZmsfrR1747902661.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>WPW Syndrome </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Most common type of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"7f4d0d8f101692777196e3e7b74479\">preexcitation</span> syndrome, characterized by preexcited QRS during <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> rhythm and episodes of <span class=\"customMeta\" data-dictid=\"cd15fe58221692777194fbb9eec8d1\">paroxysmal</span> <span class=\"customMeta\" data-dictid=\"619efd9f7b169277719928c9441919\">supraventricular</span> <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> (PSVT).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> from <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> to the <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> (Bundle of Kent) bypasses the rate-slowing AV node, causing partial early <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> depolarisation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ECG Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delta wave with widened QRS complex and shortened PR interval.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PIM121 Delta wave\" data-author=\"James Heilman, MD\" data-hash=\"13143\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.m.wikipedia.org/wiki/File:DeltaWave09.JPG\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/5WnQG2L2Nm7OizZmsfrR1747902661.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Consequence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May lead to a <span class=\"customMeta\" data-dictid=\"353b286cb31692777197c473828323\">reentry</span> circuit, causing <span class=\"customMeta\" data-dictid=\"cd15fe58221692777194fbb9eec8d1\">paroxysmal</span> <span class=\"customMeta\" data-dictid=\"619efd9f7b169277719928c9441919\">supraventricular</span> <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> (PSVT).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents to the dermatology clinic with an itchy skin rash. Physical examination reveals flat-topped, polygonal, purplish papules with fine white lines on the surface. The lesions are primarily located on the inner wrists and forearms, as well as on the lower back. The patient reports that he has been experiencing oral discomfort and noticed white, lacy patches on the inside of his cheeks. There is no family history of similar conditions. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Psoriasis", "correct": false}, {"label": "B", "text": "Eczema", "correct": false}, {"label": "C", "text": "Lichen planus", "correct": true}, {"label": "D", "text": "Tinea corporis", "correct": false}], "correct_answer": "C. Lichen planus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following patient has presented after chest trauma. On examination, crepitus is felt. The clinical diagnosis is?", "options": [{"label": "A", "text": "Subcutaneous emphysema", "correct": true}, {"label": "B", "text": "Gas gangrene", "correct": false}, {"label": "C", "text": "Acute tubular necrosis", "correct": false}, {"label": "D", "text": "SVC syndrome", "correct": false}], "correct_answer": "A. Subcutaneous emphysema", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not correct about Defibrillation?", "options": [{"label": "A", "text": "Only be used by a trained person", "correct": false}, {"label": "B", "text": "Decrease in success rate with delay in initiation", "correct": false}, {"label": "C", "text": "Improve prognosis", "correct": false}, {"label": "D", "text": "1 minute gap between 2 shocks", "correct": true}], "correct_answer": "D. 1 minute gap between 2 shocks", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with lesions, as shown in the image below, and later developed arthritis also. What is the treatment of choice for this condition?", "options": [{"label": "A", "text": "PUVA", "correct": false}, {"label": "B", "text": "Steroids", "correct": false}, {"label": "C", "text": "Methotrexate", "correct": true}, {"label": "D", "text": "Infliximab", "correct": false}], "correct_answer": "C. Methotrexate", "question_images": ["https://image.prepladder.com/content/iU6hRMCrqiLBU4NB17YK1745904326.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When assessing a patient before anesthesia, the oral cavity should be examined. The image provided below displays the examined cavity. It illustrates:", "options": [{"label": "A", "text": "Mallampati class IV", "correct": false}, {"label": "B", "text": "Mallampati Class II", "correct": false}, {"label": "C", "text": "Mallampati class III", "correct": true}, {"label": "D", "text": "Mallampati class I", "correct": false}], "correct_answer": "C. Mallampati class III", "question_images": ["https://image.prepladder.com/content/pgIRU9eFThaRpo6GUDCT1745903268.png"], "explanation_images": ["https://image.prepladder.com/content/L8OohHJ0SjHRTe5XYnnO1745904712.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Modified Mallampati scoring</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class 0</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Any part of the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> is visible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class I</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Faucial pillars, uvula, and soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> are visualized. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class II</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uvula and soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> are visualized. Tip of <span class=\"customMeta\" data-dictid=\"0227a2cae316927772010b25c75fd4\">uvula</span> is not visualized. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only Soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> and base of the <span class=\"customMeta\" data-dictid=\"0227a2cae316927772010b25c75fd4\">uvula</span> are visible.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Predict difficult intubation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only <span class=\"customMeta\" data-dictid=\"ed42fa72d416927771882540eb1e48\">hard palate</span> is visible. <strong>(Option ruled A out)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jmarchn\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Mallampati.svg\" data-tags=\"\" height=\"616\" src=\"https://image.prepladder.com/content/L8OohHJ0SjHRTe5XYnnO1745904712.png\" width=\"572\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fulminant diabetes mellitus is seen in?", "options": [{"label": "A", "text": "Diabetic ketoacidosis", "correct": false}, {"label": "B", "text": "Coxsackie B virus", "correct": true}, {"label": "C", "text": "Non ketonic hyperosmolar coma", "correct": false}, {"label": "D", "text": "Autoimmune pancreatitis", "correct": false}], "correct_answer": "B. Coxsackie B virus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the potential diagnosis for a 7-year-old boy with intellectual disability who has developed extensive warty crusts on the trunk, hands, and feet, along with severe fissuring and scaling on the soles of his feet?", "options": [{"label": "A", "text": "Scabies incognito", "correct": false}, {"label": "B", "text": "Animal scabies", "correct": false}, {"label": "C", "text": "Nodular scabies", "correct": false}, {"label": "D", "text": "Norwegian scabies", "correct": true}], "correct_answer": "D. Norwegian scabies", "question_images": ["https://image.prepladder.com/notes/YN8G8RrkgT4RnmuhV6YQ1747895842.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Classic Scabies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Crusted (Norwegian) Scabies</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Prevalence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>More common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Less common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Skin Lesions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Small erythematous papules, \"knots on a rope\"</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Erythematous, scaling, crusting, and fissuring</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pruritus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Severe, worse at night</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Usually mild or absent due to nerve damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Onset</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>3-6 weeks after initial colonization, 1-3 days after reinfestation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gradual but progressive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>No specific <span class=\"customMeta\" data-dictid=\"498d3df3a416927771894f595a597a\">immunosuppression</span> required</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Occurs in immunosuppressed patients (HIV, elderly, cancer, etc.)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Mite Burden</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Low <span class=\"customMeta\" data-dictid=\"b7fceea4781692777192e02222d4e1\">mite</span> burden</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>High <span class=\"customMeta\" data-dictid=\"b7fceea4781692777192e02222d4e1\">mite</span> burden</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Transmission</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Direct skin-to-skin contact</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>More commonly transmitted via <span class=\"customMeta\" data-dictid=\"1d1697a1861692777203fc83768d8e\">fomites</span> (objects)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Common Sites</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Webs of fingers, axillae, areola, genitalia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hands, feet, and scalp</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition shown in the image below:", "options": [{"label": "A", "text": "Impetigo", "correct": true}, {"label": "B", "text": "Chickenpox", "correct": false}, {"label": "C", "text": "Herpes Simplex", "correct": false}, {"label": "D", "text": "Molluscum contagiosum", "correct": false}], "correct_answer": "A. Impetigo", "question_images": ["https://image.prepladder.com/notes/cfn1Nehrw1jzACxz4YdM1747896026.png"], "explanation_images": ["https://image.prepladder.com/notes/uENZPwNrxsMgBknjxbgD1747896164.png", "https://image.prepladder.com/notes/svd4rWACv2pKBZtuoI9v1747897483.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><em>Staphylococcus aureus</em>, <em>Streptococcus pyogenes</em></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-bullous (crusted), Bullous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Honey-colored crusts, vesicles, erosions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Face (perioral, perinasal), extremities</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Topical mupirocin, oral antibiotics if extensive</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following induction agents is most appropriate for a patient with cardiac disease?", "options": [{"label": "A", "text": "Ketamine", "correct": false}, {"label": "B", "text": "Etomidate", "correct": true}, {"label": "C", "text": "Propofol", "correct": false}, {"label": "D", "text": "Thiopentone", "correct": false}], "correct_answer": "B. Etomidate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An unresponsive patient in ambulance on attachment of monitors showed following rhythm. What should be done immediately?", "options": [{"label": "A", "text": "Check for pulse and breathing", "correct": false}, {"label": "B", "text": "Chest compressions and defibrillation", "correct": true}, {"label": "C", "text": "Put the patient in left lateral position", "correct": false}, {"label": "D", "text": "Cardioversion", "correct": false}], "correct_answer": "B. Chest compressions and defibrillation", "question_images": ["https://image.prepladder.com/notes/m2h36yRBguOqt5VrW4TP1747893382.png"], "explanation_images": ["https://image.prepladder.com/notes/DRPKi2miq8gsLKl9CYio1747893469.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is incorrect regarding vasectomy?", "options": [{"label": "A", "text": "The procedure is done under local anaesthesia", "correct": false}, {"label": "B", "text": "Sterility is achieved 3 weeks after the procedure", "correct": true}, {"label": "C", "text": "A no-scalpel technique is being widely used now", "correct": false}, {"label": "D", "text": "The vas deferens is the structure that is divided in the procedure", "correct": false}], "correct_answer": "B. Sterility is achieved 3 weeks after the procedure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A couple brought their son to doctor. They were worried because their son likes to eat foods from multinational companies. What will we call this shift from consumption of traditional natural food to western fast foods?", "options": [{"label": "A", "text": "Food transition", "correct": false}, {"label": "B", "text": "Social pathology", "correct": false}, {"label": "C", "text": "Acculturation", "correct": true}, {"label": "D", "text": "Demographic change", "correct": false}], "correct_answer": "C. Acculturation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Acculturation</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Term</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Definition/Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Social structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Patterns of inter-relationships between persons in a society</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Socialism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Economic doctrine that favours the use of property and resources of the country for public welfare; system of production and distribution based on social ownership</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Socialization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Process by which an individual gradually acquires culture and becomes a member of a social group</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Medical sociology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Includes studies of medical profession, relationship of medicine to public, social factors in disease prevalence, incidence, and interpretation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Society</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>A group of individuals who have organized themselves and follow a way of life, featuring a system of relationships between individuals</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Community</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>A social group determined by geographical boundaries and/or common values or interests</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Sociology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Study of individuals as well as groups in society, <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> on relationships and behavior</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Learned behavior socially acquired</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Acculturation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cultural contact or mixing of two cultures through trade, industrialization, religion propagation, education, and conquest</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Custom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Established patterns of behavior objectively verified within a particular social setting</li>\n<li><strong>Folkways: </strong>Right ways of doing things in less vital areas of human conduct</li>\n<li><strong>Mores: </strong>More stringent customs within society</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Standard of Living</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Refers to usual scale of expenditure, goods consumed, and services enjoyed, including income, occupation, housing, sanitation, nutrition, health, education, recreational services</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Social Pathology</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Study of social problems that undermine the social, psychological, or economic health of populations; describes the relationship between disease and social conditions</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following are non depolarizing muscle relaxants except?", "options": [{"label": "A", "text": "Pancuronium", "correct": false}, {"label": "B", "text": "Rocuronium", "correct": false}, {"label": "C", "text": "Suxamethonium", "correct": true}, {"label": "D", "text": "Vecuronium", "correct": false}], "correct_answer": "C. Suxamethonium", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reversal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Depolarizing NMBAs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Suxamethonium (Succinylcholine)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Binds to <span class=\"customMeta\" data-dictid=\"c10496dcc416927771937d7280d782\">nicotinic</span> receptors</strong> at the <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> junction, causing persistent <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> and temporary paralysis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultra-short acting (5-10 min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Not reversed by neostigmine</strong>; metabolized by <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cholinesterase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Depolarizing NMBAs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancuronium, Rocuronium, Vecuronium, Atracurium, Cisatracurium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Competitively <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> <span class=\"customMeta\" data-dictid=\"fba05f424716927771802b63f6c392\">ACh</span> binding</strong> at <span class=\"customMeta\" data-dictid=\"c10496dcc416927771937d7280d782\">nicotinic</span> receptors, preventing <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> and muscle contraction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Short (Rocuronium, Vecuronium), Intermediate, or Long-acting (Pancuronium)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reversed by <span class=\"customMeta\" data-dictid=\"745c56551716927771931e99109e78\">neostigmine</span> or sugammadex (for steroidal NMBAs)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman who underwent dilatation and curettage for molar pregnancy six months ago presents with persistent abdominal pain and distention symptoms. On further evaluation, the beta-hCG levels were persistently elevated, and cannonball foci were found on the chest X-ray. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Gestational trophoblastic disease", "correct": true}, {"label": "B", "text": "Endometriosis", "correct": false}, {"label": "C", "text": "Ovarian cyst", "correct": false}, {"label": "D", "text": "Asherman's syndrome", "correct": false}], "correct_answer": "A. Gestational trophoblastic disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/c5NZGX6w2vWLc33oKWS11745905380.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gestational Trophoblastic Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition and Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hydatidiform Moles (HM):\n\t\t\t\t<ul>\n<li>Complete Mole: No <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> parts, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> development</li>\n<li>Partial Mole: Some <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> parts present, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> tissue</li>\n</ul>\n</li>\n<li>Gestational Trophoblastic <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">Neoplasia</span> (GTN):\n\t\t\t\t<ul>\n<li>Invasive Mole: Deep <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> into <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall</li>\n<li>Choriocarcinoma: Aggressive <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> form</li>\n<li>Epithelioid Trophoblastic Tumor (ETT): Rare variant</li>\n<li>Placental Site Trophoblastic Tumor (PSTT): Originating from <span class=\"customMeta\" data-dictid=\"52007706a216927771899e36747712\">implantation</span> site</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk Factors:\n\t\t\t\t<ul>\n<li>Maternal age &gt;35 or &lt;21 years</li>\n<li>Previous <span class=\"customMeta\" data-dictid=\"58e80747fc169277719279c08168e1\">molar pregnancy</span> (1% <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk)</li>\n<li>Asian ethnicity</li>\n<li>History of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> abortion</li>\n<li>Dietary deficiencies (vitamin A, animal fats)</li>\n<li>Blood type A</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis and Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete Mole:\n\t\t\t\t<ul>\n<li>46,XX (90%) - all paternal chromosomes</li>\n<li>46,XY (10%) - all paternal chromosomes</li>\n<li>Empty egg fertilized by <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> that duplicates</li>\n<li>Maternal mitochondrial DNA present</li>\n</ul>\n</li>\n<li>Partial Mole:\n\t\t\t\t<ul>\n<li>Triploid: 69,XXX, 69,XXY, or 69,XYY</li>\n<li>Fertilization by two sperm</li>\n<li>Contains both <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> and paternal DNA</li>\n</ul>\n</li>\n<li>Molecular Features:\n\t\t\t\t<ul>\n<li>p53 and MDM2 overexpression</li>\n<li>HLA-G expression in choriocarcinoma</li>\n<li>Altered NECC1 and growth factor expression</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>First Trimester:\n\t\t\t\t<ul>\n<li>Vaginal <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (84% of cases)</li>\n<li>Dark brown/prune juice-like discharge</li>\n<li>Passage of grape-like vesicles</li>\n<li>Hyperemesis gravidarum</li>\n</ul>\n</li>\n<li>Later Presentation:\n\t\t\t\t<ul>\n<li>Hyperthyroidism symptoms</li>\n<li>Early pre-eclampsia (&lt;20 weeks)</li>\n<li>Respiratory distress</li>\n<li>Theca <span class=\"customMeta\" data-dictid=\"cb86764f631692777191898edd4296\">lutein</span> cysts</li>\n</ul>\n</li>\n<li>Physical Findings:\n\t\t\t\t<ul>\n<li>Uterine size-date discrepancy</li>\n<li>Absent <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heart tones (complete mole)</li>\n<li>Adnexal masses</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Imaging Studies:\n\t\t\t\t<ul>\n<li>Ultrasound: \"Snowstorm\" or \"grape-like\" pattern</li>\n<li>Chest X-ray for <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> (Cannonball <span class=\"customMeta\" data-dictid=\"e2071f8f891692777203982b3fa0f5\">foci</span> in lungs)</li>\n<li style=\"text-align:center\">\n\t\t\t\t\t<figure class=\"caption_element\"><img alt=\"\" data-author=\"Louisa Stockton Elizabeth Green Baljeet Kaur Emma de Winton\" data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/Left-chest-X-ray-from-admission-showing-multiple-lesions-in-both-lungs-Right-chest_fig1_323764845\" data-tags=\"\" height=\"514\" src=\"https://image.prepladder.com/content/c5NZGX6w2vWLc33oKWS11745905380.png\" width=\"514\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n<li>CT/PET for staging</li>\n<li>MRI for <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> presentations</li>\n</ul>\n</li>\n<li>Laboratory Tests:\n\t\t\t\t<ul>\n<li>Quantitative β-hCG levels</li>\n<li>Complete blood count</li>\n<li>Coagulation studies</li>\n<li>Liver and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function</li>\n<li>Thyroid function tests</li>\n</ul>\n</li>\n<li>Histopathological Features:\n\t\t\t\t<ul>\n<li>Complete Mole: Diffuse <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> edema, trophoblastic hyperplasia</li>\n<li>Partial Mole: Mixed normal and hydropic villi</li>\n<li>Choriocarcinoma: Biphasic pattern with hemorrhage</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of GTD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fetal Development</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Placental Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Malignancy Potential</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hydatidiform Mole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A noncancerous growth in the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> that forms from the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"2a8e411e2116927772022dd4b365bc\">fertilization</span> of an egg by sperm.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely malignant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Partial <span class=\"customMeta\" data-dictid=\"7c7412c552169277718978073c8c85\">Hydatidiform</span> Mole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A type of <span class=\"customMeta\" data-dictid=\"7c7412c552169277718978073c8c85\">hydatidiform</span> mole characterized by some <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development and an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> placenta.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Some</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely malignant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete <span class=\"customMeta\" data-dictid=\"7c7412c552169277718978073c8c85\">Hydatidiform</span> Mole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A type of <span class=\"customMeta\" data-dictid=\"7c7412c552169277718978073c8c85\">hydatidiform</span> mole characterized by the absence of a <span class=\"customMeta\" data-dictid=\"421fecf0e21692777202704942ac48\">fetus</span> and a complete <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> placenta.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely malignant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invasive Mole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A rare condition where a <span class=\"customMeta\" data-dictid=\"7c7412c552169277718978073c8c85\">hydatidiform</span> mole penetrates deeply into the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be locally invasive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Choriocarcinoma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of GTD that can develop from a <span class=\"customMeta\" data-dictid=\"7c7412c552169277718978073c8c85\">hydatidiform</span> mole, a normal pregnancy, or a miscarriage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly malignant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Placental-site Trophoblastic Tumor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A rare <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of GTD that develops in the <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"52007706a216927771899e36747712\">implantation</span> site after a normal pregnancy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Locally invasive</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Modified duke criteria are used for diagnosis of?", "options": [{"label": "A", "text": "Infective endarteritis", "correct": false}, {"label": "B", "text": "Infectious mononucleosis", "correct": false}, {"label": "C", "text": "Inflammatory myopathy", "correct": false}, {"label": "D", "text": "Infective endocarditis", "correct": true}], "correct_answer": "D. Infective endocarditis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>I. Definite Endocarditis:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A. <span class=\"customMeta\" data-dictid=\"e32252a2c41692777194fe542b3e35\">Pathologic</span> Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Microorganisms identified in the context of clinical signs of active <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> in a <span class=\"customMeta\" data-dictid=\"a55b16a09b169277720184a41c82c4\">vegetation</span> from <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tissue; from explanted <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> or sewing ring; from <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> aortic <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> (with <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> evidence of <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> involvement); from an <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> <span class=\"customMeta\" data-dictid=\"f4cdbeaedf16927771906a0e1ec3de\">intra</span> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> implantable electronic device (CIED) or from an arterial <span class=\"customMeta\" data-dictid=\"cd7b88eaf5169277718749baf505bd\">embolus</span> OR</p>\n<p>2. Active <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> in the same above mentioned locations.</p>\n<ul>\n<li>Microorganisms identified in appropriate sample by PCR, amplicon or metagenomic sequencing, or <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> hybridization</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B. Clinical Criteria (mentioned below)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. 2 Major Criteria OR</p>\n<p>2. 1 Major and 3 Minor Criteria OR</p>\n<p>3. 5 Minor Criteria</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>II. Possible Endocarditis:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A. 1 Major <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">Criterion</span> and 1 Minor <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">Criterion</span> OR</p>\n<p>B. 3 Minor Criteria</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>III. Rejected Endocarditis:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A. Firm <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> diagnosis explaining signs/symptoms OR</p>\n<p>B. Lack of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> despite <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy for only &lt; 4 days OR</p>\n<p>C. No pathologic/macroscopic evidence of IE at surgery or <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> with <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy for less than 4 days OR</p>\n<p>D. Does not meet criteria of possible IE</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Clinical Criteria</strong></td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I. Major Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A. Microbiologic Major Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(i) Positive blood cultures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Microorganisms that commonly cause IE isolated from 2 or more separate <span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\">blood culture</span> sets</p>\n<p style=\"text-align: center;\">OR</p>\n<p style=\"text-align: center;\">Microorganisms that occasionally or rarely cause IE isolated from 3 or more separate <span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\">blood culture</span> sets</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(ii) Positive laboratory tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Positive <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> chain reaction (PCR) or other nucleic acid-based technique for <strong>Coxiella burnetii</strong>, <strong>Bartonella</strong> species, or <strong>Tropheryma whipplei</strong> from blood</p>\n<p style=\"text-align: center;\">OR</p>\n<p style=\"text-align: center;\"><strong>Coxiella burnetii</strong> antiphase I <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> G (IgG) <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> <span class=\"customMeta\" data-dictid=\"07e6f3a1921692777200051f692a60\">titer</span> &gt; 1:800 or isolated from a single blood culture</p>\n<p style=\"text-align: center;\">OR</p>\n<p style=\"text-align: center;\">Indirect <span class=\"customMeta\" data-dictid=\"0b338fb71b16927771895a4ee94faa\">immunofluorescence</span> assays (IFA) for <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> and <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> antibodies to<strong> <span class=\"customMeta\" data-dictid=\"f19dcceb1b1692777182a7202283a9\">Bartonella</span> henselae or <span class=\"customMeta\" data-dictid=\"f19dcceb1b1692777182a7202283a9\">Bartonella</span> quintana</strong> with <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> <span class=\"customMeta\" data-dictid=\"07e6f3a1921692777200051f692a60\">titer</span> ≥ 1:800</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B. <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Major Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(i) <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">Echocardiography</span> and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"44b07c254816927771855a12777513\">computed tomography</span> (CT) imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Echocardiography and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> CT showing vegetation, valve/leaflet perforation, valve/leaflet aneurysm, abscess, pseudoaneurysm, or <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> fistula</p>\n<p style=\"text-align: center;\">OR</p>\n<p style=\"text-align: center;\">Significant new valvular <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> on <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> as compared with previous imaging.</p>\n<p style=\"text-align: center;\">Worsening or changing of preexisting <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> is not sufficient</p>\n<p style=\"text-align: center;\">OR</p>\n<p style=\"text-align: center;\">New partial <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> of <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> as compared with previous imaging.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(ii) 18F-FDG PET/CT imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> activity involving a native or <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> valve, <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> aortic <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> (with <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> evidence of <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> involvement), <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> device leads, or other <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> material</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C. <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Major Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Evidence of IE documented by direct inspection during heart surgery neither Major <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Criteria <span class=\"customMeta\" data-dictid=\"fe5171bb0016927771933a5ca5d376\">nor</span> subsequent <span class=\"customMeta\" data-dictid=\"a77eb309ca16927771897b99ead59f\">histologic</span> or microbiologic confirmation</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>II. MINOR CRITERIA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A. Predisposition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Previous history of IE</li>\n<li>Prosthetic valve</li>\n<li>Previous <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> repair</li>\n<li>Congenital heart disease</li>\n<li>More than mild <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> or <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> of any etiology</li>\n<li>Endovascular <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> implantable electronic device (CIED)</li>\n<li>Hypertrophic obstructive cardiomyopathy</li>\n<li>Intravenous drug use</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B. Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Temperature greater than 38.0°C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C. <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Phenomena</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical or radiological evidence of arterial emboli, <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infarcts, cerebral or splenic abscess, <span class=\"customMeta\" data-dictid=\"39f702525516927771939b0791cac7\">mycotic</span> aneurysm, <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hemorrhage, conjunctival hemorrhages, Janeway lesions, <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> pericardium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>D. <span class=\"customMeta\" data-dictid=\"fced475d231692777189effb72c5c7\">Immunologic</span> Phenomena</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> factor, Osler nodes, Roth spots, or immune complex-mediated glomerulonephritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>E. Microbiologic Evidence (Falling Short of Major Criterion)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Positive blood cultures for a <span class=\"customMeta\" data-dictid=\"03aede3b101692777192c7f7a5e99c\">microorganism</span> consistent with IE but not meeting the requirements for Major Criterion</p>\n<p style=\"text-align: center;\">OR</p>\n<p style=\"text-align: center;\">Positive culture, PCR, or other nucleic acid-based test (amplicon or shotgun sequencing, <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> hybridization) for organisms consistent with IE from a <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> body site other than <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tissue, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> prosthesis, or arterial embolus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>F. <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal 18F-FDG PET/CT within 3 months of <span class=\"customMeta\" data-dictid=\"52007706a216927771899e36747712\">implantation</span> of <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> valve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>G. <span class=\"customMeta\" data-dictid=\"27ac5e3413169277719548c1b36288\">Physical Examination</span> Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>New valvular <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> identified on <span class=\"customMeta\" data-dictid=\"b2f0dbabe516927771821b0ec5ba85\">auscultation</span> if <span class=\"customMeta\" data-dictid=\"32ccb4a6911692777186e785958dbf\">echocardiography</span> is not available.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Preoperative assessment of oral cavity for endotracheal intubation in an adult is done by:", "options": [{"label": "A", "text": "Mallampatti score", "correct": true}, {"label": "B", "text": "Conmack lehane", "correct": false}, {"label": "C", "text": "ASA grading", "correct": false}, {"label": "D", "text": "AHA grading", "correct": false}], "correct_answer": "A. Mallampatti score", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following indicators shall be seen with use of a small-sized BP cuff?", "options": [{"label": "A", "text": "False elevation of BP", "correct": true}, {"label": "B", "text": "Falsely low value of BP", "correct": false}, {"label": "C", "text": "Cancels the effects of calcified arteries", "correct": false}, {"label": "D", "text": "Increases trans arm impedance", "correct": false}], "correct_answer": "A. False elevation of BP", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the appropriate course of action for managing a 17-year-old female who is experiencing primary amenorrhea but presents with monthly abdominal pain? Upon examination, she exhibits normal development of secondary sexual characteristics, an abdominal lump, and a blush bulge when the labia are separated. Given the suspected diagnosis, what treatment or intervention would be suitable?", "options": [{"label": "A", "text": "Excision of the septum", "correct": false}, {"label": "B", "text": "Extensive dissection and vaginoplasty", "correct": false}, {"label": "C", "text": "The cruciate incision on the hymen", "correct": true}, {"label": "D", "text": "Hysterectomy", "correct": false}], "correct_answer": "C. The cruciate incision on the hymen", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Elderly male patient has presented with recurrent falls. Which of the following medicines is responsible?", "options": [{"label": "A", "text": "Prazocin", "correct": true}, {"label": "B", "text": "Metformin", "correct": false}, {"label": "C", "text": "Acarbose", "correct": false}, {"label": "D", "text": "Thiazide", "correct": false}], "correct_answer": "A. Prazocin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old woman who has given birth twice and had two miscarriages comes to your clinic complaining of a strong-smelling discharge of blood from her vagina. She has been diagnosed with stage III B cervical cancer according to the FIGO classification. What is the recommended initial course of treatment for this patient?", "options": [{"label": "A", "text": "Chemoradiation", "correct": true}, {"label": "B", "text": "Radical hysterectomy", "correct": false}, {"label": "C", "text": "Pelvic exenteration", "correct": false}, {"label": "D", "text": "Radical hysterectomy + pelvic lymph node dissection", "correct": false}], "correct_answer": "A. Chemoradiation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Post-Surgical Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IA1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Simple <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> (Type I).</li>\n<li>Conization if family not complete</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Regular <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> exams and <span class=\"customMeta\" data-dictid=\"db0c1e31b81692777194c625af6798\">Pap</span> smears.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IA1 (with LVSI)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Modified radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> (Type II) + <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"27896a100c169277719111d4c4f539\">lymphadenectomy</span> (PLND).</li>\n<li>Radical <span class=\"customMeta\" data-dictid=\"bfdf455449169277720023fbcbb064\">trachelectomy</span> + PLND (consider SNLB) for selected patients desiring fertility</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IA2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> + PLND (consider SNLB if tumor &lt;2 cm).</li>\n<li>Radical <span class=\"customMeta\" data-dictid=\"bfdf455449169277720023fbcbb064\">trachelectomy</span> + PLND for selected patients desiring fertility.</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>If the <span class=\"customMeta\" data-dictid=\"c02ad9ae0f1692777198d76afc93c4\">specimen</span> shows high-risk features - <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">Adjuvant</span> chemoradiation.</li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> exams and <span class=\"customMeta\" data-dictid=\"db0c1e31b81692777194c625af6798\">Pap</span> smears.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IB1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> + PLND (consider SNLB if tumor &lt;2 cm).</li>\n<li>Radical <span class=\"customMeta\" data-dictid=\"bfdf455449169277720023fbcbb064\">trachelectomy</span> + PLND for selected patients desiring fertility.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IB2</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> + PLND</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IIA1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IB3 - IIA2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chemoradiation</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Regular <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> exams and <span class=\"customMeta\" data-dictid=\"db0c1e31b81692777194c625af6798\">Pap</span> smears</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IIB - IVA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemoradiation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IVB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palliative <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> and/or <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">Palliative</span> radiotherapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the waist to hip ratio that is associated with an increased risk of heart disease?", "options": [{"label": "A", "text": "&amp;gt; 0.80 in males", "correct": false}, {"label": "B", "text": "&amp;gt; 0.80 in females", "correct": false}, {"label": "C", "text": "&amp;gt; 0.85 in males", "correct": false}, {"label": "D", "text": "&amp;gt; 0.85 in females", "correct": true}], "correct_answer": "D. &gt; 0.85 in females", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Best management of a hemodynamically stable patient with ECG showing Broad QRS complex with antidromic tachycardia is?", "options": [{"label": "A", "text": "Oral verapamil", "correct": false}, {"label": "B", "text": "Oral Beta-blocker", "correct": false}, {"label": "C", "text": "Cardioversion", "correct": false}, {"label": "D", "text": "Intravenous Procainamide", "correct": true}], "correct_answer": "D. Intravenous Procainamide", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/r2RSgVYnz8OoZLQwuhzq1747902778.png", "https://image.prepladder.com/notes/AeeLWXhAanXR8LrBsQ0X1747902839.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old G3P2L2 woman with a history of Cesarean section and dilatation and curettage presents to the ER with hypotension, tachycardia, and severe abdominal pain. On examination, fetal parts are palpable in the abdomen, and the fetal heart rate is weak. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Amniotic fluid embolization", "correct": false}, {"label": "B", "text": "Placental abruption", "correct": false}, {"label": "C", "text": "Uterine rupture", "correct": true}, {"label": "D", "text": "Local anesthesia anaphylaxis", "correct": false}], "correct_answer": "C. Uterine rupture", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the radiological evaluation of a pregnant woman, it is observed that the pelvic inlet appears oval-shaped and has the largest diameter in the anteroposterior direction. According to Caldwell and Moloy's classification, the pelvis is likely to be?", "options": [{"label": "A", "text": "Android pelvis", "correct": false}, {"label": "B", "text": "Anthropoid pelvis", "correct": true}, {"label": "C", "text": "Gynecoid pelvis", "correct": false}, {"label": "D", "text": "Platypelloid pelvis", "correct": false}], "correct_answer": "B. Anthropoid pelvis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d1GJI0iTQv7Iqkbjrn4Z1745906194.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Under which health organization are the Sustainable Development Goals (SDGs) implemented?", "options": [{"label": "A", "text": "United nations development programme", "correct": true}, {"label": "B", "text": "United nations children's fund", "correct": false}, {"label": "C", "text": "United nations educational, scientific and cultural organisation", "correct": false}, {"label": "D", "text": "World health organization", "correct": false}], "correct_answer": "A. United nations development programme", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hbbUaSwGC9egh2UkOS2S1745906438.png"], "explanation": "<p>Correct Answer A - United nations development programme</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">1.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>End poverty everywhere in all its forms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Zero hunger-<strong> </strong>Achieve food security, improve nutrition, and promote sustainable agriculture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">3.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure healthy lives and well-being for all ages.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">4.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provide inclusive and equitable quality education and lifelong learning opportunities.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">5.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Achieve gender equality and empower women and girls.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">6.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure access to sustainable &amp; clean water and <span class=\"customMeta\" data-dictid=\"18aafee1a71692777198cdc688e8aa\">sanitation</span> for all.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">7.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure access to affordable, clean and modern energy for all.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">8.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Promote sustainable economic growth, full employment, and decent work.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">9.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Build <span class=\"customMeta\" data-dictid=\"691088249a1692777197943b52a313\">resilient</span> infrastructure, promote sustainable industrialization, and foster innovation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">10.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduce inequality within and among countries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">11.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Make cities and human settlements inclusive, safe, resilient, and sustainable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">12.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure sustainable consumption and production patterns.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">13.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Take urgent action to combat climate change and its impacts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">14.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conserve and sustainably use water bodies - oceans, seas, and marine resources.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">15.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protect, restore, and sustainably use terrestrial ecosystems and preserve biodiversity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">16.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Promote peaceful and inclusive societies, ensure access to justice, and build effective institutions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">17.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Strengthen global partnerships for sustainable development.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely reason for the food poisoning experienced by the worker in the groundnut factory who consumed spoiled groundnuts that were stored in the facility?", "options": [{"label": "A", "text": "Beta oxalyl amino alanine", "correct": false}, {"label": "B", "text": "Smoke from factory", "correct": false}, {"label": "C", "text": "Sanguinarine", "correct": false}, {"label": "D", "text": "Aflatoxins", "correct": true}], "correct_answer": "D. Aflatoxins", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Aflatoxins </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Features of <span class=\"customMeta\" data-dictid=\"cbc7c810ce1692777188e6eaf3eba2\">hepatotoxicity</span> (jaundice, hepatomegaly)</li>\n<li>Hepatocellular carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infestation of <span class=\"customMeta\" data-dictid=\"e3baadccd91692777182c9724090b3\">Aspergillus</span> flavus and <span class=\"customMeta\" data-dictid=\"e3baadccd91692777182c9724090b3\">Aspergillus</span> parasiticus over stored rice, wheat, and corn</li>\n<li>Produce mycotoxins: <span class=\"customMeta\" data-dictid=\"4435e6aa0e1692777180e2f819ad80\">aflatoxin</span> B1 &amp; G1 (both are <span class=\"customMeta\" data-dictid=\"aad52f4a541692777188bfd2c5830b\">hepatotoxic</span> &amp; carcinogenic)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Storage temperature of 11 to 37 degree Celsius</li>\n<li>Moisture content &gt;16%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Educating people</li>\n<li>Moisture content &lt;10% during storage</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the standard delivery of a primigravida with polyhydramnios, the intern prematurely removes the placenta, leading to profuse bleeding. Examination reveals an intact placenta and that the uterus is partly outside the introitus. The patient is in hemorrhagic shock, so initial resuscitative measures are taken. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Amniotic fluid embolism", "correct": false}, {"label": "B", "text": "Postpartum hemorrhage", "correct": false}, {"label": "C", "text": "Uterine inversion", "correct": true}, {"label": "D", "text": "Uterine rupture", "correct": false}], "correct_answer": "C. Uterine inversion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uDzttlHFp5kdf6IxV6rP1745906539.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Four Classifications Of <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">Uterine</span> Inversion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1<sup>st</sup> degree (incomplete)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The uterus's top has collapsed inside the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2<sup>nd</sup> degree (complete):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>As a sock turned inside out, the top of your <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> folds into the opening of your <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> (cervix)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3<sup>rd</sup> degree (prolapsed):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> of your <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> enters the <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> at its deepest point</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4<sup>th</sup> degree (total): </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> and <span class=\"customMeta\" data-dictid=\"8537d8358c169277720162f2f6971b\">vagina</span> both protrude from your body</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is brought to the PHC with acute diarrhoea. The doctor, based on history, suspects that the child may be suffering from an infection due to Shigella over cholera and proceeds to give ciprofloxacin as the antibiotic. Which of the following points on history, apart from bloody stools, favour the doctor's suspicion?", "options": [{"label": "A", "text": "Absence of rectal pain", "correct": false}, {"label": "B", "text": "Presence of abdominal cramps", "correct": false}, {"label": "C", "text": "Presence of vomiting", "correct": false}, {"label": "D", "text": "Presence of fever", "correct": true}], "correct_answer": "D. Presence of fever", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Presence of fever </p>\n<p><strong>Educational Objective:</strong></p>\n<ul><li>➤ Presence of vomiting (Option C):</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old woman, who is pregnant for the second time, with one living child, and is at 18 weeks of gestation. She presents with a complaint of PV bleeding for the past 4 hours. On examination, her membranes are ruptured, and she is experiencing uterine contractions. A transvaginal ultrasound reveals a cervix that is shorter than 25 mm and funneling of the internal os by more than 1 cm. What is the diagnosis?", "options": [{"label": "A", "text": "Cervical incompetence", "correct": true}, {"label": "B", "text": "Placenta previa", "correct": false}, {"label": "C", "text": "Abruptio placentae", "correct": false}, {"label": "D", "text": "Traumatic injury", "correct": false}], "correct_answer": "A. Cervical incompetence", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics:</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Painless dilation</strong> of the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> in the 2nd trimester.</li>\n<li>Characterised by spontaneous, painless <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> followed by expulsion of products of conception.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors:</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Past history of <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> surgeries such as LEEP, conization</li>\n<li>Cervical trauma (during labour or <span class=\"customMeta\" data-dictid=\"e6f43ff48d1692777190f74dcd81d0\">instrumental</span> delivery)</li>\n<li>Congenital abnormality</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>History of pregnancy loss in 2nd trimester:</strong></p>\n<ul>\n<li>TVUS- investigation of choice</li>\n<li>Normal shape and length of the cervix- T shaped and 3-4 cm</li>\n<li>Cervical length ≤2.5 cm with one 2nd <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> painless abortion, then diagnosed as <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> insufficiency</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-pregnant women:</strong></p>\n<p>If Hegar no. 8 <span class=\"customMeta\" data-dictid=\"34cb72fd361692777186bfa0354926\">dilator</span> can be passed through internal os without any resistance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management:</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progesterone and <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"13508a2eb21692777184b37534a0ae\">cerclage</span> placement.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocrinopathies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypothyroidism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TSH</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncontrolled DM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels/ HbA1c</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Luteal phase defects</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progesterone levels in 2nd half</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PCOS</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pelvic USG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uterine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cervical insufficiency</li>\n<li>Uterine malformations</li>\n<li>Submucous fibroids</li>\n<li>Asherman syndrome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pelvic USG/ TVUS/ Hysterosalpingography</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>APLA syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lupus anticoagulant</strong></p>\n<p><strong>Anticardiolipin antibody</strong></p>\n<p><strong>Beta2 <span class=\"customMeta\" data-dictid=\"06477fc93b16927771922ca7cd0afd\">microglobulin</span> antibody</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chromosomal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Translocation of chromosomes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Karyotyping of both parents</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which disease is targeted under the National Vector Borne Disease Control Program, with the insect depicted below acting as the vector?", "options": [{"label": "A", "text": "Chikungunya", "correct": false}, {"label": "B", "text": "Visceral leishmaniasis", "correct": false}, {"label": "C", "text": "Malayan filariasis", "correct": false}, {"label": "D", "text": "Japanese encephalitis", "correct": true}], "correct_answer": "D. Japanese encephalitis", "question_images": ["https://image.prepladder.com/content/IHMrWKybgnXLSDAqOGnu1745906802.png"], "explanation_images": ["https://image.prepladder.com/content/hei2kixUn0qdrjX4SV4b1745906846.png", "https://image.prepladder.com/notes/84Gg2bSb5dxBoJtnUsKr1747723741.png", "https://image.prepladder.com/notes/WGam1MffMxCKyii1nZNF1747723819.png", "https://image.prepladder.com/notes/EtLyVMmSE844SNKIooqm1747723925.png", "https://image.prepladder.com/notes/VUAiT8HHT9Kl1K1suyye1747723972.png"], "explanation": "<p>Correct Answer D - Japanese encephalitis:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vector</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Anopheles</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malaria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Aedes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dengue &amp; chikungunya</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Culex</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Japanese encephalitis: Culex quinquefasciatus/ Culex fatigans</li>\n<li>Filariasis: Culex tritaeniorhynchus, Culex vishnui</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Sandfly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Kala-azar</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of waste in the following bag is disposed of through incineration?", "options": [{"label": "A", "text": "Yellow", "correct": true}, {"label": "B", "text": "Red", "correct": false}, {"label": "C", "text": "Blue", "correct": false}, {"label": "D", "text": "Black", "correct": false}], "correct_answer": "A. Yellow", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Yellow</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Waste Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of bag or container to be used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Method of disposal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>All <strong>infectious </strong>waste.</li>\n<li>Human <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Animal <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste</li>\n<li><strong>Soiled </strong>waste (contaminated with blood, body fluids, dressings and swabs, <strong>blood bags</strong>).</li>\n<li>Expired or discarded medicines</li>\n<li>Chemical waste.</li>\n<li><strong>Microbiological </strong>and other <span class=\"customMeta\" data-dictid=\"3ec60edb4a16927771842bb9fd9aa4\">clinical laboratory</span> waste.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Yellow coloured <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> <span class=\"customMeta\" data-dictid=\"b0628f561616927771849023eb3a3d\">chlorinated</span> plastic bags.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incineration</li>\n<li>Plasma pyrolysis</li>\n<li>Deep burial</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Red</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Contaminated waste (recyclable)</strong>: Tubing, bottles, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> tubes and sets, catheters, <strong>urine bags</strong>, syringes (without needles), vacutainers and gloves.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Red coloured <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> <span class=\"customMeta\" data-dictid=\"b0628f561616927771849023eb3a3d\">chlorinated</span> plastic bags.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoclaving or microwaving/hydroclaving, and then sent for recycling (not to landfill).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Blue</strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Glassware:</strong> Broken or discarded and contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic waste.</li>\n<li><strong>Metallic body implants</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardboard boxes with blue coloured markings.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Disinfection or autoclaving/microwaving, hydroclaving and then sent to recycling.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>White</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Waste <strong>sharps </strong>including metals: Needles, syringes with fixed needles, scalpels or any other sharp object that may cause <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> and cuts.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Puncture proof and leak proof containers.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Auto or <span class=\"customMeta\" data-dictid=\"2d95ddf7b8169277718654aee27077\">dry heat</span> <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> followed by shredding and <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> or encapsulation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Determine the classification of the myoma denoted as '4' in the provided image.", "options": [{"label": "A", "text": "Pedunculated submucosal myoma", "correct": true}, {"label": "B", "text": "Subserous myoma", "correct": false}, {"label": "C", "text": "Parasitic myoma", "correct": false}, {"label": "D", "text": "Submucous myoma", "correct": false}], "correct_answer": "A. Pedunculated submucosal myoma", "question_images": ["https://image.prepladder.com/notes/MdPwWo5nJwV7NZXg6gbK1747900975.png"], "explanation_images": ["https://image.prepladder.com/notes/gEs3UiqZDAby1WGIMoxN1747901033.png", "https://image.prepladder.com/notes/CMoYZDfC1lyPQw4jM11C1747901094.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Orthotolidine test is used to determine", "options": [{"label": "A", "text": "Nitrates in water", "correct": false}, {"label": "B", "text": "Nitrites in water", "correct": false}, {"label": "C", "text": "Free and combined chlorine in water", "correct": true}, {"label": "D", "text": "Ammonia content in water", "correct": false}], "correct_answer": "C. Free and combined chlorine in water", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/GSVvoy0sUKbSGELrcaxx1747917824.png"], "explanation": "<p>Correct Answer C - Free and combined &lt;span class=\"customMeta\" data-dictid=\"3c268a141b1692777184336bc40100\"&gt;chlorine&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young woman experiencing amenorrhea, who has a previous history of spontaneous abortion, has a current FSH level of 6 mIU/ml. What is the potential cause for the given manifestations?", "options": [{"label": "A", "text": "Sheehan's syndrome", "correct": false}, {"label": "B", "text": "Premature ovarian failure", "correct": false}, {"label": "C", "text": "PCOS", "correct": false}, {"label": "D", "text": "Asherman syndrome", "correct": true}], "correct_answer": "D. Asherman syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of these vaccines do not follow open vial policy?", "options": [{"label": "A", "text": "OPV", "correct": false}, {"label": "B", "text": "DPT", "correct": false}, {"label": "C", "text": "TT", "correct": false}, {"label": "D", "text": "Measles", "correct": true}], "correct_answer": "D. Measles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\"&gt;Measles&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A public health worker is going out into the community once every 15 days for collection of blood smears for malaria surveillance. What type of surveillance is this?", "options": [{"label": "A", "text": "Sentinel", "correct": false}, {"label": "B", "text": "Active", "correct": true}, {"label": "C", "text": "Passive", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Active", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Activ\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A couple visited the outpatient department due to their inability to conceive. The husband's semen analysis came back as normal. The wife complained of excessive menstrual bleeding, and a hysterosalpingogram revealed the presence of distal tube dilatation resembling a \"tobacco pouch appearance.\" What is the most probable diagnosis in this case?", "options": [{"label": "A", "text": "Tubal salpingitis", "correct": true}, {"label": "B", "text": "Tubal endometriosis", "correct": false}, {"label": "C", "text": "Tubal polyp", "correct": false}, {"label": "D", "text": "Tubal spasm", "correct": false}], "correct_answer": "A. Tubal salpingitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9SQJcZ2jBLJl1nxIIzB01747901175.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the predominant factor leading to consumptive coagulopathy in the field of obstetrics?", "options": [{"label": "A", "text": "Intrauterine death", "correct": false}, {"label": "B", "text": "Placental abruption", "correct": true}, {"label": "C", "text": "Sepsis", "correct": false}, {"label": "D", "text": "Amniotic fluid embolism", "correct": false}], "correct_answer": "B. Placental abruption", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disseminated <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> (DIC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DIC is a condition characterized by widespread <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of blood <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> mechanisms, leading to the formation of small clots throughout the body</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preeclampsia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preeclampsia is a <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> disorder that can lead to organ damage, including liver dysfunction, which may trigger consumptive coagulopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HELLP syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HELLP syndrome is a severe <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"1fa06d396c1692777196050a5db718\">preeclampsia</span> characterized by Hemolysis, Elevated Liver enzymes, and Low <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">Platelet</span> count</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> liver of pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This rare condition affects liver function and may result in a consumptive <span class=\"customMeta\" data-dictid=\"09376c06ef16927771848108fd8f70\">coagulopathy</span> due to liver dysfunction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Septic abortion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Septic abortion refers to an infection of the products of conception, which can cause <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> clotting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Placenta percreta/increta/accreta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These conditions involve <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"5f8b7d103016927771806be7e4190b\">adherence</span> of the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> to the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall, which can lead to significant <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> abnormalities</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What phase of the demographic cycle is the low stationary phase of demographic cycle?", "options": [{"label": "A", "text": "Phase 1", "correct": false}, {"label": "B", "text": "Phase 2", "correct": false}, {"label": "C", "text": "Phase 3", "correct": false}, {"label": "D", "text": "Phase 4", "correct": true}], "correct_answer": "D. Phase 4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vBRC4JbzThgZvMHA5sjQ1745907731.png"], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"e9aca840061692777195df858e7591\"&gt;Phase 4&lt;/span&gt; </p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Birth rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Death rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Population </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>I. High stationery <strong>(Option A)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Population is stable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>II. Early expanding <strong>(Option B)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Starts declining</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Population grows at faster rate . Also called demographic trap</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>III. Late expanding <strong>(Option C)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Starts declining</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Keeps declining</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Population grows at slower rate (birth &gt; death)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IV. Low stationery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stable population</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V. Declining</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Population declines (death rate &gt; birth rate)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman at 36 weeks of gestation with a prosthetic valve replacement for mitral stenosis is on warfarin therapy. Her INR is 3. What is the appropriate next step in management?", "options": [{"label": "A", "text": "Stop warfarin and start LMWH", "correct": true}, {"label": "B", "text": "Stop warfarin and start heparin", "correct": false}, {"label": "C", "text": "Continue warfarin", "correct": false}, {"label": "D", "text": "Stop warfarin, start LMWH and aspirin", "correct": false}], "correct_answer": "A. Stop warfarin and start LMWH", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medicine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>FDA category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adverse effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Teratogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Use during lactation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Remark</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vitamin K antagonists (warfarin)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">X</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Teratogenicity, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> complications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Yes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allowed: Small amounts of metabolites pass into breast milk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heparin (UFH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bone demineralization, osteoporosis, fractures in mother, risk of HIT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allowed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LMWH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower risk of HIT and <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> than UFH</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allowed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Danaparoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">No</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allowed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The average number of children a woman would have if she were to pass through her reproductive years bearing children at the same rates as the women in her age group is called as:", "options": [{"label": "A", "text": "General fertility rate", "correct": false}, {"label": "B", "text": "Total fertility rate", "correct": true}, {"label": "C", "text": "Gross reproduction rate", "correct": false}, {"label": "D", "text": "Net reproduction rate", "correct": false}], "correct_answer": "B. Total fertility rate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PU2elX2bdiKxIW6Pd5tZ1745907830.png"], "explanation": "<p>Correct Answer B - Total &lt;span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\"&gt;fertility&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a 23-year-old female who has been experiencing fever for the past week and displays the following rhythm on the monitor?", "options": [{"label": "A", "text": "Atrial fibrillation", "correct": true}, {"label": "B", "text": "Atrial flutter", "correct": false}, {"label": "C", "text": "Supra ventricular tachyarrhythmia", "correct": false}, {"label": "D", "text": "Ventricular tachyarrhythmia", "correct": false}], "correct_answer": "A. Atrial fibrillation", "question_images": ["https://image.prepladder.com/notes/CEUek5LIpR5GPrX8oXOS1747902918.png"], "explanation_images": ["https://image.prepladder.com/content/W4l63ull5VPXdWRfBJrI1745908019.png", "https://image.prepladder.com/content/YLaPIYmhjI6wnC4ollmx1745908019.png", "https://image.prepladder.com/content/dnnKpc2OlZFjV8hsH8NM1745908019.png", "https://image.prepladder.com/notes/6QSmujtKlVqt3yKhYynh1747902991.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most reliable indicator of recent malaria transmission?", "options": [{"label": "A", "text": "Spleen rate", "correct": false}, {"label": "B", "text": "Infant parasite rate", "correct": true}, {"label": "C", "text": "Parasite density index", "correct": false}, {"label": "D", "text": "Slide positivity rate", "correct": false}], "correct_answer": "B. Infant parasite rate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/B8s4DAoE4S78rEFBWYPJ1745908025.png"], "explanation": "<p>Correct Answer B - Infant &lt;span class=\"customMeta\" data-dictid=\"a59b97ce831692777194f6c0160f15\"&gt;parasite&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the adverse effect linked to intravenous bolus administration of oxytocin?", "options": [{"label": "A", "text": "Hypotension", "correct": true}, {"label": "B", "text": "Hypertension", "correct": false}, {"label": "C", "text": "Hyperglycemia", "correct": false}, {"label": "D", "text": "Hypoglycemia", "correct": false}], "correct_answer": "A. Hypotension", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Different Side Effects Of <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">Oxytocin</span> And Their Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uterine Hyperstimulation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">dosage</span> or rapid increase in <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">Oxytocin</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> rate</li>\n<li>Prolonged administration of Oxytocin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fetal Distress</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uterine <span class=\"customMeta\" data-dictid=\"97cdd1c214169277718992e2918f2c\">hyperstimulation</span> leading to decreased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and oxygen supply to the fetus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Water Intoxication</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prolonged high-dose administration of Oxytocin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nausea and Vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of the <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> center in the brain by Oxytocin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Headache</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasodilation and changes in cerebral <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> caused by Oxytocin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypotension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oxytocin-induced <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> and decreased <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Postpartum Hemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rarely, high doses of <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">Oxytocin</span> may contribute to <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"d4d4e36d2416927771828288897bf3\">atony</span> or excessive <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allergic Reactions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypersensitivity or allergic response to <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">Oxytocin</span> or other components of the medication</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiac Arrhythmias</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct effects of <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">Oxytocin</span> on <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> electrical activity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maternal Fluid Overload</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oxytocin-induced <span class=\"customMeta\" data-dictid=\"27bd08bbaa16927771812e98e16787\">antidiuretic</span> effect leading to fluid retention</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uterine <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">Rupture</span> (Rare)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excessive <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions or <span class=\"customMeta\" data-dictid=\"97cdd1c214169277718992e2918f2c\">hyperstimulation</span> of the uterus</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Recommended Dose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adverse Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Induction of Labor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial: 0.5-1 milliunits/min IV infusion, gradually increasing by 1-2 milliunits/min every 15-60 min until desired contractions occur</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uterine hyperstimulation</li>\n<li>Fetal distress</li>\n<li>Water <span class=\"customMeta\" data-dictid=\"fa5fbbb509169277719078b91cffd9\">intoxication</span> (rare, with prolonged high-dose administration)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Augmentation of Labor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial: 0.5-1 milliunits/min IV infusion, gradually increasing by 1-2 milliunits/min every 15-60 min as needed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uterine hyperstimulation</li>\n<li>Fetal distress</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevention of <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">Postpartum</span> Hemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV infusion: 10-40 units in 1000 mL of <span class=\"customMeta\" data-dictid=\"8baf7b24c316927771847e2b2ae466\">compatible</span> IV solution, usually at a rate of 20-40 milliunits/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uterine hyperstimulation</li>\n<li>Postpartum <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (rare, when given in excessive doses)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management of <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">Postpartum</span> Hemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV infusion: 10 units in 1000 mL of <span class=\"customMeta\" data-dictid=\"8baf7b24c316927771847e2b2ae466\">compatible</span> IV solution, usually at a rate of 20-40 milliunits/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uterine hyperstimulation</li>\n<li>Postpartum <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (rare, when given in excessive doses)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uterine Atony</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV infusion: 10-20 units in 1000 mL of <span class=\"customMeta\" data-dictid=\"8baf7b24c316927771847e2b2ae466\">compatible</span> IV solution, usually at a rate of 20-40 milliunits/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uterine hyperstimulation</li>\n<li>Postpartum <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (rare, when given in excessive doses)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facilitation of <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">Placental</span> Delivery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV infusion: 10 units in 1000 mL of <span class=\"customMeta\" data-dictid=\"8baf7b24c316927771847e2b2ae466\">compatible</span> IV solution, usually at a rate of 20-40 milliunits/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uterine hyperstimulation</li>\n<li>Postpartum <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (rare, when given in excessive doses)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stimulation of Breast Milk Ejection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intranasal spray: Single spray (40 IU) into one <span class=\"customMeta\" data-dictid=\"102abb4d3c16927771939d6ef97c5f\">nostril</span> approximately 5-10 min before <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> or pumping</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nausea and vomiting</li>\n<li>Headache</li>\n<li>Hypotension (rare)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person was brought to the emergency department with facial swelling, itching, and hypotension following a bee sting. The mentioned clinical features are due to the increase in which of the following immunoglobulins?", "options": [{"label": "A", "text": "IgA", "correct": false}, {"label": "B", "text": "IgE", "correct": true}, {"label": "C", "text": "IgM", "correct": false}, {"label": "D", "text": "IgG", "correct": false}], "correct_answer": "B. IgE", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/cDxAnUpYqIaRtUs8yCNh1747907531.png"], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Early phase reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Late phase reaction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate (within minutes of <span class=\"customMeta\" data-dictid=\"7396dd35a41692777181bd7038fa9b\">allergen</span> exposure).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delayed (several hours after exposure) and can last for days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cells involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mast cells, basophils.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eosinophils, T lymphocytes.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cellular events</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Activation of <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells and basophils.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recruitment and <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of leukocytes, especially eosinophils.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mediators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histamine</strong>, leukotrienes (LTB4, LTC4, LTD4), prostaglandins (PGD2) and Platelet-activating factor (PAF).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytokines (e.g., IL-4, IL-5, TNF), chemokines (e.g., eotaxin).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initiating event</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exposure to <span class=\"customMeta\" data-dictid=\"7396dd35a41692777181bd7038fa9b\">allergen</span> triggers <span class=\"customMeta\" data-dictid=\"2cf4952c63169277718543a0883583\">cross-linking</span> of IgE on <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells/basophils.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recurrent inflammation, sustained by recruited leukocytes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effect on tissues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vasodilation, increased <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> permeability, smooth muscle contraction.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sustained <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and tissue damage due to <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> infiltration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allergic <span class=\"customMeta\" data-dictid=\"a8dad7cd171692777197e6d4ac2a1c\">rhinitis</span> (hay fever), <span class=\"customMeta\" data-dictid=\"7e814d15c31692777201fe0d9c1a61\">urticaria</span> (hives), Angioedema bronchoconstriction.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allergic <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> exacerbation, persistent inflammation, and tissue damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Therapeutic Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antihistamines for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> relief.</p>\n<p>Adrenaline in anaphylactic shock.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Broad-spectrum anti-inflammatory drugs (e.g., steroids) to suppress <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and prevent tissue damage.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the Ayushman Bharat scheme, what is the annual health insurance coverage offered to a qualifying family?", "options": [{"label": "A", "text": "5 lakhs per family per year", "correct": true}, {"label": "B", "text": "4 lakhs per family per year", "correct": false}, {"label": "C", "text": "6 lakhs per family per year", "correct": false}, {"label": "D", "text": "3 lakhs per family per year", "correct": false}], "correct_answer": "A. 5 lakhs per family per year", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hkMmxoEUZs8QvV956FCg1745908260.png"], "explanation": "<p>Correct Answer A - 5 lakh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After 18 hours of which peak in the provided image is associated with the occurrence of ovulation?", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": true}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "B. 2", "question_images": ["https://image.prepladder.com/notes/P0bzkETvJ1Hxk8LWqweG1747901250.png"], "explanation_images": ["https://image.prepladder.com/notes/RIgUZXs44hc71iMGNRRa1747901302.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hormonal Changes During Menstrual Cycle</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Menstrual Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Follicular Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ovulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Luteal Phase</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Follicle-Stimulating Hormone (FSH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luteinizing Hormone (LH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surge in LH levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Estrogen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progesterone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased levels</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A Rh-negative mother delivered an Rh-positive baby, and Coomb’s test was positive for the baby. What is the mechanism of hypersensitivity seen in this scenario?", "options": [{"label": "A", "text": "Antigen-dependent cellular cytotoxicity", "correct": false}, {"label": "B", "text": "Antibody-dependent cellular cytotoxicity", "correct": true}, {"label": "C", "text": "Antigen-antibody immune complex deposition", "correct": false}, {"label": "D", "text": "CD4 T-cell-mediated cytokine release", "correct": false}], "correct_answer": "B. Antibody-dependent cellular cytotoxicity", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanisms of <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">Type II</span> hypersensitivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Opsonisation and <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">Phagocytosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>IgG</strong> antibodies coat cells, helping phagocytes recognise circulating antigen-opsonin complexes <strong>through Fc receptors</strong> or <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> activation, <strong>leading to phagocytosis.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoimmune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia</li>\n<li>Immune thrombocytopenic purpura</li>\n<li><strong>Rh <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> disease of the newborn</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Complement activation</strong></p>\n<p><strong>and inflammation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<ul>\n<li>Antibody deposition in <strong>extracellular</strong> tissues triggers <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> rather than <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> or cell lysis.</li>\n<li>The deposited antibodies <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> the <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> system, attracting neutrophils and monocytes via their Fc receptors.</li>\n<li>Activated leukocytes release enzymes, causing tissue damage.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<ul>\n<li>Goodpasture syndrome.</li>\n<li>Acute rheumatic fever.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Antibody-dependent</strong></p>\n<p><strong>cellular <span class=\"customMeta\" data-dictid=\"569eae3b3516927771850ba9123b99\">cytotoxicity</span> (ADCC)</strong><br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Natural killer cells</strong> bind to antibody-antigen complexes, inducing apoptotic cell death.</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<ul>\n<li>Pernicious anemia</li>\n<li>Insulin resistant diabetes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Antibody-mediated <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (non-cytotoxic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Antibodies physically impair or dysregulate <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> function by binding to cell surface receptors. This includes both <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> (e.g., <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> in Graves disease) and <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> (e.g., <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> in <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">Myasthenia</span> gravis).</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<ul>\n<li>Graves disease</li>\n<li><strong>Myasthenia gravis</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:365px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mnemonic: My <span class=\"customMeta\" data-dictid=\"a3c99b36b6169277718332b20cc393\">Blood Group</span> Is Rh Positive</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>My</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Myasthenia Gravis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> reaction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Group<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good pasture syndrome,</p>\n<p>Graves disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Is<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immune <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anaemia,</p>\n<p>Immune thrombocytopenic purpura</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>R<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rh incompatibility</strong>,</p>\n<p>Rheumatic fever</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperacute transplant rejection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pemphigus (Bullous),<strong> </strong></p>\n<p>Pernicious Anemia</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type II <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> (Antibody-mediated)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Opsonisation and <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> activation→Phagocytosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transfusion reaction, <strong>erythroblastosis fetalis</strong>, AIHA, ITP.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complement, F<sub>c</sub></strong><strong> receptor-mediated →Inflammation.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Goodpasture syndrome, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Rheumatic fever, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> rejections, vasculitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antibody-mediated <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> dysfunctions.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Myasthenia gravis, <span class=\"customMeta\" data-dictid=\"73d23b64831692777195fed10389ac\">Pemphigus</span> Vulgaris, Graves disease, <span class=\"customMeta\" data-dictid=\"5cc1ea37091692777195fbd0aa687b\">Pernicious</span> Anemia, Insulin-resistant diabetes, <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> disease of the newborn.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old woman presents with hypopigmented macules and confluent patches over the chest. Skin scraping and KOH preparation show an abundance of yeast-like cells and short branch filaments like a ‘Spaghetti and meatball appearance’ as shown in the image below. What is the most likely organism?", "options": [{"label": "A", "text": "Malassezia", "correct": true}, {"label": "B", "text": "Trichophyton", "correct": false}, {"label": "C", "text": "Chlamydospores", "correct": false}, {"label": "D", "text": "Candida", "correct": false}], "correct_answer": "A. Malassezia", "question_images": ["https://image.prepladder.com/content/xMt56qb9EC3q0R6dBGbw1745907956.png"], "explanation_images": ["https://image.prepladder.com/content/S3VRL7YTcn4xQsVQZuzx1745908420.png", "https://image.prepladder.com/content/oPm45RVRzFH709VZ33ce1745908429.png", "https://image.prepladder.com/content/MJX5ChSY52C95nJCxGHB1745908453.png", "https://image.prepladder.com/content/TnY1VJIGr8mN78TmSU4t1745908468.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Test/Tool</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Microscopy (Skin Scrapings)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abundant <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells and short, branched filaments <strong>(yeast cells grouped in a “grape bunch” format with short, branched filaments)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Veasey, John &amp; Avila, Ricardo &amp; Miguel, Barbara &amp; Muramatu, Laura. \" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Mycological-examinations-for-pityriasis-versicolor-A-Direct-mycological-examination-of_fig5_318687018\" data-tags=\"\" height=\"452\" src=\"https://image.prepladder.com/content/S3VRL7YTcn4xQsVQZuzx1745908420.png\" width=\"334\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Spaghetti and meatball appearance under KOH microscopy</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Singla, Pooja &amp; Sharma, NidhiR &amp; Mane, Pratibha &amp; Patil, Anant &amp; Sangwan, Jyoti &amp; Sharma, Sudhanshu.\" data-hash=\"\" data-license=\"CC BY NC SA 4.0\" data-source=\"https://www.researchgate.net/figure/mage-showing-Spaghetti-and-meatball-appearance-in-pityriasis-versicolor-under-KOH_fig1_364413061\" data-tags=\"\" height=\"496\" src=\"https://image.prepladder.com/content/oPm45RVRzFH709VZ33ce1745908429.png\" width=\"600\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grown on Sabouraud <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> with an <strong>olive oil overlay</strong>.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Veasey, John &amp; Avila, Ricardo &amp; Miguel, Barbara &amp; Muramatu, Laura. \" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Mycological-examinations-for-pityriasis-versicolor-A-Direct-mycological-examination-of_fig5_318687018\" data-tags=\"\" height=\"780\" src=\"https://image.prepladder.com/content/MJX5ChSY52C95nJCxGHB1745908453.png\" width=\"355\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Wood’s Lamp Exam</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infected areas fluoresce golden-yellow under UV light.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Warfieldian\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Tinea_versicolor#/media/File:Tinea_Versicolor_(Wood's_Lamp).JPG\" data-tags=\"\" height=\"597\" src=\"https://image.prepladder.com/content/TnY1VJIGr8mN78TmSU4t1745908468.png\" width=\"471\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following molecules helps in the adhesion of the leukocyte to the endothelium during inflammation?", "options": [{"label": "A", "text": "P-selectin", "correct": false}, {"label": "B", "text": "Platelet-activating factor", "correct": false}, {"label": "C", "text": "VCAM-1", "correct": true}, {"label": "D", "text": "Complements", "correct": false}], "correct_answer": "C. VCAM-1", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/a4cEIxT0GyPLmfAyRPXH1747907673.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man comes with complaints of fever and increasing fatigue for the past week. On examination, he is febrile, hypotensive, and tachycardic. The findings of the microscopic examination of his peripheral blood smear are given below. What is the causative agent?", "options": [{"label": "A", "text": "Plasmodium vivax", "correct": false}, {"label": "B", "text": "Plasmodium falciparum", "correct": true}, {"label": "C", "text": "Plasmodium ovale", "correct": false}, {"label": "D", "text": "Plasmodium malariae", "correct": false}], "correct_answer": "B. Plasmodium falciparum", "question_images": ["https://image.prepladder.com/content/X5sBbfCac5Qj3LQPNDi21745908651.png"], "explanation_images": ["https://image.prepladder.com/content/NpW0lx8RrIwOLFTmmzOZ1745908714.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:765px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vivax </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Falciparum </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Malariae </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ovale </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>RBC size </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enlarged</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enlarged with frayed margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pigments </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yellowish brown</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dark brown</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schizont </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large (9-10 μm)</p>\n<p>Fills the RBC</p>\n<p>Contains 12-24 merozoite</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not seen in the periphery</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small (6 μm), almost fills the RBC and contains 8 merozoites</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gametocytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spherical</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crescentic</p>\n<p>Larger than RBC</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spherical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ring <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5 μm</p>\n<p>Occupies ⅙ of RBC size</p>\n<p>It may be</p>\n<ul>\n<li>Multiple forms</li>\n<li>Accole (attached to RBC membrane)</li>\n<li>Double dot/headphone shaped with fragment nucleus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Band form</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In Plasmodium falciparum, only <span class=\"customMeta\" data-dictid=\"36514f2a4416927771881b27e74758\">gametocyte</span> and ring forms are demonstrated in the PBS, as later stages of the <span class=\"customMeta\" data-dictid=\"7d53fd92541692777187195e87ab70\">erythrocytic</span> cycle occur in deep vessels and not in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The current approach for the initial screening of women for cervical cancer at a primary health center is-", "options": [{"label": "A", "text": "Visual inspection after application of freshly prepared solution 5% acetic acid solution", "correct": true}, {"label": "B", "text": "Colposcopy", "correct": false}, {"label": "C", "text": "Cervical biopsy", "correct": false}, {"label": "D", "text": "High vaginal biopsy", "correct": false}], "correct_answer": "A. Visual inspection after application of freshly prepared solution 5% acetic acid solution", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Visual inspection after application of freshly prepared solution 5% &lt;span class=\"customMeta\" data-dictid=\"0dd11cf9621692777180830d7825b2\"&gt;acetic&lt;/span&gt; acid solu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not considered a pillar of primary health care?", "options": [{"label": "A", "text": "Health education", "correct": true}, {"label": "B", "text": "Intersectoral coordination", "correct": false}, {"label": "C", "text": "Appropriate technology", "correct": false}, {"label": "D", "text": "Equitable distribution", "correct": false}], "correct_answer": "A. Health education", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Health education</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Equitable distribution (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Equitable distribution of health services irrespective of their socio-economic status.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intersectoral <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> (Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Involves collaboration from other sectors like agriculture, education, etc.</li>\n<li>Maintains good health.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appropriate technology (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Use of technology that is accessible, affordable, and suitable for the community</li>\n<li>Eg:\n\t\t\t\t<ul>\n<li>ORS</li>\n<li>VVM (Vaccine <span class=\"customMeta\" data-dictid=\"cd235a18081692777202343e31b264\">Vial</span> Monitor): Heat sensitive label</li>\n<li>Shakir tape: <span class=\"customMeta\" data-dictid=\"cbd2d1fd521692777191d00c1a4ede\">Malnutrition</span> grading</li>\n<li>Kangaroo mother care: <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">Preterm</span> care</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Community participation </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ensure the participation of the community in planning, implementing and maintaining.</li>\n<li>For the promotion and maintenance of their health.</li>\n<li>Eg: <span class=\"customMeta\" data-dictid=\"817804153a16927771822a30e05c60\">ASHA</span> workers are residents of the same community.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable tumour that a 22-year-old woman with a sizable growth in her right ovary, which has been determined to originate from all three germ layers based on histopathology, is experiencing?", "options": [{"label": "A", "text": "Dysgerminoma", "correct": false}, {"label": "B", "text": "Teratoma", "correct": true}, {"label": "C", "text": "Thecoma", "correct": false}, {"label": "D", "text": "Theca lutein cyst", "correct": false}], "correct_answer": "B. Teratoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WWoY57QW12n1xoqcr9aj1745909144.png", "https://image.prepladder.com/content/c1PU47mRR75zd8z1JgJU1745909144.png", "https://image.prepladder.com/notes/gljYWAkFRPllGTjsGZHu1747999159.png", "https://image.prepladder.com/notes/prAMbCtyx2BWrRBKUdSP1747907942.png", "https://image.prepladder.com/content/oipwzoYlcYBB65H5QL9r1745909144.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the current ideal total fertility rate in India?", "options": [{"label": "A", "text": "2.3", "correct": false}, {"label": "B", "text": "2.2", "correct": false}, {"label": "C", "text": "2.1", "correct": true}, {"label": "D", "text": "2.0", "correct": false}], "correct_answer": "C. 2.1", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6frgkkPNFo3YnsS07WgW1745909235.png"], "explanation": "<p>Correct Answer C - 2.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for an 18-year-old male with gum bleeding, fever for two months, pallor, low haemoglobin (3 gm/dL), low TLC (1500/microL), low platelet count (15000/microL), macrocytes on peripheral smear, 0.5% reticulocyte count, and bone marrow examination showing fatty streaks and a lack of megakaryocytes but no immature cells?", "options": [{"label": "A", "text": "Idiopathic acquired aplastic anemia", "correct": true}, {"label": "B", "text": "Paroxysmal nocturnal hemoglobinuria", "correct": false}, {"label": "C", "text": "Myelodysplastic syndrome", "correct": false}, {"label": "D", "text": "Tuberculosis", "correct": false}], "correct_answer": "A. Idiopathic acquired aplastic anemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most effective approach to educating an urban slum community about oral rehydration solution (ORS) is -", "options": [{"label": "A", "text": "Lecture", "correct": false}, {"label": "B", "text": "Roleplay", "correct": false}, {"label": "C", "text": "Flashcards", "correct": false}, {"label": "D", "text": "Demonstration", "correct": true}], "correct_answer": "D. Demonstration", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary risk factor for the disease in a patient who exhibits symptoms of a black, malodorous nasal discharge, along with the presence of a black, necrotic mass that fills the nasal cavity and causes erosion of the septum and hard palate during examination?", "options": [{"label": "A", "text": "Hypothyroidism", "correct": false}, {"label": "B", "text": "Diabetes", "correct": true}, {"label": "C", "text": "Hypertension", "correct": false}, {"label": "D", "text": "Foreign body", "correct": false}], "correct_answer": "B. Diabetes", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BXyrcfLzBGpCGKrwOgzt1745908874.png", "https://image.prepladder.com/content/Hy7y6MKeWGl0C938PmG61745908874.png", "https://image.prepladder.com/content/mA04lXkvYFklZwtCDvFt1745908874.png", "https://image.prepladder.com/content/5EwSBDswwYtSpou5SVac1745908874.png", "https://image.prepladder.com/content/7CVk0SuXxpVf5ucFDUPI1745908874.png", "https://image.prepladder.com/content/I6W1PL9VYLkqrIWuw2Qe1745908874.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:730px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mucormycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is an <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> disease caused by zygomycetes (phycomycetes) - Rhizopus, <span class=\"customMeta\" data-dictid=\"2cd8f411371692777193c9fa32b32c\">Mucor</span> and Absidia. <strong>Rhizopus Arrhizus </strong>is the most common pathogen</p>\n<p><strong>Rhizopus</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Timleo\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Rhizopus\" data-tags=\"\" height=\"327\" src=\"https://image.prepladder.com/content/BXyrcfLzBGpCGKrwOgzt1745908874.png\" width=\"415\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" CDC/Dr. Lucille K. Georg \" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Absidia\" data-tags=\"\" height=\"295\" src=\"https://image.prepladder.com/content/Hy7y6MKeWGl0C938PmG61745908874.png\" width=\"417\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kouser Sideeq Lone, Bilquees S, S M Salim Khan, Inaamul Haq\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/class-III-bite-on-lower-limb-most-common-sites-Table-4-Distribution-of-victims-on-site_fig2_321867070\" data-tags=\"\" height=\"346\" src=\"https://image.prepladder.com/content/mA04lXkvYFklZwtCDvFt1745908874.png\" width=\"414\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Absidia</strong> <strong>Mucor</strong> (Lactophenol cotton blue stained)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Begins in the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, where spores germinate and <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> mycelia → invade adjacent tissues, leading to local destruction.</p>\n<p>Fungi invade blood vessels, causing <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> and <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> in affected areas, which contributes to its high mortality rate (Angio-invasiveness)</p>\n<p><strong>Common Sites</strong></p>\n<p><strong>Rhinocerebral Form</strong>: Involves the nose, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> sinuses, and orbit; frequently seen in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</p>\n<p><strong>Pulmonary Infections</strong>: When the lungs are the primary site, the <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> can invade lung arteries, leading to serious complications.</p>\n<p>Others: Cutaneous mucormycosis, GI mucormycosis, Disseminated mucormycosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<h3><strong>Clinical Features</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rhinocerebral Zygomycosis</strong>:</p>\n<p>Facial swelling, <strong>nasal discharge</strong> (often <strong>black</strong>), fever, and <strong>mucosal necrosis</strong>.</p>\n<p>Rapid <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> can lead to severe complications, including visual loss and neurological symptoms.</p>\n<p><strong>Pulmonary Zygomycosis</strong>:</p>\n<p>Symptoms may include cough, fever, and <strong>hemoptysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histological Examination</strong>:</p>\n<p>Diagnosis is confirmed by identifying broad, non-septate (or sparsely septate) hyphae.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"295\" src=\"https://image.prepladder.com/content/5EwSBDswwYtSpou5SVac1745908874.png\" width=\"324\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Culture: </strong></p>\n<p>After <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> for 3-4 days on Sabouraud <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> at 30-37°C, the colonies are grey-white with a thick cottony, fluffy surface.</p>\n<p>Under the microscope, nonseptate, broad hyphae with aerial sporangiophores which end in a <span class=\"customMeta\" data-dictid=\"7234e0b4e11692777199d188770525\">sporangium</span> (a <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> containing spores are seen.)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"256\" src=\"https://image.prepladder.com/content/7CVk0SuXxpVf5ucFDUPI1745908874.png\" width=\"291\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Sabouraud's <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">dextrose</span> <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> (SDA) medium showing Rhizopus growth</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"273\" src=\"https://image.prepladder.com/content/I6W1PL9VYLkqrIWuw2Qe1745908874.png\" width=\"340\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Microscopy of LPCB stained preparation demonstrating <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">morphology</span> of Rhizopus spp. (non-septate hyphae, sporangiophore, <span class=\"customMeta\" data-dictid=\"7234e0b4e11692777199d188770525\">sporangium</span> and spores)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intravenous amphotericin B combined, where appropriate, with <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> is the recommended treatment.</p>\n<p>Medical control of diabetes is required.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man working in the sandblasting industry developed hemoptysis and a productive cough. A chest x-ray is suggestive of tuberculosis. Which of the following is associated with the same?", "options": [{"label": "A", "text": "Asbestosis", "correct": false}, {"label": "B", "text": "Silicosis", "correct": true}, {"label": "C", "text": "Anthracosis", "correct": false}, {"label": "D", "text": "Siderosis", "correct": false}], "correct_answer": "B. Silicosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/fC3Qcl9LS2VxCylghukj1747908066.png", "https://image.prepladder.com/content/wbbojFwtCCLYcdlCGfQ51745909368.png", "https://image.prepladder.com/notes/Xtw3z8UDuh1Fd1dpW7w51747908113.png", "https://image.prepladder.com/notes/79GGHEfKKVgWZr7GLpb31747908193.png", "https://image.prepladder.com/notes/H9zeff1qNGEl5HKvhZib1747914450.png"], "explanation": "\n<p><strong>References:</strong></p>\n<ul><li>↳ Robbins &amp; Cotran Pathologic Basis of Disease, 10th Edition, Page 691</li><li>↳ Eggshell calcification (lymph nodes) | Radiology Reference Article | Radiopaedia.org</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a 48-year-old patient who came with scrotal swelling, had elevated LDH levels but normal AFP levels on tests for testicular tumours, and exhibited a specific histological picture after orchidectomy?", "options": [{"label": "A", "text": "Yolk sac tumor", "correct": false}, {"label": "B", "text": "Teratoma", "correct": false}, {"label": "C", "text": "Seminoma", "correct": true}, {"label": "D", "text": "Embryonal carcinoma", "correct": false}], "correct_answer": "C. Seminoma", "question_images": ["https://image.prepladder.com/content/VAzXtKYoWwzg1MPUcwIU1745909483.png"], "explanation_images": ["https://image.prepladder.com/notes/aduxHJoE52ZF0aXnz1AO1747908313.png", "https://image.prepladder.com/content/XkxwxnJmWrTMAsZCERYw1745909510.png", "https://image.prepladder.com/content/WZ4wI6B62hoWP4mWXJ8B1745909510.png", "https://image.prepladder.com/notes/SZW5mycV0e7KoSlQ3OdC1747908378.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:696px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Testicular Tumour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Corresponding Tumor Markers</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Seminoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Placental <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> (PLAP)</li>\n<li>HCG</li>\n<li>LDH</li>\n<li>Newer markers: Oct 3/4, Nanog, CD117, SALL4</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Embryonal Carcinoma</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Nephron \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Embryonal_carcinoma#/media/File:Embryonal_carcinoma_-_very_high_mag_-_cropped.jpg\" data-tags=\"\" height=\"272\" src=\"https://image.prepladder.com/content/XkxwxnJmWrTMAsZCERYw1745909510.png\" width=\"404\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>CD-30</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> tumour</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Michal Hošala,L Laca,J Hosalova Matisova,Ján Janík,M Adamik,B Palkoci,Karol Kajo\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Histological-features-of-yolk-sac-tumour-with-pathognomic-Schiller-Duval-Bodies-in_fig2_271390449\" data-tags=\"\" height=\"358\" src=\"https://image.prepladder.com/content/WZ4wI6B62hoWP4mWXJ8B1745909510.png\" width=\"406\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Alpha-fetoprotein (AFP)</li>\n<li>Alpha-1 antitrypsin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Choriocarcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Beta-human <span class=\"customMeta\" data-dictid=\"6d72527c991692777184af095c6f14\">chorionic gonadotropin</span> (β-hCG)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Teratoma</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Immature teratoma\" data-author=\"Nephron\" data-hash=\"13155\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Immature_teratoma_high_mag.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/SZW5mycV0e7KoSlQ3OdC1747908378.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Cytokeratin</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the gene mutation seen in hemochromatosis?", "options": [{"label": "A", "text": "HFE", "correct": true}, {"label": "B", "text": "PTEN", "correct": false}, {"label": "C", "text": "ATP7B gene", "correct": false}, {"label": "D", "text": "MRP2 protein", "correct": false}], "correct_answer": "A. HFE", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oJKO1xbdr2rRBLi7mDOo1745909674.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Organs affected </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Liver </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hepatomegaly, elevated liver enzymes, risk of HCC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreas </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iron-induced damage of <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cells - diabetes mellitus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Heart </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cardiomyopathy, arrhythmias, congestive heart failure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperpigmentation (<strong>bronze</strong> skin due to <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> and iron deposition)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Joints </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arthropathy and joint pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CNS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely - Memory issues, depression and fatigue</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of <span class=\"customMeta\" data-dictid=\"558e2213a916927771883c4b724e1a\">hemochromatosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hereditary <span class=\"customMeta\" data-dictid=\"558e2213a916927771883c4b724e1a\">hemochromatosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>HFE</strong>-related: It is the classic <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> <span class=\"customMeta\" data-dictid=\"558e2213a916927771883c4b724e1a\">hemochromatosis</span> that is inherited in an autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> (chromosome 6p)</li>\n<li><strong>HAMP</strong> gene mutation-related</li>\n<li><strong>HJV</strong> gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> (juvenile hemochromatosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired/secondary <span class=\"customMeta\" data-dictid=\"558e2213a916927771883c4b724e1a\">hemochromatosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Repeated blood transfusion</li>\n<li>Excessive oral <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> or iron</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old male child was brought to your clinic with an erythematous rash on the cheek which later spread downwards to involve his trunk and limbs. He has also had a low-grade fever, headache, and mild upper respiratory tract infection for the past few days. The suspected organism contains single-stranded DNA. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Scarlet fever", "correct": false}, {"label": "B", "text": "Erythema infectiosum", "correct": true}, {"label": "C", "text": "Exanthema subitum", "correct": false}, {"label": "D", "text": "Rubeola", "correct": false}], "correct_answer": "B. Erythema infectiosum", "question_images": ["https://image.prepladder.com/content/DUhoBro5WOm5Nmhf7D8R1745909675.png"], "explanation_images": ["https://image.prepladder.com/content/xtxhn5jBSOQGzPmxBFVp1745909768.png", "https://image.prepladder.com/content/iAOHe6mAx2pn7dAXJ8iI1745909773.png", "https://image.prepladder.com/content/J3eQKvctuAevm4vzwRKN1745909761.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parvovirus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n<ul>\n<li>Simplest animal viruses infecting humans, responsible for <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> infectiosum (fifth disease).</li>\n<li>Smallest viruses (18–26 nm in size).</li>\n<li><strong>Non-enveloped </strong>with <span class=\"customMeta\" data-dictid=\"79e4da26b21692777189e6a7a8c456\">icosahedral</span> symmetry.</li>\n<li>Only DNA viruses with <strong>single-stranded DNA</strong>.</li>\n<li>Dependent on host cell enzymes for replication.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Exclusively infects humans.</li>\n<li><strong>Transmission</strong>:</li>\n</ul>\n<ul>\n<li>Primarily through the <strong>respiratory route</strong>.</li>\n<li>Blood transfusion.</li>\n<li>Transplacental transmission.</li>\n</ul>\n<ul>\n<li><strong>Target Cells</strong>: Tropism for<strong> <span class=\"customMeta\" data-dictid=\"892718f3e916927771871389d2e1a3\">erythroid</span> progenitor cells</strong> in adult <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> and <strong>fetal liver</strong>.</li>\n<li><strong>Receptor Binding</strong>: Binds to blood group<strong> P antigen</strong> on RBC surface.</li>\n<li><strong>Effects</strong>: Leads to RBC destruction and <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of erythropoiesis, potentially causing anemia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:639px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Manifestations of Parvovirus infections:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gzzz\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Slapped_cheek_Erythema_Infectiosum.png\" data-tags=\"\" height=\"238\" src=\"https://image.prepladder.com/content/xtxhn5jBSOQGzPmxBFVp1745909768.png\" width=\"367\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Chuh, Antonio &amp; Zawar, Vijay &amp; Law, Michelle &amp; Sciallis, Gabriel.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Typical-lesions-of-papular-purpuric-gloves-and-socks-syndrome-in-an-Indian-child_fig7_259957932\" data-tags=\"\" height=\"142\" src=\"https://image.prepladder.com/content/iAOHe6mAx2pn7dAXJ8iI1745909773.png\" width=\"367\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Erythema Infectiosum (Fifth Disease)</strong> <strong>(Option A )</strong>\n<ul>\n<li>Children: <strong>\"Slapped cheek\"</strong> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> rash.</li>\n<li>Adult women: Symmetrical polyarthropathy, often in hand and knee joints.</li>\n</ul>\n</li>\n<li><strong>Transient Aplastic Crisis</strong>:\n\t\t\t\t<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> in patients with pre-existing <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia.</li>\n</ul>\n</li>\n<li><strong>Pure Red Cell Aplasia</strong>:\n\t\t\t\t<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> in<strong> <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> individuals</strong> due to persistent B19 infection.</li>\n</ul>\n</li>\n<li><strong>Non-Immune Hydrops Fetalis</strong>:\n\t\t\t\t<ul>\n<li>Fatal <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> and death; occurs via <span class=\"customMeta\" data-dictid=\"32583099e91692777200c34d388c09\">transplacental</span> transmission (30% of cases)</li>\n<li>Highest risk in the<strong> second </strong>trimester.</li>\n</ul>\n</li>\n<li><strong>Papular-Purpuric Gloves and Socks Syndrome</strong>:\n\t\t\t\t<ul>\n<li>Painful, itchy, and symmetric <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> hands and feet; may <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> meningococcemia. <strong>(Option B)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>PCR</strong>: Highly sensitive, detects <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> DNA (VP1, VP2 genes) in serum, tissue, or <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> secretions.</li>\n<li><strong>ELISA</strong>: Detects IgM <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> (early indicator, elevated 2–3 months) and IgG against VP1 and VP2 antigens.</li>\n<li><strong>Immunohistochemistry</strong>: Detects <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> antigens in <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> tissues and bone marrow.</li>\n<li><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> cytology</strong> shows Giant pro-erythroblasts with multiple cytoplasmic projections that look like <strong>\"dog ears\"</strong> or <strong>\"pseudopodia\"</strong>.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Yadav Kamlesh,Pallav Gupta,Manjula Murari,Rohan Malik\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Bone-marrow-aspiration-showing-giant-proerythroblast-with-prominent-nucleoli-and_fig2_51494153\" data-tags=\"\" height=\"435\" src=\"https://image.prepladder.com/content/J3eQKvctuAevm4vzwRKN1745909761.png\" width=\"709\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Condyloma acuminata is most commonly caused by?", "options": [{"label": "A", "text": "HPV 31, 33", "correct": false}, {"label": "B", "text": "HPV 6, 11", "correct": true}, {"label": "C", "text": "HPV 16, 18", "correct": false}, {"label": "D", "text": "HPV 16, 11", "correct": false}], "correct_answer": "B. HPV 6, 11", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BvRqQaCz90nWV3fICjeE1745910149.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:562px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Oncogenic potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HPV types</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plantar warts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common skin warts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2, 4, 27, 57</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epidermodysplasia verrucosa</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mostly benign, rarely progresses to malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5, 8, 9, 12, 17</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Anogenital warts</strong></li>\n<li><strong>Laryngeal papilloma</strong></li>\n<li><strong>Intraepithelial neoplasia</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6, 11</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Palmar warts in butchers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carcinomas of the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> &amp; other <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> mucosa/larynx/oesophagus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16, 18, 31, 33, 45, 51, 52, 56, 58, 59, 68</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old boy is brought to the OPD with complaints of fever, ear pain, and difficulty in swallowing for 1 week. On examination, there is testicular swelling, and his jaw is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Croup", "correct": false}, {"label": "B", "text": "Mumps", "correct": true}, {"label": "C", "text": "Infectious mononucleosis", "correct": false}, {"label": "D", "text": "Herpangina", "correct": false}], "correct_answer": "B. Mumps", "question_images": ["https://image.prepladder.com/content/BXGx8PM9QyV7n7p85KGk1745910263.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p><strong>Complications of Mumps</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Orchitis (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>The most common extra salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> manifestation of <span class=\"customMeta\" data-dictid=\"f61c340e77169277719339e74267c4\">mumps</span> in post pubertal patients.</p>\n<p>Common among adolescents and is usually unilateral.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Oophoritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Most common among adolescents and is mostly unilateral.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Pancreatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Mumps is the leading cause of <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> in children.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Aseptic Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>The most common <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of mumps.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none\">\n<p><strong>Sensorineural Deafness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Mumps is one of the most common <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> causes of <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> hearing loss.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What steps should be taken to manage the case of a 24-year-old male who was hit by a motorbike while crossing the road, leading to abdominal injuries and bruising, with a blood pressure of 88/60 and IV fluids already administered, along with a positive FAST examination?", "options": [{"label": "A", "text": "Abdominal CT scan", "correct": false}, {"label": "B", "text": "Abdominal MRI scan", "correct": false}, {"label": "C", "text": "Exploratory laparotomy", "correct": true}, {"label": "D", "text": "Diagnostic peritoneal lavage", "correct": false}], "correct_answer": "C. Exploratory laparotomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) E\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man presents with fever, headache, photophobia, and neck rigidity for the last 2 days. He had undergone a heart transplant one year back and is on immunomodulatory drugs. On microscopy, differential motility was seen, non-motile at 37°C, and motile at 25°C. What is the most likely organism causing this?", "options": [{"label": "A", "text": "Listeria", "correct": true}, {"label": "B", "text": "Streptococcus", "correct": false}, {"label": "C", "text": "Staphylococcus", "correct": false}, {"label": "D", "text": "Giardia lamblia", "correct": false}], "correct_answer": "A. Listeria", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Listeria monocytogenes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Mode of Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Contaminated food</li>\n<li>Vertical transmission (mother to fetus, during birth)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Common Food Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Contaminated coleslaw</li>\n<li>Milk, Soft cheeses</li>\n<li>\"Ready-to-eat\" foods (delicatessen meat, uncooked hotdogs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Age Groups at Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Neonates</li>\n<li>Elderly individuals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Increased Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Use of <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> pump inhibitors</li>\n<li>Pregnant women</li>\n<li>Immunocompromised individuals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Survival in Food</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Survives <span class=\"customMeta\" data-dictid=\"66802d2b3916927771977ebb4da718\">refrigeration</span> (4°C)</li>\n<li>Found in stored foods (aged soft cheeses, packaged meats, milk, cold salads)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Infection Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Sporadic</li>\n<li>Outbreaks can occur</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Psychrotrophic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>L. monocytogenes is a psychrotrophic organism with an <span class=\"customMeta\" data-dictid=\"9627da6bc21692777194438ac75f8d\">optimum</span> growth temperature of 30ºC to 37ºC but has the ability to grow at a wide range of temperatures from 1ºC to 45ºC.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Motility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Shows Tumbling and <span class=\"customMeta\" data-dictid=\"6bd54dfc48169277718674cd08e586\">Differential</span> motility(motile at 25.C by forming <span class=\"customMeta\" data-dictid=\"8e023fb81e16927771802d21820404\">actin</span> rockets, <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> <span class=\"customMeta\" data-dictid=\"27cf09e9d316927771928763e99e0d\">motile</span> at 37.C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Intracellular survival: <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> of <span class=\"customMeta\" data-dictid=\"9df7e598501692777195d1e772d3dc\">phagosome</span> (listeriolysin O)</li>\n<li>Host cell <span class=\"customMeta\" data-dictid=\"8e023fb81e16927771802d21820404\">actin</span> <span class=\"customMeta\" data-dictid=\"1346ac97b61692777196b91eff8228\">polymerization</span> (cell <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> approach)</li>\n<li>Direct cell-to-cell spread (listeriopods)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Neonatal listeriosis:</strong> Early-onset and late-onset disease</li>\n<li><strong>Pregnant women: </strong>\n<ul>\n<li><strong>Granulomatosis infantiseptica</strong> in baby in 3rd trimester</li>\n<li>Fetal complications (abortion, <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">preterm</span> delivery)</li>\n<li>Maternal complications (flu-like symptoms, bacteremia, rarely meningitis)</li>\n</ul>\n</li>\n<li><strong>Adults:</strong>\n<ul>\n<li>Bacteremia and <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> (elderly, &gt;60 years)</li>\n<li>Immunosuppression- higher risk (steroid therapy, HIV, diabetes, malignancy)</li>\n<li>Post-kidney transplant <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> (1-month post-transplant)</li>\n<li>Gastroenteritis (consumption of contaminated milk, meat, salads)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with complaints of fever for 3 days and general fatigue. Echocardiography revealed vegetations on the valves, and a blood culture was performed. The organism in the culture showed alpha hemolysis on blood agar and was resistant to optochin and bile. Which of the following bacteria is most commonly implicated in this condition?", "options": [{"label": "A", "text": "Mycoplasma", "correct": false}, {"label": "B", "text": "Streptococcus sanguis", "correct": true}, {"label": "C", "text": "Enterococcus", "correct": false}, {"label": "D", "text": "Streptococcus agalactiae", "correct": false}], "correct_answer": "B. Streptococcus sanguis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:575px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Epidemiology</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Dental procedures can introduce <span class=\"customMeta\" data-dictid=\"9562e26acc16927771995a2028dd05\">Streptococcus</span> viridans into the bloodstream, potentially leading to <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> endocarditis.</li>\n<li><strong>Patients with pre-existing heart conditions, such as valvular heart disease or <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> valves, are at higher risk.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infection Mechanism</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Capable of producing biofilms,<strong> aiding in <span class=\"customMeta\" data-dictid=\"5f8b7d103016927771806be7e4190b\">adherence</span> to heart valves, and resistance to <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> and antibiotics.</strong></li>\n<li>Production of <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> polysaccharides enhances its ability to colonize and persist in host tissues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms can include fever, chills, heart murmur, fatigue, and signs of <span class=\"customMeta\" data-dictid=\"acd7af7f74169277718736b038fb02\">embolic</span> events such as <span class=\"customMeta\" data-dictid=\"8fad605541169277719552afc9ebac\">petechiae</span> or <span class=\"customMeta\" data-dictid=\"2bb63f81301692777199461e9fc6f4\">splinter</span> hemorrhages.</li>\n<li>Complications may involve<strong> heart failure</strong>, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> embolization, and<strong> severe <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> dysfunction.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood cultures are essential for identifying the <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organism.</li>\n<li>Echocardiography (especially <span class=\"customMeta\" data-dictid=\"8ba00f15d31692777200f1c6d2cbae\">transesophageal</span> echocardiography) is used to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> vegetations on the heart valves</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Prolonged <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy, often involves <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> or ceftriaxone combined with an aminoglycoside.</strong></li>\n<li>In some cases, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention may be necessary to repair or replace damaged valves.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely cause of the symptoms experienced by a 70-year-old woman who was hospitalized for 3 days due to right leg cellulitis and later developed diarrhea, abdominal pain, and an elevated temperature? Her blood reports indicate a hemoglobin level of 12 g/dL, a white blood cell count of 18,000/mm³, and a C-reactive protein (CRP) level of 160 mg/L.", "options": [{"label": "A", "text": "Clostridium coli", "correct": true}, {"label": "B", "text": "Escherichia coli", "correct": false}, {"label": "C", "text": "Norovirus", "correct": false}, {"label": "D", "text": "Rotavirus", "correct": false}], "correct_answer": "A. Clostridium coli", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with liver cirrhosis, what is the primary cause of mortality when esophageal varices are present?", "options": [{"label": "A", "text": "Hypovolemic shock", "correct": true}, {"label": "B", "text": "Cardiogenic shock", "correct": false}, {"label": "C", "text": "Obstructive shock", "correct": false}, {"label": "D", "text": "Distributive shock", "correct": false}], "correct_answer": "A. Hypovolemic shock", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A) Hypovolemic shock\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old male was brought to the emergency department after suffering severe injuries in a motorcycle accident. His blood pressure was 80/60 mm Hg, and he was tachycardic with cold, clammy skin. An ultrasound examination revealed a ruptured spleen. Arterial blood gas analysis was suggestive of metabolic acidosis. Which of the following conditions most likely caused the patient to suffer?", "options": [{"label": "A", "text": "Cardiogenic shock", "correct": false}, {"label": "B", "text": "Septic shock", "correct": false}, {"label": "C", "text": "Hypovolemic shock", "correct": true}, {"label": "D", "text": "Neurogenic shock", "correct": false}], "correct_answer": "C. Hypovolemic shock", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has complaints of fever with a mild headache associated with difficulty in swallowing. A throat examination reveals swollen glands and a thick, whitish membrane over the tonsils, which bleeds on scraping. A sample is taken from the exudate, and a Gram stain is performed. What is the organism associated with the disease?", "options": [{"label": "A", "text": "Parvovirus", "correct": false}, {"label": "B", "text": "HHV-6", "correct": false}, {"label": "C", "text": "Corynebacterium diphtheriae", "correct": true}, {"label": "D", "text": "Beta-hemolytic streptococci", "correct": false}], "correct_answer": "C. Corynebacterium diphtheriae", "question_images": ["https://image.prepladder.com/content/rFROTOB6fEuJsZeohpgx1745910854.png"], "explanation_images": ["https://image.prepladder.com/content/hgZmv9EUVCI7nbPWSHGy1745910896.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:506px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Sore throat</li>\n<li>Difficulty <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> (dysphagia)</li>\n<li>Low-grade fever</li>\n<li><strong>Pseudomembrane formation in the throat</strong></li>\n<li><strong>Non-healing ulcers covered by grey <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> on the skin</strong></li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Myocarditis</li>\n<li>Neurological complications (e.g., paralysis, neuropathy)</li>\n<li>Renal failure</li>\n<li>Airway obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Albert Solution 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malachite Green for organism staining</li>\n<li>Toluidine Blue for <span class=\"customMeta\" data-dictid=\"2a980628c2169277719296f9072e4a\">metachromatic</span> staining</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Enhances contrast and <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> in staining.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Albert Solution 2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Iodine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Specifically targets <span class=\"customMeta\" data-dictid=\"6dd80630fd16927772026fda726e31\">volutin</span> or Babes-Ernst granules.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with hypocalcemia, thymic hypoplasia, cardiac abnormalities, and deletion of chromosome 22q11.2?", "options": [{"label": "A", "text": "Williams syndrome", "correct": false}, {"label": "B", "text": "Pitt syndrome", "correct": false}, {"label": "C", "text": "DiGeorge syndrome", "correct": true}, {"label": "D", "text": "Cri-du-chat syndrome", "correct": false}], "correct_answer": "C. DiGeorge syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/qXdvLOuCU3RdckW35wPJ1747908478.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a component of Meigs syndrome?", "options": [{"label": "A", "text": "Ascites", "correct": false}, {"label": "B", "text": "Right-sided hydrothorax", "correct": false}, {"label": "C", "text": "Fibromas of ovary", "correct": false}, {"label": "D", "text": "Dysgerminoma of ovary", "correct": true}], "correct_answer": "D. Dysgerminoma of ovary", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/6kS2eviPv2dRGgpGfuOR1747908563.png", "https://image.prepladder.com/notes/rY4Diw0PALX8TfrUSmA31747908618.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the primary referral centers in India's healthcare system?", "options": [{"label": "A", "text": "Primary health centres and district hospitals", "correct": false}, {"label": "B", "text": "Medical colleges and district hospitals", "correct": false}, {"label": "C", "text": "Community health centres and medical colleges", "correct": false}, {"label": "D", "text": "Sub-district hospitals and community health centres", "correct": true}], "correct_answer": "D. Sub-district hospitals and community health centres", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Sub-district hospitals and community health centres </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Level of Health Care Delivery System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Rural</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Urban</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Tertiary Level of Health Care</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>MC: Medical colleges</li>\n<li>SSH: Superspeciality hospitals</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Medical colleges</li>\n<li>SSH: Superspeciality hospitals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Secondary Level of Health Care</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>CHC: Community health center,</li>\n<li>SDH: Sub-district hospital</li>\n<li>DH: District hospital</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Urban CHC (u-CHC)</li>\n<li>Metrocity</li>\n<li>Non-metrocity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Primary Level of Health Care</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>SC: Sub-centers</li>\n<li>PHCs: Primary health centers</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Swasthya Chowki</li>\n<li>Urban PHC or Urban health center</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Grass Root Level Workers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>ASHA</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>USHA</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 50-year-old male who worked in the dye industry and had exposure to aniline dyes, and is now experiencing bladder problems?", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": false}, {"label": "B", "text": "Basal cell carcinoma", "correct": false}, {"label": "C", "text": "Transitional cell carcinoma", "correct": true}, {"label": "D", "text": "Adenocarcinoma", "correct": false}], "correct_answer": "C. Transitional cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Transitional cell carcinoma</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Chemical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Note</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Aflatoxin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hepatocellular Carcinoma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Aspergillus; stored grains</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Alkylating Agents</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lymphoma &amp; Leukemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Caused by chemotherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Alcohol</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>SCC of Oropharynx/Esophagus, Pancreatic Ca, HCC</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">—</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Arsenic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>SCC of Skin, <span class=\"customMeta\" data-dictid=\"bd5cc7040a16927771812ebd87a3b6\">Angiosarcoma</span> of Liver, Lung Ca</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Contained in cigarette smoke</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Cigarette Smoke</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Bladder, Lung, Oropharynx, Kidney, Esophagus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Polycyclic hydrocarbons</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Nitrosamines</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Stomach Ca</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Smoked foods, Japan</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Napthylamine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Urothelial (bladder) Ca</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Comes from cigarette smoke</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Vinyl Chloride</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Angiosarcoma of liver</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Polyvinyl <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> (PVC) pipes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Chromium, Beryllium, Nickel, Silica</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lung Ca</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">—</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old male chronic smoker presents with pain in the fingers for a few months. On examination, gangrenous ulcers were present in the fingers, as shown below. Investigation showed blood glucose and lipid profile within normal limits. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Buerger’s disease", "correct": true}, {"label": "B", "text": "Diabetic ulcers", "correct": false}, {"label": "C", "text": "Acute paronychia", "correct": false}, {"label": "D", "text": "Raynaud’s phenomenon", "correct": false}], "correct_answer": "A. Buerger’s disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A) Buerger’s disease</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-atherosclerotic, <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> affecting small &amp; medium-sized arteries and veins.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strong association with tobacco use (smoking or chewing). Exact cause unknown (likely immune-mediated).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Young males (20–45 years), most commonly smokers.</p>\n<p>More common in Middle East, South Asia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inflammation leads to <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> occlusion.</li>\n<li>Sparing of <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> arteries (unlike atherosclerosis).</li>\n<li>Segmental involvement (skip lesions).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Claudication, <span class=\"customMeta\" data-dictid=\"13b8c213ce1692777197b4b758ae57\">rest pain</span> (foot, hands).</li>\n<li>Raynaud’s phenomenon (vasospasm causing colour changes in fingers/toes).</li>\n<li>Ulcers &amp; <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> (especially in fingers/toes).</li>\n<li>Migratory <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> <span class=\"customMeta\" data-dictid=\"31f2c60d1e1692777200a4eae70af9\">thrombophlebitis</span> (inflamed veins).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical diagnosis (no specific lab tests).</li>\n<li>Doppler &amp; <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">Angiography</span> → Corkscrew <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> vessels (pathognomonic).</li>\n<li>Exclusion of other causes (diabetes, atherosclerosis, vasculitis).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Complete smoking cessation (most important).</li>\n<li>Vasodilators (e.g., <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blockers for Raynaud’s).</li>\n<li>Antiplatelets &amp; anticoagulants (limited benefit).</li>\n<li>Pain management (NSAIDs, opioids if needed).</li>\n<li>Amputation (for non-healing ulcers or gangrene).</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor if smoking continues but stabilises with smoking cessation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on Globocan 2020 data, which cancer type is the most prevalent among males in India?", "options": [{"label": "A", "text": "Lung", "correct": false}, {"label": "B", "text": "Lip and oral cavity", "correct": true}, {"label": "C", "text": "Colorectal", "correct": false}, {"label": "D", "text": "Liver", "correct": false}], "correct_answer": "B. Lip and oral cavity", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Lip and oral cavity</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>According to the Global Cancer Observatory (GLOBOCAN), </strong></p>\n<p><strong>Most common cancer worldwide (Both Genders):</strong></p>\n<ol>\n<li>Absolute numbers, Incidence, Both sexes, in 2022 (World Wide)- Lung Cancer.</li>\n<li>Age-Standardized Rate (World) per 100 000, Incidence, Both sexes, in 2022- Breast Cancer.</li>\n</ol>\n<p><strong>Most common cancer in India in terms of absolute numbers, incidence:</strong></p>\n<ol>\n<li>Lip/Oral Cancer in Males</li>\n<li>Breast cancer in females</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>According to the National Cancer Registry, the most common cause of cancer in </strong></p>\n<ol>\n<li>Males in India – Lung cancer.</li>\n<li>Females in India - Breast cancer.</li>\n</ol>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Ribbon colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Meaning</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Red</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>HIV/AIDS</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Pink</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Breast cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Light Blue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Prostate cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Dark Blue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Colon Cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Green</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Mental illness</li>\n<li>Liver cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Orange/Yellow</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Suicide prevention</li>\n<li>Leukaemia</li>\n<li>Kidney cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>White</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lung cancer</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was diagnosed with TB and while testing for resistance, he was found to be resistant to Isoniazid, Rifampicin, Amikacin, and Levofloxacin. What is this type of TB called?", "options": [{"label": "A", "text": "Poly-drug resistant TB", "correct": false}, {"label": "B", "text": "Multi-drug resistant TB", "correct": false}, {"label": "C", "text": "Extensively drug-resistant TB (XDR-TB)", "correct": true}, {"label": "D", "text": "Rifampicin-resistant TB", "correct": false}], "correct_answer": "C. Extensively drug-resistant TB (XDR-TB)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug sensitive TB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Patients are sensitive to 4 TB drugs: R,H,Z,E (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mono-resistant (MR) (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resistant to one 1st line anti-TB drug only.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>H-Mono-resistant (H-MR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resistant to <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> (H) only.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rifampicin resistant (RR) (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resistant to <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">Rifampicin</span> (R) only.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Multi drug resistant (MDR) (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resistant to both <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">Rifampicin</span> (R) &amp; <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> (H).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Poly-Drug resistant (PDR) (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resistant to 2 drugs other than <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">Rifampicin</span> (R) &amp; <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> (H).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pre-Xtensive resistant (pre-XDR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Any <span class=\"customMeta\" data-dictid=\"3c0021ebec1692777192f766374e40\">MDR</span> patient (H+R) resistant to any fluoroquinolone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extensive resistant (XDR) (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Any <span class=\"customMeta\" data-dictid=\"3c0021ebec1692777192f766374e40\">MDR</span> patient (H+R) resistant to any <span class=\"customMeta\" data-dictid=\"f4975edd0b1692777203b54cf45c2d\">fluoroquinolone</span> and Group 4 drugs (Bedaquiline, Linezolid, Levo/Moxifloxacin).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman arrived at the emergency department following an incident where she was scratched by a stray dog while walking on the streets one hour ago. She has only suffered minor abrasions without any bleeding. What course of treatment should be provided to her?", "options": [{"label": "A", "text": "No treatment as she is pregnant now", "correct": false}, {"label": "B", "text": "Only local wound cleaning", "correct": false}, {"label": "C", "text": "Local wound cleaning and rabies vaccine", "correct": true}, {"label": "D", "text": "Local wound cleaning, Rabies vaccines and immunoglobulins", "correct": false}], "correct_answer": "C. Local wound cleaning and rabies vaccine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Local wound cleaning and &lt;span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\"&gt;rabies&lt;/span&gt; vaccine:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Exposure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Class I</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Licks and touch on intact skin (skin integrity not broken)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Local wound management: soap, running water, <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> <span class=\"customMeta\" data-dictid=\"c24e790aa2169277720062b62227ae\">tincture</span> for 15-20 min.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Class II<br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abrasion, <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> (skin integrity broken)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Local wound management</li>\n<li>Immediate <span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\">Rabies</span> vaccination</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Class III<br/>\n<strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bleeding, licks on mucosa/ broken skin, deep tissue injury, all wild animal or bat bite</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wound management (avoid suturing)</li>\n<li>Rabies vaccination</li>\n<li>Rabies immunoglobulin</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable medical condition for an 80-year-old male who experienced pain and swelling in the calf muscle on the right side after being immobilized due to a fracture in the right inter-trochanteric region?", "options": [{"label": "A", "text": "Chronic osteomyelitis", "correct": false}, {"label": "B", "text": "Deep vein thrombosis", "correct": true}, {"label": "C", "text": "Compartment syndrome", "correct": false}, {"label": "D", "text": "Arterial claudication", "correct": false}], "correct_answer": "B. Deep vein thrombosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) Deep &lt;span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\"&gt;vein&lt;/span&gt; th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An intern has to study the relationship between ordering food online and development of obesity using a case-control study. What are the best study groups to be selected?", "options": [{"label": "A", "text": "Only obese persons", "correct": false}, {"label": "B", "text": "Only online food eaters", "correct": false}, {"label": "C", "text": "Obese and non-obese persons", "correct": true}, {"label": "D", "text": "Online food eaters and non-online food eaters", "correct": false}], "correct_answer": "C. Obese and non-obese persons", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/5e8Po0qwbTNRBQgusdYR1747918000.png"], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"43663fecf11692777194c870d1d548\"&gt;Obese&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The term demographic bonus is due to:", "options": [{"label": "A", "text": "Decline in dependency ratio", "correct": true}, {"label": "B", "text": "Increase in dependency ratio", "correct": false}, {"label": "C", "text": "Increase in population", "correct": false}, {"label": "D", "text": "Decrease in population", "correct": false}], "correct_answer": "A. Decline in dependency ratio", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/i6rY5XDmTf5zoxsNKbA91747724463.png"], "explanation": "<p>Correct Answer A - Decline in &lt;span class=\"customMeta\" data-dictid=\"4fe4b79dde16927771866f60a939e2\"&gt;dependency&lt;/span&gt; ratio</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Demographic Gift</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Demographic Liability</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The demographic gift occurs when the working-age population is high relative to dependents.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The higher proportion of elderly individuals refers to demographic liability.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Represents a potential demographic dividend due to a larger workforce contributing to economic growth.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Represents potential economic challenges due to increased <span class=\"customMeta\" data-dictid=\"4fe4b79dde16927771866f60a939e2\">dependency</span> ratios and healthcare costs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contributors include higher productivity, increased savings, and economic growth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dependents include retirees, elderly individuals, and those requiring significant healthcare</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following stains is used for the diagnosis of Mycobacterium tuberculosis infection?", "options": [{"label": "A", "text": "Gomori Methenamine silver", "correct": false}, {"label": "B", "text": "Perl’s Prussian blue", "correct": false}, {"label": "C", "text": "Ziehl-Neelsen stain", "correct": true}, {"label": "D", "text": "Masson-Fontana stain", "correct": false}], "correct_answer": "C. Ziehl-Neelsen stain", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aGsK3viIyoKvQFNR5OZS1745911928.png", "https://image.prepladder.com/content/bfN88akfgmLRrCT8HLsj1745911934.png", "https://image.prepladder.com/content/miDBNb2gseFp8XhaQ3dg1745911958.png", "https://image.prepladder.com/content/yFpE85y3HfQ91xV0jv0k1745911961.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a hospital setting, the management seeks to determine the average duration of doctor-patient interactions in order to assess the need for adjusting the number of doctors. This adjustment is aimed at enhancing the quality of care provided. Which management technique would be most appropriate for this purpose?", "options": [{"label": "A", "text": "Model", "correct": false}, {"label": "B", "text": "Decision making", "correct": false}, {"label": "C", "text": "Personnel management", "correct": false}, {"label": "D", "text": "Work sampling", "correct": true}], "correct_answer": "D. Work sampling", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Work &lt;span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\"&gt;sampling&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Qualitative (Based on behavioural sciences)</strong></p>\n<p style=\"text-align: center;\"><strong>POCIMon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Quantitative</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Personal management</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Cost-benefit analysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Organizational design</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Cost-effective analysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Communication</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Cost-accounting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Information system</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Decision making</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Management by objectives</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">PPBS - Planning, Programming, and Budgeting System</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Work sampling</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Network analysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">System analysis</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old lactating mother presents with pain in her left breast and a fever. On examination of the affected side, there is localized erythema, warmth, and point tenderness, the fluctuation test is positive. There is mild axillary lymphadenopathy on the affected side and the contralateral breast is normal. Repeated aspirations under antibiotic cover were unsuccessful. A USG done showed fluid collection. What is the management plan for this patient?", "options": [{"label": "A", "text": "Incision and drainage", "correct": true}, {"label": "B", "text": "Broad spectrum antibiotics only", "correct": false}, {"label": "C", "text": "Breast conservation surgery", "correct": false}, {"label": "D", "text": "Punch biopsy", "correct": false}], "correct_answer": "A. Incision and drainage", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breast Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pus-filled <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> within the breast tissue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Types</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lactational Abscess: </strong>Associated with breastfeeding.</li>\n<li><strong>Non-Lactational Abscess: </strong>Occurs in non-lactating women, e.g., <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">periductal</span> mastitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes and Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lactation: </strong>\n<ul>\n<li>Incidence: 3% to 20% in lactating mothers.</li>\n<li>Common pathogen: <strong>Staphylococcus aureus </strong>(methicillin-resistant strains in hospital settings).</li>\n<li>Entry points: <strong>Cracked/retracted nipple, blocked <span class=\"customMeta\" data-dictid=\"8ef2f22a3f1692777191d43bb00fb2\">lactiferous</span> ducts.</strong></li>\n</ul>\n</li>\n<li><strong>Non-Lactation: </strong>\n<ul>\n<li>Often in<strong> <span class=\"customMeta\" data-dictid=\"341daa40bb169277719303fbd1ce1a\">nulliparous</span> women or post-lactation.</strong></li>\n<li>Conditions:<strong> <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">Periductal</span> mastitis, <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> mastitis, <span class=\"customMeta\" data-dictid=\"daf5ee63361692777201129f498a4d\">tubercular</span> mastitis.</strong></li>\n<li><strong>Smoking and diabetes </strong>as risk factors.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Signs and symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, leukocytosis, erythema, pain and tenderness, swelling, malaise, difficulty feeding, enlarged and tender axillary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ultrasonography: </strong>\n<ul>\n<li>Detects cellulitis, and <span class=\"customMeta\" data-dictid=\"8170dc8ad81692777191ec56a3f27c\">liquefaction</span> necrosis.</li>\n<li>Confirms <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> size, location, and loculation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lactational Mastitis:</strong>\n<ul>\n<li>Antibiotics: Anti-staphylococcal (e.g., cloxacillin, flucloxacillin, erythromycin).</li>\n<li>Breast emptying: Frequent <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> or pumping.</li>\n<li>Support: Breast support garment, cold compresses, analgesia.</li>\n<li>Drainage: Ultrasound-guided is preferred over <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> incision. <strong> </strong><strong>(Option A)</strong></li>\n<li>Follow-up: Regular clinical and ultrasonographic reviews of culture-based <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> modification.</li>\n</ul>\n</li>\n<li><strong>Non-Lactational Mastitis:</strong>\n<ul>\n<li>Broad-spectrum antibiotics for <span class=\"customMeta\" data-dictid=\"ba2454588016927771996f5f346221\">subareolar</span> infections.</li>\n<li>Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> for <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> drainage.</li>\n<li>Major milk <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for complications like <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> or fistula.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old female patient presented with a malar rash, recurrent oral ulcers, and multiple joint pains. She has a relevant past history and does not take any medication. Upon further investigations, thrombocytopenia was seen, and the anti-Smith (anti-Sm) antibody was positive. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Scleroderma", "correct": false}, {"label": "B", "text": "Sjögren syndrome", "correct": false}, {"label": "C", "text": "Systemic lupus erythematosus (SLE)", "correct": true}, {"label": "D", "text": "Rheumatoid arthritis", "correct": false}], "correct_answer": "C. Systemic lupus erythematosus (SLE)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:676px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Marker/Antibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anti-Smith (anti-Sm) antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Highly specific for <span class=\"customMeta\" data-dictid=\"d9bf27b09416927771984cdc6c0bc4\">SLE</span> (&lt;30% of patients)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anti-dsDNA antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Highly specific for <span class=\"customMeta\" data-dictid=\"d9bf27b09416927771984cdc6c0bc4\">SLE</span> (60-70% of patients);</strong> correlates with the disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antinuclear antibodies (ANA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Highly sensitive</strong> but not specific for SLE</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anti-Ro (SSA) and Anti-La (SSB) antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Found in <strong>SLE</strong> and <strong>Sjögren syndrome;</strong> associated with <strong>neonatal lupus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anti-ribosomal-P antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specific for <strong>neuropsychiatric manifestations</strong> in SLE</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anti-histone antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seen in <strong>drug-induced lupus;</strong> less specific for SLE</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complements C3 and C4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low levels indicate <strong>complement consumption</strong> and disease activity</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Examine the provided graphs depicting various occupational groups and their likelihood of developing fever. Identify the group with the greatest probability of experiencing fever.", "options": [{"label": "A", "text": "Industrial workers", "correct": false}, {"label": "B", "text": "Farmers", "correct": false}, {"label": "C", "text": "White-collar jobs", "correct": true}, {"label": "D", "text": "Housewives", "correct": false}], "correct_answer": "C. White-collar jobs", "question_images": ["https://image.prepladder.com/notes/KY0iiluJEX4JlcfsDcjh1747918095.png", "https://image.prepladder.com/notes/JcaIKmxE8yvhCElhbXMj1747918136.png"], "explanation_images": ["https://image.prepladder.com/content/OWOnRSw1HmzYrCnq2D1n1745912386.png", "https://image.prepladder.com/content/0SW02jtaGzOUEuObwwgK1745912393.png", "https://image.prepladder.com/content/B62FmdpwrAtlhFU1oaUg1745912310.png", "https://image.prepladder.com/content/0STWS1sHfCAW9wS1fXi61745912399.png", "https://image.prepladder.com/content/pWa4C7GDKjDzVEEKmfNa1745912405.png", "https://image.prepladder.com/content/0QoJCN1R6boUZHe2VUYE1745912422.png"], "explanation": "<p>Correct Answer C - White-collar jobs</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Explanation</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"329\" src=\"https://image.prepladder.com/content/OWOnRSw1HmzYrCnq2D1n1745912386.png\" width=\"466\"/><strong> </strong></p>\n<p style=\"text-align: center;\"><strong>Simple Bar <span class=\"customMeta\" data-dictid=\"a445e59f7816927771864e36b1dbd3\">Diagram</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple bar diagrams represent the frequency of <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> variables like gender.</li>\n<li>Discrete variables:These variables take fewer values and no in between values.\n\t\t\t\t<ul>\n<li>Examples: Religion, Blood groups</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"246\" src=\"https://image.prepladder.com/content/0SW02jtaGzOUEuObwwgK1745912393.png\" width=\"466\"/><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"18\" src=\"https://image.prepladder.com/content/B62FmdpwrAtlhFU1oaUg1745912310.png\" width=\"18\"/><strong></strong></p>\n<p style=\"text-align: center;\"><strong>Compound Bar <span class=\"customMeta\" data-dictid=\"a445e59f7816927771864e36b1dbd3\">Diagram</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>There are gaps (discrete data) represented with multiple bars.</li>\n<li>It is <span class=\"customMeta\" data-dictid=\"1304db17d3169277719684a316a8c4\">qualitative</span> in the first quarter.</li>\n<li>It is a Multiple bar diagram/Compound bar diagram.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"321\" src=\"https://image.prepladder.com/content/0STWS1sHfCAW9wS1fXi61745912399.png\" width=\"466\"/></p>\n<p style=\"text-align: center;\"><strong>Component Bar <span class=\"customMeta\" data-dictid=\"a445e59f7816927771864e36b1dbd3\">Diagram</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Same bar has been divided into different components and each component represents its frequency.</li>\n<li>It is a frequency of <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> variables.</li>\n<li>It is known as the Component bar diagram.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"458\" src=\"https://image.prepladder.com/content/pWa4C7GDKjDzVEEKmfNa1745912405.png\" width=\"466\"/></p>\n<p style=\"text-align: center;\"><strong>Histogram </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>It is not a bar diagram.</li>\n<li>It represents the frequency of continuous variables or <span class=\"customMeta\" data-dictid=\"ef5cb829b8169277719603304e73cb\">quantitative</span> variables.</li>\n<li>Height is a <span class=\"customMeta\" data-dictid=\"ef5cb829b8169277719603304e73cb\">quantitative</span> or <span class=\"customMeta\" data-dictid=\"558c892bf516927771857a44d2fe91\">continuous variable</span> (can take many possible values and also in between values)</li>\n<li>It can be expressed in decimals and there is no gap in between.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the maximum population size observed in relation to reproductive programs?", "options": [{"label": "A", "text": "World bank", "correct": false}, {"label": "B", "text": "UNFPA", "correct": true}, {"label": "C", "text": "UNESCO", "correct": false}, {"label": "D", "text": "UNICEF", "correct": false}], "correct_answer": "B. UNFPA", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/K8zA0cWJypmOXfqoqj3f1745912571.png"], "explanation": "<p>Correct Answer B - UNFPA\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old woman presents to the surgery out-patient with a left-sided breast lump, which she noticed on a self-breast examination 3 weeks ago. She has no other complaints. On palpation, the lump seems to be mobile and firm. FNAC is characterized by stromal and epithelial elements with no signs of malignancy. What is the best next step in management?", "options": [{"label": "A", "text": "Mammography", "correct": false}, {"label": "B", "text": "Reassurance and follow-up", "correct": true}, {"label": "C", "text": "Surgical excision", "correct": false}, {"label": "D", "text": "Start Tamoxifen", "correct": false}], "correct_answer": "B. Reassurance and follow-up", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) Reassurance and follow-up</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibroadenoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign tumors arising from the <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> of <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> tissue in the breast</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common in women aged <strong>15-25 years</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Believed to be influenced by <strong>hormonal fluctuations </strong>during <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> years</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless, firm, rubbery, and mobile lumps</li>\n<li>Described as feeling like a<strong> \"marble in the breast\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Triple Assessment: </strong>Clinical examination, radiological <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> (ultrasound), tissue <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> (core-needle biopsy)</li>\n<li>Ultrasound: Helps distinguish fibroadenomas from cysts</li>\n<li>Core-Needle Biopsy: Provides <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> diagnosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative Management: Watchful waiting, regular monitoring</li>\n<li>Surgical Excision: For larger fibroadenomas, those causing symptoms, or uncertain diagnosis</li>\n<li>Giant Fibroadenomas: Over 5 cm, may require <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> through <span class=\"customMeta\" data-dictid=\"d8c57cf5eb169277719912053c51a1\">submammary</span> incision</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Benign</strong>, do not increase risk of breast cancer</li>\n<li>Growth can vary, influenced by hormonal changes</li>\n<li>Recurrence is uncommon</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relationship to ANDI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Categorised according to ANDI as:\n\t\t\t\t<ul>\n<li><strong>Normal: Small fibroadenomas (≤1 cm)</strong></li>\n<li><strong>Disorder: Larger fibroadenomas (≤3 cm)</strong></li>\n<li><strong>Disease: Giant fibroadenomas (&gt;3 cm), multiple fibroadenomas</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In India, which organization is responsible for promoting health awareness?", "options": [{"label": "A", "text": "Central Bureau of health intelligence", "correct": false}, {"label": "B", "text": "Indian council of medical research", "correct": false}, {"label": "C", "text": "Central health education bureau", "correct": true}, {"label": "D", "text": "National health library", "correct": false}], "correct_answer": "C. Central health education bureau", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/AKhoj4vSDj9Mueflp0Ij1747918241.png"], "explanation": "<p>Correct Answer C - Central health education bureau\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The false statement about cystic masses of the neck is:", "options": [{"label": "A", "text": "Type 3 branchial fistula has its internal orifice on cricopharynxgeus", "correct": true}, {"label": "B", "text": "Cystic hygroma is filled with clear lymph", "correct": false}, {"label": "C", "text": "Thyroglossal cyst moves upwards on swallowing, and tongue protrusion", "correct": false}, {"label": "D", "text": "Fluctuation is positive in branchial cyst", "correct": false}], "correct_answer": "A. Type 3 branchial fistula has its internal orifice on cricopharynxgeus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"6f809a27121692777201d1ccde5ace\"&gt;Type 3&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"cb3fde922016927771830912ac2fcf\"&gt;branchial&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\"&gt;fistula&lt;/span&gt; has its internal &lt;span class=\"customMeta\" data-dictid=\"1aca482e7e169277719443d10dbe5f\"&gt;orifice&lt;/span&gt; on cricopharynxgeu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organization is not involved in providing funding for India's national TB program?", "options": [{"label": "A", "text": "Government of India", "correct": false}, {"label": "B", "text": "World Bank", "correct": false}, {"label": "C", "text": "Global Fund", "correct": false}, {"label": "D", "text": "UNICEF", "correct": true}], "correct_answer": "D. UNICEF", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/p2vor8r2dMtDAa6dEJH01747918297.png"], "explanation": "<p>Correct Answer D - UNICEF\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man living in Nellore, Andhra Pradesh presents with the following lesions on his teeth. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Selenosis", "correct": false}, {"label": "B", "text": "Plumbism", "correct": false}, {"label": "C", "text": "Fluorosis", "correct": true}, {"label": "D", "text": "Lathyrism", "correct": false}], "correct_answer": "C. Fluorosis", "question_images": ["https://image.prepladder.com/content/KPGdEFQugU0XpZlTePcB1745913053.png"], "explanation_images": ["https://image.prepladder.com/content/wKrFhkm9Gs7USY1NibEz1745913200.png", "https://image.prepladder.com/content/oAnoy0uvQBAgSBs2sbBZ1745913205.png", "https://image.prepladder.com/content/MlS6gqWalqpDnE2H24QV1745913223.png", "https://image.prepladder.com/content/zpTBjIZmyJ9wfMxC5soh1745913231.png"], "explanation": "<p>Correct Answer C - Fluorosis</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:right\"><strong>Fluorine content in water</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:right\"><strong>Related symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;0.5mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dental caries</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Suyash.dwivedi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dental_Caries_Cavity_2.JPG\" data-tags=\"\" height=\"394\" src=\"https://image.prepladder.com/content/wKrFhkm9Gs7USY1NibEz1745913200.png\" width=\"492\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;1.5mg/L<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dental fluorosis</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" Peter JM Crawford, Michael Aldred, Agnes Bloch-Zupan.\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/Dental_fluorosis#/media/File:G_amelogenesis_imperfecta.jpg\" data-tags=\"\" height=\"358\" src=\"https://image.prepladder.com/content/oAnoy0uvQBAgSBs2sbBZ1745913205.png\" width=\"492\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3-6mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skeletal fluorosis</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mirrel\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Genu-Valgum.png\" data-tags=\"\" height=\"665\" src=\"https://image.prepladder.com/content/MlS6gqWalqpDnE2H24QV1745913223.png\" width=\"492\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;10mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crippling fluorosis</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Shanti Lal Choubisa\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Tribal-individuals-suffering-with-crippling-severe-skeletal-fluorosis-with-paraplegia-and_fig3_361388877\" data-tags=\"\" height=\"425\" src=\"https://image.prepladder.com/content/zpTBjIZmyJ9wfMxC5soh1745913231.png\" width=\"492\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the potential health risks faced by workers in a sugarcane factory?", "options": [{"label": "A", "text": "Anthracosis", "correct": false}, {"label": "B", "text": "Siderosis", "correct": false}, {"label": "C", "text": "Bagassosis", "correct": true}, {"label": "D", "text": "Byssinosis", "correct": false}], "correct_answer": "C. Bagassosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Bag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred management of angular dermoid cyst?", "options": [{"label": "A", "text": "Surgical excision", "correct": true}, {"label": "B", "text": "Wait and watch", "correct": false}, {"label": "C", "text": "Wide local excision with a 2 cm margin", "correct": false}, {"label": "D", "text": "Laser ablation", "correct": false}], "correct_answer": "A. Surgical excision", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What treatment should be administered to a patient diagnosed with P. Falciparum malaria from a North-Eastern state?", "options": [{"label": "A", "text": "Artemether plus lumefantrine", "correct": true}, {"label": "B", "text": "Sulfadoxine plus pyrimethamine", "correct": false}, {"label": "C", "text": "Chloroquine", "correct": false}, {"label": "D", "text": "Mefloquine", "correct": false}], "correct_answer": "A. Artemether plus lumefantrine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"d145aa2b061692777182012254937c\"&gt;Artemether&lt;/span&gt; plus lumefantrine</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Initial <span class=\"customMeta\" data-dictid=\"f4eacdbe7b1692777194d7caa2017d\">parenteral</span> treatment (48 hours)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Follow-up treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Quinine</strong></p>\n<ul>\n<li>Loading dose: 20 mg/kg</li>\n<li>Maintenance dose : 10 mg/kg TDS</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Quinine</strong> 10 mg/kg TDS +</p>\n<ul>\n<li><strong>Doxycycline</strong> 3 mg/kg (or)</li>\n<li><strong>Clindamycin </strong>10 mg/kg<strong> </strong>(if pregnant / children &lt; 8 years)</li>\n</ul>\n<p>Total treatment duration: <strong>7 days</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Artesunate</strong>: 2.4 mg/kg <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose, then at 12th and 24th hour followed by once a day.</li>\n<li><strong>Artemether</strong>: <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">Loading</span> dose of 3.2 mg/kg; <span class=\"customMeta\" data-dictid=\"c673060f4c16927771917496b672c8\">maintenance dose</span> of 1.6 mg/kg per day.</li>\n<li><strong>Arteether</strong>: 150 mg per day for 3 days.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ACT therapy</strong></p>\n<ul>\n<li>North-eastern states: Age &amp; weight adjusted <strong>ACT-AL</strong> for 3 days + primaquine on second day.</li>\n<li>Other states: <strong>ACT-SP</strong> <strong>(Option B) </strong>(sulfadoxine-pyrimethamine) for 3 days + primaquine on second day.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Escherichia coli can be grown best in which of the following media?", "options": [{"label": "A", "text": "Chocolate agar", "correct": false}, {"label": "B", "text": "Thayer-Martin agar", "correct": false}, {"label": "C", "text": "Sabouraud dextrose agar", "correct": false}, {"label": "D", "text": "MacConkey agar", "correct": true}], "correct_answer": "D. MacConkey agar", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/unIQTg1YCtyvaJW1murb1745913145.png", "https://image.prepladder.com/content/Tosx3E4Tx4Rn42oGkZNK1745913145.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Result</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indole Production</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> is typically <span class=\"customMeta\" data-dictid=\"bc8d0dbfcf169277719012cdb493a1\">indole</span> positive.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Methyl Red (MR) Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> shows a positive result.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Voges-Proskauer (VP) Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> is typically negative.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Citrate Utilization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> usually does not utilize <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> (negative result).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Triple Sugar Iron (TSI) Agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shows <span class=\"customMeta\" data-dictid=\"cc108d77f11692777202478d5c72bf\">fermentation</span> of glucose, lactose, and production of gas.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urease Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> is <span class=\"customMeta\" data-dictid=\"f9076f5a1d1692777201e6af082c74\">urease</span> negative.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Member </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Motility </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lactose fermenting/Non-Lactose fermenting </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>IMViC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Urease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E.Coli</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>++--</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Klebsiella</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Motile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>--++</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enterobacter</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>--++</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Citrobacter</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shigella</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Motile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-+--</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Salmonella</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-+-+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proteus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yersinia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motile/ Non-Motile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-+--</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a resource-limited setting, what diagnostic method can be utilized to identify the condition when there is a visible painless hardened genital ulcer following unprotected sexual activity, as reported by a truck driver?", "options": [{"label": "A", "text": "Dark field microscopy", "correct": true}, {"label": "B", "text": "Fluorescent treponema antibody absorption", "correct": false}, {"label": "C", "text": "Venereal disease research laboratory (VDRL) test", "correct": false}, {"label": "D", "text": "Treponema pallidum immobilization test", "correct": false}], "correct_answer": "A. Dark field microscopy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/85JcKlsiIwIFj48ef6al1745913687.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Besides NK cells, what other types of cells are capable of identifying and lysing target cells that have specific antibody-bound membrane surface antigens as part of their effector mechanisms in cell-mediated immunity?", "options": [{"label": "A", "text": "Natural killer (NK) cells only", "correct": false}, {"label": "B", "text": "Macrophages only", "correct": false}, {"label": "C", "text": "Neutrophils and eosinophils", "correct": true}, {"label": "D", "text": "Neutrophils only", "correct": false}], "correct_answer": "C. Neutrophils and eosinophils", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 21-year-old girl who presented with multiple beefy-red painless ulcers over the vulval region is diagnosed with granuloma inguinale. What is the causative organism?", "options": [{"label": "A", "text": "Chlamydia trachomatis", "correct": false}, {"label": "B", "text": "Klebsiella granulomatis", "correct": true}, {"label": "C", "text": "Haemophilus ducreyi", "correct": false}, {"label": "D", "text": "Herpes simplex virus 2", "correct": false}], "correct_answer": "B. Klebsiella granulomatis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/szKIz1zqsQHMdQk3crdw1745914076.png", "https://image.prepladder.com/content/zgEaDfRR2kBzaYLziGrg1745914085.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Klebsiella granulomatis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Granuloma inguinale</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Symptoms:<strong> Painless, beefy-red genital</strong> or anal ulcers, tissue granulation, <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from lesions</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Donovanosis.JPG\" data-tags=\"\" height=\"366\" src=\"https://image.prepladder.com/content/szKIz1zqsQHMdQk3crdw1745914076.png\" width=\"391\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Microscopy:<strong> Donovan bodies</strong> are seen, they are <span class=\"customMeta\" data-dictid=\"45e0bd1529169277719054d85830ce\">intracytoplasmic</span> inclusions found in macrophages and are a <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> feature of this condition.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"unknown author\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.ask4healthcare.com/content/DisDescription?strdisease=RHINOSCLEROMA#google_vignette\" data-tags=\"\" height=\"442\" src=\"https://image.prepladder.com/content/zgEaDfRR2kBzaYLziGrg1745914085.png\" width=\"600\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer with a history of flea bite in a godown presents with high fever, painful inguinal lymphadenopathy, vomiting, diarrhea, and hypotension. Smears prepared from the discharge of these swellings revealed bacteria with bipolar staining. Which stain will help in the diagnosis?", "options": [{"label": "A", "text": "Neisser stain", "correct": false}, {"label": "B", "text": "Wayson’s stain", "correct": true}, {"label": "C", "text": "Albert’s stain", "correct": false}, {"label": "D", "text": "McFadyean’s reaction", "correct": false}], "correct_answer": "B. Wayson’s stain", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1oYW2UyXDKKLE6G1WObL1745914207.png", "https://image.prepladder.com/content/TgyrMX6ctTTlQ9gXaE291745914207.png", "https://image.prepladder.com/content/gKAilgRNJViBrDhnHOOl1745914207.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:669px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Plague (Yersinia pestis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endemic Foci</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Kolar (Tamil Nadu),</li>\n<li>Beed Latur (Maharashtra)</li>\n<li>Rhoru (Himachal)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reservoir</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wild rodents</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vector</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rat <span class=\"customMeta\" data-dictid=\"173a38842916927772025c562c498b\">flea</span> (Xenopsylla cheopis, Xenopsylla astia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types of Plague</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bubonic Plague: 2-7 days <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> period; <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> painful <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> and fever</li>\n</ul>\n<ul>\n<li>Pneumonic Plague: 1-3 days <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> period; Respiratory symptoms; Associated with bio-terrorism</li>\n</ul>\n<ul>\n<li>Septicemic Plague: 2-7 days <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> period; A/k/a Black death; DIC, shock and multi-organ failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Safety pin appearance (Bipolar staining) using Wayson stain</strong>, Wright stain, Giemsa stain</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"U.S. Center for Disease Control\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Yersinia_pestis_wayson.jpg\" data-tags=\"\" height=\"191\" src=\"https://image.prepladder.com/content/1oYW2UyXDKKLE6G1WObL1745914207.png\" width=\"244\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nutrient <span class=\"customMeta\" data-dictid=\"46988d61a21692777183ac440c691a\">broth</span> with oil/ghee (Ghee broth): Stalactite growth (hanging from the top)</li>\n</ul>\n<ul>\n<li>Selective <span class=\"customMeta\" data-dictid=\"0d4e0410a5169277718498b6521933\">CIN</span> agar: Bullseye colonies</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"U.S. Center for Disease Control\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Yersinia_pestis_wayson.jpg\" data-tags=\"\" height=\"267\" src=\"https://image.prepladder.com/content/TgyrMX6ctTTlQ9gXaE291745914207.png\" width=\"258\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Donatella M. Rodio, Alessia Bressan, Cecilia Ambrosi, Daniela Scribano, Rita Tolli, Wassim Mansour, Francesco Speziale, Guido Antonelli, Maria Trancassini, Valeria Antonietta Pietropaolo\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Y-enterocolitica-on-CIN-agar-small-colonies-with-the-typical-red-bulls-eye-appearance_fig2_325352259\" data-tags=\"\" height=\"422\" src=\"https://image.prepladder.com/content/gKAilgRNJViBrDhnHOOl1745914207.png\" width=\"334\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Biochemical Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fermentation [+ve acid production -ve gas production]</li>\n<li><strong>Catalase positive</strong></li>\n<li><strong>Oxidase negative</strong></li>\n<li>IMViC = - - + -</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vaccine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recombinant R1F1v Vaccine: Pre-exposure Prophylaxis</li>\n</ul>\n<ul>\n<li>Sokhey's Modification of Haffkine Vaccine- Protects only against bubonic plague,</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Streptomycin</li>\n</ul>\n<ul>\n<li>Fluoroquinolones: For CNS and <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> involvement</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a young girl who presents with continuous dribbling of urine despite voiding normally, as reported by her parents, who mention her never being completely dry since birth?", "options": [{"label": "A", "text": "Ectopic ureter", "correct": true}, {"label": "B", "text": "Ureterocele", "correct": false}, {"label": "C", "text": "Congenital megaureter", "correct": false}, {"label": "D", "text": "Vesicoureteric reflux", "correct": false}], "correct_answer": "A. Ectopic ureter", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\"&gt;Ectopic&lt;/span&gt; u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 13-year-old girl has had 4 episodes of meningitis over the last 4 years, with the disease lasting a few days at a time, slowly resolving neurological symptoms such as visual and memory loss. A CSF cytology shows lymphocytic pleocytosis, and a diagnosis of Mollaret’s meningitis is made. Which organism is implicated here?", "options": [{"label": "A", "text": "Measles virus", "correct": false}, {"label": "B", "text": "Mumps virus", "correct": false}, {"label": "C", "text": "Herpes simplex virus", "correct": true}, {"label": "D", "text": "Rubella virus", "correct": false}], "correct_answer": "C. Herpes simplex virus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XdgYbqECkSvsu8Yjhjqk1745914413.png", "https://image.prepladder.com/content/zUa1jZH1SwU1rhhkjUGj1745914413.png", "https://image.prepladder.com/content/G2NRxCApsfitXc5ujArM1745914413.png", "https://image.prepladder.com/content/qeehL1nRDT8KTe13yRNo1745914413.png", "https://image.prepladder.com/content/soeXktk6QaqjfKqKn14f1745914413.png", "https://image.prepladder.com/content/71IWdNEGPVJgu8qKcpVO1745914413.png", "https://image.prepladder.com/content/VNqm3ukKFlFMnoJBbnh11745914413.png", "https://image.prepladder.com/content/JMSIS5qpMxBuEuEsWBqC1745914413.png", "https://image.prepladder.com/content/j0iN9Jxm8sa4gBqj5K4K1745914413.png", "https://image.prepladder.com/content/C10WoOMoPN6RhsVC6ynW1745914413.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Reinfection with which of the following viruses can lead to more severe disease with complications?", "options": [{"label": "A", "text": "Dengue", "correct": true}, {"label": "B", "text": "Rabies", "correct": false}, {"label": "C", "text": "Measles", "correct": false}, {"label": "D", "text": "Mumps", "correct": false}], "correct_answer": "A. Dengue", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following cell organelles is associated with destruction of bacteria and viruses?", "options": [{"label": "A", "text": "Peroxisomes", "correct": false}, {"label": "B", "text": "Lysosomes", "correct": true}, {"label": "C", "text": "Golgi complex", "correct": false}, {"label": "D", "text": "Ribosomes", "correct": false}], "correct_answer": "B. Lysosomes", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes Taenia solium?", "options": [{"label": "A", "text": "Eggs are not infective to man", "correct": false}, {"label": "B", "text": "Hooks are absent", "correct": false}, {"label": "C", "text": "The eggs do not float in saturated salt solution", "correct": true}, {"label": "D", "text": "Intermediate host is cow", "correct": false}], "correct_answer": "C. The eggs do not float in saturated salt solution", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) The eggs do not float in &lt;span class=\"customMeta\" data-dictid=\"bd2ac838bb16927771983dd9afc74c\"&gt;saturated&lt;/span&gt; salt solu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old primigravida at 18 weeks of gestation presents for her antenatal check-up. Her random plasma glucose level was 243 mg/dL, and thus, she was asked to undergo further tests. The fasting blood glucose levels were 146 mg/dl, and HbA1c was 7.6%. Which among the following is the most likely diagnosis in this patient?", "options": [{"label": "A", "text": "Maturity onset diabetes of the young", "correct": false}, {"label": "B", "text": "Overt diabetes", "correct": true}, {"label": "C", "text": "Gestational diabetes mellitus", "correct": false}, {"label": "D", "text": "Latent autoimmune diabetes in adults", "correct": false}], "correct_answer": "B. Overt diabetes", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gestational Diabetes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pre-existing Diabetes</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Timing </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>During pregnancy</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present before conception</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fasting <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> glucose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>92 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>126 mg/dL (on two occasions)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-hour <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>180 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥200 mg/dL (with <span class=\"customMeta\" data-dictid=\"36a802ceb516927771893371227fb8\">hyperglycemic</span> symptoms)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2-hour <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>153 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥200 mg/dL (during an <span class=\"customMeta\" data-dictid=\"1132c78e2716927771943d6ef17c70\">OGTT</span> in <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> individuals)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HbA1c</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥5.7-6.4%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥6.5%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resolves after delivery.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires <span class=\"customMeta\" data-dictid=\"901bf573f216927771905f0abedca2\">intensive</span> management before and during pregnancy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent surgery for lipoma 5 weeks ago and now presents with a scar at the incision site, which is limited to the original wound boundaries. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Keloid", "correct": false}, {"label": "B", "text": "Exuberant granulation", "correct": false}, {"label": "C", "text": "Hypertrophic scar", "correct": true}, {"label": "D", "text": "Granulation tissue", "correct": false}], "correct_answer": "C. Hypertrophic scar", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZUll2rt3l0nWORd0ZNS31745918504.png", "https://image.prepladder.com/content/T7d60DOYATsDPtI3rKdM1745918504.png", "https://image.prepladder.com/content/dX3Edn9wse2Xr6YcI44Q1745918504.png", "https://image.prepladder.com/content/K9ePKhVCweJBKe1USExr1745918504.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following statements is false regarding the instrument/procedure?", "options": [{"label": "A", "text": "It is used for termination of pregnancy up to 12 weeks", "correct": false}, {"label": "B", "text": "Can be done on an OP basis", "correct": false}, {"label": "C", "text": "The capacity of the syringe is 30 ml", "correct": true}, {"label": "D", "text": "It created a negative pressure of 600 mmHg", "correct": false}], "correct_answer": "C. The capacity of the syringe is 30 ml", "question_images": ["https://image.prepladder.com/notes/2UWHqCeKD1QGrwS7rntn1747901386.png"], "explanation_images": ["https://image.prepladder.com/notes/2UWHqCeKD1QGrwS7rntn1747901386.png", "https://image.prepladder.com/content/Wqo72HaMsUCF51Qd2o0N1745918506.png", "https://image.prepladder.com/content/uyLxeavWAygxszGUF0vz1745918520.png", "https://image.prepladder.com/content/8R9IerreDn25HqI2XXlq1745918525.png", "https://image.prepladder.com/content/kjLadEK7RdQssEpsKCQc1745918531.png", "https://image.prepladder.com/content/wSBfHFSf2xJkdPwY6P131745918536.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Uses of MVA Syringe</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pregnancy Termination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MVA syringes are commonly used for the <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">termination</span> of early pregnancies (up to 12 weeks).</li>\n<li>The <span class=\"customMeta\" data-dictid=\"29863704261692777199d30fdfa6fa\">syringe</span> is used to <span class=\"customMeta\" data-dictid=\"a246c8382816927771821a267ea486\">aspirate</span> and remove the contents of the uterus.</li>\n<li>It is a safe and effective method for <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> abortion in appropriate settings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uterine Evacuation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MVA syringes are utilized for <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> in cases of incomplete miscarriage.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"29863704261692777199d30fdfa6fa\">syringe</span> is used to remove retained products of conception from the uterus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endometrial Sampling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MVA syringes can be employed for endometrial <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> or <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> procedures.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"29863704261692777199d30fdfa6fa\">syringe</span> is used to collect a small sample of the endometrial tissue for <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> purposes.</li>\n<li>It is commonly done to investigate <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> or to evaluate <span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\">fertility</span> issues.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Trimester</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Procedure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1st</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Manual Vacuum Aspiration (MVA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MVA is an <span class=\"customMeta\" data-dictid=\"a9f32a257d1692777194caf3b4cf78\">outpatient</span> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> abortion procedure used up to 12 weeks of gestation.</li>\n<li>The procedure involves dilating the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> and inserting a <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> attached to a manual vacuum <span class=\"customMeta\" data-dictid=\"559fa730881692777182e593effebf\">aspirator</span> or a 60-mL syringe.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> is used to remove retained tissue from the uterus.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"f3c62587931692777181dabdaa512d\">approximate</span> pressure is around -610 mmHg.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"323\" src=\"https://image.prepladder.com/content/Wqo72HaMsUCF51Qd2o0N1745918506.png\" width=\"275\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Electric Vacuum Aspiration (EVA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>EVA is similar to MVA.</li>\n<li>Instead of a manual syringe, it uses an electric pump to generate <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> to remove retained products of conception.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dilation and Curettage (D&amp;C)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>D&amp;C is performed up to 12 weeks of <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> by dilating the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> and using instruments like curettes and <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> cannula.</li>\n<li><strong>MVA and EVA are preferred over sharp D&amp;C</strong> for being safer and more efficient.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"233\" src=\"https://image.prepladder.com/content/uyLxeavWAygxszGUF0vz1745918520.png\" width=\"275\"/></p>\n<p style=\"text-align: center;\">Karman’s cannula</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"citizen\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hegar_dilators\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/8R9IerreDn25HqI2XXlq1745918525.png\" width=\"275\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\">Hegar’s dilator</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"https://commons.wikimedia.org/wiki/File:Uterine_Curette_01.jpg#/media/File:Uterine_Curette_02.jpg\" data-hash=\"\" data-license=\"\" data-source=\"https://commons.wikimedia.org/wiki/File:Uterine_Curette_01.jpg#/media/File:Uterine_Curette_02.jpg\" data-tags=\"\" height=\"446\" src=\"https://image.prepladder.com/content/kjLadEK7RdQssEpsKCQc1745918531.png\" width=\"132\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\">Uterine curette</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2nd</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dilation and Evacuation (D&amp;E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>D&amp;E is a <strong>2nd-trimester abortion method</strong> involving <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> using osmotic dilators. Ovum <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> are then used to remove the pregnancy tissue.</li>\n<li>Draining <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid before removing the <span class=\"customMeta\" data-dictid=\"421fecf0e21692777202704942ac48\">fetus</span> is crucial to minimize the risk of <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> during the procedure.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"271\" src=\"https://image.prepladder.com/content/wSBfHFSf2xJkdPwY6P131745918536.png\" width=\"275\"/></p>\n<p style=\"text-align: center;\">Ovum forceps</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hysterotomy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"6b602c38bf16927771898ad1392b00\">hysterotomy</span> is a <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedure where the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> is <span class=\"customMeta\" data-dictid=\"13e924e3cb169277719021021fc6d2\">incised</span> to remove the fetus.</li>\n<li>Reserved for 2nd-trimester abortions<strong> where other methods are not feasible or have failed.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male presents with fatigue for the past year. Examination reveals massive splenomegaly. His blood workup shows the following findings: Anemia Total leukocyte count (TLC): 150,000/microliter Peripheral smear: 60% neutrophils, 6% basophils, 4% eosinophils, myeloblasts, myelocytes, and metamyelocytes Myeloid to erythroid ratio: 18:1 What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute Lymphoblastic Leukemia (ALL)", "correct": false}, {"label": "B", "text": "Acute Myeloid Leukemia (AML)", "correct": false}, {"label": "C", "text": "Chronic Myelogenous Leukemia (CML)", "correct": true}, {"label": "D", "text": "Chronic Lymphocytic Leukemia (CLL)", "correct": false}], "correct_answer": "C. Chronic Myelogenous Leukemia (CML)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/u9tP6gEHlrzvUBDguGR31745918653.png", "https://image.prepladder.com/content/nquxzOK57n5HpQRxIT041745918653.png", "https://image.prepladder.com/content/XJDOpLZmoF5hBWYmjA6x1745918653.png", "https://image.prepladder.com/content/av10wRjJ3hT6NevdRwOw1745918653.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Philadelphia <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> (t(9;22))</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Myeloid lineage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BCR-ABL <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> gene causes overactive tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> activity and is associated with radiation exposure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common in adults, presenting with splenomegaly, fatigue, weight loss, night sweats, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort.</li>\n<li>It can progress to a <span class=\"customMeta\" data-dictid=\"c961b3ec6516927771831836e7f351\">blast crisis</span> with <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> leukaemia features.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> <span class=\"customMeta\" data-dictid=\"a246c8382816927771821a267ea486\">aspirate</span> to confirm diagnosis</li>\n<li>FISH to detect BCR-ABL <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> gene product</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (e.g., Imatinib)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>1) Chronic phase:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Leukocytosis, <strong>&lt; 10% blast cells, basophils &lt;20% </strong>and <span class=\"customMeta\" data-dictid=\"cc8beb11041692777192b19dfb290a\">monocytosis</span> &lt; 3%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2) Accelerated phase:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>10%-19% blasts, ≥ 20% basophils</strong> in the <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood or bone marrow</li>\n<li>Persistent or increasing WBC (&gt;10 × 10^9/L) and <strong>splenomegaly,</strong> unresponsive to therapy</li>\n<li>Persistent <strong>thrombocytosis</strong> (&gt;1000 × 10^9/L), unresponsive to therapy</li>\n<li>Persistent <strong>thrombocytopenia</strong> (&lt;100 × 10^9/L) unrelated to therapy</li>\n<li>This phase often leads to the<strong> <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> <span class=\"customMeta\" data-dictid=\"c961b3ec6516927771831836e7f351\">blast crisis</span> within 6-12 months.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3) Blast Crisis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>≥20% blasts</strong> in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood or bone marrow</li>\n<li>In 50% of patients, the <span class=\"customMeta\" data-dictid=\"c961b3ec6516927771831836e7f351\">blast crisis</span> occurs abruptly without an accelerated phase.</li>\n<li><strong>Extensive <span class=\"customMeta\" data-dictid=\"0ba1f7edfa1692777187ae6f51e603\">extramedullary</span> hematopoiesis</strong> occurs to compensate for CML and leads to significant splenomegaly.</li>\n<li>Transformation into <strong>AML</strong> is more predominant than ALL.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"VashiDonsk\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Acute_leukemia-ALL.jpg\" data-tags=\"\" height=\"438\" src=\"https://image.prepladder.com/content/u9tP6gEHlrzvUBDguGR31745918653.png\" width=\"585\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute Lymphoblastic Leukemia (ALL)</strong></p>\n<p> </p>\n<ul>\n<li><strong>Lymphoblasts in <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> &gt;=20%</strong></li>\n<li><strong>Cytoplasmic vacuolations</strong></li>\n<li>They contain fat (Oil Red O Positive)</li>\n<li><strong>Hand mirror-shaped cells</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"The Armed Forces Institute of Pathology\" data-hash=\"\" data-license=\"Public domain\" data-source=\"https://commons.wikimedia.org/wiki/File:Faggot_cell_in_AML-M3.jpg\" data-tags=\"\" height=\"492\" src=\"https://image.prepladder.com/content/nquxzOK57n5HpQRxIT041745918653.png\" width=\"585\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">Myeloid</span> Leukemia (AML) </strong></p>\n<ul>\n<li>Blasts ≥ 20%</li>\n<li><strong>Myeloblasts with AuerRods </strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"The Armed Forces Institute of Pathology\" data-hash=\"\" data-license=\"Public domain\" data-source=\"https://commons.wikimedia.org/wiki/File:B-cell_chronic_lymphocytic_leukemia_(B-CLL).jpg\" data-tags=\"\" height=\"471\" src=\"https://image.prepladder.com/content/XJDOpLZmoF5hBWYmjA6x1745918653.png\" width=\"584\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3. Chronic Lymphocytic Leukemia (CLL):</strong></p>\n<ul>\n<li><strong>Smudge cells</strong> (or parachute/basket cell): Due to the <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> of lymphocytes during slide preparation</li>\n<li><strong>Convent Girl Appearance:</strong> Lot of homogenous, small, mature-like, round lymphocytes with scant cytoplasm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Paulo Henrique Orlandi Mourao\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Chronic_myelogenous_leukemia#/media/File:Chronic_Myeloid_Leukemia_smear_2009-04-09.JPG\" data-tags=\"\" height=\"497\" src=\"https://image.prepladder.com/content/av10wRjJ3hT6NevdRwOw1745918653.png\" width=\"584\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">Myeloid</span> Leukemia (CML)</strong></p>\n<ul>\n<li>Leukocytosis</li>\n<li>Cell Types: Neutrophils( multilobed nucleus), metamyelocytes (indented nucleus), myelocytes (D-shaped nucleus), and eosinophils (orange cells)</li>\n<li><strong>College girl/garden party appearance: </strong>Due to the variety of cell appearances</li>\n<li><strong>Shift to the Left:</strong> Presence of <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> cell types, mainly <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> neutrophils, in the blood.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 23-year-old woman who is pregnant for the first time, currently at 25 weeks gestation, and experiencing pain in the right upper quadrant of her abdomen, along with nausea and vomiting for the past two days? Her blood pressure is 104/72 mm Hg, heart rate is 72 bpm, and she has generalized swelling. A peripheral smear shows hemolysis, and the following lab values are provided:Leukocyte count: 10,500/mm3 Platelet count: 62000/mm3 Hematocrit: 26% AST: 90 IU/L", "options": [{"label": "A", "text": "HELLP syndrome", "correct": true}, {"label": "B", "text": "Hepatitis B", "correct": false}, {"label": "C", "text": "Acute fatty liver of pregnancy", "correct": false}, {"label": "D", "text": "Obstetric cholestasis", "correct": false}], "correct_answer": "A. HELLP syndrome", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:584px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Haemolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> (Hemolysis)</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> (LDH &gt; 600 IU/L)</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> (≥ 1.2 mg/dL)</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> haptoglobin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Elevated Liver Enzymes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated (AST &amp; <span class=\"customMeta\" data-dictid=\"2f5467ff0116927771811fdf3e9911\">ALT</span> &gt; 70 IU/L)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">Platelet</span> Count</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Platelets<strong> &lt; 100,000/μL</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:486px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mississippi Triple Class System</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class I (severe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>AST &amp; <span class=\"customMeta\" data-dictid=\"2f5467ff0116927771811fdf3e9911\">ALT</span> &gt; 70 IU/L</li>\n<li>LDH &gt; 600 IU/L</li>\n<li>Platelets &lt;50 x 10<sup>9</sup> /L</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class II (moderate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>AST &amp; <span class=\"customMeta\" data-dictid=\"2f5467ff0116927771811fdf3e9911\">ALT</span> &gt; 70 IU/L</li>\n<li>LDH &gt; 600 IU/L</li>\n<li>Platelets 50-100 x 10<sup>9</sup> /L</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class III (mild)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>AST &amp; <span class=\"customMeta\" data-dictid=\"2f5467ff0116927771811fdf3e9911\">ALT</span> &gt; 40 IU/L</li>\n<li>LDH &gt; 600 IU/L</li>\n<li>Platelets 100-150 x 10<sup>9</sup> /L</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:641px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HELLP Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">Fatty</span> Liver of Pregnancy (AFLP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Intrahepatic <span class=\"customMeta\" data-dictid=\"77786ce4911692777184f875836332\">Cholestasis</span> of Pregnancy (ICP)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Main Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hemolysis (breakdown of red blood cells), Elevated liver enzymes, Low <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">Platelet</span> count</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Buildup of fat in the liver, liver dysfunction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> flow, elevated <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> acids, itching</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Occurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually occurs in the third trimester, but can also occur postpartum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically occurs in the third trimester</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually occurs in the third trimester, but can occur earlier</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abdominal pain, nausea, vomiting, headache, edema</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abdominal pain, nausea, vomiting, jaundice, malaise</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intense itching, especially on palms and soles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk to Mother</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can lead to serious complications such as liver rupture, liver failure, <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> (DIC)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can lead to liver failure, coagulopathy, and other complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally uncomfortable but usually does not pose a significant threat to the mother's overall health</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk to Fetus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can lead to <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> growth restriction, <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">preterm</span> birth, stillbirth, <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> abruption</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can lead to <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> distress, <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">preterm</span> birth, and stillbirth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased risk of adverse <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> outcomes, such as <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">preterm</span> birth or stillbirth</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate medical attention required, delivery of the baby may be necessary</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urgent medical intervention required, delivery of the baby may be necessary</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptom relief, monitoring of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> acid levels, early delivery may be considered</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver rupture, liver failure, DIC, <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> and <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> mortality</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver failure, coagulopathy, <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> and <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> mortality</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased risk of <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">preterm</span> birth, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> distress, stillbirth</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HELLP Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>History of <span class=\"customMeta\" data-dictid=\"1fa06d396c1692777196050a5db718\">preeclampsia</span> or HELLP syndrome</li>\n<li>Multiparity</li>\n<li>Advanced <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> age</li>\n<li>Obesity</li>\n<li>Diabetes</li>\n<li>Chronic hypertension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> or epigastric pain</li>\n<li>Nausea and vomiting</li>\n<li>Malaise</li>\n<li>Headache &amp; visual disturbances</li>\n<li>Hypertension</li>\n<li>Proteinuria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mother:</strong></p>\n<ul>\n<li>Liver <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or rupture</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Pulmonary edema</li>\n<li>Disseminated <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> (DIC)</li>\n<li>Placental abruption</li>\n</ul>\n<p><strong>Fetus: </strong></p>\n<ul>\n<li>Preterm birth</li>\n<li>IUGR or Stillbirth</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most accurate test for evaluating the effectiveness of treatment in chronic myeloid leukemia (CML)?", "options": [{"label": "A", "text": "СВС", "correct": false}, {"label": "B", "text": "RT PCR", "correct": true}, {"label": "C", "text": "Cytogenetic test", "correct": false}, {"label": "D", "text": "FISH", "correct": false}], "correct_answer": "B. RT PCR", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 1-month-old child is brought to the OPD for consultation regarding an empty scrotal sac. On examination B/L inguinal masses are palpable. What is the next step of management for this child?", "options": [{"label": "A", "text": "Perform karyotyping", "correct": false}, {"label": "B", "text": "Surgical exploration within the next 2 weeks", "correct": false}, {"label": "C", "text": "Perform orchidopexy now", "correct": false}, {"label": "D", "text": "Wait and watch for spontaneous descent within the next 6 months.", "correct": true}], "correct_answer": "D. Wait and watch for spontaneous descent within the next 6 months.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer D) Wait and watch for &lt;span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\"&gt;spontaneous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\"&gt;descent&lt;/span&gt; within the next 6 months</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> (Cryptorchidism)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cryptorchidism is a condition where one or both <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> fail to descend into the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> from the abdomen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inguinal/Palpable undescended testis: 80%</li>\n<li>Abdominal/Non-Palpable undescended testis: 20%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes and Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Developmental and Genetic Factors:</strong> Conditions like <span class=\"customMeta\" data-dictid=\"8e151ee847169277719083d35bdd10\">Klinefelter syndrome</span> and <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> imbalances can impair testicular descent.</li>\n<li><strong>Prematurity and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">Maternal</span> Factors:</strong> <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">Premature</span> birth and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> issues like diabetes or medication exposure can lead to undescended testes.</li>\n<li><strong>Mechanical and Physical Factors: </strong>Obstructions in the inguinal canal, scrotum, or related conditions such as inguinal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> can prevent normal testicular descent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>(SATHI Mnemonic):</strong></p>\n<ul>\n<li><strong>S: <span class=\"customMeta\" data-dictid=\"61755425bd1692777199771cd3fa1e\">Sterility</span> -</strong> Elevated <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> temperature can impair <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> production, leading to potential <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> if untreated.</li>\n<li><strong>A: <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">Atrophy</span> -</strong> Prolonged exposure to heat can cause the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> to shrink or become non-functional.</li>\n<li><strong>T: Trauma, Tumor, <span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\">Torsion</span> </strong>- Increased risk of testicular torsion, which can cause severe pain and potentially result in testicular loss. The most common tumor associated is <span class=\"customMeta\" data-dictid=\"0b7129b26c16927771988bb64b78ef\">seminoma</span> with the highest risk of tumor development in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> testes.</li>\n<li><strong>H: <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">Hernia</span> - </strong>Over 90% of cases are associated with a patent <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">processus</span> vaginalis, increasing the risk of inguinal hernia.</li>\n<li><strong>I: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> - </strong>The undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is more <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions.</li>\n</ul>\n<p><strong>Note: </strong>Leydig cells are unaffected, maintaining secondary sexual characteristics, while Sertoli cells are impaired, affecting spermatogenesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Palpable undescended testis:</strong> Inguinal exploration.</li>\n<li><strong>Non-Palpable undescended testis:</strong> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> laparoscopy.</li>\n<li><strong>Imaging:</strong> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> may be utilized to locate the testis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical <span class=\"customMeta\" data-dictid=\"5913e35df9169277719717f79fbae7\">Repositioning</span> (Orchidopexy):</strong> Usually performed when the child is between 6-12 months old. <strong>(Option D)</strong></p>\n<p><strong>Types of Orchidopexy</strong></p>\n<ul>\n<li>Ombridannes</li>\n<li>Keetley-Torek</li>\n<li>Stephen-Fowler</li>\n<li>Ladd &amp; Gross</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most characteristic feature of diabetic nephropathy, which is shown below?", "options": [{"label": "A", "text": "Kimmelstiel Wilson nodules", "correct": true}, {"label": "B", "text": "Armanni Ebstein change", "correct": false}, {"label": "C", "text": "Aschoff nodule", "correct": false}, {"label": "D", "text": "Anitschkow cell", "correct": false}], "correct_answer": "A. Kimmelstiel Wilson nodules", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/FSI0PV7i67gctdpkID0S1747908773.png", "https://image.prepladder.com/notes/h561qiLnwi8H9pmexAiP1747908839.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 37-week primigravida has mild labor pains for 20 hours, and the cervix is persistently 1 cm dilated but non-effaced. What would be the appropriate management?", "options": [{"label": "A", "text": "Sedation and waiting", "correct": true}, {"label": "B", "text": "Augmentation with oxytocin", "correct": false}, {"label": "C", "text": "Cesarean section", "correct": false}, {"label": "D", "text": "Amniotomy", "correct": false}], "correct_answer": "A. Sedation and waiting", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/TH0qVpqzfEf6FRcZixuI1747901490.png"], "explanation": "\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bishop Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dilation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3-4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Length (Effacement)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;4 or 0-30%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3-4 or 40-50%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-2 or 50-70%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0 ≥80%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Consistency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Firm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medium</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soft</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>--</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Midline</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>--</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Head Station</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-1,0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+1,+2</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good score: ≥9</p>\n<p>Unfavorable score: ≤4</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who underwent surgery for a lipoma 5 weeks ago now presents with a scar at the incision site that is limited to the original wound boundaries. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Keloid", "correct": false}, {"label": "B", "text": "Exuberant granulation", "correct": false}, {"label": "C", "text": "Hypertrophic scar", "correct": true}, {"label": "D", "text": "Granulation tissue", "correct": false}], "correct_answer": "C. Hypertrophic scar", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Hypertrophic scar</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertrophic Scar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Keloid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exuberant <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">Granulation</span> (\"Proud Flesh\")</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulation Tissue</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excess <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition leading to a raised <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> within wound boundaries.</p>\n<p><strong>(Option D ruled out )</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excess <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition extending beyond the wound. <strong>(Option A ruled out )</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Overgrowth of <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue above skin level. <strong>(Option B ruled out )</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early vascularized tissue forming during wound healing. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wound Boundaries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confined to the original wound.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends beyond the wound margins.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protrudes beyond the skin level.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confined to wound, but not raised.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weeks after injury.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Months after injury.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early post-injury phase.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Forms within days of injury.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Resolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May regress over time.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persists and grows continuously.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires treatment (cauterization or excision).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal component of healing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Areas of high tension (joints, chest, back).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Earlobes, shoulders, chest, upper arms.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open wounds, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> sites.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> wound.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collagen organized <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to skin surface.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disorganized, excessive <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excess <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, rich in capillaries.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fibroblasts, capillaries, and <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pressure therapy, steroids, laser therapy (if symptomatic).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intralesional steroids, cryotherapy, <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> (high recurrence).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Silver <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> cautery, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> trimming.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No treatment needed (normal part of healing).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of lactational amenorrhea?", "options": [{"label": "A", "text": "Increased progesterone", "correct": false}, {"label": "B", "text": "Increased GnRH secretion", "correct": false}, {"label": "C", "text": "Decreased prolactin secretion", "correct": false}, {"label": "D", "text": "Increased prolactin secretion", "correct": true}], "correct_answer": "D. Increased prolactin secretion", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hormones that favor milk production</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hormones that <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> milk production</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prolactin</li>\n<li>Insulin</li>\n<li>Glucocorticoids</li>\n<li>Growth hormone</li>\n<li>Thyroxine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Estrogen</li>\n<li>Progesterone</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Stellate granuloma is found in:", "options": [{"label": "A", "text": "Cat scratch disease", "correct": true}, {"label": "B", "text": "Leprosy", "correct": false}, {"label": "C", "text": "Coccidomycosis", "correct": false}, {"label": "D", "text": "Histoplasmosis", "correct": false}], "correct_answer": "A. Cat scratch disease", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Infectious causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Non-infectious causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>TB (Caseating and non-caseating granuloma)</li>\n<li>Leprosy</li>\n<li>Syphilis</li>\n<li>Malaria (Durck granuloma)</li>\n<li>Cat-scratch disease and <span class=\"customMeta\" data-dictid=\"1df59c006c1692777191996da1b3f0\">Lymphogranuloma</span> venerum (Stellate granuloma)</li>\n<li>Q fever (Doughnut granuloma/ <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">Fibrin</span> ring granuloma)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sarcoidosis (Naked granuloma)</li>\n<li>Giant cell arteritis</li>\n<li>Crohn’s disease</li>\n<li>Churg-Strauss syndrome (Eosinophilic granuloma)</li>\n<li>Berylliosis (Foreign body granuloma)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Xenograft is:", "options": [{"label": "A", "text": "Graft across species", "correct": true}, {"label": "B", "text": "Grafts from the same species", "correct": false}, {"label": "C", "text": "Graft from the same individual", "correct": false}, {"label": "D", "text": "Graft between genetically identical individuals", "correct": false}], "correct_answer": "A. Graft across species", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:716px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Type of Graft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Autograft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>An organ or tissue is taken from an individual and grafted on him/ herself</p>\n<p><strong>(Option C ruled out) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Isograft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Grafts between genetically identical individuals, such as identical twins</p>\n<p><strong>(Option D ruled out) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Allograft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Graft between two genetically non-identical members of the same species (e.g. organ transplants between two non-identical and <span class=\"customMeta\" data-dictid=\"8baf7b24c316927771847e2b2ae466\">compatible</span> individuals.<strong> (Option B ruled out) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Xenograft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Graft from one species to another (e.g., pig skin is a temporary <span class=\"customMeta\" data-dictid=\"02f0c206e716927771999e45b2d63b\">substitute</span> for burn treatment). <strong> (Option A) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Synthetic Graft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Artificial materials or bioengineered constructs replace or support damaged tissue (e.g., artificial skin substitutes, <span class=\"customMeta\" data-dictid=\"c293dda462169277718335b755e1a9\">bone graft</span> substitutes).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions shown below has a false positive Barr body?", "options": [{"label": "A", "text": "Klinefelter's syndrome", "correct": true}, {"label": "B", "text": "Turner's syndrome", "correct": false}, {"label": "C", "text": "Down's syndrome", "correct": false}, {"label": "D", "text": "Edward's syndrome", "correct": false}], "correct_answer": "A. Klinefelter's syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/NE6l5cxseTo3FpUWJyYH1747901579.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about anaplasia?", "options": [{"label": "A", "text": "Loss of cohesion between cells", "correct": false}, {"label": "B", "text": "Loss of differentiation", "correct": true}, {"label": "C", "text": "Change of epithelium type", "correct": false}, {"label": "D", "text": "Benign and fully reversible", "correct": false}], "correct_answer": "B. Loss of differentiation", "question_images": [], "explanation_images": [], "explanation": "\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:708px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metaplasia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Dysplasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anaplasia </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiated cell</p>\n<p>type (epithelial or mesenchymal) is replaced by another cell type.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disordered growth and loss of architectural orientation of cells.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lack of <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> and organisation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adaptive response to stress or injury.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preneoplastic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated with <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reversibility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reversible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reversible in early stages</p>\n<p>(irreversible if whole</p>\n<p>the <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> is involved).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Irreversible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pleomorphism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present in low-grade</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present in high-grade</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nuclear-to-cytoplasmic ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal (1:4 to 1:6)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased (↑)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased (↑↑↑)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mitotic figures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent/minimal at normal places.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typical <span class=\"customMeta\" data-dictid=\"e0da80f7b91692777192668c299922\">mitotic figures</span> present at <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> places.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atypical, bizarre mitotic figures</p>\n<p>present at <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> places.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> integrity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intact</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intact</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breached</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Example</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Barret’s oesophagus,</p>\n<p>myositis ossificans</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cervical <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> of</p>\n<p>squamous cells</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carcinoma of the cervix, <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> oesophagus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A postmenopausal woman presented with pain in her lower abdomen for the past 4 months. She has had fibroids for a long time. The radiological investigation is shown below. What is the type of degeneration that occurred in this patient?", "options": [{"label": "A", "text": "Fatty degeneration", "correct": false}, {"label": "B", "text": "Hyaline degeneration", "correct": false}, {"label": "C", "text": "Calcific degeneration", "correct": true}, {"label": "D", "text": "Cystic degeneration", "correct": false}], "correct_answer": "C. Calcific degeneration", "question_images": ["https://image.prepladder.com/notes/0YO6s3dK1GaObpGD37i11747901685.png"], "explanation_images": [], "explanation": "\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Change</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Microscopic/Gross Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Pearls</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyaline Degeneration</strong></p>\n<p><strong>(65% - Most Common) (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Decreased blood supply</li>\n<li>Accumulation of <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> proteins</li>\n<li>More common in tumors with high <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue content</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cut surface: Irregular <span class=\"customMeta\" data-dictid=\"d9ec45007b1692777189e3b26e44ca\">homogeneous</span> areas</li>\n<li>Loss of whorl-like appearance</li>\n<li>Microscopy: <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">Hyaline</span> changes of both muscle and <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common type</li>\n<li>Can occur at any stage</li>\n<li>Usually asymptomatic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red Degeneration</strong></p>\n<p><strong>(5-10%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hemorrhagic infarction</li>\n<li>Occurs during pregnancy</li>\n<li>Vascular origin</li>\n<li>Venous thrombosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dark red appearance</li>\n<li>Raw-beef appearance on cut section</li>\n<li>Fishy <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> (fatty acids)</li>\n<li>Hemorrhagic areas with <span class=\"customMeta\" data-dictid=\"d32945833c16927772005b5e05a44f\">thrombosed</span> vessels</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High-yield: Associated with pregnancy</li>\n<li>Acute pain common</li>\n<li>Partial recovery possible</li>\n<li>Important in <span class=\"customMeta\" data-dictid=\"6bd54dfc48169277718674cd08e586\">differential</span> of pregnancy pain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cystic Degeneration</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Follows <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">hyaline</span> change</li>\n<li>Liquefactive necrosis</li>\n<li>Common in <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> fibroids</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fluid-filled spaces</li>\n<li>Irregular <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> areas</li>\n<li>May be confused with pregnancy on ultrasound</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Can <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> pregnancy on imaging</li>\n<li>Important radiological differential</li>\n<li>More common in larger fibroids</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcific Degeneration</strong></p>\n<p><strong>(10%) (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Usually follows <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> degeneration</li>\n<li>Calcium/phosphate deposition</li>\n<li>Common in <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> women</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\"Womb stone\" formation</li>\n<li>Dense calcified mass</li>\n<li>Radio-opaque on imaging</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High-yield: Associated with menopause</li>\n<li>Visible on plain X-ray</li>\n<li>Often small and pedunculated</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Myxomatous Degeneration</strong></p>\n<p><strong>(15%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Central part involvement</li>\n<li>Smooth muscle cell changes</li>\n<li>Mucoid accumulation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gelatinous appearance</li>\n<li>Mainly affects central portions</li>\n<li>Smooth muscle degeneration</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Less commonly tested</li>\n<li>Can affect tumor size</li>\n<li>May alter <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> characteristics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fatty <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">Degeneration</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Occurs at/after menopause</li>\n<li>Fat <span class=\"customMeta\" data-dictid=\"88f6237b6516927771880fecb15875\">globule</span> deposition in muscle cells</li>\n<li>Often precedes calcification</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fat globules in muscle cells</li>\n<li>May show lipid-laden cells</li>\n<li>Often <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> distribution</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> status</li>\n<li>Can precede calcification</li>\n<li>Usually asymptomatic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sarcomatous Change</strong></p>\n<p><strong>(&lt;0.1%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malignant transformation</li>\n<li>Risk factors: rapid growth</li>\n<li>Postmenopausal bleeding</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden enlargement</li>\n<li>Irregular margins</li>\n<li>Necrosis and hemorrhage</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High-yield: Very rare but important</li>\n<li>Red flag: rapid growth in <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> woman</li>\n<li>Requires immediate evaluation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Atrophic Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> support</li>\n<li>Postmenopausal change</li>\n<li>Reduction in cellularity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Size reduction</li>\n<li>Decreased cellularity</li>\n<li>Increased fibrosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Expected finding after menopause</li>\n<li>May help with symptoms</li>\n<li>Natural evolution</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most prevalent condition that leads to the occurrence of heartburn and chest pain in a patient?", "options": [{"label": "A", "text": "Barrett's esophagus", "correct": false}, {"label": "B", "text": "Pneumonia", "correct": false}, {"label": "C", "text": "Myocardial infarction", "correct": false}, {"label": "D", "text": "Esophagitis", "correct": true}], "correct_answer": "D. Esophagitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer D) Esophag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following histopathological findings is not seen 12 hours after an ischemic injury to the heart?", "options": [{"label": "A", "text": "Karyorrhexis of myocytes", "correct": false}, {"label": "B", "text": "Neocapillary invasion of myocytes", "correct": false}, {"label": "C", "text": "Hyper-eosinophilia of myocytes", "correct": true}, {"label": "D", "text": "Coagulation necrosis of myocytes", "correct": false}], "correct_answer": "C. Hyper-eosinophilia of myocytes", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/1nZNP6Hpiubn6zpRGxaD1747909330.png", "https://image.prepladder.com/notes/HBqftxsFEAiNeRDXcIuc1747909062.png", "https://image.prepladder.com/notes/vTSgfEWM3vFpwMUqnLZ01747909469.png", "https://image.prepladder.com/notes/f6xVtu6WncNpoRjV8iJZ1747909568.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Time </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gross Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Light Microscope</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Electron Microscope</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reversible Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0– 1/2 hour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Relaxation of myofibrils; <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">glycogen</span> loss; mitochondrial swelling</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Irreversible Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1/2 –4 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually none; variable waviness of fibres at the border; <span class=\"customMeta\" data-dictid=\"4d740152f5169277719373f5cf60e6\">myocyte</span> vacuolisation</p>\n<figure class=\"caption_element\"><img alt=\" MI Waviness of fibres\" data-author=\"Katarzyna Michaud, Cristina Basso, Giulia d’Amati, Carla Giordano, Ivana Kholová, Stephen D. Preston, Stefania Rizzo, Sara Sabatasso, Mary N. Sheppard, Aryan Vink, Allard C. van der Wal &amp; on behalf of the Association for European Cardiovascular Pathology (AECVP)\" data-hash=\"13162\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Histopathology_of_myofiber_waviness_in_myocardial_infarction.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/1nZNP6Hpiubn6zpRGxaD1747909330.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sarcolemmal disruption;</p>\n<p>mitochondrial <span class=\"customMeta\" data-dictid=\"837f5783cf1692777181d8a586fd8c\">amorphous</span> densities (Calcium in mitochondria)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4–12 hours<br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occasional dark mottling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early <span class=\"customMeta\" data-dictid=\"d25e3f25ed169277718419e6bab67a\">coagulative</span> necrosis, oedema, haemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>12–24 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dark mottling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ongoing <span class=\"customMeta\" data-dictid=\"d25e3f25ed169277718419e6bab67a\">coagulative</span> necrosis; <span class=\"customMeta\" data-dictid=\"bf97c6fd301692777196300645cf12\">pyknosis</span> of nuclei; <span class=\"customMeta\" data-dictid=\"4d740152f5169277719373f5cf60e6\">myocyte</span> hypereosinophilia; marginal <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> band necrosis; early <span class=\"customMeta\" data-dictid=\"041f0e547a1692777193350b3f7d39\">neutrophilic</span> infiltrate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1–3 days<br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mottling with yellow-tan infarct</p>\n<p>centre</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coagulative necrosis, with loss of <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> and striations; brisk <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> of neutrophils (Acute inflammation)</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"MI Neutrophil infiltration\" data-author=\"NA\" data-hash=\"13161\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Acute_myocardial_infarction_with_coagulative_necrosis_(4).JPG\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/HBqftxsFEAiNeRDXcIuc1747909062.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3–7 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperemic border; central</p>\n<p>yellow-tan softening</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Beginning <span class=\"customMeta\" data-dictid=\"4b47ea9a2816927771864d1b0a12f9\">disintegration</span> of dead myofibers, with dying neutrophils; early <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> of dead cells by macrophages at the <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> border (Chronic inflammation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7–10 days<br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maximally yellow-tan and soft, with depressed red-tan margins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Well-developed <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> of dead cells; <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue at margins (Repair)</p>\n<figure class=\"caption_element\"><img alt=\"MI Well developed granulation tissue\" data-author=\"Katarzyna Michaud, Cristina Basso, Giulia d’Amati, Carla Giordano, Ivana Kholová, Stephen D. Preston, Stefania Rizzo, Sara Sabatasso, Mary N. Sheppard, Aryan Vink, Allard C. van der Wal &amp; on behalf of the Association for European Cardiovascular Pathology (AECVP)\" data-hash=\"13163\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Histopathology_of_granulation_tissue_with_formation_of_microvessels_in_myocardial_infarction.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/vTSgfEWM3vFpwMUqnLZ01747909469.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10–14 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Red-gray depressed <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> borders</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Well-established <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue with new blood vessels and <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2–8 weeks<br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grey-white scar, progressive from the border toward the core of the infarct</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition, with decreased cellularity.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;2 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scarring complete</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dense <span class=\"customMeta\" data-dictid=\"79dbeeeba41692777184e63d6d214e\">collagenous</span> scar</p>\n<figure class=\"caption_element\"><img alt=\"MI Dense collagenous scar\" data-author=\"Katarzyna Michaud, Cristina Basso, Giulia d’Amati, Carla Giordano, Ivana Kholová, Stephen D. Preston, Stefania Rizzo, Sara Sabatasso, Mary N. Sheppard, Aryan Vink, Allard C. van der Wal &amp; on behalf of the Association for European Cardiovascular Pathology (AECVP)\" data-hash=\"13164\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Histopathology_of_dense_fibrous_scar_replacing_myocyte_loss_in_myocardial_infarction.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/f6xVtu6WncNpoRjV8iJZ1747909568.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the causative agent of the sago-grain appearance of the conjunctiva?", "options": [{"label": "A", "text": "Chlamydia trachomatis", "correct": true}, {"label": "B", "text": "Neisseria gonorrhoeae", "correct": false}, {"label": "C", "text": "Haemophilus influenzae", "correct": false}, {"label": "D", "text": "Vitamin A deficiency", "correct": false}], "correct_answer": "A. Chlamydia trachomatis", "question_images": ["https://image.prepladder.com/content/xEpZSaQ2JRHqk5DkFT9B1745919509.png"], "explanation_images": ["https://image.prepladder.com/content/sGxd4Y8uWwuj4kYDj4Ky1745919559.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Signs of active trachoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Signs of <span class=\"customMeta\" data-dictid=\"315587fa991692777184026693ef7f\">cicatricial</span> trachoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conjunctival signs:</strong></p>\n<ul>\n<li>Conjunctival congestion</li>\n<li>Follicles in the upper <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> conjunctiva: Look like <strong>sago-grains</strong></li>\n</ul>\n<ul>\n<li>Papillary enlargement: red, velvety</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Diane K. Lavett, Van C Lansingh, Marissa J Carter, Kristen A Eckert, Juan Carlos Silva\" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Inflammatory-trachoma-with-Follicular-trachoma-TI-TF-stage-Figure-courtesy-of_fig6_237843559\" data-tags=\"\" height=\"320\" src=\"https://image.prepladder.com/content/sGxd4Y8uWwuj4kYDj4Ky1745919559.png\" width=\"447\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conjunctival signs:</strong></p>\n<ul>\n<li><strong>Scarring </strong>\n<ul>\n<li>It may be irregular, star-shaped, or linear</li>\n<li>Linear <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> in the <span class=\"customMeta\" data-dictid=\"2a56f52a921692777199df43853eba\">sulcus</span> subtarsalis is called <strong>Arlt’s line</strong></li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>accumulation of dead epithelial cells and <span class=\"customMeta\" data-dictid=\"11d92ee2d916927771907f5dfc40d1\">inspissated</span> <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> in the glands of Henle</li>\n<li>Pseudocyst</li>\n<li>Xerosis</li>\n<li>Symblepharon</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corneal signs:</strong></p>\n<ul>\n<li>Superficial <span class=\"customMeta\" data-dictid=\"f1711947d41692777190ce56ef2f7d\">keratitis</span> on <span class=\"customMeta\" data-dictid=\"7fbb9ec5b716927771981c011f4299\">slit</span> lamp and fluorescein</li>\n<li><strong>Herbert’s follicles </strong></li>\n<li><strong>Progressive </strong>pannus/<strong>Trachomatous pannus</strong>: The <strong>upper part of the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> is cloudy</strong></li>\n</ul>\n<ul>\n<li><strong>Corneal ulcers </strong>are common at the advancing edge of the pannus\n\n\t\t\t\t<ul>\n<li>Shallow, little infiltrated</li>\n<li>Cause <span class=\"customMeta\" data-dictid=\"7b8d2e6b3a1692777191cfff333306\">lacrimation</span> and photophobia</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corneal signs:</strong></p>\n<ul>\n<li><strong>Regressive </strong>pannus or <strong>pannus siccus</strong>:\n\n\t\t\t\t<ul>\n<li>Receding infiltration</li>\n<li>Vessels extend beyond the area of <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> and haze</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Herbert pits</strong>: <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> or <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> pitted scars <strong>formed after the <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> of Herbert’s follicles in the <span class=\"customMeta\" data-dictid=\"71928251b41692777191a31e57c47f\">limbal</span> area</strong></li>\n</ul>\n<ul>\n<li>Vascularized and <strong>opaque cornea.</strong></li>\n<li>Corneal xerosis</li>\n<li>Corneal ectasia</li>\n<li>Total corneal <span class=\"customMeta\" data-dictid=\"388a4ccfbf1692777194a8f6a2d3b4\">pannus</span> (blinding sequelae)</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lid signs:</strong></p>\n<ul>\n<li>Distortion of the lids</li>\n<li><strong>Tylosis</strong>: Thickening of the <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> plate/lid margin</li>\n<li><strong>Trichiasis: </strong>due to <span class=\"customMeta\" data-dictid=\"97ae59957c1692777197359406f6f4\">rubbing</span> of lashes on the cornea</li>\n<li><strong>Trachomatous <span class=\"customMeta\" data-dictid=\"e18c2053271692777194e62a208e01\">ptosis</span> </strong>(sleepy appearance)</li>\n<li><strong>Entropion</strong></li>\n<li>Madarosis</li>\n<li>Ankyloblepharon</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with left eyelid drooping and experiencing double vision. Upon examination, it was observed that the pupil in the affected eye was dilated. The following eye movement examination was conducted. Which nerve is most likely injured in this case?", "options": [{"label": "A", "text": "Optic nerve", "correct": false}, {"label": "B", "text": "Oculomotor", "correct": true}, {"label": "C", "text": "Trochlear", "correct": false}, {"label": "D", "text": "Abducens", "correct": false}], "correct_answer": "B. Oculomotor", "question_images": ["https://image.prepladder.com/notes/53XxCGTmZNijao6lRGTq1747910667.png"], "explanation_images": ["https://image.prepladder.com/notes/53XxCGTmZNijao6lRGTq1747910667.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn baby presents with irritability and cyanosis which subsides on crying. On examination, you are unable to pass a nasogastric tube and no mist formation is noted on the laryngeal mirror test. Which of the following is the best next step in management?", "options": [{"label": "A", "text": "Endotracheal intubation", "correct": false}, {"label": "B", "text": "Oropharyngeal airway", "correct": true}, {"label": "C", "text": "Oxygen inhalation", "correct": false}, {"label": "D", "text": "Epinephrine nebulization", "correct": false}], "correct_answer": "B. Oropharyngeal airway", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"b1a011ab5416927771949dde193e3a\"&gt;Oropharyngeal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby playing unsupervised was brought with complaints of difficulty in swallowing for the last few hours. The x-ray image is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Foreign body in the trachea", "correct": false}, {"label": "B", "text": "Foreign body in the esophagus", "correct": true}, {"label": "C", "text": "Foreign body in lungs", "correct": false}, {"label": "D", "text": "Foreign body in pleura", "correct": false}], "correct_answer": "B. Foreign body in the esophagus", "question_images": ["https://image.prepladder.com/content/KZi79NlPwQc8hfEjwPNe1745919811.png"], "explanation_images": [], "explanation": "<p>Correct answer B) Foreign body in the esophagu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old woman presents for an antenatal check-up and is currently on lithium for her bipolar disorder. This drug must be stopped, due to the risk of development of which of the following conditions in the fetus?", "options": [{"label": "A", "text": "Ebstein anomaly", "correct": true}, {"label": "B", "text": "VACTERL defects", "correct": false}, {"label": "C", "text": "Coarctation of aorta", "correct": false}, {"label": "D", "text": "Supravalvular aortic stenosis", "correct": false}], "correct_answer": "A. Ebstein anomaly", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SZ6RCyyo5pVq1iAoik0o1745920098.png", "https://image.prepladder.com/content/bEhW0yuVNngOTQxRkBpN1745920108.png"], "explanation": "<p>Correct Answer A - E\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent laparoscopic cholecystectomy and was discharged after removing the drain tube on the first postoperative day. On day two, the patient came back to the hospital with complaints of increasing abdominal pain with tachycardia and was febrile on examination. On ultrasound examination, there was a 5 x 5 cm collection in the subhepatic space. What is the most likely cause of this condition?", "options": [{"label": "A", "text": "Infection", "correct": false}, {"label": "B", "text": "Surgical site pain", "correct": false}, {"label": "C", "text": "Bile leak", "correct": true}, {"label": "D", "text": "Retained gallstones", "correct": false}], "correct_answer": "C. Bile leak", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\"&gt;Bile&lt;/span&gt; leak\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the probable diagnosis for the eye lesion observed in a 21-year-old male patient?", "options": [{"label": "A", "text": "Bitot’s spots", "correct": true}, {"label": "B", "text": "Pterygium", "correct": false}, {"label": "C", "text": "Phlyctenular conjunctivitis", "correct": false}, {"label": "D", "text": "Pinguecula", "correct": false}], "correct_answer": "A. Bitot’s spots", "question_images": ["https://image.prepladder.com/content/osQtETyJiJxAbpq0ennE1745920316.png"], "explanation_images": ["https://image.prepladder.com/content/KQ5z9sLHF5rJGc6N2rTi1745920380.png", "https://image.prepladder.com/content/jJx206U0kBz02VoOEqqU1745920416.png", "https://image.prepladder.com/content/Wz05drbfaGE0mv2cY6N91745920398.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>XN</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Night blindness: Difficulty seeing in low light or at night.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X1A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjunctival xerosis: Dryness of the <span class=\"customMeta\" data-dictid=\"d168af6e7f1692777185683fea5e7f\">conjunctiva</span> without foamy patches (Bitot spots).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X1B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bitot spots:</strong> Presence of foamy, whitish accumulations on the <span class=\"customMeta\" data-dictid=\"d168af6e7f1692777185683fea5e7f\">conjunctiva</span> <strong>(Option A)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Community Eye Health\" data-hash=\"\" data-license=\"CC BY NC 2.0\" data-source=\"https://www.flickr.com/photos/communityeyehealth/5444948403/in/photostream/\" data-tags=\"\" height=\"257\" src=\"https://image.prepladder.com/content/KQ5z9sLHF5rJGc6N2rTi1745920380.png\" width=\"257\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corneal xerosis: The cornea's dryness makes it appear <span class=\"customMeta\" data-dictid=\"68d37494591692777186d7c7ce4531\">dull</span> and hazy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X3A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corneal ulceration/keratomalacia (&lt;1/3rd of the cornea)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X3B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corneal ulceration/keratomalacia (&gt;1/3rd of the cornea)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>XS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corneal scar: Scarring of the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> resulting from the <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> of ulcers or keratomalacia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>XF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Xerophthalmic fundus: Retinal changes associated with chronic Vitamin A deficiency.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for a 3-year-old child with amblyopia in the right eye?", "options": [{"label": "A", "text": "Observe for 3 months", "correct": false}, {"label": "B", "text": "Occlusion of the right eye", "correct": false}, {"label": "C", "text": "Occlusion of the left eye", "correct": true}, {"label": "D", "text": "Surgical correction", "correct": false}], "correct_answer": "C. Occlusion of the left eye", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Amblyopia treatment should be started as early as possible (younger the child, better the prognosis). <span class=\"customMeta\" data-dictid=\"48ecf3114716927771818db0abb2a6\">Amblyopia</span> therapy works best when initiated in young children under 3 years of age and comprise:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Occlusion therapy (Option C):</strong> <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">Occlusion</span> of the sound (normal) eye to force use of amblyopic eye is the main stay in the treatment of amblyopia. Following methods are deployed,</p>\n<ul>\n<li><strong>Full-time occlusion: </strong>Up to 2 years, the <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> should be done in 2:1, i.e. 2 days in sound eye and one day in amblyopic eye; at the age of 3 years, 3:1; at the age of 4 years, 4:1; At the age of 5 years, 5:1; and after the age of 6 years 6:1.</li>\n<li><strong>Part-time occlusion:</strong> 4-6 hours/day, as shown by <span class=\"customMeta\" data-dictid=\"48ecf3114716927771818db0abb2a6\">Amblyopia</span> Treatment Study (ATS), and is as effective as full-time occlusion.</li>\n<li><strong>Maintenance occlusion: </strong>After vision equalization, part-time <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> continues until at least 8 years of age.</li>\n<li>Ensure no media <span class=\"customMeta\" data-dictid=\"a8eadab50316927771948be0cc91ca\">opacity</span> or <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> errors before starting <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other Methods:</strong></p>\n<ul>\n<li><strong>Penalization: </strong>Blurring vision in the sound eye with <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> or over-plus lenses.</li>\n<li><strong>Computerized Home Vision Therapy:</strong> Uses specially designed software as an <span class=\"customMeta\" data-dictid=\"e405fcd2f2169277718034536f004a\">adjunct</span> to <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> therapy.</li>\n<li><strong>Pharmacologic Manipulation</strong>\n<ul>\n<li><strong>Levodopa/Carbidopa:</strong> Studied as an <span class=\"customMeta\" data-dictid=\"e405fcd2f2169277718034536f004a\">adjunct</span> to <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> therapy.</li>\n<li>Other agents: Citicoline and <span class=\"customMeta\" data-dictid=\"5e18c6662c16927771946257c6b8d2\">omega</span> <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids</li>\n</ul>\n</li>\n<li><strong>Pleoptics:</strong> Pleoptic exercises are done to improve foveal fixation, though less commonly used now.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your approach in managing a patient who is a 40-year-old woman with a 5 mm gallbladder polyp detected on abdominal ultrasound, but no gallbladder stones? The patient is overall healthy and shows no symptoms.", "options": [{"label": "A", "text": "Regular follow-up every 2 months", "correct": true}, {"label": "B", "text": "Polypectomy", "correct": false}, {"label": "C", "text": "Laparoscopic cholecystectomy", "correct": false}, {"label": "D", "text": "Open cholecystectomy", "correct": false}], "correct_answer": "A. Regular follow-up every 2 months", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) Regular follow-up every 2 months:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Polyp Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&lt;6 mm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regular follow-up (USG every 6–12 months for 2 years)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6–9 mm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Follow-up every <strong>3–6 months</strong>, consider <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> if growth or risk factors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>≥10 mm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopic cholecystectomy</strong> (higher <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Any size + symptoms or high-risk features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopic cholecystectomy</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common association with Tetralogy of Fallot?", "options": [{"label": "A", "text": "Klinefelters syndrome", "correct": false}, {"label": "B", "text": "Edwards syndrome", "correct": false}, {"label": "C", "text": "Down’s syndrome", "correct": true}, {"label": "D", "text": "Turner’s syndrome", "correct": false}], "correct_answer": "C. Down’s syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Down’\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the given images to their descriptions: 1. A. Posterior subcapsular cataract 2. B. Sunflower cataract 3. C. Morgagnian cataract 4. D. Snowflake cataract", "options": [{"label": "A", "text": "1A 2D 3B 4C", "correct": false}, {"label": "B", "text": "1D 2B 3A 4C", "correct": false}, {"label": "C", "text": "1B 2C 3D 4A", "correct": true}, {"label": "D", "text": "1C 2B 3D 4A", "correct": false}], "correct_answer": "C. 1B 2C 3D 4A", "question_images": ["https://image.prepladder.com/content/euIl1aalgcTC1rNBUHrJ1745920628.png", "https://image.prepladder.com/content/W3tyylrIt0Qn3TgJqJ8Z1745920628.png", "https://image.prepladder.com/content/0peqwe9HeUNZetilyXx21745920628.png", "https://image.prepladder.com/content/FPS2NQByX8PxAaLtKrsL1745920628.png"], "explanation_images": ["https://image.prepladder.com/content/G5vCOpkU0yX3mR1YlcvW1745920787.png", "https://image.prepladder.com/content/gxb7tiKhI2NazrDx8wEs1745920787.png", "https://image.prepladder.com/content/XRNa58CYiGtN86POYbEq1745920787.png", "https://image.prepladder.com/content/yXCkqwAsW6X2eDA2v4kC1745920787.png", "https://image.prepladder.com/content/PHdLUI93DqS1c7jzM0rJ1745920850.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>1.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Imrankabirhossain\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"Sunflower cataract - Cataract - Wikipedia\" data-tags=\"\" height=\"363\" src=\"https://image.prepladder.com/content/G5vCOpkU0yX3mR1YlcvW1745920787.png\" width=\"447\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>B) <strong>Sunflower cataract:</strong></p>\n<ul>\n<li>Deposition of <strong>copper</strong> under the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> of the lens.</li>\n<li>Cause: <strong>Wilson's disease</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Amanda C. Maltry\" data-hash=\"\" data-license=\"CC BY-NC-ND 3.0\" data-source=\"Atlas Entry - Morgagnian cataract (uiowa.edu)\" data-tags=\"\" height=\"280\" src=\"https://image.prepladder.com/content/gxb7tiKhI2NazrDx8wEs1745920787.png\" width=\"446\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C) Morgagnian cataract:</strong></p>\n<ul>\n<li>Seen in <strong>hypermature <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">senile</span> cataract</strong></li>\n<li>Cortex liquefies</li>\n<li><strong>Nucleus sinks to the bottom</strong></li>\n<li>Bag of <span class=\"customMeta\" data-dictid=\"70da66640f16927771920de556da59\">milky</span> fluid appearance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"Open Access\" data-source=\"Figure 2 from Role of biochemical markers in type 2 diabetic patients of cataract and retinopathy attending Index Medical College, Hospital and Research Centre, Indore (M.P) | Semantic Scholar\" data-tags=\"\" height=\"354\" src=\"https://image.prepladder.com/content/XRNa58CYiGtN86POYbEq1745920787.png\" width=\"448\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>D) Snowflake cataract:</strong></p>\n<ul>\n<li>Also known as snowburst cataract</li>\n<li>Cause:<strong> Diabetes mellitus</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Imrankabirhossain\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Posterior_Subcapsular_Cataract.jpg\" data-tags=\"\" height=\"393\" src=\"https://image.prepladder.com/content/yXCkqwAsW6X2eDA2v4kC1745920787.png\" width=\"446\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A) <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> <span class=\"customMeta\" data-dictid=\"550fa75ff216927771992c0987c58e\">subcapsular</span> cataract:</strong></p>\n<ul>\n<li>Opacity below the <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> in the central part of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cortex.</li>\n<li>Causes:\n\t\t\t\t<ul>\n<li>Complicated cataract</li>\n<li>Blunt trauma</li>\n<li><strong>Myotonic <span class=\"customMeta\" data-dictid=\"04568e3d19169277718672d9da94fd\">dystrophy</span> (Christmas tree cataract)</strong></li>\n<li><strong>Glactosemia (Oil <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> cataract)</strong></li>\n<li>Drugs: <strong>Steroid</strong>, chloroquine, busulfan</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Cataract</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Visual Impact</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cuneiform <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">Senile</span> Cortical Cataract</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Wedge-shaped opacities</strong> with clear areas in between.</li>\n<li>Extends from <span class=\"customMeta\" data-dictid=\"316866040e1692777195f45393e010\">periphery</span> to center.</li>\n<li>First appears in the lower <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> quadrant. Present in both <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cortex.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> spoke-like pattern of opacities is seen.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visual disturbances are noted at a comparatively late stage (since it starts at the periphery).</li>\n<li>Vision improves in bright light with contracted pupils.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cupuliform <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">Senile</span> Cortical <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Saucer-shaped opacities</strong> are typically in the central part of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> <strong>(posterior <span class=\"customMeta\" data-dictid=\"550fa75ff216927771992c0987c58e\">subcapsular</span> cataract)</strong>.</li>\n<li>Extends from center to periphery.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Causes an early loss of visual acuity.- Due to the involvement of the nodal point</li>\n<li><strong>Glares</strong> seen in PSC</li>\n<li>Better vision in dim light with dilated pupils.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. Stage of Lamellar Separation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Earliest stage of <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">senile</span> cataract</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Formation of vacuoles and water clefts within the cortex</li>\n<li>Reversible change</li>\n<li>Can only be demonstrated by <span class=\"customMeta\" data-dictid=\"7fbb9ec5b716927771981c011f4299\">slit</span> lamp examination</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2. Stage of Incipient Cataract</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detectable opacities with clear areas present between. Causes visual disturbances.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cuneiform type:</strong></p>\n<ul>\n<li>Wedge-shaped opacities, extending from the <span class=\"customMeta\" data-dictid=\"2056156e8d169277718799b9e86725\">equator</span> appear as <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> spoke-like opacities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cupuliform type:</strong></p>\n<ul>\n<li>Saucer-shaped <span class=\"customMeta\" data-dictid=\"a8eadab50316927771948be0cc91ca\">opacity</span> in the central <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cortex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3. Immature <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">Senile</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Progression of opacification</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Iris shadow visible</strong> (clear <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> visible) -Iris Shadow present here due to opacities + clear areas</li>\n<li>Can progress to <span class=\"customMeta\" data-dictid=\"efbe4dea2e1692777190fabea13765\">Intumescent</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> leading to the shallow <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chamber.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4. <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">Mature</span> <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">Senile</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> (aka <span class=\"customMeta\" data-dictid=\"efbe4dea2e1692777190fabea13765\">intumescent</span> cataract)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complete <span class=\"customMeta\" data-dictid=\"990cbfd3111692777194c6967ee125\">opacification</span> of cortex</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The lens appears pearly white</li>\n<li>Referred to as a \"ripe cataract\"</li>\n<li><strong>No <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">iris</span> shadow</strong> as the whole lens is opacified with a chalky white color</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5. Hypermature <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">Senile</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> (HMSC)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Advanced stage of <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">cataract</span> beyond maturity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morgagnian Hypermature Cataract: </strong></p>\n<ul>\n<li>Cortex liquefies</li>\n<li><strong>Nucleus sinks to the bottom</strong></li>\n<li>Bag of <span class=\"customMeta\" data-dictid=\"70da66640f16927771920de556da59\">milky</span> fluid appearance</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"318\" src=\"https://image.prepladder.com/content/PHdLUI93DqS1c7jzM0rJ1745920850.png\" width=\"508\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sclerotic Hypermature Cataract: </strong></p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> disintegrates, lens and <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> shrink.</li>\n<li><strong>Deep <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chamber</strong></li>\n<li>Iridodonesis may be present.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common side effect of cholecystectomy?", "options": [{"label": "A", "text": "Acute kidney injury", "correct": false}, {"label": "B", "text": "Osteoporosis", "correct": false}, {"label": "C", "text": "Steatorrhea", "correct": true}, {"label": "D", "text": "Colorectal cancer", "correct": false}], "correct_answer": "C. Steatorrhea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Steatorrhea</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description/Features</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early (Intraoperative &amp; Immediate Postoperative)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bile <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Accidental damage to the <strong>common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (CBD)</strong> leads to <strong>bile leakage or strictures</strong> (More common in <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> cholecystectomy).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding from the <strong>cystic artery</strong> or liver bed; managed with <span class=\"customMeta\" data-dictid=\"4cb859ed5d16927771884925c4eef7\">hemostasis</span> or blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> if severe.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bowel Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unintended injury to the <strong>duodenum or colon</strong>, is rare but serious.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anesthesia-related Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspiration, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> depression, hypotension</strong>, and arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">Postoperative</span> (0–7 Days)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infection (Wound/Port-Site Abscess)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fever, erythema, tenderness</strong> at the <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> site. More common in <strong>diabetics</strong> or <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bile Leak (Biloma)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fever, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, nausea</strong>, and <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <strong>fluid collection</strong> on imaging. Often from <strong>cystic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"cd187682b0169277719976b8127f36\">stump</span> or <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> injury</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subhepatic Collection (Abscess)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fever, RUQ pain, and tachycardia</strong>; requires <strong>percutaneous drainage</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retained Gallstones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Residual gallstones in the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</strong> can cause <strong>biliary colic or cholangitis</strong> postoperatively.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">Vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">Thrombosis</span> (DVT) &amp; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">Embolism</span> (PE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to <strong>prolonged immobilization</strong>, leading to leg <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or <strong>sudden dyspnea</strong> (Prevent with early ambulation, anticoagulation).</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">Postoperative</span> (&gt;7 Days – Months/Years)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steatorrhea (Fatty Stools)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common long-term issue</strong> due to <strong>continuous <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> secretion</strong>, leading to <strong>fat malabsorption</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-Cholecystectomy Syndrome (PCS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Persistent dyspepsia, bloating, diarrhea, or RUQ pain</strong> due to <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> or <span class=\"customMeta\" data-dictid=\"bead1cecfa16927771979940742ada\">remnant</span> stones.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biliary Strictures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic narrowing of the <strong>CBD</strong>, leading to <strong>jaundice and cholangitis</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Diarrhea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Related to <strong>altered <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> acid metabolism</strong>, may require <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> acid sequestrants (e.g., cholestyramine).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased Risk of <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">Colorectal</span> Cancer (Debatable)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Some studies suggest a mild <strong>increase in <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> cancer risk</strong> due to <strong>altered <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> acid metabolism</strong>, but <strong>evidence is weak</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Vitamin K supplementation is given to neonates to prevent:", "options": [{"label": "A", "text": "Breast milk jaundice", "correct": false}, {"label": "B", "text": "Hemorrhagic disease of the newborn", "correct": true}, {"label": "C", "text": "Keratomalacia", "correct": false}, {"label": "D", "text": "Scurvy", "correct": false}], "correct_answer": "B. Hemorrhagic disease of the newborn", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate treatment for a 55-year-old woman who is experiencing long-term mucopurulent discharge from her left eye and swelling near the inner corner of the eye?", "options": [{"label": "A", "text": "Dacryocystorhinostomy", "correct": true}, {"label": "B", "text": "Dacryocystectomy", "correct": false}, {"label": "C", "text": "Incision and drainage", "correct": false}, {"label": "D", "text": "Balloon catheter dilation", "correct": false}], "correct_answer": "A. Dacryocystorhinostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/PWUz0RG0DUEfxiReyFzx1747910819.png", "https://image.prepladder.com/notes/giGbkRuPDXpE98NTF0jY1747910854.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:651px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Acute Dacryocystitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Chronic Dacryocystitis</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> of chronic dacryocystitis</li>\n<li>Spread from neighbouring infected structures (e.g., sinuses, bones, <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> abscess)</li>\n<li><strong>Causative organisms: </strong>Streptococcus haemolyticus, Pneumococcus, Staphylococcus</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Stasis and mild infection of long duration</li>\n<li>Common in women aged 40-60</li>\n<li><strong>Causes:</strong> <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> factors (narrow bony canal), <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> diseases, foreign bodies, infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Features/ Sequelae</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ol>\n<li><strong>Stage of cellulitis: </strong>Painful <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> at the <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> sac, epiphora, fever, redness, and oedema.</li>\n<li><strong>Lacrimal abscess: </strong>Pus-filled sac, <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> swelling, may <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> forming an abscess.</li>\n<li><strong>Fistula formation: </strong>Untreated <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> leads to <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> discharge, forming a fistula.</li>\n</ol>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ol>\n<li><strong>Stage of chronic catarrhal dacryocystitis: </strong>Watering eye, mild redness, NLD block</li>\n<li><strong>Lacrimal mucocele: </strong>Swelling below inner canthus, <span class=\"customMeta\" data-dictid=\"14f3af3bf516927771939c1efb8726\">mucoid</span> fluid regurgitation.</li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> dacryocystitis: </strong>Purulent <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> (d/t infection), <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> conjunctivitis.</li>\n</ol>\n<ol>\n<li><strong>Chronic fibrotic sac: </strong>Thickened mucosa, persistent epiphora, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> folds.</li>\n</ol>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Acute Dacryocystitis with lacrimal fistula\" data-author=\"Chaiti Aranke Waman Chavan\" data-hash=\"13167\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Acute-dacryocystitis-with-pre-septal-cellulitis-with-fistula_fig1_381056510\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/PWUz0RG0DUEfxiReyFzx1747910819.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"OP564 Chronic Dacryocystitis\" data-author=\"Alexis Mathieu 1,*,Stéphanie Baillif 2,3ORCID,Marie-Noelle Delyfer 1,4ORCID,Éric Longueville 1,Valentine Coste-Verdier 1,Jacques Lagier 2,Abdulrhman Alrabiah 2 andArnaud Martel 2,3ORCID\" data-hash=\"13168\" data-license=\"OPEN ACCESS\" data-source=\"https://www.mdpi.com/2077-0383/13/17/5129\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/giGbkRuPDXpE98NTF0jY1747910854.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Conjunctivitis, corneal ulcer, lid abscess, <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> cellulitis, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> cellulitis, rarely <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombosis.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Conjunctivitis, <span class=\"customMeta\" data-dictid=\"410b701d9916927771861ac447b041\">ectropion</span> of lower lid, risk of corneal ulcers.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Cellulitis:</strong> Systemic antibiotics, anti-inflammatory drugs, hot fomentation.</li>\n<li><strong>Lacrimal abscess:</strong> <strong>Drainage</strong> with incision, antibiotics, possible DCT or DCR later. <strong>(Option C)</strong></li>\n<li><strong>External fistula: Fistulectomy </strong>with DCT or DCR after controlling infection.</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Conservative: </strong>Probing and syringing (early stages).</li>\n<li><strong>Dacryocystorhinostomy (DCR):</strong> Preferred surgery to re-establish <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> drainage. <strong>(Option A)</strong></li>\n<li><strong>Dacryocystectomy (DCT):</strong> Indicated if DCR is contraindicated or in cases of fibrosis, infection, or old age (&gt;60y). <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The characteristic appearance of the esophagus on barium swallow, as shown in the image below, is seen in which of the following conditions?", "options": [{"label": "A", "text": "Diffuse oesophageal spasm", "correct": true}, {"label": "B", "text": "Esophageal carcinoma", "correct": false}, {"label": "C", "text": "Esophageal ulcer", "correct": false}, {"label": "D", "text": "Achalasia cardia", "correct": false}], "correct_answer": "A. Diffuse oesophageal spasm", "question_images": ["https://image.prepladder.com/content/WUGDk033LiLZx5wXE9h61745920997.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Barium Swallow Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diffuse <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> (DES)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corkscrew or <span class=\"customMeta\" data-dictid=\"b03d2e290016927771975cb2a45366\">rosary</span> <span class=\"customMeta\" data-dictid=\"b65b938dfa16927771826d42406534\">bead</span> esophagus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uncoordinated contractions, chest pain, <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> dysphagia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Esophageal carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Irregular <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> defect, apple-core lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Progressive dysphagia, weight loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Esophageal ulcer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Niche or crater-like defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated with <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> or malignancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Achalasia cardia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bird’s <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">beak</span> appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Failure of <span class=\"customMeta\" data-dictid=\"8a16e8c6941692777191cdd86f5bc5\">LES</span> relaxation, progressive dysphagia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the heart chamber marked in the given CT image", "options": [{"label": "A", "text": "Right atrium", "correct": false}, {"label": "B", "text": "Right ventricle", "correct": false}, {"label": "C", "text": "Left ventricle", "correct": false}, {"label": "D", "text": "Left atrium", "correct": true}], "correct_answer": "D. Left atrium", "question_images": ["https://image.prepladder.com/notes/wBNSw7YKc1Mse7hQQOjY1747914532.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Chamber</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location on CT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right Atrium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior, right side</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Receives deoxygenated blood from IVC/SVC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right Ventricle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chamber</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lies close to the sternum, pumps blood to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left Atrium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior aspect</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Receives oxygenated blood from <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> veins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left Ventricle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left, inferior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thickest-walled chamber, pumps blood into aorta</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an absolute contraindication for breastfeeding?", "options": [{"label": "A", "text": "Alcoholic mother", "correct": false}, {"label": "B", "text": "Classic galactosemia in the infant", "correct": true}, {"label": "C", "text": "A mother with HIV infection", "correct": false}, {"label": "D", "text": "Infants born to an HbsAg-positive mother", "correct": false}], "correct_answer": "B. Classic galactosemia in the infant", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Classic &lt;span class=\"customMeta\" data-dictid=\"a62cd844a916927771883fd1e691f5\"&gt;galactosemia&lt;/span&gt; in the infant</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Breastfeeding Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Maternal Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infectious Diseases:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Active Tuberculosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mothers with active <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> should delay <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> until they have completed at least <strong>two weeks</strong> of appropriate treatment to reduce the risk of transmission.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Active <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">Herpes</span> Simplex Virus (HSV) Lesions on the Breast:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breastfeeding is contraindicated if a mother has <strong>active <span class=\"customMeta\" data-dictid=\"f17a671af3169277718889c787fa9c\">herpetic</span> lesions</strong> on her breast to prevent transmission to the infant.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varicella-Zoster Infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>If the mother has active <span class=\"customMeta\" data-dictid=\"d5b9e7187c16927771847488b5f135\">chickenpox</span> lesions, <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> should be avoided to prevent <span class=\"customMeta\" data-dictid=\"1ed9501c341692777186f4793753eb\">direct contact</span> between the lesions and the infant. The infant should also receive appropriate immunoglobulin.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medications and Treatments: </strong></p>\n<p>Chemotherapy, Radiopharmaceuticals and Certain Medications</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Breastfeeding is usually contraindicated during <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> treatment with <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> or radiopharmaceuticals due to the potential harm to the infant.</li>\n<li>Specific medications, such as some anticoagulants, anti-tuberculosis drugs, and anticonvulsants, may require mothers to avoid breastfeeding.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Substance Use: Alcohol </strong>and Smoking</p>\n<p><strong>(Option A) </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>While not a strict contraindication, alcohol consumption should be limited to less than 0.5g/kg/day.</li>\n<li>Cigarette smoking is strongly discouraged.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Maternal Health Conditions:</strong></p>\n<ul>\n<li>Severe Illness or Surgery</li>\n<li>Breast Conditions</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Maternal issues like <strong>mastitis or breast engorgement</strong> may complicate <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> and require temporary cessation but are not absolute contraindications.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<h4><strong>Fetal Contraindications</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Disorders:</strong> <strong>Galactosemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infants with galactosemia</strong>, a condition where they cannot process galactose, should not be breastfed. Instead, they require specialized formulas.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anatomical Challenges:</strong> Oral or <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> Anomalies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conditions like <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> that affect the infant's ability to <span class=\"customMeta\" data-dictid=\"64bc8b998d1692777199dea9cda68a\">suckle</span> may necessitate alternative <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> methods.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prematurity or Low Birth Weight:</strong> Support Needs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Premature or low-birth-weight infants may initially require supplemental <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> methods until they can effectively breastfeed.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following surgeries use this instrument?", "options": [{"label": "A", "text": "Evisceration", "correct": false}, {"label": "B", "text": "Enucleation", "correct": false}, {"label": "C", "text": "Cataract surgery", "correct": false}, {"label": "D", "text": "Dacryocystorhinostomy", "correct": true}], "correct_answer": "D. Dacryocystorhinostomy", "question_images": ["https://image.prepladder.com/notes/04QItSWRgh15Kwmm5y2M1747910928.png"], "explanation_images": ["https://image.prepladder.com/content/gOzYRmZxP0K0ixWBlNzv1745921164.png", "https://image.prepladder.com/notes/04QItSWRgh15Kwmm5y2M1747910928.png", "https://image.prepladder.com/content/hNRWbhrEn1MJxYMrwWfa1745921164.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case presented, can you identify the imaging technique employed and the specific diagnosis related to the kidneys?", "options": [{"label": "A", "text": "MRI of polycystic kidney disease", "correct": true}, {"label": "B", "text": "CT of polycystic kidney disease", "correct": false}, {"label": "C", "text": "MRI of Horseshoe kidney", "correct": false}, {"label": "D", "text": "CT of Horseshoe Kidney", "correct": false}], "correct_answer": "A. MRI of polycystic kidney disease", "question_images": ["https://image.prepladder.com/notes/5zsuEnADJpEpOk7Z9ytg1747911564.png"], "explanation_images": ["https://image.prepladder.com/notes/cKRD9QC4VlZkqHuoh8181747722144.png", "https://image.prepladder.com/content/oiVGD7iiKxpR3CRS5iwm1745921262.png", "https://image.prepladder.com/content/Z72aaMszFsKMpIH82V4S1745921262.png", "https://image.prepladder.com/content/5XZWEMh9L0zEvHQJsr3l1745921262.png", "https://image.prepladder.com/notes/Qe7YwPvJUuX3BfblqXVD1747722941.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Imaging Modality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound (USG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enlarged kidneys, multiple cysts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First-line screening in suspected PKD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple cysts, hemorrhage, infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detects complications like <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> or infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-resolution <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> of cysts, no radiation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preferred for assessing <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function and disease progression</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Plain Radiograph</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Enlarged, multilobulated <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> outlines with <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> displacement.</li>\n<li>Multiple calcifications, sometimes with multiple ring appearance.</li>\n<li><strong>Intravenous urography</strong>: \"Swiss cheese nephrogram\" (due to multiple <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cysts), \"Spiderleg pyelogram\" (stretched <span class=\"customMeta\" data-dictid=\"3cc82f8bfb1692777195602cfccef5\">pelvicalyceal</span> system).</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Swiss Cheese pattern\" data-author=\"Moreira, Ana Sofia &amp; Castro, Miguel &amp; Grande, Pablo &amp; Gameiro, Ana &amp; Bahia Soares, Carla &amp; Costa, Yessica &amp; Silva, Luís &amp; Saraiva, José &amp; Dinis, Mónica.\" data-hash=\"13056\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Swiss-Cheese-Appearance-Renal-ultrasound-showing-polycystic-kidneys-in-a-patient-with_fig3_314914201\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/cKRD9QC4VlZkqHuoh8181747722144.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple cysts: Anechoic with thin walls, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">acoustic</span> enhancement, and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> shadowing.</li>\n<li>Complicated cysts (haemorrhage/infection): Echogenic material within the cyst, possible wall calcification, absence of internal blood flow.</li>\n<li><strong>CEUS</strong>: Demonstrates enhancement</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Kristoffer Lindskov Hansen, Michael Bachmann Nielsen and Caroline Ewertsen\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Advanced_polycystic_kidney_disease_with_multiple_cysts.jpg\" data-tags=\"\" height=\"411\" src=\"https://image.prepladder.com/content/oiVGD7iiKxpR3CRS5iwm1745921262.png\" width=\"519\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple cysts: Rounded with near-water <span class=\"customMeta\" data-dictid=\"22818451b71692777182237914a233\">attenuation</span> and thin walls.</li>\n<li>Complications (haemorrhage/infection): Higher <span class=\"customMeta\" data-dictid=\"22818451b71692777182237914a233\">attenuation</span> and wall calcification.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Yamada, Yasutoshi &amp; Enokida, Hideki &amp; Mitsuke, Akihiko &amp; Nishimura, Hiroaki &amp; Tatarano, Shuichi &amp; Nakagawa, Masayuki.\" data-hash=\"\" data-license=\"CC BY-NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Preoperative-CT-Preoperative-CT-showing-large-polycystic-kidneys-occupying-the-pelvis_fig1_334567994\" data-tags=\"\" height=\"565\" src=\"https://image.prepladder.com/content/Z72aaMszFsKMpIH82V4S1745921262.png\" width=\"419\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>CT showing ADPKD</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>T2 MRI- The most sensitive <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> modality</li>\n<li>Both enlarged kidneys have multiple cysts</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Brisbane\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.ncbi.nlm.nih.gov/books/NBK373387/figure/fig4_1/\" data-tags=\"\" height=\"405\" src=\"https://image.prepladder.com/content/5XZWEMh9L0zEvHQJsr3l1745921262.png\" width=\"495\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>MRI showing ADPKD</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In what situation is popcorn calcification observed?", "options": [{"label": "A", "text": "Hodgkin’s lymphoma", "correct": false}, {"label": "B", "text": "Pulmonary hamartoma", "correct": true}, {"label": "C", "text": "Metastasis", "correct": false}, {"label": "D", "text": "Fungal ball", "correct": false}], "correct_answer": "B. Pulmonary hamartoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xGSPsQ7gYn79QO6IA98A1745921354.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child was brought to the emergency room, with a fever for 2 days, dyspnea, drooling and inspiratory stridor. Lateral x-ray neck findings were as seen below. Which is the most common organism (in India) that causes this condition in children?", "options": [{"label": "A", "text": "Haemophilus influenza B", "correct": true}, {"label": "B", "text": "Influenza virus", "correct": false}, {"label": "C", "text": "Staphylococcus", "correct": false}, {"label": "D", "text": "RSV", "correct": false}], "correct_answer": "A. Haemophilus influenza B", "question_images": ["https://image.prepladder.com/content/VRCb1r1An8OOu2NNwuQ61745921270.png"], "explanation_images": ["https://image.prepladder.com/notes/5XB6Ug3gz8gUUlZjulv71747899166.png", "https://image.prepladder.com/notes/x4NZHWMFO0wphJLRlOee1747899261.png"], "explanation": "<p>Correct Answer A - Haemophilus &lt;span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\"&gt;influenza&lt;/span&gt; B</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute Epiglottitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Life-threatening infection that causes profound <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the upper airways, which can lead to <span class=\"customMeta\" data-dictid=\"bc3e3350401692777182edb342a55b\">asphyxia</span> and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> arrest.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Agent </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Past Era (Pre-vaccine):</strong> <strong>Haemophilus influenzae type b</strong> (Hib)</li>\n<li><strong>Post-vaccine Era:</strong>\n<ul>\n<li>Streptococcus pneumoniae (M/c), Streptococcus pyogenes, non-typeable <strong>H. influenzae (Option B)</strong>, and <strong>Staphylococcus aureus</strong> <strong> (Option C)</strong></li>\n<li>Hib cases have decreased by 99% due to widespread vaccination</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High fever</li>\n<li>Sore throat</li>\n<li>Dyspnea</li>\n<li>Respiratory obstruction</li>\n<li>Respiratory distress</li>\n<li>The child appears toxic</li>\n<li>Difficulty swallowing</li>\n<li>Labored breathing</li>\n<li>Drooling</li>\n<li>Neck <span class=\"customMeta\" data-dictid=\"2ad2fb4cc8169277718925a677620c\">hyperextension</span> to maintain airway</li>\n<li>Tripod position (sitting upright, leaning forward)</li>\n<li>Stridor is a late sign indicating near-complete <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction</li>\n<li>Cyanosis</li>\n<li>Coma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Laryngoscopy: </strong>Large, cherry-red, swollen epiglottis</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Acute epiglottitis laryngoscopy\" data-author=\"Andreas Pfleger, Ernst Eber\" data-hash=\"13120\" data-license=\"NA\" data-source=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/epiglottitis\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/5XB6Ug3gz8gUUlZjulv71747899166.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li><strong>Lateral neck X-ray: </strong>Thumb sign</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Acute Epiglottitis XRAY thumb sign\" data-author=\"Niknejad M, Sharma R, Bell D\" data-hash=\"13121\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/thumb-sign-epiglottitis-1?lang=gb\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/x4NZHWMFO0wphJLRlOee1747899261.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Immediate Treatment: </strong>\n<ul>\n<li>Secure the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> with <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> or <span class=\"customMeta\" data-dictid=\"9ba22ae55f169277719389da129794\">nasotracheal</span> <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> or, less often, with tracheostomy.</li>\n<li>Intubation is generally for 2-3 days.</li>\n<li>Intubation decreases mortality from 6% to &lt;1% in <span class=\"customMeta\" data-dictid=\"116f86834a1692777187cc42a05978\">epiglottitis</span> cases.</li>\n<li>Culture Collection: Blood, epiglottic surface and CSF in certain cases after the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> is stabilized.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Antibiotics: </strong>Ceftriaxone, <span class=\"customMeta\" data-dictid=\"7f8bb85abd16927771843dfaa54ccd\">cefepime</span> or <span class=\"customMeta\" data-dictid=\"77ea8a3b721692777192e12cfb7ab6\">meropenem</span> given parenterally for 10 days.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Recovery </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms improve with a few days of antibiotics, and the patient may be extubated.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man presents to the emergency department with complaints of severe abdominal pain and 3 episodes of vomiting in the past 9 hours. He says that the pain radiates to the back and is partially relieved by bending forwards. The abdominal radiograph of the patient is given below which shows a ‘colon cut-off sign ’. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute hepatitis", "correct": false}, {"label": "B", "text": "Acute pancreatitis", "correct": true}, {"label": "C", "text": "Acute colitis", "correct": false}, {"label": "D", "text": "Intestinal obstruction", "correct": false}], "correct_answer": "B. Acute pancreatitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; pancreatitis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> due to <strong>premature <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> activation</strong>, leads to autodigestion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong> (<em>Mnemonic: \"I GET SMASHED\"</em>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong>diopathic, <strong>G</strong>allstones (most common), <strong>E</strong>thanol, <strong>T</strong>rauma, <strong>S</strong>teroids, <strong>M</strong>umps, <strong>A</strong>utoimmune, <strong>S</strong>corpion sting, <strong>H</strong>yperlipidemia/hypercalcemia, <strong>E</strong>RCP, <strong>D</strong>rugs (thiazides, azathioprine).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe epigastric pain</strong> (radiates to back, worsens after food), <strong>nausea, vomiting, fever</strong>. Severe cases: <strong>Cullen’s Sign</strong> (periumbilical bruising), <strong>Grey Turner’s Sign</strong> (flank bruising), <strong>Colon Cutoff Sign</strong> (gas-filled, distended <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> with abrupt cut-off at splenic <span class=\"customMeta\" data-dictid=\"13e47cfa68169277720299cd54beb4\">flexure</span> due to inflammation).<strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis (Atlanta Criteria)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>≥2 of 3 criteria</strong>: (1) <strong>Lipase &gt;3x ULN</strong> (more specific than amylase), (2) <strong>Epigastric pain</strong>, (3) <strong>Imaging (CT/USG/MRI) evidence</strong>. <strong>CT scan</strong> (best for complications), <strong>Ultrasound</strong> (detects gallstones).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severity Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild:</strong> No organ failure, <strong>Moderate:</strong> &lt;48 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> organ failure, <strong>Severe:</strong> &gt;48 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> organ failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV Fluids (Ringer’s lactate), <span class=\"customMeta\" data-dictid=\"cc5c05259716927771933078784603\">NPO</span> (Bowel Rest), Pain Control (IV opioids), and <span class=\"customMeta\" data-dictid=\"b36da50c8d169277718782ffc6960b\">Enteral</span> <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> are preferred over TPN. <span class=\"customMeta\" data-dictid=\"b2276d3d4c16927771872281723792\">ERCP</span> only if <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> with cholangitis. No routine antibiotics unless infected necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early (&lt;1 week): SIRS, Shock, ARDS, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> failure, DIC, Hypocalcemia. Late (&gt;1 week): <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">Necrosis</span> (sterile/infected), Pseudocyst, Abscess, Chronic Pancreatitis, <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">Biliary</span> obstruction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Steroid-resistant nephrotic syndrome is defined as failure to achieve remission after ___ weeks when on a daily corticosteroid therapy regimen.", "options": [{"label": "A", "text": "6", "correct": true}, {"label": "B", "text": "4", "correct": false}, {"label": "C", "text": "12", "correct": false}, {"label": "D", "text": "10", "correct": false}], "correct_answer": "A. 6", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - 6\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the investigation shown below which is the investigation of choice in distal bowel tumors.", "options": [{"label": "A", "text": "Enteroclysis", "correct": false}, {"label": "B", "text": "Barium meal", "correct": false}, {"label": "C", "text": "Barium meal follow-through", "correct": false}, {"label": "D", "text": "Barium enema", "correct": true}], "correct_answer": "D. Barium enema", "question_images": ["https://image.prepladder.com/notes/Z0ypXkNEmaUgCIXyy8Mj1747722478.png"], "explanation_images": ["https://image.prepladder.com/content/9yhfAOkWgffArkHYPxqT1745921507.png", "https://image.prepladder.com/content/VAy8K8llsn2M9bRGeK4I1745921507.png", "https://image.prepladder.com/notes/bCAyPHJCB8GKOHwMfOb01747911688.png", "https://image.prepladder.com/content/KXqaWJVwdvkrEz0Qx0Tc1745921507.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Best for</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Swallow</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Subhan Iqbal \" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/normal-oesophageal-contours-on-barium-swallow\" data-tags=\"\" height=\"336\" src=\"https://image.prepladder.com/content/9yhfAOkWgffArkHYPxqT1745921507.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oropharyngeal and <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> disorders</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Esophageal stricture, achalasia, tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Meal</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Seneviratne SA, Samarasekera DN\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://openi.nlm.nih.gov/detailedresult?img=PMC2740091_1757-1626-0002-0000006710-001&amp;query=barium%20meal&amp;it=xg&amp;req=4&amp;npos=13\" data-tags=\"\" height=\"178\" src=\"https://image.prepladder.com/content/VAy8K8llsn2M9bRGeK4I1745921507.png\" width=\"235\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper GI <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> evaluation (stomach, duodenum)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peptic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease, <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Meal Follow-through</strong></p>\n<figure class=\"caption_element\"><img alt=\" Barium Meal Follow through\" data-author=\" Glitzy queen00\" data-hash=\"13173\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Smallbowel.jpg\" data-tags=\"May2025\" height=\"300\" src=\"https://image.prepladder.com/notes/bCAyPHJCB8GKOHwMfOb01747911688.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> imaging</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crohn’s disease, <span class=\"customMeta\" data-dictid=\"819ebcc6691692777191f968d41a03\">malabsorption</span> syndromes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Enteroclysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detailed small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> study</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subtle small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> lesions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Enema</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Kim JS, Lee BI, Kim BW, Choi H, Lee YS, Maeng L\" data-hash=\"\" data-license=\"CC BY-NC 3.0\" data-source=\"https://openi.nlm.nih.gov/detailedresult?img=PMC3797951_ce-46-591-g001&amp;query=barium%20enema&amp;it=xg&amp;req=4&amp;npos=69\" data-tags=\"\" height=\"240\" src=\"https://image.prepladder.com/content/KXqaWJVwdvkrEz0Qx0Tc1745921507.png\" width=\"234\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Colon and rectal pathology</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> tumors, polyps, IBD</p>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Barium swallow | Radiology Reference Article | Radiopaedia.org</li><li>↳ Normal indentations on the esophagus in barium swallow</li><li>↳ Definition of barium-meal photofluorography - NCI Dictionary of Cancer Terms</li><li>↳ Barium Tests (Barium Meal, Swallow, Follow Through)</li><li>↳ Double contrast barium enema technique | Radiology Reference Article</li><li>↳ Grainger and Allison’s Textbook of Diagnostic Radiology, 7th edition, Page 483</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common radio-isotope in pet scan :", "options": [{"label": "A", "text": "13C", "correct": false}, {"label": "B", "text": "14C", "correct": false}, {"label": "C", "text": "18F", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. 18F", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) 18F\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following biochemical parameters are correct in vitamin D-dependent rickets? Serum calcium PTH level A Decreased / normal Normal B Decreased / normal Increased C Decreased Increased D Increased Increased", "options": [{"label": "A", "text": "A", "correct": false}, {"label": "B", "text": "B", "correct": true}, {"label": "C", "text": "C", "correct": false}, {"label": "D", "text": "D", "correct": false}], "correct_answer": "B. B", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - B</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Disorder </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Pi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>PTH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>25-(OH)D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>1,25-(OH)2D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>ALP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Urine Calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Urine Pi</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Vitamin D deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￬, N,￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Vitamin D-dependent <span class=\"customMeta\" data-dictid=\"3bbd4ac09b16927771974d75a8b355\">rickets</span> Type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>N,</strong><strong>￬</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>￬</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Vitamin D dependent ricketsType 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>N,</strong><strong>￬</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>￬</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￪￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child is brought to you with complaints of 18 episodes of loose stools in the last 24 hours and vomiting twice in the last 4 hours. The child is irritable but drinking fluids. The optimal therapy for this child is—", "options": [{"label": "A", "text": "Intravenous fluids", "correct": false}, {"label": "B", "text": "Oral rehydration therapy with ORS", "correct": true}, {"label": "C", "text": "Intravenous fluid initially for 4 hours followed by oral fluids", "correct": false}, {"label": "D", "text": "Plain water add lithium", "correct": false}], "correct_answer": "B. Oral rehydration therapy with ORS", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Oral &lt;span class=\"customMeta\" data-dictid=\"ffe9347bcc169277719793b2de1c6d\"&gt;rehydration&lt;/span&gt; therapy with ORS</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Constituent </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>WHO-ORS (Conventional ORS) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reduced <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> <span class=\"customMeta\" data-dictid=\"dba8ab2e8416927771945fed398293\">ORS</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sodium </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">90 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">75 mmol/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chloride </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">80 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">65 mmol/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Glucose, <span class=\"customMeta\" data-dictid=\"134c66224a16927771818327a12185\">anhydrous</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">111 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">75 mmol/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Potassium </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">20 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">20 mmol/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Citrate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">10 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">10 mmol/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Total <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">311 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">245 mmol/L</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure C.", "options": [{"label": "A", "text": "Epiglottis", "correct": true}, {"label": "B", "text": "Hyoid bone", "correct": false}, {"label": "C", "text": "Thyroid cartilage", "correct": false}, {"label": "D", "text": "Cricoid cartilage", "correct": false}], "correct_answer": "A. Epiglottis", "question_images": ["https://image.prepladder.com/notes/Dnuwm11ZPeROph6Pm6Hs1747893586.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epiglottis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leaf-shaped, <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prevents <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> by covering the <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> during swallowing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thyroid cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Largest, shield-shaped cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides structure and protects the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cricoid cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ring-shaped, below <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintains <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> patency, <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> for muscles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arytenoid cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paired, pyramid-shaped</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Controls vocal cord movement</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely cause of sudden loss of vision in the left eye for the past two hours in a 58-year-old man who experienced it after his retirement party? The fundoscopic examination reveals a similar image shown below.", "options": [{"label": "A", "text": "BRAO", "correct": false}, {"label": "B", "text": "CRAO", "correct": true}, {"label": "C", "text": "CRVO", "correct": false}, {"label": "D", "text": "BRVO", "correct": false}], "correct_answer": "B. CRAO", "question_images": ["https://image.prepladder.com/content/FfDJ8jHgFRKtPlX1QijC1745921659.png"], "explanation_images": ["https://image.prepladder.com/content/pld9ZdE9QOZOzjd2cOMH1745921865.png", "https://image.prepladder.com/content/MP147zfSaRpQwYdpvnuN1745921859.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Atherosclerosis</li>\n<li>Age</li>\n<li>Hypertension/Cardiac Diseases</li>\n<li>Thrombophilic Disorders</li>\n<li>Smoking</li>\n<li>Diabetes Mellitus</li>\n<li>Oral Contraceptive Pills</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms:</strong></p>\n<ul>\n<li><strong>Sudden, painless, profound vision loss</strong>.</li>\n<li>Painful only in GCA: May present with headache, jaw claudication, <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> tenderness, and/or pain around the temple.</li>\n</ul>\n<p> </p>\n<p><strong>Clinical Signs:</strong></p>\n<ul>\n<li>Severely <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> Visual Acuity (VA), often to <span class=\"customMeta\" data-dictid=\"e58c34390016927771859e87c91ed7\">counting</span> fingers or worse.</li>\n<li>Profound and sometimes total Relative Afferent Pupillary Defect (RAPD), also called an amaurotic pupil.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fundus Examination:</strong></p>\n<ul>\n<li>Retinal Whitening: Pale and <span class=\"customMeta\" data-dictid=\"1b8aa0db391692777194178f73c98c\">opaque</span> retina, particularly in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pole.</li>\n<li><strong>Cherry-Red Spot: </strong>Bright red area at the <span class=\"customMeta\" data-dictid=\"82c2ec751816927772034d164bf755\">fovea</span> due to the contrast between pale <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> and underlying <span class=\"customMeta\" data-dictid=\"cea77d01ce1692777184854450c378\">choroidal</span> circulation.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dr. Gopal Bisht\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Cherry_red_spot_in_patient_with_central_retinal_artery_occlusion_(CRAO).jpg\" data-tags=\"\" height=\"498\" src=\"https://image.prepladder.com/content/pld9ZdE9QOZOzjd2cOMH1745921865.png\" width=\"642\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Cattle Truck Appearance:</strong> Segmentation of the blood column in <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> veins.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Leo A. Kim, MD, PhD, Mary Elizabeth Hartnett, MD, Marianna Kavalaraki MD, Msc, Neelakshi Bhagat, MD, FACS, Cindy S. Zhao, MD, MBA, Avni Finn, MD, MBA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://eyewiki.org/Cherry-Red_Spot\" data-tags=\"\" height=\"480\" src=\"https://image.prepladder.com/content/MP147zfSaRpQwYdpvnuN1745921859.png\" width=\"647\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li>Attenuated Arteries: Narrowed and segmented <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> arterioles.</li>\n<li>Optic Disc Changes: Pale <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc over time due to <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> from prolonged <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> (chronic cases).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluorescein Angiography (FFA):</strong></p>\n<ul>\n<li>Delayed arterial filling.</li>\n<li>Masking of background <span class=\"customMeta\" data-dictid=\"da0e2a00fa1692777202d6e2054b26\">fluorescence</span> due to edematous retina.</li>\n<li><strong>Patent <span class=\"customMeta\" data-dictid=\"1e99ed05df169277718456b9311c0d\">Cilioretinal</span> Artery:</strong> Area of normal <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> of a <span class=\"customMeta\" data-dictid=\"1e99ed05df169277718456b9311c0d\">cilioretinal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> supplies the fovea, potentially preserving central vision.</li>\n</ul>\n<p><strong>Other Diagnostic Tests:</strong></p>\n<ul>\n<li>Retinal edema, structural changes, and possibly an <span class=\"customMeta\" data-dictid=\"acd7af7f74169277718736b038fb02\">embolic</span> <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> within the <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> artery.</li>\n<li>Cranial MRI or CT.</li>\n<li>Carotid duplex scanning.</li>\n<li>Echocardiography.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Smoking cessation</li>\n<li>Ocular massage</li>\n<li>IOP control agents: Acetazolamide</li>\n<li>Hyperosmotics: Mannitol</li>\n<li>Carbogen (95% O2 + 5% CO2) inhalation</li>\n<li>Nd-YAG laser embolectomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The inner layer of the fallopian tube is covered by:", "options": [{"label": "A", "text": "Simple columnar epithelium", "correct": false}, {"label": "B", "text": "Pseudostratified ciliated columnar epithelium", "correct": false}, {"label": "C", "text": "Ciliated columnar epithelium", "correct": true}, {"label": "D", "text": "Cuboidal epithelium with microvilli", "correct": false}], "correct_answer": "C. Ciliated columnar epithelium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mucosa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ciliated columnar epithelium</strong> with <span class=\"customMeta\" data-dictid=\"9e7aec9ff416927771984a1e3100b7\">secretory</span> (peg) cells</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Helps in <span class=\"customMeta\" data-dictid=\"7c1d9800e2169277719426cf66bb68\">ovum</span> transport and <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of nutrients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscularis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inner <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> and outer <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> smooth muscle layers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peristalsis aids in <span class=\"customMeta\" data-dictid=\"7c1d9800e2169277719426cf66bb68\">ovum</span> movement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serosa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Outer peritoneal covering</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides structural integrity</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common type of radiolucent renal stone?", "options": [{"label": "A", "text": "Calcium Oxalate Stones", "correct": false}, {"label": "B", "text": "Uric Acid Stones", "correct": true}, {"label": "C", "text": "Cystine Stones", "correct": false}, {"label": "D", "text": "Xanthine Stones", "correct": false}], "correct_answer": "B. Uric Acid Stones", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/82jpF0Y25pWtFruwlzAG1745921697.png", "https://image.prepladder.com/content/EEMPQSpUJ13B2ny8DGnj1745921704.png", "https://image.prepladder.com/content/MnGe9p1yLrm0N5g5zQOr1745921685.png", "https://image.prepladder.com/content/oMBSDum3pOk4mlk6PHR81745921657.png", "https://image.prepladder.com/content/HaJDqRQF9IK7wDoR9TJj1745921648.png", "https://image.prepladder.com/content/sdr862kx0cDOkDznxDO91745921634.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stone Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Oxalate</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>The most common type of stone (60–85% of all stones)</strong>;<strong> Radiopaque</strong></li>\n<li>Associated with hypercalciuria, hypercalcaemia, hyperoxaluria, hyperuricosuria, and hypocitraturia</li>\n<li><strong>Types:</strong> monohydrate (dumbbell-shaped) , <span class=\"customMeta\" data-dictid=\"168c514d4016927771861c453b7a5a\">dihydrate</span> (envelope shaped)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Doruk Salancı\" data-hash=\"\" data-license=\"CC-by-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Calcium_oxalate_crystals_(urine)_-_kalsiyum_oksalat_kristalleri_(idrar)_-_01.png\" data-tags=\"\" height=\"113\" src=\"https://image.prepladder.com/content/82jpF0Y25pWtFruwlzAG1745921697.png\" width=\"127\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong></strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Doruk Salancı\" data-hash=\"\" data-license=\"CC-by-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Calcium_oxalate_crystals_(urine)_-_kalsiyum_oksalat_kristalleri_(idrar)_-_01.png\" data-tags=\"\" height=\"254\" src=\"https://image.prepladder.com/content/EEMPQSpUJ13B2ny8DGnj1745921704.png\" width=\"90\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong></strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Phosphate</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pure <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> stones are rare</li>\n<li>Types include <span class=\"customMeta\" data-dictid=\"4cd2f5e61a1692777181e000c76341\">apatite</span> and <span class=\"customMeta\" data-dictid=\"142bd44f0b1692777183ea2f5f9fb8\">brushite</span> stones</li>\n<li>Apatite stones are seen with infection; <span class=\"customMeta\" data-dictid=\"142bd44f0b1692777183ea2f5f9fb8\">brushite</span> stones are associated with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis.</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Mikael Häggström, Klinkhardt, Julius\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://en.m.wikipedia.org/wiki/File:Calcium_phosphate_crystal.jpg\" data-tags=\"\" height=\"470\" src=\"https://image.prepladder.com/content/MnGe9p1yLrm0N5g5zQOr1745921685.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Struvite</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aka staghorn <span class=\"customMeta\" data-dictid=\"eae898f16d1692777183cc3469a664\">calculi</span> / Triple <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> stone (Ca, Mg, NH4+, Phosphate)</li>\n<li><strong>Radiopaque</strong></li>\n<li><strong>Infection stones </strong>that <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> in <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> due to <strong>urease-producing bacteria</strong> (e.g., <em>Proteus, Klebsiella, Serratia, Enterobacter</em>)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Joel Mills\" data-hash=\"\" data-license=\" CC BY-SA 3.0,\" data-source=\"https://commons.wikimedia.org/w/index.php?curid=1607945\" data-tags=\"\" height=\"416\" src=\"https://image.prepladder.com/content/oMBSDum3pOk4mlk6PHR81745921657.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong></strong> </p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystine</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Radiopaque</strong>, Constitute approximately 1% of stones</li>\n<li>Result from <strong>cystinuria</strong>, an autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> inherited disease that causes decreased <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of cystine.</li>\n<li>Very hard stones due to <span class=\"customMeta\" data-dictid=\"dee47c70a41692777186cf17523799\">disulfide</span> bonds</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Lance Wheeler\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Cystinuria#/media/File:Cystine_Crystals_in_Canine_Urine_Sediment.jpg\" data-tags=\"\" height=\"273\" src=\"https://image.prepladder.com/content/HaJDqRQF9IK7wDoR9TJj1745921648.png\" width=\"259\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uric Acid</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Radiolucent </strong></li>\n<li>Promoted by hyperuricosuria, which can be caused by conditions like<strong> <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> and <span class=\"customMeta\" data-dictid=\"8dd789d7d1169277719303d4744837\">myeloproliferative</span> disorders</strong></li>\n<li>Precipitates in <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and remains <span class=\"customMeta\" data-dictid=\"845fedd06d16927771989597afa034\">soluble</span> in <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> urine.</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Iqbal Osman - Queremel Milani DA, Jialal I\" data-hash=\"\" data-license=\"CC By 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Uric_acid_crystals_in_urine_sediment.jpg\" data-tags=\"\" height=\"342\" src=\"https://image.prepladder.com/content/sdr862kx0cDOkDznxDO91745921634.png\" width=\"347\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false about thoracolumbar fascia?", "options": [{"label": "A", "text": "They contain nociceptive nerve endings", "correct": false}, {"label": "B", "text": "In the lumbar region, it is in 4 layers", "correct": true}, {"label": "C", "text": "In the thoracic region, it is attached medially to the vertebrae", "correct": false}, {"label": "D", "text": "The anterior, posterior and middle join to form the aponeurotic origin of transversus abdominis", "correct": false}], "correct_answer": "B. In the lumbar region, it is in 4 layers", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Region</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Layers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Attachments</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thoracic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Single layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medially to vertebrae, laterally to ribs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Covers <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> back muscles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lumbar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Three layers (anterior, middle, posterior)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Encloses <span class=\"customMeta\" data-dictid=\"2443adae9d16927771966d5111bc18\">quadratus</span> lumborum and <span class=\"customMeta\" data-dictid=\"1ac45bd32a169277718722c633169f\">erector</span> spinae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supports <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine, transmits forces</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image below shows the cross-section of the trachea. Identify the structure marked.", "options": [{"label": "A", "text": "Trachealis muscle", "correct": true}, {"label": "B", "text": "Tracheal cartilage", "correct": false}, {"label": "C", "text": "Esophageal submucosal gland", "correct": false}, {"label": "D", "text": "Perichondrium", "correct": false}], "correct_answer": "A. Trachealis muscle", "question_images": ["https://image.prepladder.com/notes/TzJyOaIZS1Db1Fm35Kxa1747894003.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tracheal cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C-shaped <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">hyaline</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> rings</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Keeps the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> open</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trachealis muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior, between <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> ends</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regulates <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> diameter, aids in forceful expiration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Esophageal <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In the <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> (posterior to trachea)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Produces <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> for lubrication</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Perichondrium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surrounds cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides <span class=\"customMeta\" data-dictid=\"05bef24e711692777193a154b462b4\">nutrition</span> and support</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the auscultatory areas of the heart from the image given below.", "options": [{"label": "A", "text": "1-aortic, 2-pulmonary, 3-mitral, 4-tricuspid", "correct": false}, {"label": "B", "text": "1-aortic, 2-pulmonary, 3- tricuspid, 4-mitral", "correct": true}, {"label": "C", "text": "1-mitral, 2-pulmonary, 3- tricuspid, 4-aortic", "correct": false}, {"label": "D", "text": "1-aortic,2-tricuspid, 3- pulmonary, 4-mitral", "correct": false}], "correct_answer": "B. 1-aortic, 2-pulmonary, 3- tricuspid, 4-mitral", "question_images": ["https://image.prepladder.com/notes/CC5ujnVvECcJNX3t7D1Q1748236430.png"], "explanation_images": ["https://image.prepladder.com/notes/MTXkdmDtM1kmAIA3H9lJ1748237856.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Valve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Auscultation Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aortic valve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right 2nd ICS, parasternal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best for <strong>aortic stenosis</strong> murmur</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulmonary valve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left 2nd ICS, parasternal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best for <strong>pulmonary stenosis</strong> murmur</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tricuspid valve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left 4th ICS, parasternal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best for <strong>tricuspid regurgitation</strong> murmur</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mitral valve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left 5th ICS, midclavicular line (apex beat)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best for <strong>mitral regurgitation/stenosis</strong> murmur</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The probable cause for a patient with a corneal scar having a visual acuity of 6/36, which improves to 6/18 with a pinhole, is most likely due to...", "options": [{"label": "A", "text": "Glaucoma", "correct": false}, {"label": "B", "text": "Malingering", "correct": false}, {"label": "C", "text": "Irregular astigmatism", "correct": true}, {"label": "D", "text": "Cataract", "correct": false}], "correct_answer": "C. Irregular astigmatism", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nrAjU7bTE3BghwYVg9VY1745922026.png", "https://image.prepladder.com/content/QVeS8ySc2aETSmprwRbG1745922051.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pinhole Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stenopeic <span class=\"customMeta\" data-dictid=\"7fbb9ec5b716927771981c011f4299\">Slit</span> Test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uses a small <span class=\"customMeta\" data-dictid=\"1b8aa0db391692777194178f73c98c\">opaque</span> disc with holes to reduce <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"a24c7a76a516927771832d7d7e1a2c\">blur</span> and improve visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> in <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> errors up to 4D.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ajeeshkumar4u\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Pinhole_occluder#/media/File:Pinhole_occluder.jpg\" data-tags=\"\" height=\"342\" src=\"https://image.prepladder.com/content/nrAjU7bTE3BghwYVg9VY1745922026.png\" width=\"408\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uses a narrow <span class=\"customMeta\" data-dictid=\"7fbb9ec5b716927771981c011f4299\">slit</span> to reduce <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> aberrations and enhance depth of focus.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"329\" src=\"https://image.prepladder.com/content/QVeS8ySc2aETSmprwRbG1745922051.png\" width=\"328\"/></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p><strong>Clinical Applications</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Determines if <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> vision is due to <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> errors; vision improvement suggests a <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> issue.<strong> (Option C)</strong></li>\n<li>Quick assessment of visual acuity, often in under-resourced settings.</li>\n<li>WHO recommended <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">blindness</span> surveys.</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>To assess astigmatism, especially <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> (as it allows for a more detailed analysis of the patient's <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> by <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> light along a single axis) or complex visual issues.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"ff6ffb032616927771994e40ee7dbe\">stenopeic</span> <span class=\"customMeta\" data-dictid=\"7fbb9ec5b716927771981c011f4299\">slit</span> is used in cases of corneal opacities to help identify the best location for an <span class=\"customMeta\" data-dictid=\"39020a9ff61692777194d4aca09c3b\">optical</span> iridectomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Limitations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Can underestimate post-refractive visual acuity.</li>\n<li>Reduces light reaching the retina, potentially causing <span class=\"customMeta\" data-dictid=\"ad4c6b3e971692777186eb455dd56f\">diffraction</span> blur.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Limited mainly to complex <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> issues.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition as shown below in the x-ray radiograph of a neonate?", "options": [{"label": "A", "text": "Pneumomediastinum", "correct": false}, {"label": "B", "text": "Cystic fibrosis", "correct": false}, {"label": "C", "text": "Congenital diaphragmatic hernia", "correct": true}, {"label": "D", "text": "Bronchiolitis", "correct": false}], "correct_answer": "C. Congenital diaphragmatic hernia", "question_images": ["https://image.prepladder.com/content/hFgClm9ma4MXi49LE8x91745922169.png"], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\"&gt;Congenital&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"06ff18f51216927771867fe1461a04\"&gt;diaphragmatic&lt;/span&gt; h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the following conditions is the Whitaker test recommended?", "options": [{"label": "A", "text": "Hydronephrosis", "correct": true}, {"label": "B", "text": "Posterior urethral valve", "correct": false}, {"label": "C", "text": "Urethral atresia", "correct": false}, {"label": "D", "text": "Urethral stricture", "correct": false}], "correct_answer": "A. Hydronephrosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"441df40d111692777189b0e31acb06\"&gt;Hydronephrosis&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"8e0b8aa160169277720171f407dac5\">urodynamic</span> test that measures the pressure <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> between the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> to assess upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Equivocal cases of upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction, PUJ obstruction, post-pyeloplasty evaluation, distinguishing true <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> from hydronephrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">Percutaneous</span> <span class=\"customMeta\" data-dictid=\"d1daf6e6e71692777193b4da27724f\">nephrostomy</span> placed in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pelvis.</p>\n<p>2. <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> inserted for pressure measurement.</p>\n<p>3. Fluid <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> into <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> at 10 ml/min.</p>\n<p>4. Pressure difference between <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> &amp; <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> recorded.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interpretation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;15 cm H₂O → No obstruction.</p>\n<p>15–22 cm H₂O → Indeterminate (needs further evaluation).</p>\n<p>&gt;22 cm H₂O → Significant <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> present.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> true <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> vs. non-obstructive dilation.</p>\n<p>Useful in post-surgical cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Limitations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invasive (rarely used due to modern imaging).</p>\n<p>Replaced by <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> scan (DTPA/EC scan) &amp; MR Urography.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of collagen is present in cartilage?", "options": [{"label": "A", "text": "Type 1 collagen", "correct": false}, {"label": "B", "text": "Type 2 collagen", "correct": true}, {"label": "C", "text": "Type 3 collagen", "correct": false}, {"label": "D", "text": "Type 4 collagen", "correct": false}], "correct_answer": "B. Type 2 collagen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Collagen Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bone, skin, tendons, ligaments, cornea</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides tensile strength</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cartilage (hyaline, elastic, fibrocartilage), <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> humor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides resistance to pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reticular fibers (skin, blood vessels, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> tissue)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides structural support</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Basement membrane</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Forms structural network in BM</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn presented to the NICU with respiratory distress and meconium discharge from the umbilicus. The condition occurs due to the patency of which structure?", "options": [{"label": "A", "text": "Mesonephric duct", "correct": false}, {"label": "B", "text": "Allantois", "correct": false}, {"label": "C", "text": "Urachus", "correct": false}, {"label": "D", "text": "Vitelline Fistula", "correct": true}], "correct_answer": "D. Vitelline Fistula", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Embryological Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Failure of <span class=\"customMeta\" data-dictid=\"e5922b669a169277719487f8bbabd3\">Obliteration</span> Leads to</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vitelline Duct</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Connects <span class=\"customMeta\" data-dictid=\"8251cf3ec316927771925d519dd348\">midgut</span> to <span class=\"customMeta\" data-dictid=\"9398e57d2b16927772027826f82b50\">yolk</span> sac</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vitelline fistula</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Meconium <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> from the umbilicus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urachus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Remnant of <span class=\"customMeta\" data-dictid=\"774591ced216927771818e2164a9ec\">allantois</span> (connects <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> to umbilicus)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Patent urachus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urine <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> from umbilicus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Allantois</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contributes to <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> development</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urachal cyst, urachal sinus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cystic <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> leakage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mesonephric Duct</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wolffian <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (forms male <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> structures)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>No relation to <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> anomalies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Affects male <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> development</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the embryological basis of the developmental defects shown in the image below?", "options": [{"label": "A", "text": "Failure in closure of anterior neuropore of neural tube", "correct": true}, {"label": "B", "text": "Failure in closure of posterior neuropore of neural tube", "correct": false}, {"label": "C", "text": "Failure in closure of complete neural tube", "correct": false}, {"label": "D", "text": "Failure in closure of caudal neuropore of neural tube", "correct": false}], "correct_answer": "A. Failure in closure of anterior neuropore of neural tube", "question_images": ["https://image.prepladder.com/notes/vnYslPDJL8G2KJgUz1hv1747894729.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Neuropore</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Failure of <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">Closure</span> Leads to</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior Neuropore</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anencephaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absence of brain, skull, and scalp; open <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> vault; <span class=\"customMeta\" data-dictid=\"4dfcb33af61692777196cc08481fa0\">polyhydramnios</span> (due to absent <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> reflex)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior Neuropore</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spina bifida</strong> (Occulta, Meningocele, Myelomeningocele)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defects in vertebral arch, meninges, or <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord; may present with <span class=\"customMeta\" data-dictid=\"121d2a043516927772012d5faa616f\">tuft</span> of hair, sac-like protrusion, or neurological deficits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complete <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">Neural</span> Tube</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Craniorachischisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Entire brain and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord remain open, leading to <strong>lethal defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Caudal Neuropore</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spina bifida occulta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mildest <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"78d32c50611692777199c6c6b9b525\">spina</span> bifida, often asymptomatic, with a <strong>tuft of hair</strong> over the <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> region</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents to your outpatient department with the findings shown in the image below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Kwashiorkor", "correct": true}, {"label": "B", "text": "Marasmus", "correct": false}, {"label": "C", "text": "Nephrotic syndrome", "correct": false}, {"label": "D", "text": "Nephritic syndrome", "correct": false}], "correct_answer": "A. Kwashiorkor", "question_images": ["https://image.prepladder.com/content/iyLSFkqJCtnxnElTB8ue1745923154.png"], "explanation_images": ["https://image.prepladder.com/content/RygpKHDl4XC5KFuX8ssH1745923252.png", "https://image.prepladder.com/content/3SmZ2oGNY6Ig5gpgpJbA1745923258.png"], "explanation": "<p>Correct Answer A - Kwashiorkor</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3 style=\"text-align:center\"><strong>Kwashiorkor </strong></h3>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3 style=\"text-align:center\"><strong>Marasmus </strong><strong>(Option B)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pitting Edema:</strong> Characterized by swelling, often starting in the legs and feet, leaving a persistent <span class=\"customMeta\" data-dictid=\"cdb5523e491692777190f8bc3775ff\">indentation</span> when pressed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Absence of Edema:</strong> Unlike kwashiorkor, <span class=\"customMeta\" data-dictid=\"122de6274d169277719141ab2c8004\">marasmus</span> does not involve <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or oedema.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sugar Baby Appearance:</strong> The child may look deceptively healthy due to oedema, despite being malnourished.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monkey Facies:</strong> A sunken appearance of the cheeks due to loss of fat, giving an aged look.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscle Wasting: </strong>Despite the swollen appearance, muscle loss is present, leading to weakness and hypotonia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe Wasting:</strong> The child appears extremely thin, with prominent bones and little body fat.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mental and Neurological Symptoms:</strong> The child is apathetic, irritable, and may have <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> difficulties.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alertness: </strong>Children with <span class=\"customMeta\" data-dictid=\"122de6274d169277719141ab2c8004\">marasmus</span> remain mentally alert.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hair Changes:</strong> Hair may lose colour, become thin, and show <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> bands of colour (\"<strong>flag sign</strong>\").</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Baggy Pants Appearance:</strong> Loose, sagging skin around the <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> caused by significant <strong>muscle and fat loss</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin Changes:</strong> Includes hyperpigmentation, peeling skin (\"flaky paint\" appearance), and colour changes, particularly in the buttocks, perineum, and thighs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypoglycemia Risk:</strong> The liver's <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> capacity to produce <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> increases the risk of low blood sugar.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastrointestinal Issues:</strong> Anorexia, vomiting, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension. <strong>Anaemia is</strong> present due to nutritional deficiencies.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypothermia Risk:</strong> The child may struggle to maintain <span class=\"customMeta\" data-dictid=\"4a7581c8b01692777183819f38c633\">body temperature</span> due to energy depletion.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dr. Lyle Conrad, \" data-hash=\"\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Starved_girl.jpg\" data-tags=\"\" height=\"561\" src=\"https://image.prepladder.com/content/RygpKHDl4XC5KFuX8ssH1745923252.png\" width=\"316\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Content Providers(s): CDC/ Don Eddins,\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Starved_girl.jpg\" data-tags=\"\" height=\"519\" src=\"https://image.prepladder.com/content/3SmZ2oGNY6Ig5gpgpJbA1745923258.png\" width=\"327\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following image is of the most common cause of stridor in children. Identify it.", "options": [{"label": "A", "text": "Laryngomalacia", "correct": true}, {"label": "B", "text": "Laryngeal papilloma", "correct": false}, {"label": "C", "text": "Chronic epiglottitis", "correct": false}, {"label": "D", "text": "Laryngocele", "correct": false}], "correct_answer": "A. Laryngomalacia", "question_images": ["https://image.prepladder.com/content/2VA0QXlqbGQpy3F4NaLi1745923376.png"], "explanation_images": ["https://image.prepladder.com/notes/7VmPiDd3xrTkY2HRtHOK1747899479.png", "https://image.prepladder.com/content/AkBipft07qtqI4Y4oHci1745923452.png", "https://image.prepladder.com/content/2maSVJ9m47VkZQsQIDPd1745923465.png"], "explanation": "<p>Correct Answer A - Laryngomalacia</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Laryngomalacia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>M/c <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> laryngeal <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> in children; characterized by floppy tissues above the vocal cords that collapse during inspiration, causing stridor.</li>\n<li>Accounts for 45% to 75% of <span class=\"customMeta\" data-dictid=\"c8af142f48169277719965c593fa0b\">stridor</span> cases in infants.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Appear within the first 2 weeks of life and can worsen for up to six months, with gradual improvement often occurring thereafter.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Factors deciding severity and clinical course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gastroesophageal <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease</li>\n<li>Laryngopharyngeal <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease</li>\n<li>Neurological conditions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diagnosis is made mainly by clinical symptoms.</li>\n<li><strong>Outpatient flexible laryngoscopy</strong> is done to confirm the diagnosis<strong> </strong>but is not suitable for a baby as well as when <span class=\"customMeta\" data-dictid=\"2749f813cb16927771864616f3317f\">dysphagia</span> is suspected.</li>\n<li>Laryngoscopy sows the <strong>omega sign: </strong>The inward <span class=\"customMeta\" data-dictid=\"aaf90bd55a1692777185329fc7b5b4\">curling</span> of the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> to become omega-shaped.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"-Laryngomalacia (labelled)\" data-author=\"Doctormichael.\" data-hash=\"13123\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Laryngomalacia#/media/File:Laryngomalacia.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/7VmPiDd3xrTkY2HRtHOK1747899479.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li><strong>Airway films </strong>and <strong>chest radiographs </strong>are done when the work of breathing is moderate to severe.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Bernard F. Laya and Edward Y. Lee\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiologykey.com/upper-airway-disease/\" data-tags=\"\" height=\"332\" src=\"https://image.prepladder.com/content/AkBipft07qtqI4Y4oHci1745923452.png\" width=\"476\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>A <strong>contrast swallow </strong>study or <strong>Flexible <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> evaluation of <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> (FEES) </strong>is considered when <strong>dysphagia </strong>is suspected.</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"f8d4c5c1c01692777183ee445dc295\">bronchoscopy</span> is done for those with moderate to severe obstruction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Expectant <strong>observation </strong>for most infants as the <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> resolution of symptoms as the child grows is seen.</li>\n<li>Laryngoesophageal <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> and GERD are treated with <strong>proton pump inhibitors or <span class=\"customMeta\" data-dictid=\"b5d4ddbfe71692777189a12acd5502\">histamine</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists,</strong> considering the possible iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anaemia.</li>\n<li><strong>Supraglottoplasty </strong>is done in case of severe disease that causes progressive <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress, cyanosis, failure to thrive, or <span class=\"customMeta\" data-dictid=\"4534214488169277718575e08a9bc0\">cor</span> pulmonale.</li>\n<li>Earlier intervention is needed in children with <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> disease, neurologic disease, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disorders, or <span class=\"customMeta\" data-dictid=\"576134019e16927771859f4eac1021\">craniofacial</span> anomalies.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In an infant, which of the following milestones is achieved the earliest?", "options": [{"label": "A", "text": "Immature pincer grasp", "correct": false}, {"label": "B", "text": "Mature pincer grasp", "correct": false}, {"label": "C", "text": "Radial palmar grasp", "correct": false}, {"label": "D", "text": "Ulnar palmar grasp", "correct": true}], "correct_answer": "D. Ulnar palmar grasp", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\"&gt;Ulnar&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\"&gt;palmar&lt;/span&gt; grasp</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Gross Motor Domain Milestones </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Fine Motor Domain Milestones </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Language Domain Milestones </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Social Domain Milestones </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">1 month</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Alerts to sound</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">2 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Social smile</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">3 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Neck holding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Coos (musical vowel sounds)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Recognizes mother; anticipates feeds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>4 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Bidextrous reach</p>\n<p><strong>Ulnar <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> grasp</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Laughs loud</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">5 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Rolls over</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">6 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sits in <span class=\"customMeta\" data-dictid=\"83962896b5169277720032c8e8bd50\">tripod</span> fashion (sitting with own support)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Unidextrous reach; transfers objects</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Monosyllables (ba, da, pa), ah-goo sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Recognizes strangers, stranger anxiety</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">8 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sitting without support</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">9 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Stands holding on (with support)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Immature pincer grasp (Option A)</strong>; probes with forefinger</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Bisyllables (mama, baba, dada)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Waves “bye-bye”</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">12 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Creeps well; walks but falls; stands without support</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Pincer grasp</strong> <strong>mature (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>1-2 words with meaning</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Comes when called; plays simple ball game</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">15 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Walks alone; creeps upstairs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Imitates scribbling; the tower of 2 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Jargon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">18 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Runs; explores drawers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Scribbles; tower of 3 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>8-10 word vocabulary</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Copies parents in task (e.g., sweeping)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">2 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Walks up and downstairs (2 feet/step); jumps</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Tower of 6 blocks; vertical and <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> stroke</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>2-3 word sentences, use pronouns “I”, “me”, “you”</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Asks for food, drink, toilet; pulls people to show toys</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">3 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Rides tricycle; <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> going upstairs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Tower of 9 blocks; copies circle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Asks questions; knows full name and gender</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Shares toys; knows full name and gender</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">4 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hops on one foot; <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> going downstairs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Copies cross; bridge with blocks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Says song or poem; tells stories</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Plays cooperatively in a group; goes to the toilet alone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">5 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Skips</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Copies triangle; gate with blocks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Asks the meaning of words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Helps in household tasks, dresses, and undresses</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn infant is brought to the pediatric clinic due to the presence of a sac-like protrusion on the lower back. The protrusion is covered by a thin membrane and contains spinal cord tissue and nerves. The infant's lower limbs exhibit weakness and impaired sensation. The mother reports inadequate prenatal folic acid intake during pregnancy. Which of the following conditions is the most likely diagnosis?", "options": [{"label": "A", "text": "Cleft lip and palate", "correct": false}, {"label": "B", "text": "Down syndrome", "correct": false}, {"label": "C", "text": "Gastroschisis", "correct": false}, {"label": "D", "text": "Spina bifida", "correct": true}], "correct_answer": "D. Spina bifida", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"78d32c50611692777199c6c6b9b525\"&gt;Spina&lt;/span&gt; bifida</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Failure of proper <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube &amp; covering mesoderm/ectoderm; <strong>most common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> anomaly.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Primary NTDs have <span class=\"customMeta\" data-dictid=\"8dcd91eadf1692777193a72a442f37\">multifactorial</span> inheritance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Maternal risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Alcohol, radiation exposure, IDDM, valproate, carbamazepine, <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> and <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> deficiency.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Types of NTDs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Spina bifida occulta, meningocele, encephalocele, myelomeningocele, anencephaly,</strong> <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> syndrome, <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> sinus, tethered cord, syringomyelia, diastematomyelia, lipoma, iniencephaly.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Spina bifida occulta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Midline <strong>defect of vertebral bodies without <span class=\"customMeta\" data-dictid=\"08b787c5a41692777196c0e16b3805\">protrusion</span> of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord or meninges</strong>; usually <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> and not of consequence.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Craniorachischisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Rare <span class=\"customMeta\" data-dictid=\"88900fc4c61692777191a66457050a\">malformation</span> with <strong>skull and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> bone defects</strong>; <strong>brain and nerves exposed</strong>; may have other defects like <span class=\"customMeta\" data-dictid=\"51aedf4b7a1692777189224a776ed8\">imperforate</span> anus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Meningocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Meninges herniate</strong> through vertebral arches or sacrum; <strong>spinal cord norma</strong>l. <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">Fluctuant</span> midline mass that may<strong> transilluminate.</strong> Surgery may be delayed in <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> cases with normal neuro findings and skin covering.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Myelomeningocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Most common in<strong> <span class=\"customMeta\" data-dictid=\"2d710fe8461692777191d18505790c\">lumbosacral</span> region</strong>; sac-like <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> structure with <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tissue; 80% develop <strong>hydrocephalus with <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">type II</span> Chiari malformation.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Anencephaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Large <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> of calvarium, meninges, and scalp; associated with <span class=\"customMeta\" data-dictid=\"552c5ff93a16927771977cf35eac28\">rudimentary</span> brain due to failure of <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of <span class=\"customMeta\" data-dictid=\"1f4bb4632d16927771975d96e35378\">rostral</span> neuropore.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Iniencephaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Retroflexion of head </strong>with <strong>occipital and upper spine defects,</strong> nearly absent neck; <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> can range from <span class=\"customMeta\" data-dictid=\"ca09d35fbc1692777180daa0f01405\">acrania</span> to minimal defect.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Prenatal diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Detailed ultrasound, <strong>MSAFP</strong> (maternal <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> α-fetoprotein), <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid <span class=\"customMeta\" data-dictid=\"63b92227451692777180db3901b72f\">acetylcholinesterase</span> (<strong>AChE</strong>).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>0.4 mg <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> daily for <strong>all women of childbearing age</strong>; 4 mg daily for high-risk women (prior affected child).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Risk of recurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>3-4% after 1 affected child; 10% after 2 affected children.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Surgery for defect; VP <span class=\"customMeta\" data-dictid=\"950826ab361692777198366a25dfbf\">shunt</span> if <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">hydrocephalus</span> present. Open lesions should be closed within 24 hours. Antibiotics if infection is present.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the structure marked in the image below?", "options": [{"label": "A", "text": "Genioglossus", "correct": true}, {"label": "B", "text": "Hyoglossus", "correct": false}, {"label": "C", "text": "Styloglossus", "correct": false}, {"label": "D", "text": "Palatoglossus", "correct": false}], "correct_answer": "A. Genioglossus", "question_images": ["https://image.prepladder.com/notes/i5Iu60EaTR7MIjJh72mu1747894848.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Insertion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Innervation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genioglossus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Genial <span class=\"customMeta\" data-dictid=\"4e55f7e0e6169277720158750ed95c\">tubercle</span> of mandible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Entire tongue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protrudes tongue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypoglossal nerve (CN XII)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyoglossus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyoid bone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Side of the tongue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Depresses and retracts tongue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypoglossal nerve (CN XII)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Styloglossus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Styloid process of <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Side of tongue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Retracts and elevates tongue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypoglossal nerve (CN XII)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Palatoglossus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soft palate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Side of tongue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevates <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> tongue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vagus nerve (CN X)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with leprosy presented with the deformity as shown below. Which nerve injury causes the given condition?", "options": [{"label": "A", "text": "Ulnar nerve", "correct": true}, {"label": "B", "text": "Radial nerve", "correct": false}, {"label": "C", "text": "Median nerve", "correct": false}, {"label": "D", "text": "Posterior interosseous nerve", "correct": false}], "correct_answer": "A. Ulnar nerve", "question_images": ["https://image.prepladder.com/content/qzNyjuPPaIcOdEkzNSA31745923942.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ulnar Nerve Palsy (Claw Hand)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Affected Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lumbricals (3rd &amp; 4th), Interossei, Hypothenar muscles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Deficit Seen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MCP hyperextension, IP <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (mainly in 4th &amp; 5th fingers)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leprosy, trauma at the elbow (cubital tunnel) or wrist (Guyon's canal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tests for <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">Ulnar</span> Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Froment’s sign (weak <span class=\"customMeta\" data-dictid=\"bebdf1cab81692777180c37e36596c\">adductor</span> pollicis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Physiotherapy, nerve grafting, <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> surgery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient, aged 18, seeks medical attention due to an eye injury sustained while climbing a tree five days ago. The patient reports experiencing pain, sensitivity to light (photophobia), and redness in the affected eye for the past two days. Upon performing a slit-lamp examination, a lesion is observed as depicted below. Which of the following characteristics is associated with this particular condition?", "options": [{"label": "A", "text": "Reverse hypopyon", "correct": false}, {"label": "B", "text": "Dendritic ulcer", "correct": false}, {"label": "C", "text": "Ring abscess", "correct": false}, {"label": "D", "text": "Satellite lesion", "correct": true}], "correct_answer": "D. Satellite lesion", "question_images": ["https://image.prepladder.com/content/KnukzZE2alxYhP023ISZ1745923939.png"], "explanation_images": ["https://image.prepladder.com/content/Dl0Lh5iN7GOuuA9vjqWv1745924001.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Causative organism: <strong>Aspergillus fumigatus</strong> &gt;&gt; Fusarium</li>\n<li>Predisposing factor: <strong>Vegetative matter injury</strong> (trauma)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>SIGNS &gt;&gt; symptoms</strong></li>\n<li>Pain &amp; Foreign Body Sensation</li>\n<li>Watering/ Photophobia</li>\n<li>Blurred Vision, Redness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Corneal Ulcer:</strong> <strong>Greyish-white</strong>, dry, elevated, rolled-out margins</li>\n<li><strong>Pigmented Ulcer:</strong> Brownish, <span class=\"customMeta\" data-dictid=\"0f22e5402f16927771853bb4b7b234\">dematiaceous</span> fungi</li>\n<li><strong>Feathery Extensions:</strong> Finger-like projections in stroma</li>\n<li><strong>Sterile Immune Ring: </strong>Yellow line of demarcation</li>\n<li><strong>Satellite Lesions (Option D): </strong>Small lesions around the main ulcer</li>\n<li><strong>Hypopyon:</strong> <strong>Large, immobile, non-sterile</strong>, even in small ulcer</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"M. Upadhyay, M. Srinivasan, J. Whitcher\" data-hash=\"\" data-license=\"NA\" data-source=\"Figure 1 from Diagnosing and managing microbial keratitis | Semantic Scholar\" data-tags=\"\" height=\"233\" src=\"https://image.prepladder.com/content/Dl0Lh5iN7GOuuA9vjqWv1745924001.png\" width=\"311\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal Scraping: For microbiological examination</li>\n<li><strong>Wet KOH Mount:</strong> Filamentous <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> or yeast-like <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> (Candida)</li>\n<li>Culture: <strong>Sabouraud's agar</strong> for fungal culture</li>\n<li>PCR: For rapid identification of pathogens</li>\n<li>Corneal Biopsy: For deep stromal <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> or negative cultures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Topical Antifungal Agents:</strong> <strong>Natamycin 5%</strong>, Voriconazole, Amphotericin-B, Nystatin</li>\n<li><strong>Oral Antifungal Agents:</strong> Ketoconazole, <strong>Voriconazole</strong> (for severe ulcers)</li>\n<li><strong>Surgical Management:</strong>\n<ul>\n<li>Repeated Scraping: Removal of necrotic material</li>\n<li><strong>Cauterization Options:</strong> Carbolic acid (100%), Trichloroacetic acid (10%–20%), Povidone-iodine (5%)</li>\n<li>Therapeutic Keratoplasty: Corneal transplantation</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is wrongly labeled here?", "options": [{"label": "A", "text": "A- Superior thoracic artery", "correct": false}, {"label": "B", "text": "B- Thoracoacromial artery", "correct": false}, {"label": "C", "text": "C- Subscapular artery", "correct": true}, {"label": "D", "text": "D- Posterior circumflex artery", "correct": false}], "correct_answer": "C. C- Subscapular artery", "question_images": ["https://image.prepladder.com/notes/WswWar6HeLZ4C19BPk8x1747894934.png"], "explanation_images": ["https://image.prepladder.com/notes/Xiii15OV4u3klARphhIY1747894999.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Part of Axillary Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Branches</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First Part</strong> (proximal to <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> minor)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> artery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Second Part</strong> (behind <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> minor)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thoracoacromial artery, Lateral <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> artery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Third Part</strong> (distal to <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> minor)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subscapular artery, Anterior <span class=\"customMeta\" data-dictid=\"ed0b0613a81692777184dc4b974a19\">circumflex</span> humeral artery, Posterior <span class=\"customMeta\" data-dictid=\"ed0b0613a81692777184dc4b974a19\">circumflex</span> humeral artery</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with a history of chop injury to the right hand is undergoing surgical repairs . It is observed that the patient is unable to completely fold the right ring finger, while making the fist , which structure injury results in this?", "options": [{"label": "A", "text": "Median nerve", "correct": false}, {"label": "B", "text": "Flexor retinaculum", "correct": false}, {"label": "C", "text": "Flexor digitorum profundus", "correct": true}, {"label": "D", "text": "Flexor pollicis longus", "correct": false}], "correct_answer": "C. Flexor digitorum profundus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Movement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Muscles Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Innervation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Flexion of <span class=\"customMeta\" data-dictid=\"bc2c34fe2216927771957ca73ba3d9\">PIP</span> joints</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Flexor digitorum <span class=\"customMeta\" data-dictid=\"d3c34e683916927771998a3426c3a6\">superficialis</span> (FDS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Median nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Flexion of DIP joints</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Flexor digitorum <span class=\"customMeta\" data-dictid=\"69427990841692777196166d7a5ec9\">profundus</span> (FDP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral part (index &amp; middle fingers): <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">Median</span> nerve</strong></p>\n<p><strong>Medial part (ring &amp; little fingers): <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">Ulnar</span> nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extension of <span class=\"customMeta\" data-dictid=\"bc2c34fe2216927771957ca73ba3d9\">PIP</span> &amp; DIP joints</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extensor digitorum</strong></p>\n<p><strong>Extensor indicis (index finger only)</strong></p>\n<p><strong>Extensor <span class=\"customMeta\" data-dictid=\"71a5caf62116927771863da6f46ba3\">digiti</span> minimi (little finger only)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radial nerve (posterior <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">interosseous</span> branch)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Assists in extension of <span class=\"customMeta\" data-dictid=\"bc2c34fe2216927771957ca73ba3d9\">PIP</span> &amp; DIP joints</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lumbricals</strong></p>\n<p><strong>Palmar &amp; <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> interossei</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lumbricals:</strong> <strong>Lateral 2 (median nerve), <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> 2 (ulnar nerve)</strong></p>\n<p><strong>Interossei:</strong> <strong>Ulnar nerve</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Neostriatum consists of?", "options": [{"label": "A", "text": "Caudate nucleus and globus pallidus", "correct": false}, {"label": "B", "text": "Globus pallidus and putamen", "correct": false}, {"label": "C", "text": "Globus pallidus and lentiform nucleus", "correct": false}, {"label": "D", "text": "Caudate nucleus and putamen", "correct": true}], "correct_answer": "D. Caudate nucleus and putamen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Includes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Striatum (Neostriatum)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Caudate <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> + Putamen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Main input center of the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia, receives input from the cortex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lentiform nucleus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Putamen + <span class=\"customMeta\" data-dictid=\"86c230abe316927771889bbef8df5d\">Globus</span> pallidus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Part of the <span class=\"customMeta\" data-dictid=\"e2952dfc311692777187fa773bcc9f\">extrapyramidal</span> motor system, regulates movement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Globus pallidus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Internal (medial) and External (lateral) segments</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Main output structure, modulates <span class=\"customMeta\" data-dictid=\"796296167f1692777200ce476599bf\">thalamocortical</span> circuits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subthalamic nucleus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Located in the diencephalon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plays a role in modulating <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> <span class=\"customMeta\" data-dictid=\"f2804c808516927771887dda93e56c\">ganglia</span> output</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Substantia nigra</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Located in the midbrain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Produces dopamine; <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> leads to Parkinson’s disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 5-year-old girl presenting with decreased best corrected visual acuity in the right eye after a school vision screening revealed diminution of acuity in the right eye without any examination findings of the eye and visual pathway?", "options": [{"label": "A", "text": "Amblyopia", "correct": true}, {"label": "B", "text": "Retinoblastoma", "correct": false}, {"label": "C", "text": "Congenital cataract", "correct": false}, {"label": "D", "text": "Brain lesion", "correct": false}], "correct_answer": "A. Amblyopia", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Strabismic Amblyopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The brain suppresses input from one eye due to constant <span class=\"customMeta\" data-dictid=\"4d366430b5169277719914874d78a5\">squint</span> (strabismus).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common cause; underdevelopment of vision in the deviated eye.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stimulus <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">Deprivation</span> <span class=\"customMeta\" data-dictid=\"48ecf3114716927771818db0abb2a6\">Amblyopia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hindered vision due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> from early life (e.g., <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> cataracts, ptosis, dense central corneal opacity).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lack of visual <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> affects normal development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anisometropic <span class=\"customMeta\" data-dictid=\"48ecf3114716927771818db0abb2a6\">Amblyopia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A significant difference in <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> error between eyes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The brain favours the <span class=\"customMeta\" data-dictid=\"55436411c216927771846e318f45ce\">clearer</span> eye, leading to <span class=\"customMeta\" data-dictid=\"48ecf3114716927771818db0abb2a6\">amblyopia</span> in the other.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ametropic Amblyopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High uncorrected <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> errors in both eyes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral; is less severe compared to other types.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Meridional Amblyopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uncorrected <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> affecting specific visual meridians.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Affects one or both eyes depending on the <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> degree.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding bones is false?", "options": [{"label": "A", "text": "Osteocytes are the major cell type in mature bone", "correct": false}, {"label": "B", "text": "Collagen is synthesized in bone osteoblasts", "correct": false}, {"label": "C", "text": "Bone mainly contains type 2 collagen", "correct": true}, {"label": "D", "text": "Calcium phosphate is one of the major inorganic mineral", "correct": false}], "correct_answer": "C. Bone mainly contains type 2 collagen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Osteoblasts (bone formation), Osteocytes (maintenance), Osteoclasts (resorption)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Collagen Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I</strong> <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> is the primary structural protein in bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inorganic Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hydroxyapatite (Calcium phosphate) provides bone rigidity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bone Matrix</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Composed of organic (collagen and proteins) and <span class=\"customMeta\" data-dictid=\"fae9d02cdc1692777190a3151d6fef\">inorganic</span> (minerals) components</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most common cause of preventable childhood blindness in India?", "options": [{"label": "A", "text": "Refractive error", "correct": false}, {"label": "B", "text": "Vitamin A deficiency", "correct": true}, {"label": "C", "text": "Retinopathy of prematurity", "correct": false}, {"label": "D", "text": "Cataract", "correct": false}], "correct_answer": "B. Vitamin A deficiency", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/xOrzIxMAZgskbRi5SqzM1747911070.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:1px solid #333438\">\n<p><strong>Tier</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:1px solid #333438\">\n<p><strong>Number of Units</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:1px solid #333438\">\n<p><strong>Population Norms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:1px solid #333438\">\n<p><strong>Components</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Centres of Excellence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>20</p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>1/50 million</p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<ul>\n<li>Professional Leadership</li>\n<li>Strategy development</li>\n<li>Continued Medical Education (CME)</li>\n<li>Laying of standards and quality assurance</li>\n<li>Research</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Training Centres </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>200</p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>1/5 million</p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<ul>\n<li>Tertiary eye care including <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> surgery, corneal transplantation, <span class=\"customMeta\" data-dictid=\"61e49875801692777188ad5edea804\">glaucoma</span> surgery, etc.</li>\n<li>Training and CME</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Service Centres</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>2000</p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>1/500000</p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<ul>\n<li>Cataract Surgery</li>\n<li>Other common eye surgeries</li>\n<li>Facilities for refraction</li>\n<li>Referral services</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Vision Centres </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>20,000</p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>1/50000</p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<ul>\n<li>Refraction and prescription of glasses</li>\n<li>Primary eye care</li>\n<li>School eye screening programme</li>\n<li>Screening and referral services</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Killian’s dehiscence is seen between?", "options": [{"label": "A", "text": "Palatopharyngeus and cricopharyngeus", "correct": false}, {"label": "B", "text": "Thyropharyngeus and palatopharyngeus", "correct": false}, {"label": "C", "text": "Cricopharyngeus and thyropharyngeus", "correct": true}, {"label": "D", "text": "Palatopharyngeus and salpingopharyngeus", "correct": false}], "correct_answer": "C. Cricopharyngeus and thyropharyngeus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pharyngeal Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Relevance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thyropharyngeus (Superior part of <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Constrictor)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Constricts pharynx</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Forms upper boundary of Killian's dehiscence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cricopharyngeus (Inferior part of <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Constrictor)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acts as upper <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> sphincter</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Forms lower boundary of Killian's dehiscence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Killian’s Dehiscence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Weak area between these muscles</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Site of Zenker’s diverticulum</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 7-year-old boy who showed a white pupillary reflex and underwent enucleation, with histopathological examination showing Flexner Wintersteiner rosettes?", "options": [{"label": "A", "text": "Retinoblastoma", "correct": true}, {"label": "B", "text": "Medulloblastoma", "correct": false}, {"label": "C", "text": "Rhabdomyosarcoma", "correct": false}, {"label": "D", "text": "Astrocytoma", "correct": false}], "correct_answer": "A. Retinoblastoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pRTSX3YcGgxp6XbGO8uz1745924432.png", "https://image.prepladder.com/content/kbSlB77qtRaB5yNNNtVf1745924448.png", "https://image.prepladder.com/content/jJEi1Xp1P1PkufxGABID1745924452.png", "https://image.prepladder.com/content/pK8u8jMifYf2oK3N9y661745924402.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>Leukocoria</strong> (60%)</li>\n<li><strong>Strabismus</strong> (20%)</li>\n<li>Painful red eye (7%)</li>\n<li>Poor vision (5%)</li>\n<li>Asymptomatic (3%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fundus Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>White, elevated mass in the retina</li>\n<li>Can be endophytic, exophytic, or mixed growth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CT scan: <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">Calcification</span> in 90% of cases</li>\n<li>MRI: Better for evaluating <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve and <span class=\"customMeta\" data-dictid=\"7d57c304c01692777187da125d18d8\">extraocular</span> extension</li>\n<li>Ultrasound: Useful for initial screening</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Flexner-Wintersteiner rosettes (highly specific): </strong>These are composed of an ‘empty’ <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> surrounded by columnar cells</li>\n<li><strong>Homer-Wright rosettes: </strong>These are pseudo-rosettes and consist of cells surrounding a central <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> made up of their processes</li>\n<li>Undifferentiated tumor cells</li>\n<li>Areas of <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and calcification</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>RB1 gene</strong> <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>13q14</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a man of 45 years who arrives at the emergency department with an abrupt loss of vision and experiencing painful movements of the eye? Upon examination, a relative afferent pupillary defect is observed in the affected eye. Further visual field testing demonstrates a central scotoma in the same eye.", "options": [{"label": "A", "text": "Optic nerve glioma", "correct": false}, {"label": "B", "text": "Optic neuritis", "correct": true}, {"label": "C", "text": "Eale’s disease", "correct": false}, {"label": "D", "text": "Neuroretinitis", "correct": false}], "correct_answer": "B. Optic neuritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/D46DunGQaYKVort2Jmpu1745924614.png", "https://image.prepladder.com/content/5RSgX788fOfAyGp2kwF51745924624.png", "https://image.prepladder.com/content/HG1XGuFaK7HdD5p9MsQ91745924636.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td colspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Classification of <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> neuritis:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Papillitis </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Retrobulbar <span class=\"customMeta\" data-dictid=\"6e951a16031692777193af1c351309\">Neuritis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuroretinitis (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Optic disc</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Optic nerve behind the eyeball.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Optic disc and surrounding <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> in the <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> area.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fundoscopy reveals a blurred disc margin due to leakage and increased <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> permeability, edematous and hyperaemic disc, and <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> cup is obliterated.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Rui Zhang, Jiang Qian, Jie Guo, Yifei Yuan, Kang Xue, Han Yue, Ling Chen\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2016/2797028\" data-tags=\"\" height=\"204\" src=\"https://image.prepladder.com/content/D46DunGQaYKVort2Jmpu1745924614.png\" width=\"267\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain on eye elevation</li>\n<li><strong>RAPD (relative <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> pupillary defect)</strong> is observed.</li>\n<li>Fundoscopic examination typically reveals normal <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc, at least initially, which is why the classic phrase, “the patient sees nothing, and the doctor sees nothing” is often used to describe <span class=\"customMeta\" data-dictid=\"99ac6e31f71692777197220f87effc\">retrobulbar</span> neuritis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A <strong>macular star</strong> is seen in fundoscopy (accumulation of lipids).</li>\n<li><strong>Optic atrophy</strong> present</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Viswanath Gajula, Ravi Kamepalli, Jagadeesh K. Kalavakunta\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1002/ccr3.43\" data-tags=\"\" height=\"206\" src=\"https://image.prepladder.com/content/5RSgX788fOfAyGp2kwF51745924624.png\" width=\"270\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visual loss: <strong>Monocular sudden, progressive and profound visual loss</strong> is the hallmark of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuritis.</li>\n<li>Dark <span class=\"customMeta\" data-dictid=\"c623a72bdd16927771808d60122016\">adaptation</span> may be lowered.</li>\n<li>Visual obscuration in bright light is a typical symptom of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuritis.</li>\n<li>Impairment of <span class=\"customMeta\" data-dictid=\"c82cc1010816927771859bbfde816b\">color vision</span> is always present in <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuritis.</li>\n<li><strong>Uhthoff's symptom: </strong>Episodic <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> obscuration of vision on exertion and on exposure to heat, which recovers on resting or moving away from the heat, occurs in patients with isolated <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuritis.</li>\n<li><strong>Pulfrich's phenomenon:</strong> Depth perception may be impaired, particularly for the moving object.</li>\n<li>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> is usually <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> markedly.</li>\n<li>Visual field changes: The most common field <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> <span class=\"customMeta\" data-dictid=\"6e951a16031692777193af1c351309\">neuritis</span> is a relative central or <span class=\"customMeta\" data-dictid=\"fd318be9d4169277718460949f7037\">centrocecal</span> scotoma.</li>\n<li>Contrast sensitivity is impaired.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> neuritis:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conservative management</strong></p>\n<p>(Observation and Monitoring)</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild symptoms</li>\n<li>Known history of similar episodes</li>\n</ul>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Many cases improve spontaneously.</li>\n<li>Suitable for mild symptoms but not recommended for severe cases or first episodes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High-Dose Corticosteroids</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe vision loss</li>\n<li>No history of previous episodes</li>\n<li>MRI evidence of demyelination</li>\n</ul>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intravenous <span class=\"customMeta\" data-dictid=\"c3adf9f403169277719294351e8fb8\">methylprednisolone</span> (1 g daily for 3 days) followed by oral <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> taper as established by the ONTT trial (Optic <span class=\"customMeta\" data-dictid=\"6e951a16031692777193af1c351309\">Neuritis</span> Treatment Trial).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a patient who wears contact lenses and has been experiencing eye watering, redness, and a sensation of having a foreign object in the eye for the last two months?", "options": [{"label": "A", "text": "Follicular conjunctivitis", "correct": false}, {"label": "B", "text": "Spring catarrh", "correct": false}, {"label": "C", "text": "Giant papillary conjunctivitis", "correct": true}, {"label": "D", "text": "Acute trachoma", "correct": false}], "correct_answer": "C. Giant papillary conjunctivitis", "question_images": ["https://image.prepladder.com/notes/1lZNwXIubva5XKrizpaf1747911209.png"], "explanation_images": ["https://image.prepladder.com/notes/1lZNwXIubva5XKrizpaf1747911209.png", "https://image.prepladder.com/content/PE5mjCXWAdmllsAS2Yvx1745924832.png", "https://image.prepladder.com/content/demk85egF8UY96LGtcrp1745924832.png", "https://image.prepladder.com/content/6NE1GoqynJ4Pt9i99P7q1745924832.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Specific allergic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> affecting the superior <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> conjunctiva.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Soft <span class=\"customMeta\" data-dictid=\"db283047011692777189a869dbce07\">hydrophilic</span> <strong>contact lenses</strong></li>\n<li>Protruding <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> ends</li>\n<li>Ocular prostheses</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Underlying Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypersensitivity reactions <strong>(types I and IV)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Itching/ Watering</li>\n<li>Foreign body sensation</li>\n<li>Occasionally blurred vision</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Signs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conjunctival <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> predominantly in the upper palpebral region</li>\n<li>Large polygonal <span class=\"customMeta\" data-dictid=\"c948d4dca7169277719474a468ff5e\">papillae</span> on superior <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> conjunctiva</li>\n<li>Macropapillae (0.3-1.0 mm) and giant <span class=\"customMeta\" data-dictid=\"c948d4dca7169277719474a468ff5e\">papillae</span> (1-2 mm)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\" Giant Papillary Conjunctivitis\" data-author=\"Rosa, Mario &amp; Lionetti, Elena &amp; Reibaldi, Michele &amp; Russo, Andrea &amp; Longo, Antonio &amp; Leonardi, Salvatore &amp; Tomarchio, Stefania &amp; Avitabile, Teresio &amp; Reibaldi, Alfredo\" data-hash=\"13171\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/Giant-papillary-conjunctivitis_fig6_235966425\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/1lZNwXIubva5XKrizpaf1747911209.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Discontinue soft contact lenses, remove offending sutures, clean and polish <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> prosthesis; replace with <span class=\"customMeta\" data-dictid=\"ed1050ab241692777183d28df9ecad\">biocompatible</span> material (e.g., Biocoat).</li>\n<li>Ancillary therapy: Mast cell stabilizers (e.g., lodoxamide, <span class=\"customMeta\" data-dictid=\"d3f7cd4f92169277718588c69a0f10\">cromolyn</span> sodium, olopatadine) along with artificial tears, <span class=\"customMeta\" data-dictid=\"4b296ae29b16927771815960a008db\">antihistaminic</span> drops, and decongestants.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate next course of action in managing a male patient, aged 40, who presents with widespread abdominal pain and has a confirmed history of Crohn's disease, as well as rigidity and guarding observed during a physical examination, with ileal perforation being detected on imaging?", "options": [{"label": "A", "text": "Antibiotics and NPO", "correct": false}, {"label": "B", "text": "Upper GI endoscopy", "correct": false}, {"label": "C", "text": "Urgent surgical exploration with ileostomy", "correct": true}, {"label": "D", "text": "CT abdomen", "correct": false}], "correct_answer": "C. Urgent surgical exploration with ileostomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Urgent &lt;span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\"&gt;surgical&lt;/span&gt; exploration with\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which investigation is most suitable for localizing a foreign body in the eye of an industrial worker admitted to the hospital due to an eye injury caused by cutting stone with a hammer and iron chisel?", "options": [{"label": "A", "text": "B mode scan", "correct": false}, {"label": "B", "text": "CT", "correct": true}, {"label": "C", "text": "X-ray", "correct": false}, {"label": "D", "text": "MRI", "correct": false}], "correct_answer": "B. CT", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>An IOFB is a foreign object that penetrates the eye and remains lodged inside. It is a serious injury that can result in permanent vision loss.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Types of IOFBs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metallic (90% of cases): Iron, steel.</li>\n<li>Others: Glass, stone, lead pellets, copper, aluminium, plastic, wood.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Foreign Body Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inorganic Materials: </strong>Glass, plastic are inert; lead, aluminium, <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> cause <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> responses.</li>\n<li><strong>Organic Materials: </strong>Wood causes <strong>giant cell reactions</strong> and <strong>granulomatous inflammation</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Detailed History: Understand injury mechanism for IOFB type.</li>\n<li><strong>Ocular Examination:</strong>\n<ul>\n<li>Slit-lamp examination</li>\n<li>Gonioscopy</li>\n<li>Ophthalmoscopy (back of the eye)</li>\n</ul>\n</li>\n<li><strong>Signs:</strong>\n<ul>\n<li>Subconjunctival hemorrhage</li>\n<li>Corneal scars/ <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">Iris</span> holes</li>\n<li>Opaque tracks in the lens/ IOFB in <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> or retina</li>\n</ul>\n</li>\n<li><strong>Investigations:</strong>\n<ul>\n<li>X-rays: Less common; CT is preferred. <strong>(Option C)</strong></li>\n<li>Ultrasonography: B-mode USG locates both <span class=\"customMeta\" data-dictid=\"76584c702f1692777197ee90a74461\">radiopaque</span> and non-radiopaque IOFBs. <strong>(Option A)</strong></li>\n<li><strong>CT Scan: Investigation of choice/ Gold standard</strong> for detailed cross-sectional images.<strong>(Option B)</strong></li>\n<li><strong>MRI: Contra-indicated in case of metal foreign bodies (Option D)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>IOFB Removal:</strong> Essential except for inert, <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> IOFBs not affecting vision or if removal is too risky.\n\t\t\t\t<ul>\n<li>Magnetic IOFBs: Removed using a handheld electromagnet.</li>\n<li>Non-magnetic IOFBs: Requires specialized procedures.</li>\n</ul>\n</li>\n<li><strong>Removal Methods:</strong>\n<ul>\n<li><strong>Anterior Chamber:</strong>\n<ul>\n<li>Corneal incision, avoiding central cornea.</li>\n<li>Magnetic IOFBs: Handheld magnet.</li>\n<li>Non-magnetic IOFBs: Specialized forceps.</li>\n</ul>\n</li>\n<li><strong>Iris: </strong>Sector <span class=\"customMeta\" data-dictid=\"744b697ac31692777190fa2c638b3a\">iridectomy</span> for IOFBs in the iris.</li>\n<li><strong>Lens:</strong> <span class=\"customMeta\" data-dictid=\"ab0f3917ce1692777187309ec78709\">Extracapsular</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">cataract</span> <span class=\"customMeta\" data-dictid=\"00456bf7d8169277718782edf9fa2c\">extraction</span> <strong>(ECCE)</strong> with or without lens removal.</li>\n<li><strong>Vitreous and Retina: <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">Pars</span> <span class=\"customMeta\" data-dictid=\"2d0756b0d11692777195ef3bcd110d\">plana</span> vitrectomy</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Post-Removal Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Topical/systemic antibiotics for infection prevention.</li>\n<li>Topical corticosteroids to reduce inflammation.</li>\n<li>Cycloplegic agents (e.g., atropine) for <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> and pain relief.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male presented with a painless mass in the right inguinal region. On examination, there is a cough impulse on the index finger. The swelling reaches the scrotum and is reduced completely by pressing it through the deep inguinal ring with a gurgling sound. What is the likely diagnosis?", "options": [{"label": "A", "text": "Femoral hernia", "correct": false}, {"label": "B", "text": "Direct inguinal hernia", "correct": false}, {"label": "C", "text": "Indirect inguinal hernia", "correct": true}, {"label": "D", "text": "Umbilical hernia", "correct": false}], "correct_answer": "C. Indirect inguinal hernia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\"&gt;Indirect&lt;/span&gt; inguinal h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man is accompanied by his wife to the Neurology OPD. His wife expressed concern about her husband's condition and they were directed to this facility by a local doctor. According to the doctor's note, the patient is unable to repeat spoken words but can comprehend them and respond appropriately by nodding. The patient also experiences difficulty in naming people and writing. The doctor referred the patient to a specialized facility for a CT brain scan. As the intern on duty, you would inform the Chief Medical Officer (CMO) that this condition could be indicative of a brain lesion in which specific area?", "options": [{"label": "A", "text": "Arcuate fasciculus", "correct": true}, {"label": "B", "text": "Anterior commissure", "correct": false}, {"label": "C", "text": "Corpus callosum", "correct": false}, {"label": "D", "text": "Fornix", "correct": false}], "correct_answer": "A. Arcuate fasciculus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Aphasia Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Area Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Broca's Aphasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> (Broca's area)</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Non-fluent speech, difficulty forming sentences, good comprehension, and poor writing/speech output.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Wernicke's Aphasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> (Wernicke's area)</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Fluent speech with normal grammar, but speech is nonsensical or meaningless, poor comprehension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Conduction Aphasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Arcuate <span class=\"customMeta\" data-dictid=\"6f06ed0fab169277720273078a8258\">fasciculus</span> (connecting Broca's and Wernicke's areas)</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Difficulty repeating words or phrases, <span class=\"customMeta\" data-dictid=\"1ea569c7fa16927772020c6e8eabc1\">fluent</span> speech with errors, good comprehension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Global Aphasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Widespread damage to left <span class=\"customMeta\" data-dictid=\"d702dfe10816927771881b37be4e4a\">hemisphere</span> (Broca's, Wernicke's, and <span class=\"customMeta\" data-dictid=\"734bdc6ddd1692777182e15cb76ca5\">arcuate</span> fasciculus)</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Severe communication deficits: non-fluent speech, poor comprehension, and inability to repeat.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the medical condition depicted in the provided image.", "options": [{"label": "A", "text": "Entropion", "correct": true}, {"label": "B", "text": "Ectropion", "correct": false}, {"label": "C", "text": "Trichiasis", "correct": false}, {"label": "D", "text": "Ptosis", "correct": false}], "correct_answer": "A. Entropion", "question_images": ["https://image.prepladder.com/content/hrnLcv9NVI10vywfo4w41745925232.png"], "explanation_images": ["https://image.prepladder.com/content/sl1ueFh2OqziUaBLbi7q1745925278.png", "https://image.prepladder.com/content/ZhZmzEj5tSPnHAJcaE6G1745925278.png", "https://image.prepladder.com/content/GjnBF8Y1XvuuoQfght8G1745925278.png", "https://image.prepladder.com/content/9zY0qbbIfDMOtodDq9MG1745925278.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Grade-I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> lid border is in-rolled</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade-II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>includes in-rolling up to the intermarginal strip</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade-III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Whole lid margin including the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> border is in-rolled</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1) Congenital Entropion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present since birth, more common in the<strong> lower <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower Eyelid: Improper development of lower lid retractors.</li>\n<li>Upper Eyelid: Mechanical effects due to microphthalmos.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2) Cicatricial Entropion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Commonly involves the <strong>upper eyelid.</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common causes: <strong>Trachoma</strong>, chemical burns, pemphigus, Stevens-Johnson syndrome, symblepharon.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3) Senile (Involutional) Entropion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Affects the <strong>lower <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> in elderly individuals</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Horizontal lid laxity</strong></li>\n<li>Vertical lid instability</li>\n<li>Overriding of <span class=\"customMeta\" data-dictid=\"9bb60465b21692777196a02e5ce788\">pretarsal</span> orbicularis.</li>\n<li>Laxity of <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> septum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4) Mechanical Entropion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lack of support from the globe to the lids.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Occurs in conditions like <strong>phthisis bulbi</strong>, <span class=\"customMeta\" data-dictid=\"1f51f462bc1692777187ffc9d3094b\">enophthalmos</span> and after <span class=\"customMeta\" data-dictid=\"c4ed8e6ddb169277718796a1728b51\">enucleation</span> or <span class=\"customMeta\" data-dictid=\"00fc1a6b38169277718780d2bc69d1\">evisceration</span> operations.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 40-year-old patient who has experienced the passage of mucus and blood in their stool, with inflammation predominantly observed in the rectum during sigmoidoscopy, and the presence of crypt abscess detected during biopsy?", "options": [{"label": "A", "text": "Ulcerative colitis", "correct": true}, {"label": "B", "text": "Irritable bowel syndrome", "correct": false}, {"label": "C", "text": "Crohn disease", "correct": false}, {"label": "D", "text": "Pseudomembranous colitis", "correct": false}], "correct_answer": "A. Ulcerative colitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tWTP1ZKXyxSdhXeA15HT1745925321.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulcerative colitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crohn’s disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited to <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> and rectum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can involve any part of the GI tract</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse lesion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patchy, with skip lesions.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gross appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucosal <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> and granularity</li>\n<li>Broad-based ulcers with a continuous pattern</li>\n<li>Pseudopolyps</li>\n<li>Mucosal atrophy</li>\n<li>Smooth, continuous inflammation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transmural inflammation</li>\n<li>Aphthous ulcers</li>\n<li><strong>Cobblestone appearance</strong></li>\n<li>Fistulae, strictures, abscesses</li>\n<li>Creeping fat (mesenteric fat wrapping)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Toxic megacolon</li>\n<li>Colonic dilation</li>\n<li>Mucosal bridges</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Strictures</strong></li>\n<li><strong>Fistulae</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 3-year-old child who has recently developed 15-degree accommodative esotropia, what is the most effective treatment approach?", "options": [{"label": "A", "text": "Orthoptic exercise", "correct": false}, {"label": "B", "text": "Surgery", "correct": false}, {"label": "C", "text": "Refractive correction", "correct": true}, {"label": "D", "text": "INTACS", "correct": false}], "correct_answer": "C. Refractive correction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DSz4gqkHGV0KhBcFWgG11745925404.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Accommodative <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">Refractive</span> Esotropia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Accommodative Non-refractive Esotropia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Accommodative Mixed Esotropia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"33b2242b9d1692777189c76a31364e\">hypermetropia</span> (+4 to +7 D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal large AC/A (accommodative convergence/accommodation) ratio</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Combination of <span class=\"customMeta\" data-dictid=\"33b2242b9d1692777189c76a31364e\">hypermetropia</span> and high AC/ A ratio</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Correction of <span class=\"customMeta\" data-dictid=\"33b2242b9d1692777189c76a31364e\">hypermetropia</span> (spectacles) </strong></p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Stamatis Gatzonis, V. Follidi\" data-hash=\"\" data-license=\"NA\" data-source=\"Figure 1 from The Influence of Compliance with the Use of Refractive Correction in Hyperopic Children on Accommodation | Semantic Scholar\" data-tags=\"\" height=\"208\" src=\"https://image.prepladder.com/content/DSz4gqkHGV0KhBcFWgG11745925404.png\" width=\"241\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corrected by <strong>bifocal <span class=\"customMeta\" data-dictid=\"9e8e9086691692777188b5a212bcc7\">glasses</span> with +3 DS </strong>added for near vision</li>\n<li>Miotics (Echothiophate)</li>\n<li>Surgery: Bilateral <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> recession</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery: <strong>Bilateral <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> recession</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following lenses would be recommended to correct myopia?", "options": [{"label": "A", "text": "Convex", "correct": false}, {"label": "B", "text": "Concave", "correct": true}, {"label": "C", "text": "Cylindrical", "correct": false}, {"label": "D", "text": "Abraham lens", "correct": false}], "correct_answer": "B. Concave", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/OWWFTmI1wR4x9CQmRLpM1747914231.png", "https://image.prepladder.com/notes/Ke64BVFM4u9kx3VtA8Ur1747914193.png", "https://image.prepladder.com/notes/Ulm1GwSX886D6kNO4CxF1747914285.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>General measures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Balanced diet</li>\n<li>Visual hygiene: Posture correction, adequate illumination, reducing usage of video display units (VDUs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Concave lenses</strong> are prescribed: Spectacles/ contact lenses <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radial Keratotomy (RK): </strong></p>\n<ul>\n<li>Used for low to moderate <span class=\"customMeta\" data-dictid=\"619b89f28f16927771936b1ade010c\">myopia</span> (2-6 D).</li>\n<li>No longer recommended due to the advent of safer procedures like LASIK.</li>\n</ul>\n<p> </p>\n<p><strong>Photorefractive Keratectomy (PRK): </strong></p>\n<ul>\n<li>It uses an <span class=\"customMeta\" data-dictid=\"b29e14e78a1692777187e2ac5fccaf\">excimer laser</span> to reshape the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> by removing a thin corneal layer.</li>\n<li>Suitable for correcting <span class=\"customMeta\" data-dictid=\"619b89f28f16927771936b1ade010c\">myopia</span> up to -6 D.</li>\n</ul>\n<p> </p>\n<p><strong>Refractive Lenticule Extraction (SMILE):</strong></p>\n<ul>\n<li>A minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> laser procedure where a small lenticule is removed to reshape the cornea.</li>\n<li>Effective for <span class=\"customMeta\" data-dictid=\"619b89f28f16927771936b1ade010c\">myopia</span> up to -10 D, with or without astigmatism.</li>\n</ul>\n<p> </p>\n<p><strong>Phakic Intraocular Lens (IOL) Implantation:</strong></p>\n<ul>\n<li>Implantable lens placed without removing the natural lens.</li>\n<li>Best for <span class=\"customMeta\" data-dictid=\"619b89f28f16927771936b1ade010c\">myopia</span> exceeding -8 D, especially in patients unsuitable for laser surgery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old man was referred to the surgery OPD from the infertility clinic. On palpation, a bag of worms sensation was felt with dilated veins. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hydrocele", "correct": false}, {"label": "B", "text": "Varicocele", "correct": true}, {"label": "C", "text": "Testicular torsion", "correct": false}, {"label": "D", "text": "Epididymo Orchitis", "correct": false}], "correct_answer": "B. Varicocele", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8wzQAVFRIF42xU0bQ98g1745929006.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Varicocele</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Occurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in tall, thin young men</li>\n<li>More frequent on the left side but can be bilateral</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Idiopathic</li>\n<li>Absence or <span class=\"customMeta\" data-dictid=\"c6bd60f04c16927771907761dd90dd\">incompetent</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> at the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of the left testicular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> and left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vein</li>\n<li>Perpendicular entry of the left testicular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> into the left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vein</li>\n<li>Left-sided <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> causing <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> of the left testicular vein</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased temperature in the scrotum, depressing <span class=\"customMeta\" data-dictid=\"a3b0e644a6169277719912525dffae\">spermatogenesis</span> and causing infertility</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swelling at the root of the scrotum</li>\n<li>Dragging pain in the <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> and scrotum</li>\n<li>\"Bag of worms\" feeling</li>\n<li>Impulse on coughing</li>\n<li>Swelling reduces on lying down (except in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cell carcinoma)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Venous <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> of the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> and groin</li>\n<li>Ultrasound of the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> to check for <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> tumours</li>\n<li>Semen analysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Palomo's Operation: <span class=\"customMeta\" data-dictid=\"f8c909c45c16927771998f20372bcb\">Suprainguinal</span> <span class=\"customMeta\" data-dictid=\"1f0a3237f21692777187669004cf0a\">extraperitoneal</span> <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> of the testicular vein</li>\n<li>Ligation of veins</li>\n<li>Excision of veins</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly male patient presented with purulent discharge from an opening located in the perianal region. The patient is put in a lithotomy position, and the opening is located at the 11 o’clock position, 2 cm from the anal margin. What will be the likely position of the internal opening, and where does the internal opening start?", "options": [{"label": "A", "text": "12 o’clock and at the external anal sphincter", "correct": false}, {"label": "B", "text": "11 o’clock and at the internal anal sphincter", "correct": true}, {"label": "C", "text": "9 o’clock and at anal verge", "correct": false}, {"label": "D", "text": "6 o’clock and crypt of the dentate line", "correct": false}], "correct_answer": "B. 11 o’clock and at the internal anal sphincter", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LdwQN8OF16lZ726w3TWI1745929260.png"], "explanation": "<p>Correct answer B) 11 o’clock and at the internal anal sph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pressure greater than __ mm of Hg causes pressure sores.:", "options": [{"label": "A", "text": "33", "correct": true}, {"label": "B", "text": "45", "correct": false}, {"label": "C", "text": "54", "correct": false}, {"label": "D", "text": "67", "correct": false}], "correct_answer": "A. 33", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the best treatment option for a patient who has been diagnosed with renal cell carcinoma and has a tumour measuring 10 cm in size, located at the lower part of the kidney, and has negative regional lymph nodes?", "options": [{"label": "A", "text": "Radical nephrectomy", "correct": true}, {"label": "B", "text": "Partial nephrectomy", "correct": false}, {"label": "C", "text": "Radiotherapy", "correct": false}, {"label": "D", "text": "Chemotherapy", "correct": false}], "correct_answer": "A. Radical nephrectomy", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment of RCC: RCCs are radio and chemo-resistant.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial Nephrectomy: </strong>Involves removing only the tumour while preserving the remainder of the kidney.</p>\n<p><strong>Indications: </strong></p>\n<ul>\n<li>T1 Disease(&lt;7cm)</li>\n<li>Restricted to poles</li>\n<li>RCC in <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> kidney</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radical Nephrectomy: </strong>Involves<strong> </strong>removal of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with Gerota’s fascia, <span class=\"customMeta\" data-dictid=\"b83fd0c2a5169277719403617c9fdd\">para-aortic</span> nodes, and <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> up to the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> brim.</p>\n<p><strong>Indications: </strong>Larger tumours or when partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is not feasible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ablative Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA) and <span class=\"customMeta\" data-dictid=\"ef32d1f4571692777185565852b47f\">Cryoablation</span> </strong>involve destroying the tumour using extreme temperatures.</p>\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Patients who are not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates</li>\n<li>Patients with small tumours (T1a lesions) (usually &lt;4 cm).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n<p><strong>(For advanced/ metastatic disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Targeted Therapy</strong></p>\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (e.g., sunitinib, pazopanib)</li>\n<li>mTOR inhibitors (e.g., everolimus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunotherapy: </strong>Immune <span class=\"customMeta\" data-dictid=\"cd249aae061692777184c11176df48\">checkpoint</span> inhibitors (e.g., nivolumab)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a patient who has a scrotal mass on the left side that is hard in texture, has uneven edges, does not decrease in size when lying down or manipulated, does not have a cough impulse, but shows enlargement in the para-aortic lymph nodes?", "options": [{"label": "A", "text": "Hydrocele", "correct": false}, {"label": "B", "text": "Direct inguinal hernia", "correct": false}, {"label": "C", "text": "Indirect inguinal hernia", "correct": false}, {"label": "D", "text": "Metastasising testicular tumor", "correct": true}], "correct_answer": "D. Metastasising testicular tumor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer D) Metastasizing testicular tu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Best prognosis among the following breast cancer subtypes is for:", "options": [{"label": "A", "text": "Luminal A", "correct": true}, {"label": "B", "text": "Luminal B", "correct": false}, {"label": "C", "text": "ER negative", "correct": false}, {"label": "D", "text": "Basal like", "correct": false}], "correct_answer": "A. Luminal A", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ER Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PR Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HER2 Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ki-67 Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luminal A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally, it is low grade, has a better prognosis, and is responsive to hormonal therapy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Luminal B </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher grade, poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> compared to <span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\">Luminal</span> A, may require targeted HER2 therapy following status. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HER2-enriched</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aggressive, higher grade, poor prognosis, requires targeted HER2 therapy.</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basal-like</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes triple-negative breast cancer (TNBC), highly aggressive, no targeted hormonal therapy. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Claudin-low</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+ or -</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often associated with poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> and aggressive behaviour, typically lacks response to hormonal therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable outcome for the patient after undergoing gastrectomy?", "options": [{"label": "A", "text": "Folic acid deficiency", "correct": false}, {"label": "B", "text": "Vitamin B12 deficiency", "correct": true}, {"label": "C", "text": "Gastric ulcer", "correct": false}, {"label": "D", "text": "Constipation", "correct": false}], "correct_answer": "B. Vitamin B12 deficiency", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 308 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which class of hypovolemic shock, according to Advanced Trauma Life Support (ATLS) guidelines, is characterised by the absence of urine output?", "options": [{"label": "A", "text": "Class I", "correct": false}, {"label": "B", "text": "Class II", "correct": false}, {"label": "C", "text": "Class III", "correct": false}, {"label": "D", "text": "Class IV", "correct": true}], "correct_answer": "D. Class IV", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Class I</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Class II</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Class III</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Class IV </strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood loss (%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-15%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>15-30%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>30-40%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 40%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Central Nervous System (CNS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slightly anxious</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mildly anxious</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anxious or confused</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused or lethargic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulse (beats/min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 100</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 100</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 120</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 140</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulse pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory rate (breaths/min)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>14-20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20-30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>30-40</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 35</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urine output (mL/hr)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20-30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5-15</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negligible/Nil</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluid requirement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crystalloid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crystalloid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crystalloid + Blood</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crystalloid + Blood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Base deficit (mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0 to -2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-2 to -6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-6 to -10</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-10 or less</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 51-year-old lady presents with complaints of a mass in the right breast. On examination, the mass was larger than 5 cm and ipsilateral mobile axillary lymph nodes were present. What is the staging, considering the mass is malignant?", "options": [{"label": "A", "text": "cT3N1M0", "correct": true}, {"label": "B", "text": "cT4N0M0", "correct": false}, {"label": "C", "text": "cT4N1M0", "correct": false}, {"label": "D", "text": "cT3N0M0", "correct": false}], "correct_answer": "A. cT3N1M0", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor size (T)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary tumor cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No evidence of primary tumor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carcinoma <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (DCIS, LCIS, or Paget's disease)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor ≤ 2 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1mi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor ≤ 1 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor &gt; 1 mm but ≤ 5 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor &gt; 5 mm but ≤ 10 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor &gt; 10 mm but ≤ 20 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor &gt; 2 cm but ≤ 5 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor &gt; 5 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor of any size with direct extension to <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> or skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extension to the chest wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ulceration or skin nodules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both T4a and T4b</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4d</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inflammatory breast cancer</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Node (N)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>NX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastases to movable <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> level I, II axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes or clinically apparent internal mammary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes that are clinically fixed or matted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to internal mammary nodes without axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to axillary <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes or <span class=\"customMeta\" data-dictid=\"71409dc88a1692777190aedbc558b6\">infraclavicular</span> nodes, or to <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N3a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to <span class=\"customMeta\" data-dictid=\"71409dc88a1692777190aedbc558b6\">infraclavicular</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N3b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to internal mammary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N3c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis to <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis (M)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Genetic testing for BRCA 1/BRCA 2 is indicated for all of the following except:", "options": [{"label": "A", "text": "Breast cancer diagnosed in a postmenopausal female &amp;gt;50 years of age", "correct": true}, {"label": "B", "text": "Male breast cancer", "correct": false}, {"label": "C", "text": "Two breast cancer primaries", "correct": false}, {"label": "D", "text": "TNBC diagnosed age 60 years", "correct": false}], "correct_answer": "A. Breast cancer diagnosed in a postmenopausal female &gt;50 years of age", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the best preferred investigation for Neuroendocrine Tumors (NETs)?", "options": [{"label": "A", "text": "USG", "correct": false}, {"label": "B", "text": "SRS", "correct": false}, {"label": "C", "text": "MRI", "correct": false}, {"label": "D", "text": "PET", "correct": true}], "correct_answer": "D. PET", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male patient presents with hematuria and a neovascular mass in the left kidney on a CT scan, as shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Renal cell carcinoma", "correct": false}, {"label": "B", "text": "Renal oncocytoma", "correct": false}, {"label": "C", "text": "Renal angiomyolipoma", "correct": true}, {"label": "D", "text": "Renal cyst", "correct": false}], "correct_answer": "C. Renal angiomyolipoma", "question_images": ["https://image.prepladder.com/notes/HUENQEUgV7saPSLCrxGj1747380820.png"], "explanation_images": ["https://image.prepladder.com/content/hXQ2vAmkDvUdMNfnhxif1746164419.png", "https://image.prepladder.com/content/z1aAr2Oo3qIjMxTU4MgD1746164419.png", "https://image.prepladder.com/content/OojTd3aL8Z5QMoDtbnxp1746164419.png", "https://image.prepladder.com/content/HtFkc5XSYTQEIBYWb4Im1746164419.png", "https://image.prepladder.com/content/LbciG75vH6kk7iGap2yd1746164419.png", "https://image.prepladder.com/content/5EVW2hUzVGiUfzPKv7gV1746164419.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Arise from</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<ul>\n<li>Perivascular <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> cells</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Types</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Sporadic AMLs:</strong> Present in the 4th-6th decades, typically small, solitary, and slow-growing.</li>\n<li><strong>TSC-associated AMLs: </strong>Present earlier (3rd-4th decades), larger, multiple, bilateral, and tend to grow.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Abdominal or <span class=\"customMeta\" data-dictid=\"316968b3e116927772021379938005\">flank</span> pain, hematuria, hypertension, anemia.</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function, usually due to <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (severe complication).</li>\n<li><strong>Wunderlich syndrome</strong>: Nontraumatic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> hemorrhage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Risk Factors for AML Complications</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Pregnancy: </strong>Increased risk of hemorrhage</li>\n<li><strong>TSC-associated AMLs:</strong> Higher risk of CKD and ESKD</li>\n<li><strong>Epithelioid AMLs:</strong> Potential for <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation, metastasis, and local recurrence.</li>\n</ul>\n<p> </p>\n<p><strong>Risk factors for hemorrhage:</strong></p>\n<ul>\n<li>AML size (&gt;6 cm)</li>\n<li>Increased vascularity</li>\n<li>Large <span class=\"customMeta\" data-dictid=\"e572b487a11692777190b9f3b05fd3\">intralesional</span> aneurysms (&gt;5 mm)</li>\n<li>Exophytic growth pattern.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Histology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Circular blood vessels, muscles, and fat; <span class=\"customMeta\" data-dictid=\"a606b55b4316927771956c3cb0d383\">perivascular</span> <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> cells with dense <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> and mitotic figures.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"No machine-readable author provided. KGH assumed (based on copyright claims).,\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Renal_angiomyolipoma_(1).jpg\" data-tags=\"\" height=\"514\" src=\"https://image.prepladder.com/content/hXQ2vAmkDvUdMNfnhxif1746164419.png\" width=\"677\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td rowspan=\"9\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td rowspan=\"9\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>CT: (Investigation of choice) </strong>Presence of <span class=\"customMeta\" data-dictid=\"e572b487a11692777190b9f3b05fd3\">intralesional</span> fat and <span class=\"customMeta\" data-dictid=\"624c00049d1692777193b1a9d81379\">neovascular</span> mass.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Angiomyolipoma#/media/File:Angiomyolipome_der_Niere_CT.jpg\" data-tags=\"\" height=\"274\" src=\"https://image.prepladder.com/content/z1aAr2Oo3qIjMxTU4MgD1746164419.png\" width=\"741\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>USG: </strong>Appears as hyperechoic</li>\n<li><strong>Immunocytochemical analysis: </strong>Differentiates AML from RCC, using markers like HMB-45 and melan-A<strong>.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Observation (tumors &lt;4 cm)</li>\n<li>Nephron-Sparing Surgery(Partial nephrectomy) (larger tumors or those with a high risk of bleeding)</li>\n<li>Angioembolization (acute hemorrhage).</li>\n<li>Medications (mTOR inhibitors like <span class=\"customMeta\" data-dictid=\"aa8d032496169277718724299fb4cb\">everolimus</span> and sirolimus).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman after thyroidectomy comes to you for a 2 nd opinion for further treatment of papillary thyroid cancer. What would you recommend for this patient?", "options": [{"label": "A", "text": "Radiotherapy", "correct": false}, {"label": "B", "text": "Chemotherapy", "correct": false}, {"label": "C", "text": "Radioiodine scan", "correct": true}, {"label": "D", "text": "Wait and watch", "correct": false}], "correct_answer": "C. Radioiodine scan", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Differentiated <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancers\n\t\t\t\t<ul>\n<li>E.g., <strong>Papillary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> </strong></li>\n<li><strong>Follicular <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</strong></li>\n<li><strong>Hurthle cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> </strong></li>\n</ul>\n</li>\n<li>Tumor size <strong>&gt;2cm</strong></li>\n<li>One or more risk factors</li>\n<li>Obvious <span class=\"customMeta\" data-dictid=\"756a84577116927771871853f8642e\">extrathyroidal</span> extension</li>\n<li>&gt;45 years of age</li>\n<li>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> and distant metastasis</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Poorly differentiated <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancers\n\t\t\t\t<ul>\n<li>E.g., <strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</strong></li>\n<li>Anaplastic <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</li>\n</ul>\n</li>\n<li>Pregnancy &amp; Breastfeeding<strong> (Absolute contraindications)</strong></li>\n<li>Vomiting &amp; <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">Diarrhea</span> (Relative contraindications)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:747px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Isotopes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Route of administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Half-life</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of rays </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I-123</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>13 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>𝜸-rays</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> purposes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I-124</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PET scan in <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I-125 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>60 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>𝜸-rays</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnostic purposes and, in some cases, for brachytherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I-131</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>𝜷 and 𝜸-rays</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radioactive <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I-132</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.3 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in research</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tc-99 scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technetium is better at identifying non-functioning secondaries.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 17-year-old woman with no comorbidities presents with numbness and paraesthesia of the fingers along with the characteristic finding as shown in the image below. She has no history of smoking or history of other illnesses. She mentions the episodes occur when she is under excess stress or during cold temperatures. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Buerger’s disease", "correct": false}, {"label": "B", "text": "Atherosclerosis", "correct": false}, {"label": "C", "text": "Raynaud’s phenomenon", "correct": true}, {"label": "D", "text": "Giant cell arteritis", "correct": false}], "correct_answer": "C. Raynaud’s phenomenon", "question_images": ["https://image.prepladder.com/content/4VfFjsQorPcsvjxJ3e1O1746164862.png"], "explanation_images": ["https://image.prepladder.com/content/ZvRGQM5GpZXrLUWebDMq1746164905.png", "https://image.prepladder.com/content/kQSyqT94aMQGbcIeo13J1746164905.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is characterized by episodic reduction in blood flow, typically in the fingers, <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by cold exposure or stress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pallor:</strong> Skin becomes pale or white due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood flow.</li>\n<li><strong>Cyanosis:</strong> Skin turns blue or purple due to <span class=\"customMeta\" data-dictid=\"2819f49f1a169277718587145c3004\">deoxygenation</span> of blood.</li>\n</ul>\n<ul>\n<li><strong>Rubor:</strong> Skin turns red as <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> returns, often with <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and tingling.</li>\n<li><strong>Cold Sensitivity:</strong> Cold, <span class=\"customMeta\" data-dictid=\"c1f2cd78a916927771936efc6a16cf\">numb</span> fingers.</li>\n<li><strong>Pain:</strong> Pain during the cyanotic phase.</li>\n</ul>\n<ul>\n<li><strong>Swelling and Tingling:</strong> Occurs in the <span class=\"customMeta\" data-dictid=\"04658981de1692777197ed1ff49228\">rubor</span> phase.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary Raynaud Phenomenon (Raynaud Disease):</strong>\n<ul>\n<li>Occurs without underlying disease.</li>\n<li>More common and has a better prognosis.</li>\n</ul>\n</li>\n<li><strong>Secondary Raynaud Phenomenon (Raynaud Syndrome):</strong>\n<ul>\n<li>Occurs due to an underlying condition (e.g., scleroderma, lupus).</li>\n<li>Often more severe.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Lifestyle Modifications:</strong> Avoid cold exposure, stress reduction, and smoking cessation.</li>\n<li><strong>Medications:</strong> Calcium channel blockers (e.g., nifedipine), alpha-blockers (e.g., prazosin), and other vasodilators.</li>\n<li><strong>Avoidance of Triggers:</strong> Avoid cold, beta-blockers, and caffeine.</li>\n<li><strong>Advanced Treatments:</strong> Surgical <span class=\"customMeta\" data-dictid=\"1c33ea213b1692777199f5837fbe93\">sympathectomy</span> for severe cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Clinical Presentation and History:</strong> Based on symptoms and triggers.</li>\n<li><strong>Nailfold Capillaroscopy:</strong> To examine <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> changes.</li>\n<li><strong>Blood Tests:</strong> To identify underlying <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> or <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue diseases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are anterior mediastinal tumors except:", "options": [{"label": "A", "text": "Parathyroid adenoma", "correct": false}, {"label": "B", "text": "Lymphoma", "correct": true}, {"label": "C", "text": "Teratoma", "correct": false}, {"label": "D", "text": "Thymoma", "correct": false}], "correct_answer": "B. Lymphoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yt1wlbkNr4uopgyg8pci1746164987.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tumors of mediastinum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior mediastinum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Middle mediastinum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior mediastinum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thymomas <strong>(Option D ruled out)</strong></li>\n<li>Thymic carcinomas</li>\n<li>Thymic cyst</li>\n<li>Germ cell tumors <strong>(Option C ruled out)</strong></li>\n<li>Lymphomas</li>\n<li>Parathyroid adenomas <strong>(Option A ruled out)</strong></li>\n<li>Carcinoid tumour</li>\n<li>Fibroma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lymphomas<strong> (Option B)</strong></li>\n<li>Tumors of the heart and great vessels</li>\n<li>Tumours of the trachea, mainstem bronchi, and oesophagus</li>\n<li>Aortic pathologies such as aortic aneurysm, abscess, or dissection.</li>\n<li>Pericardial cysts</li>\n<li>Bronchogenic cysts</li>\n<li>Neuroenteric cyst</li>\n<li>Mesothelial cyst</li>\n<li>Pheochromocytoma</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neurilemomas (schwannomas)</li>\n<li>Neurofibromas</li>\n<li>Ganglioneuromas</li>\n<li>Ganglioneuroblastomas</li>\n<li>Neuroblastomas</li>\n<li>Pheochromocytomas</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic-alcoholic presents to the emergency room with acute pain in the abdomen in the epigastric region radiating to the back with nausea, anorexia, and occasional vomiting. Investigations showed elevated amylase levels (3 times) and total count. Likely diagnosis is:", "options": [{"label": "A", "text": "Acute hepatitis", "correct": false}, {"label": "B", "text": "Acute pancreatitis", "correct": true}, {"label": "C", "text": "Acute cholecystitis", "correct": false}, {"label": "D", "text": "Acute appendicitis", "correct": false}], "correct_answer": "B. Acute pancreatitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0HWNV9cQiO7BTOdSrK8w1746165064.png", "https://image.prepladder.com/content/R1Gzi6QbHXZIaP7jKDN51746165064.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4><strong>X-ray Features</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Sentinel loop sign</strong>:\n\t\t\t\t<ul>\n<li>Dilated loop of small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> near the inflamed <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> due to <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> ileus.</li>\n<li><strong>Significance</strong>: Early indicator of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> on X-ray.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohammad Niknejad\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/sentinel-loop-acute-appendicitis-2#image-3004244\" data-tags=\"\" height=\"600\" src=\"https://image.prepladder.com/content/0HWNV9cQiO7BTOdSrK8w1746165064.png\" width=\"447\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Sentinel loop sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Colon cut-off sign</strong>:\n\t\t\t\t<ul>\n<li>Abrupt <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">termination</span> of gas in the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> at the splenic flexure, with collapsed <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> loops.</li>\n<li><strong>Significance</strong>: Suggests <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pancreatic inflammation, causing <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> as an <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> sign of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> pancreatitis</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Cerevisae\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Colonic_cut_off_sign_on_chest_X-ray.jpg\" data-tags=\"\" height=\"323\" src=\"https://image.prepladder.com/content/R1Gzi6QbHXZIaP7jKDN51746165064.png\" width=\"446\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vitamin deficiency is most likely responsible for the chronic alcoholic patient’s presentation with confusion, aphasia, unstable gait, and symptoms related to Wernicke’s encephalopathy?", "options": [{"label": "A", "text": "Vit B1", "correct": true}, {"label": "B", "text": "Vit C", "correct": false}, {"label": "C", "text": "Vit D", "correct": false}, {"label": "D", "text": "Vit B3", "correct": false}], "correct_answer": "A. Vit B1", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Vit B1</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wernicke Encephalopathy:</strong></p>\n<ul>\n<li>Symptoms: Ophthalmoplegia, nystagmus, cerebellar ataxia, global confusion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Korsakoff Psychosis:</strong></p>\n<ul>\n<li>Symptoms: <span class=\"customMeta\" data-dictid=\"6f04a43a8c16927771816dd61a4f17\">Anterograde</span> and <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> amnesia, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> agnosia, and confabulation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">Thiamine</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> in Alcoholics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> requirements due to alcohol consumption. Alcohol is a source of empty calories.</li>\n<li>Inhibition of intestinal <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> by alcohol.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Implications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Impaired conversion of <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> to acetyl-CoA.</li>\n<li>Accumulation of <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> and <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> in the blood.</li>\n<li>Potential for life-threatening <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not true about Congenital Hypertrophic Pyloric Stenosis?", "options": [{"label": "A", "text": "Presents with non-bilious vomiting", "correct": false}, {"label": "B", "text": "Caused by hypertrophy of longitudinal muscles", "correct": true}, {"label": "C", "text": "USG is the gold standard investigation for this condition", "correct": false}, {"label": "D", "text": "Hypokalemic metabolic alkalosis seen", "correct": false}], "correct_answer": "B. Caused by hypertrophy of longitudinal muscles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d2bZFJsSoYNpuRfm2GMG1746166879.png", "https://image.prepladder.com/content/doCciw5xVXJS6qeqp8f41746166879.png", "https://image.prepladder.com/content/NKL6uPryhD0bI4whuHYw1746166879.png", "https://image.prepladder.com/content/S9GPAOnb76uGgkimVq261746166879.png", "https://image.prepladder.com/content/nuCm9USXKsQVoSAupmLO1746166879.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:703px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Typical onset: 3 to 6 weeks of age</li>\n<li><strong>Symptoms:</strong>\n<ul>\n<li>Projectile, non-bilious <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> <strong>(Option A ruled out)</strong></li>\n<li>Visible <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> peristalsis</li>\n<li>Palpable \"<strong>olive-like</strong>\" mass in the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> (hypertrophied pylorus), best felt from the left side\n\t\t\t\t\t<ul>\n<li><strong>Test feed:</strong> <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> is seen passing from left to right across the abdomen, and in a relaxed (feeding) baby, the pyloric ‘tumor’ is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> as an ‘olive’ in the right upper quadrant.</li>\n</ul>\n</li>\n<li>Dyselectrolytemias-\n\t\t\t\t\t<ul>\n<li>Hypochloremia</li>\n<li>Hypokalemia due to persistent vomiting</li>\n<li>Metabolic alkalosis. <strong>(Option D ruled out)</strong></li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"465\" src=\"https://image.prepladder.com/content/d2bZFJsSoYNpuRfm2GMG1746166879.png\" width=\"465\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound (Gold Standard)</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Characteristic \"<strong>doughnut sign</strong>\" indicating thickened pyloric muscle</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Maulik S Patel\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/intussusception-transient-small-bowel#image-382247\" data-tags=\"\" height=\"463\" src=\"https://image.prepladder.com/content/doCciw5xVXJS6qeqp8f41746166879.png\" width=\"568\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Diagnostic criteria:</strong>\n<ul>\n<li>Pyloric muscle <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> ≥ 4 mm</li>\n<li>Pyloric <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> length &gt; 14 mm</li>\n<li>\"Cervix sign\" on long-axis view</li>\n<li>\"Target sign\" on short-axis view</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ahmad Ali Alomari\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/hypertrophic-pyloric-stenosis-37\" data-tags=\"\" height=\"443\" src=\"https://image.prepladder.com/content/NKL6uPryhD0bI4whuHYw1746166879.png\" width=\"443\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Meal (Less Common)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can assist in diagnosis but is less accurate than ultrasound, it reveals:</p>\n<ul>\n<li>\"String sign\": Thin streak of contrast through narrowed pylorus</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Adityagupta95, \" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hypertrophic_pyloric_stenosis.png\" data-tags=\"\" height=\"407\" src=\"https://image.prepladder.com/content/S9GPAOnb76uGgkimVq261746166879.png\" width=\"320\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>\"Railroad track sign\": Two thin lines of contrast indicating mild narrowing</li>\n<li>\"Double track sign\": Similar to railroad track sign, indicating thickened muscle</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Niknejad M, Bell D, Gaillard F, Double track sign (pyloric stenosis). Reference article, Radiopaedia.org (Accessed on 02 Jan 2025) https://doi.org/10.53347/rID-22049\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/double-track-sign-pyloric-stenosis?lang=us\" data-tags=\"\" height=\"395\" src=\"https://image.prepladder.com/content/nuCm9USXKsQVoSAupmLO1746166879.png\" width=\"593\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old lactating mother presents with pain in her left breast. Which of the following is the most likely cause of acute mastitis?", "options": [{"label": "A", "text": "Breast engorgement", "correct": false}, {"label": "B", "text": "Hormonal influence", "correct": false}, {"label": "C", "text": "Absence of lactation", "correct": false}, {"label": "D", "text": "Crack in the nipple", "correct": true}], "correct_answer": "D. Crack in the nipple", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which lymph node is most commonly involved in prostate cancer?", "options": [{"label": "A", "text": "Deep inguinal", "correct": false}, {"label": "B", "text": "Retroperitoneal", "correct": false}, {"label": "C", "text": "Superficial inguinal", "correct": false}, {"label": "D", "text": "Pelvic", "correct": true}], "correct_answer": "D. Pelvic", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tumor in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> over the age of 65 years.</li>\n<li>Most common among Afro-American</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factor </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Advanced age</li>\n<li>High-fat diet</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protective factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(Mnemonic: LESA)</strong></p>\n<ul>\n<li><strong>L</strong>ycopene</li>\n<li>Vitamin <strong>E</strong></li>\n<li><strong>S</strong>elenium</li>\n<li>Vitamin <strong>A</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common site- <strong>peripheral zone (75%)</strong> &gt; <span class=\"customMeta\" data-dictid=\"1ef284d05a169277720146906d01cb\">transitional zone</span> (15%) &gt; central zone (10%)</li>\n<li>Most common <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> type is <strong>adenocarcinoma</strong></li>\n<li>Most common genetic alteration seen in CA prostate- <strong>hypermethylation of GSTP1 </strong>(Glutathione <span class=\"customMeta\" data-dictid=\"2288cbf3741692777200318d2f5b39\">transferase</span> <span class=\"customMeta\" data-dictid=\"239a5e19771692777196d5b860c695\">promoter</span> region 1) located on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 11.</li>\n<li>70-80% of the cases.</li>\n<li>Microscopy: small, crowded, absent <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> layer, lack of branching</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Commonly asymptomatic.</li>\n<li>Bladder outlet obstruction.</li>\n<li>Haematuria</li>\n<li>Pelvic pain, back pain, <span class=\"customMeta\" data-dictid=\"2b0ec4bfad1692777182bbd41fc010\">arthritic</span> pain in <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint-features of secondaries</li>\n<li>On per rectal examination: hard, nodular, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> often with loss of <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> groove.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Routes of spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common route of spread- <strong>haematogenous</strong> (skeletal metastases: <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> bones and the lower <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> vertebrae)</li>\n<li><strong>Lymphatic: </strong>Internal iliac, external <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">retroperitoneal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> nodes and occasionally the <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> nodes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>DRE (Digital Rectal Exam): </strong>Physical examination; detects nodules but limited in early-stage</li>\n<li><strong>PSA (prostate-specific antigen) Test: </strong>Measures <span class=\"customMeta\" data-dictid=\"9a70998c381692777196f5daf6edb1\">PSA</span> levels; elevated levels suggest cancer</li>\n<li><strong>TRUS (Transrectal Ultrasound): </strong>Imaging with rectal probe; detects abnormalities</li>\n<li><strong>mpMRI (Multiparametric MRI): </strong>Advanced imaging; superior for <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> and capsular spread</li>\n<li><strong>Prostate Biopsy: </strong>Gold standard for diagnosis; tissue <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> for cancer cells</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Active Surveillance: </strong>For low-risk cases; regular monitoring</li>\n<li><strong>Radical Prostatectomy: </strong>Surgery for <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> cancer; potentially curative</li>\n<li><strong>Radiation Therapy: </strong>High-energy rays; external or brachytherapy</li>\n<li><strong>Hormone Therapy: </strong>Reduces/block testosterone; for advanced/metastatic cases</li>\n<li><strong>Chemotherapy: </strong>Systemic drug treatment; for advanced/metastatic cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false about the following image?", "options": [{"label": "A", "text": "Staphylococcus aureus is the causative organism", "correct": true}, {"label": "B", "text": "Common in diabetic patients", "correct": false}, {"label": "C", "text": "High mortality", "correct": false}, {"label": "D", "text": "The testes remain unaffected", "correct": false}], "correct_answer": "A. Staphylococcus aureus is the causative organism", "question_images": ["https://image.prepladder.com/notes/TSNHX377XxwownoRJm6R1747381244.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fournier's Gangrene</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Necrotizing infection of the soft tissues in the perineum, external genitalia, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> region, akin to <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Organisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mixed infection of <span class=\"customMeta\" data-dictid=\"789c9dd31a16927771801dd2426384\">aerobic</span> and <span class=\"customMeta\" data-dictid=\"4880fc99551692777181e25a64560f\">anaerobic</span> bacteria in a fulminating <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissues. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms: Intense pain in the genitalia, progressing through five phases:\n\t\t\t\t<ul>\n<li><strong>Prodromal Phase: </strong>Fever and lethargy.</li>\n<li><strong>Early Pain Phase:</strong> Intense pain, possible edema, pruritus.</li>\n<li><strong>Progressive Phase: </strong>Increased pain, erythema.</li>\n<li><strong>Crepitation Phase: </strong>Dusky skin with <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> crepitation.</li>\n<li><strong>Gangrene Phase: </strong>Gangrene with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</li>\n</ul>\n</li>\n<li>Pain may decrease as <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> progresses.</li>\n<li>Severity ranges from <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease</li>\n<li>Diabetes mellitus <strong>(Option B ruled out)</strong></li>\n<li>Malnutrition</li>\n<li>Alcoholism</li>\n<li>Immunocompromised states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical presentation supported by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Fluid resuscitation.</li>\n<li>Broad-spectrum antibiotics.</li>\n<li>Surgical debridement of necrotic tissue.</li>\n</ul>\n<p><strong>Additional Measures:</strong></p>\n<ul>\n<li>Daily rounds (high rates mortality and morbidity) <strong>(Option C ruled out)</strong></li>\n<li>Urinary and fecal <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> to prevent wound contamination.</li>\n<li>Intensive monitoring for sepsis.</li>\n<li>Wound review and vacuum-assisted dressing.</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> post-infection control.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of hernia is a funicular hernia? Direct inguinal hernia", "options": [{"label": "A", "text": "Direct inguinal hernia", "correct": false}, {"label": "B", "text": "Indirect inguinal hernia", "correct": true}, {"label": "C", "text": "Femoral hernia", "correct": false}, {"label": "D", "text": "Umbilical hernia", "correct": false}], "correct_answer": "B. Indirect inguinal hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s6V3IqtzvKmt9oZsIHrC1746167265.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indirect Inguinal Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Direct Inguinal Hernia</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Young adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It enters through the deep inguinal ring, traverses the inguinal canal, and exits via the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> inguinal ring.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protrudes directly through Hesselbach's triangle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">Spermatic</span> Cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location of Neck of Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> tubercle.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lies within the Hesselbach's triangle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to Scrotum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Descends into the scrotum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Does not Descend</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bubonocele:</strong> Confined to inguinal canal</li>\n<li><strong>Funicular:</strong> <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">Processus</span> vaginalis closed above epididymis, <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> content distinct from <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> <strong>(Option B)</strong></li>\n<li><strong>Complete/Scrotal:</strong> <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> in the lower part of the hernia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><strong>—</strong></p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Indirect inguinal hernia</p>\n<ul>\n<li>Normal internal inguinal ring\n\t\t\t\t<ul>\n<li>e.g., <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> hernia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indirect inguinal hernia</strong></p>\n<ul>\n<li>Dilated internal inguinal ring</li>\n<li>Posterior inguinal wall intact</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A: </strong>Direct inguinal hernia</p>\n<p><strong>B: </strong>Indirect inguinal hernia</p>\n<ul>\n<li>Internal inguinal ring dilated</li>\n<li>Encroaching medially or destroying the <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> of the Hesselbach <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> (e.g. scrotal sliding or pantaloon hernia)</li>\n</ul>\n<p><strong>C: </strong>Femoral hernia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV (Recurrent Hernia)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A: </strong>Direct</p>\n<p><strong>B</strong>: Indirect</p>\n<p><strong>C: </strong>Femoral</p>\n<p><strong>D: </strong>Combined</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common type of anorectal fistula?", "options": [{"label": "A", "text": "Intersphincteric", "correct": true}, {"label": "B", "text": "Trans-sphincteric", "correct": false}, {"label": "C", "text": "Suprasphincteric", "correct": false}, {"label": "D", "text": "Extrasphincteric", "correct": false}], "correct_answer": "A. Intersphincteric", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uZJkGJQyRNxvbQWab1y01746167348.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type 1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Inter- sphincteric (<strong>most common</strong>, 70%) <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trans- sphincteric (25%) <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supra- sphincteric (4%) <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 4 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extra- sphincteric (1%) <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old man was brought to the emergency department after sustaining an RTA and injury to the lower chest. On presentation, the patient is stable, and vitals are normal. Chest radiography showed clear lung fields. What is the next step in management?", "options": [{"label": "A", "text": "eFAST", "correct": true}, {"label": "B", "text": "Tube thoracostomy", "correct": false}, {"label": "C", "text": "CECT chest", "correct": false}, {"label": "D", "text": "CECT abdomen", "correct": false}], "correct_answer": "A. eFAST", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/u3GKOBXLa24YZhCw805M1746167420.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male patient came to the outpatient department with complaints of hematuria. A 2x2 cm bladder mass is seen which is low-grade transitional cell carcinoma. Which among the following is the ideal management?", "options": [{"label": "A", "text": "Transurethral resection of the tumor", "correct": true}, {"label": "B", "text": "Resection with ileal conduit", "correct": false}, {"label": "C", "text": "Partial cystectomy with bladder reconstruction", "correct": false}, {"label": "D", "text": "Neoadjuvant chemotherapy", "correct": false}], "correct_answer": "A. Transurethral resection of the tumor", "question_images": ["https://image.prepladder.com/notes/k5feFp2x6mCLTdcS65LK1747381598.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Tumor Stage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Tis (Carcinoma in situ)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT (Transurethral <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Tumor)</strong></p>\n<ul>\n<li>May be used for initial diagnosis and tumor <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> if not already performed</li>\n</ul>\n<p><strong>Intravesical BCG</strong></p>\n<ul>\n<li>Induction: Weekly for 6 weeks</li>\n<li>Maintenance: Weekly for 3 weeks at months 3, 6, 12, 18, 24, 30, and 36</li>\n</ul>\n<p><strong>Continue BCG Maintenance Therapy</strong></p>\n<ul>\n<li>Up to 3 years</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ta (Non-muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT</strong></p>\n<ul>\n<li>Complete <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of tumor</li>\n</ul>\n<p><strong>Low-risk:</strong></p>\n<ul>\n<li>Single Instillation (SI) of Intravesical <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> (e.g., gemcitabine, mitomycin)</li>\n<li>SI within 24 hours of TURBT</li>\n<li>Alternative: Continuous <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> irrigation</li>\n</ul>\n<p><strong>Intermediate-risk:</strong></p>\n<ul>\n<li>Intravesical <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">Chemotherapy</span> (e.g., gemcitabine)</li>\n<li>Induction: 6 weekly courses</li>\n<li>Maintenance: Up to 1 year</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T1 (Muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT</strong>- For initial diagnosis and tumor debulking</p>\n<p><strong>High-risk:</strong></p>\n<ul>\n<li>Intravesical BCG</li>\n<li>Induction: Weekly for 6 weeks</li>\n<li>Maintenance: Up to 3 years</li>\n</ul>\n<p><strong>Consider Cystectomy</strong></p>\n<ul>\n<li>If BCG is not tolerated or ineffective- Alternative: Trimodality therapy (TURBT + Chemoradiation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T2 (Muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>TURBT</strong>- May be used for tumor <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> and staging</p>\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Consider Cystectomy</li>\n<li>Alternatively, Trimodality therapy (TURBT + Chemoradiation)</li>\n</ul>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Depending on response and tumor characteristics</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T3 (Advanced muscle invasive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Cystectomy with possible <span class=\"customMeta\" data-dictid=\"1c14f072f516927771934b6b87b57b\">neoadjuvant</span> chemotherapy</li>\n</ul>\n<p><strong>TURBT </strong>- Often not performed if <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> is planned</p>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Based on <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> and staging</li>\n<li>Neoadjuvant therapy may continue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T4 (Locally advanced)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Initial Treatment:</strong></p>\n<ul>\n<li>Cystectomy</li>\n<li>Neoadjuvant Chemotherapy, if not yet administered</li>\n</ul>\n<p><strong>TURBT</strong>- Typically avoided if <span class=\"customMeta\" data-dictid=\"cc8d1a4ba11692777185484fbd1d69\">cystectomy</span> and <span class=\"customMeta\" data-dictid=\"1c14f072f516927771934b6b87b57b\">neoadjuvant</span> therapy are planned</p>\n<p><strong>Adjuvant Therapy:</strong></p>\n<ul>\n<li>Additional <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> or radiation based on <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> disease and staging</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following will have unilateral hydronephrosis?", "options": [{"label": "A", "text": "Urethral atresia", "correct": false}, {"label": "B", "text": "Posterior urethral valves", "correct": false}, {"label": "C", "text": "Benign Prostatic Hyperplasia", "correct": false}, {"label": "D", "text": "Retrocaval ureter", "correct": true}], "correct_answer": "D. Retrocaval ureter", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Unilateral Hydronephrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bilateral Hydronephrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extramural Causes:</strong></p>\n<ul>\n<li>Advanced Malignancies\n\t\t\t\t<ul>\n<li>Colorectal cancer</li>\n<li>Carcinoma cervix</li>\n<li>Carcinoma Prostate</li>\n</ul>\n</li>\n<li>Retroperitoneal fibrosis</li>\n<li>Retrocaval Ureter<strong> (Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Congenital Causes:</strong></p>\n<ul>\n<li>Posterior Urethral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> <strong>(Option B ruled out)</strong></li>\n<li>Urethral <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intramural Causes:</strong></p>\n<ul>\n<li>PUJ Obstruction</li>\n<li>Ureterocele</li>\n<li>Ureteric Stricture</li>\n<li>Urothelial tumor</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired Causes:</strong></p>\n<ul>\n<li>Bladder neck stenosis</li>\n<li>BPH (Benign Prostatic Hyperplasia) <strong>(Option C ruled out)</strong></li>\n<li>CA Prostate</li>\n<li>Urethral strictures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intraluminal Causes:</strong></p>\n<ul>\n<li>Stone</li>\n<li>Papillary Slough</li>\n<li>Due to:\n\t\t\t\t<ul>\n<li>Analgesic nephropathy</li>\n<li>Sickle cell anemia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Unilateral Hydronephrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bilateral Hydronephrosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Congenital PUJ obstruction</strong> and <strong>calculus </strong>are the most common causes</li>\n<li>Male to Female ratio 2:1</li>\n<li>Right side <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> is affected more commonly</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>From lower <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction:</strong></p>\n<ul>\n<li>Loin pain</li>\n<li>Features of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outlet obstruction—frequency, hesitancy, poor stream</li>\n<li>Kidneys are not <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> if <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure develops early</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dull aching <span class=\"customMeta\" data-dictid=\"728cfabb201692777191311e96713d\">loin</span> pain with dragging sensation or heaviness</li>\n<li>Mass in the <span class=\"customMeta\" data-dictid=\"728cfabb201692777191311e96713d\">loin</span> which moves with respiration</li>\n<li><strong>Dietl's crisis (Intermittent Hydronephrosis)</strong>: <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">Swelling</span> in the <span class=\"customMeta\" data-dictid=\"728cfabb201692777191311e96713d\">loin</span> after <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> colic, disappears after passing a large volume of urine<strong> </strong></li>\n<li>Dysuria, haematuria. If infected, fever and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> angle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>From <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction:</strong></p>\n<ul>\n<li>Loin pain, mass in the loin, attacks of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> colic</li>\n<li>In severe cases, features of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure like oliguria, edema, and hiccoughs may be present</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 44-year-old lady presents to the hospital with a ballotable flank mass. The mass measures 4 cm on CT imaging. Urine examination shows malignant cells. What is the most appropriate management for her condition?", "options": [{"label": "A", "text": "Partial nephrectomy", "correct": true}, {"label": "B", "text": "Partial nephrectomy + Neoadjuvant chemotherapy", "correct": false}, {"label": "C", "text": "Radical nephrectomy", "correct": false}, {"label": "D", "text": "Radical nephrectomy + Postoperative radiotherapy", "correct": false}], "correct_answer": "A. Partial nephrectomy", "question_images": ["https://image.prepladder.com/content/GeUNOVN7WBBJNM5pi8cH1746167730.png"], "explanation_images": ["https://image.prepladder.com/content/bJS2CD1qtIab88QC9ZeA1746167775.png", "https://image.prepladder.com/content/FmaAcUaaJ1QIUDe3cleh1746167788.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">RCCs are radio and chemo-resistant.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Partial Nephrectomy: </strong>Involves removing only the tumor while preserving the remainder of the kidney. <strong>(Option A)</strong></p>\n<p><strong>Indications: </strong></p>\n<ul>\n<li>T1 Disease(&lt;7cm)</li>\n<li>Restricted to poles</li>\n<li>RCC in <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> kidney</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radical Nephrectomy: </strong>Involves<strong> </strong>removal of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with Gerota’s fascia, <span class=\"customMeta\" data-dictid=\"b83fd0c2a5169277719403617c9fdd\">para-aortic</span> nodes, and <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> up to the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> brim. <strong>(Option C ruled out)</strong></p>\n<p><strong>Indications: </strong>Larger tumors or when partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is not feasible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ablative Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA) and Cryoablation: </strong>Involve destroying the tumor using extreme temperatures.</p>\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Patients who are not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates</li>\n<li>Patients with small tumors(T1a lesions) (usually &lt;4 cm).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n<p><strong>(For advanced/ metastatic disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Targeted Therapy</strong></p>\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (e.g., sunitinib, pazopanib)</li>\n<li>mTOR inhibitors (e.g., everolimus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunotherapy: </strong>Immune <span class=\"customMeta\" data-dictid=\"cd249aae061692777184c11176df48\">checkpoint</span> inhibitors (e.g., nivolumab)</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A soldier arrives at a referral hospital 24 hours after experiencing a shrapnel injury to his right thigh caused by a high-speed projectile. He expresses significant discomfort at the site of the wound. Upon examination, there is evidence of crepitus. Which of the following microorganisms is the probable culprit behind his current state?", "options": [{"label": "A", "text": "Clostridium septicum", "correct": false}, {"label": "B", "text": "Clostridium difficile", "correct": false}, {"label": "C", "text": "Clostridium novyi", "correct": false}, {"label": "D", "text": "Clostridium perfringens", "correct": true}], "correct_answer": "D. Clostridium perfringens", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/IRFjpSNnDnNTbh0dlljz1746167891.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>A rapidly progressive, potentially fatal condition characterized by widespread <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of muscles and soft-tissue destruction, often due to late-presenting missile wounds or crushing injuries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clostridium perfringens<strong> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;24 hours but ranges from 1 hour to 6 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sources and <span class=\"customMeta\" data-dictid=\"80c0cb2a5f1692777196ba45847553\">predisposing</span> factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contaminated soil and feces.</li>\n<li>Wounds with necrotic or foreign material.</li>\n<li>Crush wounds, road traffic accidents, amputations.</li>\n<li>Anaerobic environments in the wound.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common sites of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Adductor region of the <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> and buttocks.</li>\n<li>Subscapular region in the upper limb.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe pain with limb <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> rapidly increases in severity.</li>\n<li>Serosanguineous discharge.</li>\n<li>Skin turns brown to blue-black with hemorrhagic bullae.</li>\n<li>Sweet, sticky <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> &amp; Soft-tissue <span class=\"customMeta\" data-dictid=\"2483707fe9169277718541a169f5b4\">crepitus</span> (presence of gas in the tissues).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Septicaemia, toxemia, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure, liver failure.</li>\n<li>Circulatory failure, DIC, secondary infections.</li>\n<li>Death occurs in critically ill patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: Gas in soft tissues.</li>\n<li>Gram <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> &amp; blood culture: Large Gram-positive <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> without neutrophils.</li>\n<li>Biochemical profile: Metabolic acidosis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n<li>Peripheral blood smear: Haemolysis.</li>\n<li>CT scan for chest or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High-dose <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> and clindamycin, along with 3rd generation cephalosporins, are given intravenously.</li>\n<li>Polyvalent antiserums given intravenously.</li>\n<li>All dead tissues are excised, and debridement is performed until healthy tissue bleeds.</li>\n<li>Amputation done in severe cases</li>\n<li>Hyperbaric oxygen therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proper debridement of devitalized crushed wounds.</li>\n<li>Devitalized wounds should not be sutured.</li>\n<li>Adequate cleaning of wounds with H₂O₂ and normal saline.</li>\n<li>Penicillin - As a <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> antibiotic.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Heather Murphy-Lavoie\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Gas_gangrene2.jpg#/media/File:Gas_gangrene2.jpg\" data-tags=\"\" height=\"469\" src=\"https://image.prepladder.com/content/IRFjpSNnDnNTbh0dlljz1746167891.png\" width=\"262\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not included in the qSOFA score components?", "options": [{"label": "A", "text": "Respiratory rate &amp;gt;22", "correct": false}, {"label": "B", "text": "Lactate dehydrogenase", "correct": true}, {"label": "C", "text": "Altered mental status", "correct": false}, {"label": "D", "text": "Systolic blood pressure &amp;lt;100 mmHg", "correct": false}], "correct_answer": "B. Lactate dehydrogenase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Inhalational induction of choice in children is:", "options": [{"label": "A", "text": "Sevoflurane", "correct": true}, {"label": "B", "text": "Desflurane", "correct": false}, {"label": "C", "text": "Halothane", "correct": false}, {"label": "D", "text": "Isoflurane", "correct": false}], "correct_answer": "A. Sevoflurane", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sevoflurane</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Properties</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sevoflurane is a fluorinated <span class=\"customMeta\" data-dictid=\"191f7b5f441692777187971c7d6ee2\">ether</span> with low blood <span class=\"customMeta\" data-dictid=\"a9295e67a41692777198dce0de3f34\">solubility</span> (λb/g 0.65), allowing for<strong> rapid <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">induction</span> and emergence. </strong></p>\n<p><strong>Its non-pungency makes it suitable for <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> induction, especially in <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> patients.</strong> It is used with conventional vaporizers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ideal for smooth and rapid <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> induction, particularly in daycare procedures (4-8% concentration with <span class=\"customMeta\" data-dictid=\"b83d31a7d61692777193c128d13c7d\">nitrous</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> and oxygen).</p>\n<p><strong>It is commonly used for both <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> and adult anesthesia.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C/I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Should be avoided in cases of severe hypovolemia, <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> to <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> hyperthermia, and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hypertension.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiovascular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild myocardial depression with slight reduction in <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance and blood pressure. It causes minimal heart rate increase and may prolong the QT interval.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hepatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> flow but increases <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> flow, maintaining overall <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> perfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slightly decreases <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> but has no known association with significant <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> toxicity.</p>\n<p><strong>Compound A</strong>, a <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> product of sevoflurane, is <span class=\"customMeta\" data-dictid=\"0834e545c9169277719383768d0ff2\">nephrotoxic</span> in animals but has no known adverse effects on humans.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuromuscular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides adequate muscle <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> for <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> but is often combined with other agents or muscle relaxants.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cerebral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slight increases in cerebral <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> (CBF) and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure. High concentrations may impair <span class=\"customMeta\" data-dictid=\"e2744175f516927771837e3273ef78\">CBF</span> autoregulation. Seizures have not been reported.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Depresses <span class=\"customMeta\" data-dictid=\"aea081ceb416927771976e2c17be74\">respiration</span> and helps reverse bronchospasm. Thus agent of choice in asthmatics.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common side effect induced by cisplatin chemotherapy?", "options": [{"label": "A", "text": "GI symptoms", "correct": true}, {"label": "B", "text": "Neuropathy", "correct": false}, {"label": "C", "text": "Cardiotoxicity", "correct": false}, {"label": "D", "text": "Myopathy", "correct": false}], "correct_answer": "A. GI symptoms", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/DhyV4cugT185VUZ7gUAR1747394703.png"], "explanation": "<p>Correct Answer A - GI\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is most suitable for intravenous regional anesthesia?", "options": [{"label": "A", "text": "Bupivacaine", "correct": false}, {"label": "B", "text": "Mepivacaine", "correct": false}, {"label": "C", "text": "Procaine", "correct": false}, {"label": "D", "text": "Lidocaine", "correct": true}], "correct_answer": "D. Lidocaine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3JCEfCQJcgg3nlAg1KBI1746168883.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Suitable for minor <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures on the upper or lower extremities (hand surgeries, <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> procedures, and foot surgeries).</li>\n<li>Used when general <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> is not necessary and for patients with contraindications to other forms of anesthesia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anesthetic Agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Commonly used local anesthetics include</strong>\n<ul>\n<li><strong>Lidocaine (most frequent) </strong></li>\n<li><strong>Prilocaine </strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedure Steps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Tourniquet Application:</strong> Apply a <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> to the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> part of the <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">extremity</span> to prevent <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and keep the local <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> localized.</li>\n<li><strong>Venous Access:</strong> Establish <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> access in the selected limb.</li>\n<li><strong>Administration of <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">Anesthetic</span> agent:</strong> Inject the local <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> into the IV line, typically in a volume of 40-50 mL.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"371\" src=\"https://image.prepladder.com/content/3JCEfCQJcgg3nlAg1KBI1746168883.png\" width=\"371\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tourniquet Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> should be inflated to a pressure that is approximately 50 mmHg above <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> blood pressure.</li>\n<li>It is typically safe to keep the <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> inflated for 30-60 minutes; prolonged inflation can increase the risk of complications.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Provides effective <span class=\"customMeta\" data-dictid=\"66ccee483016927771810c2c295d74\">analgesia</span> with minimal <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> absorption.</li>\n<li>Allows for a <span class=\"customMeta\" data-dictid=\"1ad3dee7d11692777183c0670e32a1\">bloodless</span> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> field.</li>\n<li>Quick onset of action and ease of administration.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages and Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Local <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">Anesthetic</span> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">Toxicity</span> (LAST) Can occur if the local <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> enters the <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> circulation.</li>\n<li>Tourniquet Pain</li>\n<li>Nerve Damage</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infection at the <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> site or over the tourniquet.</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease.</li>\n<li>Patient refusal or inability to cooperate.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lipid <span class=\"customMeta\" data-dictid=\"424b9f12511692777187541c585eb9\">Emulsion</span> Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used as a treatment for Local <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> toxicity, acts by sequestering the local <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> from <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> and mitigating toxic effects.</li>\n<li><strong>Administer a 20% <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> <span class=\"customMeta\" data-dictid=\"424b9f12511692777187541c585eb9\">emulsion</span> intravenously if <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> occurs.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient in the ICU with an endotracheal tube now needs a tracheostomy tube. Which type of tube will you use?", "options": [{"label": "A", "text": "Uncuffed tracheostomy tube", "correct": false}, {"label": "B", "text": "Cuffed tracheostomy tube", "correct": true}, {"label": "C", "text": "Metallic tracheostomy tube", "correct": false}, {"label": "D", "text": "Endotracheal tube", "correct": false}], "correct_answer": "B. Cuffed tracheostomy tube", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Resistance of the tube shown below is primarily because of:", "options": [{"label": "A", "text": "Curvature", "correct": false}, {"label": "B", "text": "Circumference", "correct": false}, {"label": "C", "text": "Length", "correct": false}, {"label": "D", "text": "Diameter", "correct": true}], "correct_answer": "D. Diameter", "question_images": ["https://image.prepladder.com/content/P4GfiacqCpsCDjgcBL8g1746169006.png"], "explanation_images": ["https://image.prepladder.com/content/mLXfjfl5vSl1aoA0gQmr1746169039.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:543px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Internal Diameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>length</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Term-Neonate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 mm (uncuffed)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1 Year Old</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 mm (uncuffed)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Child (&gt;1 Year)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age/4 + 4 mm (uncuffed)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age/2 + 12 cm</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adult</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 7 mm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18-22 cm</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the least commonly used graft for coronary artery bypass graft (CABG)?", "options": [{"label": "A", "text": "Long saphenous vein", "correct": false}, {"label": "B", "text": "Internal mammary artery", "correct": false}, {"label": "C", "text": "Intercostal artery", "correct": true}, {"label": "D", "text": "Radial artery", "correct": false}], "correct_answer": "C. Intercostal artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ND9tbNnq5ebpc6zQFMmF1746169263.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 45-year-old patient undergoing a preoperative assessment for a surgical procedure, which classification of Mallampati score is assigned based on the following description: Hard palate, soft palate, uvula, tip of the uvula, and tonsil pillars are visible. No oropharyngeal structures are obstructing the view.", "options": [{"label": "A", "text": "Grade I", "correct": true}, {"label": "B", "text": "Grade II", "correct": false}, {"label": "C", "text": "Grade III", "correct": false}, {"label": "D", "text": "Grade IV", "correct": false}], "correct_answer": "A. Grade I", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9FKoDcHDruxqPS8F8rWs1746169317.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the recommended treatment for the condition shown in the image, where the size of the stone is 1.5 cm?", "options": [{"label": "A", "text": "Percutaneous nephrolithotomy", "correct": false}, {"label": "B", "text": "Ureteroscopy", "correct": true}, {"label": "C", "text": "ESWL", "correct": false}, {"label": "D", "text": "Wait and watch", "correct": false}], "correct_answer": "B. Ureteroscopy", "question_images": ["https://image.prepladder.com/notes/LK02IRYkyb6AHbHgCvIs1747407623.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate antidote for Benzodiazepine overdose?", "options": [{"label": "A", "text": "Flumazenil", "correct": true}, {"label": "B", "text": "Flurazepam", "correct": false}, {"label": "C", "text": "Barbiturates", "correct": false}, {"label": "D", "text": "Buspirone", "correct": false}], "correct_answer": "A. Flumazenil", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"3ad8a42ad216927772024759d8ec38\"&gt;Flumazenil&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the initial management approach for urinary symptoms in a patient with benign prostatic hyperplasia (BPH)?", "options": [{"label": "A", "text": "TURP: Transurethral resection of prostate", "correct": false}, {"label": "B", "text": "Tamsulosin", "correct": true}, {"label": "C", "text": "Finasteride", "correct": false}, {"label": "D", "text": "Observation", "correct": false}], "correct_answer": "B. Tamsulosin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>1st line management: ⍺ 1 <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">Blocker</span> </strong>\n<ul>\n<li>Prazosin</li>\n<li>Terazosin</li>\n<li>Silodosin</li>\n<li>Most commonly used:<strong> Tamsulosin</strong> (⍺ 1A selective Blocker) <strong>(Option B)</strong></li>\n</ul>\n</li>\n<li><strong>2nd line: 5 𝛼 <span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\">Reductase</span> inhibitors</strong>\n<ul>\n<li>Finasteride <strong>(Option C ruled out)</strong></li>\n<li>Dutasteride</li>\n<li>Triptorelin pamoate</li>\n</ul>\n</li>\n<li>Combination treatment with <strong> </strong>⍺ 1 <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">Blocker</span> and 5 𝛼 <span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\">Reductase</span> inhibitors are used in large prostate.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Indications: </strong>\n<ul>\n<li>No improvement in medical management.</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> of urine</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> with <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> of more than 200 ml.</li>\n<li>Complications like hydroureter, hydronephrosis, stone formation, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infection, and gross haematuria</li>\n</ul>\n</li>\n<li><strong>Surgeries: </strong>\n<ul>\n<li><strong>Gold standard- TURP</strong> (Trans urethral <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of prostate). <strong>(Option A ruled out)</strong></li>\n<li>Trans urethral <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> of <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> (TUIP)</li>\n<li>Open <span class=\"customMeta\" data-dictid=\"4f419067a61692777196c1039e5eb3\">prostatectomy</span> procedures</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:724px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Benign prostatic <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (BPH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiopathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Role of hormones in BPH:</strong>\n<ul>\n<li><strong>DHT (Dihydrotestosterone)</strong>\n<ul>\n<li>DHT, derived from <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> via 5-alpha reductase, binds to <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> receptors in the prostate, promoting <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> and contributing to prostatic enlargement.</li>\n</ul>\n</li>\n<li><strong>Estrogen</strong>\n<ul>\n<li>Estrogen levels increase relative to <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> in <span class=\"customMeta\" data-dictid=\"c13872f9e3169277718001d2a0f063\">aging</span> men, influencing <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> growth through <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> receptors, particularly ER-α, in the prostatic tissue.</li>\n</ul>\n</li>\n</ul>\n</li>\n<li>Affects both <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> and <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> to variable degrees.</li>\n<li><strong>Most common site of origin:</strong> <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> glands of <span class=\"customMeta\" data-dictid=\"9f0c1a99081692777195efa0fd76d0\">periurethral</span> <strong>transitional zone </strong></li>\n<li>Secondary changes in the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> (due to increased force of <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of <span class=\"customMeta\" data-dictid=\"80d318a6701692777186805934d86a\">detrusor</span> muscles):\n\t\t\t\t<ul>\n<li>Collagen deposition</li>\n<li>Detrusor muscle hyperplasia</li>\n<li>Detrusor muscle hypertrophy.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age affected: <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">Men</span> over 50 years</li>\n<li>Common cause of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> outflow <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (BOO) in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> more than 70 years of age: BPH</li>\n<li><strong>Obstructive symptoms:</strong>\n<ul>\n<li>Poor flow/stream</li>\n<li>Hesitancy</li>\n<li>Intermittency</li>\n<li>Incomplete voiding-High post-void <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> urine</li>\n<li>Dribbling of urine</li>\n</ul>\n</li>\n<li><strong>Irritative symptoms:</strong>\n<ul>\n<li>Frequency</li>\n<li>Urgency</li>\n<li>Nocturia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urine <span class=\"customMeta\" data-dictid=\"51df8cdfc91692777192aa76f4de51\">microscopy</span> and C/S.</li>\n<li>Ultrasound abdomen- <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> size.</li>\n<li><strong>Uroflowmetry (Qmax):</strong>\n<ul>\n<li>Normal: &gt; 15 ml/sec.</li>\n<li>Equivocal: 10-15 ml.</li>\n<li>Low: &lt;10 ml</li>\n</ul>\n</li>\n<li><strong>Cystometry:</strong>\n<ul>\n<li>Voiding pressure</li>\n<li>Normal: &lt;60 cm of H₂O</li>\n<li>Equivocal: 60- 80 cm of H₂O</li>\n<li>High: &gt;80 cm of H₂O</li>\n</ul>\n</li>\n<li>Prostate-specific <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (PSA)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Retention</li>\n<li>Haematuria</li>\n<li>Urinary infection</li>\n<li>Stone formation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are true about nephroblastoma except:", "options": [{"label": "A", "text": "Treatment is chemotherapy followed by surgery", "correct": false}, {"label": "B", "text": "Lung metastasis is common", "correct": false}, {"label": "C", "text": "Hematogenous spread", "correct": false}, {"label": "D", "text": "Most common intra-abdominal malignancy in children", "correct": true}], "correct_answer": "D. Most common intra-abdominal malignancy in children", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Caused by mutations in WT1 and WT2 genes on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 11.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated syndromes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Denys-Drash Syndrome (DDS): </strong>A rare genetic disorder caused by mutations in the WT1 gene, characterized by a <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> of Wilms' tumor, <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">nephrotic</span> syndrome due to <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> mesangial sclerosis, and male pseudohermaphroditism</li>\n<li><strong>WAGR Syndrome: </strong>A rare genetic condition caused by a <span class=\"customMeta\" data-dictid=\"cf1e8ec6121692777185eba2630061\">deletion</span> on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 11p13, leading to a combination of Wilms' tumor, <span class=\"customMeta\" data-dictid=\"6f7ae5c0d01692777181fda74da32a\">aniridia</span> (absence of the iris), <span class=\"customMeta\" data-dictid=\"2fd33fb2ac16927771889901daadeb\">genitourinary</span> abnormalities, and intellectual disability.</li>\n<li><strong>Beckwith-Wiedemann Syndrome (BWS): </strong>A genetic disorder characterized by overgrowth, increased tumor risk, macroglossia, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall defects, and hemihyperplasia, often due to abnormalities on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 11p15.5.</li>\n<li><strong>Perlman Syndrome: </strong>A rare genetic disorder characterized by overgrowth, developmental delay, intellectual disability, distinctive <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> features, and an increased risk of Wilms' tumor, often caused by mutations in the DIS3L2 gene.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tumor.</li>\n</ul>\n<p><strong>Triad:</strong></p>\n<ul>\n<li>Asymptomatic <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> mass <strong>(MC presentation)</strong></li>\n<li>Fever (disappears after tumor resection)</li>\n<li>Hematuria (Gross/Microscopic)</li>\n</ul>\n<p><strong>Rarely</strong>: Pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>USG- </strong>Primary investigation</p>\n<p><strong>CECT- Investigation of choice.</strong></p>\n<p><strong>MRI - </strong>For better soft tissue visualization.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chemotherapy followed by surgery.<strong> (Option A ruled out)</strong></p>\n<p><strong>Multimodal approach</strong></p>\n<ul>\n<li><strong>Surgery</strong>: Radical <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> or nephron-sparing surgery</li>\n</ul>\n<ul>\n<li><strong>Chemotherapy</strong>: <strong>VCD <span class=\"customMeta\" data-dictid=\"988bd8e7c71692777197b9f1d5d5ca\">regimen</span> </strong></li>\n</ul>\n<p>Vincristine, Cyclophosphamide, Dactinomycin/Doxorubicin</p>\n<ul>\n<li><strong>Radiation therapy</strong>: For higher stages or unfavorable histology</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I.</strong> Disease confined to the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> and completely resectable</p>\n<p><strong>II</strong>. Tumor extends beyond the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> but can be excised completely</p>\n<p><strong>Ill</strong>. <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> disease after <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> with positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes and massive spillage</p>\n<p><strong>IV</strong>. Blood-borne metastasis</p>\n<p><strong>V</strong>. <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most important <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">Prognostic</span> Factor - <strong>Histology &gt; Stage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mainly through a <strong>hematogenous route </strong>into: <strong> (Option C ruled out)</strong></p>\n<ul>\n<li>Lungs (MC)<strong> (Option B ruled out)</strong></li>\n<li>Liver</li>\n<li>Bones (Rarely)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient complains of swelling and pain in her great toe. Her uric acid level is found to be high. A drug that reduces uric acid levels is prescribed. Which of the following enzymes should the drug inhibit?", "options": [{"label": "A", "text": "Urease", "correct": false}, {"label": "B", "text": "Homogentisate oxidase", "correct": false}, {"label": "C", "text": "Lysyl oxidase", "correct": false}, {"label": "D", "text": "Xanthine oxidase", "correct": true}], "correct_answer": "D. Xanthine oxidase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZFeZZMDg3Cd2F0mjMBIf1746169580.png"], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"c9a23eabc41692777202d1d98467d5\"&gt;Xanthine&lt;/span&g\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attack of gout</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DOC- NSAIDS (All types) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Except <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> and paracetamol</li>\n<li>Anti-inflammatory</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colchicine (spindle poison)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MOA: <span class=\"customMeta\" data-dictid=\"ef00bb99bd1692777192dbc816b3d4\">microtubule</span> inhibitor</li>\n<li>Used in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks of <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> and <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> Mediterranean fever and is also the <span class=\"customMeta\" data-dictid=\"357ecf18f2169277718661a76111ea\">DOC</span> for karyotyping</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corticosteroids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intra <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> injections, avoid oral route</li>\n<li>Immunosuppressive and anti-inflammatory</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs for chronic gout</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Xanthine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> inhibitors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drugs include <span class=\"customMeta\" data-dictid=\"6337926de316927771812a6842721f\">Allopurinol</span> (DOC), Oxipurinol, Febuxostat</li>\n<li>MOA: Blocks <span class=\"customMeta\" data-dictid=\"c9a23eabc41692777202d1d98467d5\">xanthine</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> → Inhibits the conversion of <span class=\"customMeta\" data-dictid=\"304c30e55316927771895062b17e8b\">hypoxanthine</span> to <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid in the liver.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uric acid <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drugs include <span class=\"customMeta\" data-dictid=\"953ec049a6169277719556031fce96\">Pegloticase</span> and Rasburicase</li>\n<li>MOA: <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">Uric</span> acid is converted to <span class=\"customMeta\" data-dictid=\"eae976dfa31692777181804c2b20e7\">allantoin</span> and excreted in urine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uricosuric agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drugs include Probenecid, Benzbromaron, Sulfinpyrazone, Lesinurad</li>\n<li>MOA: <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">Inhibit</span> OATP transporter/URAT-1 in the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> → inhibits <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid → increased <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid.</li>\n</ul>\n<p> </p>\n<p>(OATP - Organic <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> transport protein, URAT-1 - <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">Uric</span> acid transporter)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is correct regarding the mechanism of action of labetalol?", "options": [{"label": "A", "text": "Directly acts as arterial vasodilator resulting in indirect effect tachycardia", "correct": false}, {"label": "B", "text": "Blocks both alpha and beta-adrenergic receptors", "correct": false}, {"label": "C", "text": "Primarily acts as a vasodilator with little effect on arterioles", "correct": false}, {"label": "D", "text": "Decreases peripheral vascular resistance by directly acting as a relaxant for vascular smooth muscles", "correct": true}], "correct_answer": "D. Decreases peripheral vascular resistance by directly acting as a relaxant for vascular smooth muscles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Blocks both &lt;span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\"&gt;alpha&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"43f90e42341692777182f9e20606bb\"&gt;beta-adrenergic receptors&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non selective 𝛃1 + 𝛃2 <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardioselective 𝛃1 <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Without ISA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>With ISA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>With ɑ <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> activity</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<ul>\n<li>Metoprolol</li>\n<li>Esmolol</li>\n<li>Atenolol</li>\n<li>Bisoprolol</li>\n<li>Acebutolol</li>\n<li>Betaxolol</li>\n<li>Nebivolol</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Propranolol</li>\n<li>Sotalol</li>\n<li>Timolol</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pindolol</li>\n<li>Celiprolol</li>\n<li>Oxprenolol</li>\n<li>Penbutolol</li>\n<li>Pindolol</li>\n<li>Bopindolol</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Labetalol </strong></li>\n<li>Carvedilol</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During an endoscopy, when a constriction is detected at the esophageal junction approximately 25 cm from the incisor, what is the likely cause?", "options": [{"label": "A", "text": "Inferior vena cava", "correct": false}, {"label": "B", "text": "Arch of aorta", "correct": true}, {"label": "C", "text": "Right bronchus", "correct": false}, {"label": "D", "text": "Diaphragmatic opening", "correct": false}], "correct_answer": "B. Arch of aorta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RkIw9acQ4TX3yUoqu5cx1746169889.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old patient presents to the surgical OPD with a painless left inguinal reducible mass. On examination cough impulse is positive. After further investigations, the patient is diagnosed with an inguinal hernia. What is the surgical management of this patient?", "options": [{"label": "A", "text": "Herniotomy", "correct": false}, {"label": "B", "text": "Hernioplasty", "correct": true}, {"label": "C", "text": "Wait and watch", "correct": false}, {"label": "D", "text": "Emergency laparotomy", "correct": false}], "correct_answer": "B. Hernioplasty", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Fxto3T31GOkxsTgEagXS1746169975.png", "https://image.prepladder.com/content/IsDW33cb5VsEpbIY1L8W1746169975.png", "https://image.prepladder.com/content/KgxOL68fkIvZkRfQAZBX1746169975.png", "https://image.prepladder.com/content/tDRrWfcjvOXehAakDmwI1746169975.png", "https://image.prepladder.com/content/88Px5MFP29DEfYM0UOFz1746169975.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:514px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bassini's Repair:</strong></p>\n<ul>\n<li>Involves suturing the internal oblique, <span class=\"customMeta\" data-dictid=\"b4b7ff709c1692777200a120b1b991\">transversus</span> abdominis, and <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> to the inguinal ligament. Known as a triple-layer repair.</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Anpol42\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bassini_Operation._The_first_suture.jpg\" data-tags=\"\" height=\"585\" src=\"https://image.prepladder.com/content/Fxto3T31GOkxsTgEagXS1746169975.png\" width=\"392\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shouldice Repair:</strong> involves a four-layer repair (double breasting of <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> transversalis), resulting in lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to Bassini's.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Kumar hari rajah M. Somanathan\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/The-shouldice-repair_fig2_376511441\" data-tags=\"\" height=\"278\" src=\"https://image.prepladder.com/content/IsDW33cb5VsEpbIY1L8W1746169975.png\" width=\"391\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Modified Shouldice</strong>: A six-layer repair, including additional layers for reinforcement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman was prescribed a diuretic by a doctor to manage hypertension. Which of the following diuretic acts on the site 'A' is marked in the given image?", "options": [{"label": "A", "text": "Furosemide", "correct": false}, {"label": "B", "text": "Hydrochlorothiazide", "correct": true}, {"label": "C", "text": "Acetazolamide", "correct": false}, {"label": "D", "text": "Mannitol", "correct": false}], "correct_answer": "B. Hydrochlorothiazide", "question_images": ["https://image.prepladder.com/notes/TkfGgb09BwqaYF7LVRZ81747394851.png"], "explanation_images": ["https://image.prepladder.com/notes/Yj1qluxT8bBtJnQ5fpWv1747394940.png"], "explanation": "<p>Correct Answer B - Hydrochlorothiazide</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Class &amp; Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> inhibitors </strong></p>\n<ul>\n<li>Acetazolamide <strong>(Option C)</strong></li>\n<li>Methazolamide</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tubule, decreasing <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> reabsorption</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glaucoma, Altitude sickness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metabolic acidosis, Hypokalemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Loop diuretics </strong></p>\n<ul>\n<li>Furosemide <strong>(Option A)</strong></li>\n<li>Bumetanide</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit the Na-K-2Cl <span class=\"customMeta\" data-dictid=\"1bede64bc91692777199b477cf43f1\">symporter</span> in the thick <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> loop of Henle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema, Chronic heart failure, Hypercalcemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypokalemia, <strong>Ototoxicity, </strong>Metabolic alkalosis,</li>\n<li>Hyperglycemia,</li>\n<li>Hyperuricemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thiazide diuretics </strong></p>\n<ul>\n<li>Hydrochlorothiazide<strong> (Option B)</strong></li>\n<li>Chlorthalidone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit sodium <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension, Edema</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypokalemia, Hyponatremia,</li>\n<li>Hyperglycemia</li>\n<li>Hyperuricemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Potassium-sparing</strong></p>\n<ul>\n<li>Spironolactone</li>\n<li>Amiloride</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit sodium channels in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"32562f5afa1692777193c891837db9\">nephron</span> or block <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> receptors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heart failure, Hyperaldosteronism</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperkalemia, Gynecomastia (for Spironolactone)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osmotic diuretics</strong></p>\n<ul>\n<li>Mannitol <strong>(Option D)</strong></li>\n<li>Glycerin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increase <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> of the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> filtrate, inhibiting water reabsorption.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cerebral oedema, Acute glaucoma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dehydration, Electrolyte imbalance</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A homosexual man presents with painful defecation and a protruding mass from the anal canal. Biopsy confirms squamous cell carcinoma of the anus. What is the appropriate course of action for managing this patient?", "options": [{"label": "A", "text": "Chemotherapy", "correct": false}, {"label": "B", "text": "Abdominoperineal repair", "correct": false}, {"label": "C", "text": "Combined chemoradiation", "correct": true}, {"label": "D", "text": "Wide local excision", "correct": false}], "correct_answer": "C. Combined chemoradiation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> Carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Human <span class=\"customMeta\" data-dictid=\"70ae0d8a1f1692777194515e8836a4\">Papillomavirus</span> (HPV) Infection: </strong>Strongly <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> cancer, particularly high-risk subtypes (16, 18, 31, 33)</li>\n<li><strong>Anal <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">Intraepithelial</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">Neoplasia</span> (AIN): </strong>A precancerous condition significantly increases the risk of <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> cancer, especially from AIN II or III.</li>\n<li><strong>Immunosuppression </strong>(e.g., HIV-positive, transplant recipients)</li>\n<li><strong>Sexual Practices: </strong>Anal <span class=\"customMeta\" data-dictid=\"ad25936d1916927771900a1de2dd77\">intercourse</span> increases <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> transmission risk.</li>\n<li><strong>History of Other <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">Genital</span> Neoplasia: </strong>Vulvar <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> (VIN) or <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">neoplasia</span> (CIN)</li>\n<li><strong>Extensive Anogenital Condylomata: </strong>The presence of extensive anal warts <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain</li>\n<li>Bleeding</li>\n<li>Palpable Mass</li>\n<li>Pruritus (Itching)</li>\n<li>Discharge</li>\n<li>Incontinence</li>\n<li>Fistulation (anterior tumour extension in women can create a <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> between the <span class=\"customMeta\" data-dictid=\"08e2e9f18c169277718155d36ba98e\">anus</span> and vagina).</li>\n<li><strong>Appearance</strong>:\n\t\t\t\t<ul>\n<li><strong>Anal margin tumours:</strong> Often resemble <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> ulcers with raised, hardened edges.</li>\n<li><strong>Anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> tumours: </strong>Typically <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> as irregular, hardened, and tender ulcerated areas.</li>\n</ul>\n</li>\n<li><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Involvement:</strong> Enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes in the <span class=\"customMeta\" data-dictid=\"9626003516169277719575ac559a91\">perirectal</span> or <span class=\"customMeta\" data-dictid=\"a48fa02dfe1692777188de798e404f\">groin</span> regions may indicate cancer spread.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Biopsy from the Anal Region: </strong>The primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test to confirm the presence of carcinoma.</li>\n<li>FNAC of Inguinal Nod (assess metastasis).</li>\n<li>USG <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">Abdomen</span> (check for any spread of the disease).</li>\n<li>MRI of the <span class=\"customMeta\" data-dictid=\"ea5dd28db71692777195ee64c2f690\">Perineum</span> (assess the extent of the tumour).</li>\n<li><strong>Proctosigmoidoscopy: </strong>Assess the upper extent of the tumour within the anal canal.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Chemoradiation (Nigro regimen): </strong>The preferred treatment <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> for <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> of the anal canal. <strong>(Option C)</strong>\n<ul>\n<li><strong>Chemotherapy Drugs:</strong> Commonly used drugs include 5-fluorouracil (5-FU), bleomycin, vincristine, and adriamycin.</li>\n<li><strong>Radiotherapy: </strong>Often used alone in advanced cases where the tumour is not resectable.</li>\n</ul>\n</li>\n<li><strong>Surgical Interventions:</strong>\n<ul>\n<li><strong>Abdominoperineal <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">Resection</span> (APR) with Colostomy: </strong>For persistent or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> disease after combined <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> therapy (CMT), or for cases where the tumor does not respond to chemoradiation. <strong>(Option B ruled out)</strong></li>\n<li><strong>Neoadjuvant Chemotherapy: </strong>Involves using 5-FU, cisplatin, and <span class=\"customMeta\" data-dictid=\"2df4bdd7081692777192438ea42a62\">mitomycin</span> C before surgery to shrink the tumour.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A psychiatrist prescribes lithium for a patient who is diagnosed with bipolar disorder. Which of the following statements is incorrect regarding lithium?", "options": [{"label": "A", "text": "Lithium is teratogenic if given to pregnant females", "correct": false}, {"label": "B", "text": "Lithium toxicity is exacerbated with thiazide", "correct": false}, {"label": "C", "text": "Lithium can decrease thyroid hormone levels", "correct": false}, {"label": "D", "text": "Hemodialysis is not useful in lithium overdose", "correct": true}], "correct_answer": "D. Hemodialysis is not useful in lithium overdose", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"6ba3fb0ce51692777188eaf7843351\"&gt;Hemodialysis&lt;/span&gt; is not useful in &lt;span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\"&gt;lithium&lt;/span&gt; overdose</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lithium</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increase the level of <span class=\"customMeta\" data-dictid=\"38c81721001692777181c671bce8b3\">amine</span> (if the mood is low) by inhibiting the <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">Glycogen</span> <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">synthase</span> kinase-3 enzyme</li>\n<li>Decrease the level of <span class=\"customMeta\" data-dictid=\"38c81721001692777181c671bce8b3\">amine</span> (if the mood is high)\n\t\t\t\t<ul>\n<li>Inhibits <span class=\"customMeta\" data-dictid=\"88151824d916927771903e5ea91ffc\">inositol</span> monophosphatase enzyme</li>\n<li>Inhibits the release of amines</li>\n<li>Stabilises neuronal membrane</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bipolar disorder</li>\n<li>Hypnic headache (occurs in sleep)</li>\n<li>Anti-suicidal action (another drug is clozapine)</li>\n<li>Resistant cases of depression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adverse effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alopecia and acne</li>\n<li>Weight gain</li>\n<li>Seizures and <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (leading to AV block)</li>\n<li>Hypothyroidism (hyperthyroidism in rare cases)</li>\n<li>High doses can cause <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> tremors, ataxia, tinnitus, diarrhea, and seizures.</li>\n<li><strong>Ebstein’s anomaly: </strong>A <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> called <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> atresia, which has a <span class=\"customMeta\" data-dictid=\"8e016cf2891692777200f428d4b4db\">teratogenic</span> effect <strong>(Option A)</strong> when administered to pregnant women.</li>\n<li>Nephrogenic <span class=\"customMeta\" data-dictid=\"aabafbc36d16927771861d9dae54ed\">diabetes insipidus</span> (DI)</li>\n<li>Fine tremors (most common adverse effect)</li>\n<li>ECG changes: T-wave flattening</li>\n<li>Leukocytosis</li>\n<li>Loose stools (diarrhea)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Four friends are planning a trip to Ladakh. During their stay, one of them began experiencing headaches, nausea, dizziness, and fatigue. Which of the following is the most appropriate treatment for this patient?", "options": [{"label": "A", "text": "Sumatriptan", "correct": false}, {"label": "B", "text": "Promethazine", "correct": false}, {"label": "C", "text": "Scopolamine", "correct": false}, {"label": "D", "text": "Acetazolamide", "correct": true}], "correct_answer": "D. Acetazolamide", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2EkdNJYbXfFCHG5hx9It1746170522.png"], "explanation": "<p>Correct Answer D - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of these drugs stimulates PPAR-alpha?", "options": [{"label": "A", "text": "Gemfibrozil", "correct": true}, {"label": "B", "text": "Ezetimibe", "correct": false}, {"label": "C", "text": "Colestipol", "correct": false}, {"label": "D", "text": "Simvastatin", "correct": false}], "correct_answer": "A. Gemfibrozil", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"c328d6e14f1692777188f13145f8da\"&gt;Gemfibrozil&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Fibrate or PPAR-α agonist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Activate <span class=\"customMeta\" data-dictid=\"c0d194cb5b16927771957905b7aad6\">peroxisome</span> proliferator-activated <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> (PPAR-α), leading to the following effects:</p>\n<ul>\n<li>Reduce <span class=\"customMeta\" data-dictid=\"482f0bd5841692777200af07c2766c\">triglyceride</span> production</li>\n<li>Elevate <span class=\"customMeta\" data-dictid=\"9b15516f9716927771891e052899de\">high-density lipoprotein</span> (HDL) cholesterol levels</li>\n<li>Decrease <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"482f0bd5841692777200af07c2766c\">triglyceride</span> synthesis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperlipidemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adverse effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>GI side effects (nausea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, diarrhea)</li>\n<li>Myopathy, especially when used with statins</li>\n<li>Hepatotoxicity (elevated liver enzymes)</li>\n<li>Renal dysfunction</li>\n<li>Gallbladder disease</li>\n<li>Contraindicated in children and pregnancy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient comes to you with increased cough, breathlessness, and decreased exercise capacity. Chest X-ray shows pulmonary fibrosis. Which drug can be administered in the given condition?", "options": [{"label": "A", "text": "Bortezomib", "correct": false}, {"label": "B", "text": "Roflumilast", "correct": false}, {"label": "C", "text": "Imatinib", "correct": false}, {"label": "D", "text": "Pirfenidone", "correct": true}], "correct_answer": "D. Pirfenidone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Pirfenidone </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">Interstitial</span> lung disease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Idiopathic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pirfenidone + Nintedanib</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nonspecific <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> pneumonitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prednisolone + <span class=\"customMeta\" data-dictid=\"a6ed2a5f63169277718507c569e576\">cyclophosphamide</span> or rituximab</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desquamative <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> pneumonitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corticosteroids</strong> or <strong>Cytotoxic agents (Azathioprine) </strong></p>\n<p><strong>Bronchodilators </strong>may be used</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cryptogenic organising pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corticosteroids</strong></p>\n<p>Cyclophosphamide or <span class=\"customMeta\" data-dictid=\"e3802f488416927771979c6d76c756\">Rituximab</span> can be used alternatively</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hamman-Rich syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who was in excruciating pain all over his body was taken to the hospital. In recent years, he has experienced these incidents frequently. When exercising vigorously, the ache begins. Anemia was detected on blood examination along with elongated RBC as opposed to concave ones. It was determined that he had sickle cell anemia. What substitution takes place in sickle cell anemia?", "options": [{"label": "A", "text": "Substitution of valine by glutamic acid at the 6th position", "correct": false}, {"label": "B", "text": "Substitution of glutamic acid by valine at the 6th position", "correct": true}, {"label": "C", "text": "Substitution of valine by glutamic acid at the 5th position", "correct": false}, {"label": "D", "text": "Substitution of glutamic acid by valine at the 5th position", "correct": false}], "correct_answer": "B. Substitution of glutamic acid by valine at the 6th position", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PwEeINbSZ2OWUjoHT6TB1746170763.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is most appropriate to be used for the treatment of diarrhea in a patient who was treated for colorectal carcinoma with 5-fluorouracil?", "options": [{"label": "A", "text": "Ciprofloxacin", "correct": false}, {"label": "B", "text": "Loperamide", "correct": true}, {"label": "C", "text": "Atropine", "correct": false}, {"label": "D", "text": "Ornidazole", "correct": false}], "correct_answer": "B. Loperamide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Among the options provided, which pairing correctly matches the trauma patients brought to the casualty?", "options": [{"label": "A", "text": "Extradural hemorrhage (EDH) - Pin point pupil", "correct": false}, {"label": "B", "text": "Penetrating injury to eustachian tube - CSF otorrhea", "correct": false}, {"label": "C", "text": "Penetrating injury to eye - Battle sign", "correct": false}, {"label": "D", "text": "Gaze palsy - Mid brain lesion", "correct": true}], "correct_answer": "D. Gaze palsy - Mid brain lesion", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs are used to treat chemotherapy-induced nausea and vomiting?", "options": [{"label": "A", "text": "Doxylamine + domperidone + aprepitant", "correct": false}, {"label": "B", "text": "Prochlorperazine + metoclopramide + domperidone", "correct": false}, {"label": "C", "text": "Dexamethasone + metoclopramide + domperidone", "correct": false}, {"label": "D", "text": "Granisteron + dexamethasone + aprepitant", "correct": true}], "correct_answer": "D. Granisteron + dexamethasone + aprepitant", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Granisteron + &lt;span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\"&gt;dexamethasone&lt;/span&gt; + aprepitant</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Granisetron or Ondansetron</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>They are <strong>5-HT3 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</strong>, which blocks receptors in the gut and brain stimulated by <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> released during chemotherapy, reducing <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and preventing vomiting.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dexamethasone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> with anti-inflammatory and <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> effects, it reduces <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and suppresses the release of chemicals in the brain that trigger <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aprepitant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a <strong>substance P/neurokinin 1 (NK1) <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</strong> that works by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> NK1 receptors, inhibiting the action of <span class=\"customMeta\" data-dictid=\"b5b6dd01d6169277719947def8d8d3\">substance P</span> (a <span class=\"customMeta\" data-dictid=\"e28fd027b416927771932bc23ba0a5\">neurotransmitter</span> involved in triggering <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting).</p>\n<p>This medication is often used in combination with others as it targets different pathways in the development of chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (CINV), offering a more comprehensive approach to prevention and management. This combination therapy is particularly effective in preventing both <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> and delayed CINV.</p>\n</td>\n</tr>\n</tbody>\n\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antiemetic agents</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class &amp; Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5-HT<sub>3</sub> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists</strong></p>\n<ul>\n<li>Ondansetron</li>\n<li>Palonosetron</li>\n<li>Granisetron</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting\n\t\t\t\t<ul>\n<li>Early onset: Ondansetron</li>\n<li>Late onset: Palonosetron</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Headache</li>\n<li><strong>QT prolongation</strong>\n<ul>\n<li>Maximum: <strong>Dolasetron</strong></li>\n<li>Minimum: <strong>Palonosetron</strong></li>\n</ul>\n</li>\n<li>Hypotension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Centrally acting D2 antagonists</strong></p>\n<ul>\n<li>Metoclopramide</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting.</li>\n<li>Gastroparesis.</li>\n<li>Paralytic ileus.</li>\n<li>Bowel cleansing.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extra-pyramidal symptoms (acute dystonia).</li>\n<li>Severe hyperprolactinemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Domperidone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild-moderate vomiting.</li>\n<li>GERD.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Minor EPS features.</li>\n<li>Mild hyperprolactinema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurokinin-1 inhibitors</strong></p>\n<ul>\n<li>Aprepitant</li>\n<li>Fosaprepitant</li>\n<li>Rolapitant</li>\n<li>Netupitant</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Late-onset <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (DOC)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rolapitant:\n\t\t\t\t<ul>\n<li>Neutropenia.</li>\n<li>Hiccups.</li>\n<li>Decreased appetite.</li>\n<li>Dizziness.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cannabinoids</strong></p>\n<ul>\n<li>Dronabinol.</li>\n<li>Nabilone.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chemotherapy-induced <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting.</li>\n<li>Appetite <span class=\"customMeta\" data-dictid=\"bec9bb02501692777199b0f75e340e\">stimulant</span> (can be used in <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> and <span class=\"customMeta\" data-dictid=\"8deb4a7e2b1692777181c91be40ed9\">anorexia</span> patients.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypotension.</li>\n<li>Conjunctival <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> (bloodshot eyes)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antihistamines</strong></p>\n<ul>\n<li>Cyclizine</li>\n<li>Meclizine.</li>\n<li>Promethazine.</li>\n<li>Diphenhydramine.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Motion sickness</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sedation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Doxylamine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Morning <span class=\"customMeta\" data-dictid=\"73c1caf8d11692777198b1248373d3\">sickness</span> (given with pyridoxine)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dry mouth</li>\n<li>Drowsiness</li>\n<li>Dry mouth</li>\n<li>Constipation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscarinic <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists</strong></p>\n<ul>\n<li>Hyoscine (scopolamine)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Motion <span class=\"customMeta\" data-dictid=\"73c1caf8d11692777198b1248373d3\">sickness</span> (drug of choice, available as a <span class=\"customMeta\" data-dictid=\"48982b740216927772004a198271cd\">transdermal</span> patch)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dry mouth.</li>\n<li>Visual disturbances.</li>\n<li>Drowsiness.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the consequences of a deficiency in Vitamin A?", "options": [{"label": "A", "text": "Beriberi", "correct": false}, {"label": "B", "text": "Pellagra", "correct": false}, {"label": "C", "text": "Xerophthalmia", "correct": true}, {"label": "D", "text": "Neuropathy", "correct": false}], "correct_answer": "C. Xerophthalmia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:476px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>XN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Night blindness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X1A: Conjunctival xerosis.</li>\n<li>X1B: Bitot spots.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal xerosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X3A: Corneal ulceration, less than one-third.</li>\n<li>X3B: Corneal ulceration, more than one-third.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>XS</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal scar.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>XF</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Xerophthalmic fundus.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about p43?", "options": [{"label": "A", "text": "It increases telomere length in the liver", "correct": false}, {"label": "B", "text": "It synthesizes RNA", "correct": false}, {"label": "C", "text": "It stabilizes RNA", "correct": false}, {"label": "D", "text": "It retains the telomerase enzyme in the nucleus", "correct": true}], "correct_answer": "D. It retains the telomerase enzyme in the nucleus", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient on anti-cancer therapy developed an infection. Blood analysis revealed neutropenia. Which of the following drugs is likely to be effective in this patient?", "options": [{"label": "A", "text": "Romiplostim", "correct": false}, {"label": "B", "text": "Oprelvekin", "correct": false}, {"label": "C", "text": "Filgrastim", "correct": true}, {"label": "D", "text": "Epoetin alfa", "correct": false}], "correct_answer": "C. Filgrastim", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"961cab02fe1692777202b03db9637d\"&gt;Filgrastim&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Recombinant human <span class=\"customMeta\" data-dictid=\"a5e951c6221692777188d09fdd7e1a\">G-CSF</span> (Granulocyte colony-stimulating factor)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stimulates colony-forming unit (CFU) granulocytes to increase <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">neutrophil</span> production.</li>\n<li>Enhances <span class=\"customMeta\" data-dictid=\"b68a8f1b37169277719547f1cfda59\">phagocytic</span> and cytotoxic activities of neutrophils.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>To treat severe <span class=\"customMeta\" data-dictid=\"3925bbe5df1692777193bd03c159a8\">neutropenia</span> (after <span class=\"customMeta\" data-dictid=\"0a266da66816927771824d58668832\">autologous</span> <span class=\"customMeta\" data-dictid=\"d2e0ab499c169277718886ab5a46bf\">hematopoietic</span> stem cell transplantation, high-dose cancer chemotherapy, <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> neutropenias, and patients with AIDS receiving zidovudine)</li>\n<li>Used in patients undergoing <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood stem cell collection for stem cell transplantation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer sprayed a chemical in the pool which causes inhibition of complex-III of the electron transport chain. Identify the inhibitor?", "options": [{"label": "A", "text": "Rotenone", "correct": false}, {"label": "B", "text": "TTFA", "correct": false}, {"label": "C", "text": "Cyanide", "correct": false}, {"label": "D", "text": "Antimycin", "correct": true}], "correct_answer": "D. Antimycin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Inhibitor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Target Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rotenone (Option A) </strong></p>\n<p><strong>Amobarbital</strong></p>\n<p><strong>Piericidin A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complex I</p>\n<p>(NADH dehydrogenase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex I to ubiquinone</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TTFA (Thenoyltrifluoroacetone) (Option B)</strong></p>\n<p><strong>Carboxin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complex II</p>\n<p>(Succinate dehydrogenase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex II to ubiquinone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malonate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complex II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malonate is a competitive <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> of Complex II.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antimycin A (Option D) </strong></p>\n<p><strong>BAL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complex III</p>\n<p>Cytochrome bc1 complex</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex III to <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">Cytochrome</span> C.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cyanide (CN−) (Option C)</strong></p>\n<p><strong>Carbon <span class=\"customMeta\" data-dictid=\"03077f6c8716927771923763487a9e\">monoxide</span> (CO) </strong></p>\n<p><strong>Hydrogen <span class=\"customMeta\" data-dictid=\"0e84bc8bb5169277719934af06eb80\">Sulfide</span> (H2S) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complex IV</p>\n<p>(Cytochrome c Oxidase)</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prevents <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex IV to oxygen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oligomycin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ATP <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">Synthase</span> (Complex V)</p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks the <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> channel of <span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\">ATP</span> synthase, preventing <span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\">ATP</span> synthesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Atractyloside</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adenine <span class=\"customMeta\" data-dictid=\"94a2f0970016927771932885a3d362\">Nucleotide</span> Translocase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks ADP/ATP exchange across the mitochondrial membrane</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs reduces mortality in patients with heart failure with reduced ejection fraction (HFREF)?", "options": [{"label": "A", "text": "Metoprolol", "correct": true}, {"label": "B", "text": "Furosemide", "correct": false}, {"label": "C", "text": "Torsemide", "correct": false}, {"label": "D", "text": "Prazosin", "correct": false}], "correct_answer": "A. Metoprolol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Metoprolol</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiac side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Extracardiac side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Withdrawal can lead to the <span class=\"customMeta\" data-dictid=\"cc7b2f64b11692777196c8e39b7611\">precipitation</span> of an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> MI.</li>\n<li>Negative <span class=\"customMeta\" data-dictid=\"59e3d661b51692777184a2d67aec94\">chronotropic</span> effects include the development of <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> and heart block.</li>\n<li>Heart failure may exacerbate symptoms in patients with <span class=\"customMeta\" data-dictid=\"da8747dcd51692777185e1ed0554cc\">decompensated</span> <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> or preexisting myocardial dysfunction.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> resistance (contraindicated in patients with <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> due to bronchospasm).</li>\n<li>Exacerbation of <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease and worsen <span class=\"customMeta\" data-dictid=\"f01241cd50169277718482b7ac00eb\">claudication</span> and <span class=\"customMeta\" data-dictid=\"eba5ba77ec169277719688fab52fb0\">precipitate</span> Raynaud's disease.</li>\n<li>Masking of the <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">hypoglycemic</span> signs (tachycardia).</li>\n<li>Hyperkalemia</li>\n<li>Depression, fatigue, and sexual <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> such as <span class=\"customMeta\" data-dictid=\"5cc2a2112e16927771874c5d97065a\">erectile</span> dysfunction.</li>\n<li>Weight gain</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>First generation(Older / <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> selective)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Second generation </strong></p>\n<p style=\"text-align:center\"><strong>(Cardioselective)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Third generation </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Propranolol <strong> </strong></li>\n<li>Sotalol</li>\n<li>Pindolol (100% bioavailability)</li>\n<li>Timolol</li>\n<li>Nadolol (Maximum t1/2)</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metoprolol</li>\n<li>Esmolol (Minimum t1/2)</li>\n<li>Atenolol</li>\n<li>Bisoprolol</li>\n<li>Acebutolol</li>\n<li> </li>\n<li> </li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>With alpha-blocking activity</strong></p>\n<ul>\n<li>Labetalol</li>\n<li>Celiprolol</li>\n<li>Nebivolol</li>\n<li>Betaxolol</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>With <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blockade</strong></p>\n<ul>\n<li>Carvedilol (maximum <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> protein binding )</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>With <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> 2 agonism </strong></p>\n<ul>\n<li>Bopindolol</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>With K+ channel opening action</strong></p>\n<ul>\n<li>Tilisolol</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old female undergoes emergency laparotomy for perforation peritonitis. Which of the following is the surest sign of wound dehiscence?", "options": [{"label": "A", "text": "Copious sero-sanguinous discharge", "correct": true}, {"label": "B", "text": "Rebound tenderness", "correct": false}, {"label": "C", "text": "Hemorrhage", "correct": false}, {"label": "D", "text": "Hypotension", "correct": false}], "correct_answer": "A. Copious sero-sanguinous discharge", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Yz1a40tLyEl6RTSjftyp1746171355.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:589px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Disruption of any or all of the layers in a wound.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Occurrence </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 3% of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wounds; most commonly occurs between the 5th and 8th <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types </strong></p>\n<p> </p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Partial dehiscence:</strong> Involves only the skin and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> fat.</li>\n<li><strong>Complete dehiscence: </strong>Involves the fascial layer and may include <span class=\"customMeta\" data-dictid=\"00fc1a6b38169277718780d2bc69d1\">evisceration</span> (extrusion of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> viscera).</li>\n</ol>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"585\" src=\"https://image.prepladder.com/content/Yz1a40tLyEl6RTSjftyp1746171355.png\" width=\"545\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>General:</strong></p>\n<ul>\n<li>Malnourishment</li>\n<li>Diabetes</li>\n<li>Obesity</li>\n<li>Renal failure</li>\n<li>Jaundice</li>\n<li>Sepsis</li>\n<li>Cancer</li>\n<li>Treatment with steroids</li>\n<li>Emergency surgery</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Local:</strong></p>\n<ul>\n<li>Inadequate or poor <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of wound or <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of a wound under tension</li>\n<li>Poor local wound healing</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> pressure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pinkish serosanguinous <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> (salmon-coloured fluid), <strong>(Option A)</strong></li>\n<li>Possible evisceration,</li>\n<li>Popping sensation during straining or coughing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Partial <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> (without evisceration): </strong>Prompt reclosure of the <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> is generally advised.</li>\n<li><strong>Complete <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> with evisceration:</strong>\n<ul>\n<li>Requires urgent reoperation.</li>\n<li>Tension suturing is done.</li>\n<li>Protect eviscerated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> with moist towels; handle carefully to prevent injury.</li>\n<li>Antibiotic therapy; fluid management.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cholera is known to cause diarrhea through its interaction with specific receptors in the human body. Which of the following is known to make it easier for cholera toxin to enter the body through the intestinal mucosa?", "options": [{"label": "A", "text": "GLUT 1", "correct": false}, {"label": "B", "text": "GM2 ganglioside", "correct": false}, {"label": "C", "text": "Cephalin", "correct": false}, {"label": "D", "text": "GM1 ganglioside", "correct": true}], "correct_answer": "D. GM1 ganglioside", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old woman who experienced nausea and vomiting after being involved in a road traffic accident, and was brought to the emergency room unconscious, based on the findings of the NCCT brain?", "options": [{"label": "A", "text": "Extradural hemorrhage", "correct": true}, {"label": "B", "text": "Subdural hemorrhage", "correct": false}, {"label": "C", "text": "Intra-parenchymal hemorrhage", "correct": false}, {"label": "D", "text": "Subarachnoid hemorrhage", "correct": false}], "correct_answer": "A. Extradural hemorrhage", "question_images": ["https://image.prepladder.com/content/serU0N8sABLN5sAlj6Yd1746171401.png"], "explanation_images": ["https://image.prepladder.com/content/tuiMAZvqz24hfYJHXN561746171435.png", "https://image.prepladder.com/content/Y5FGJOcmUdy2P9CZ4i4A1746171435.png", "https://image.prepladder.com/content/y23bwk4Fm1H1KUYvqcui1746171435.png", "https://image.prepladder.com/content/lVxfkZZlgmslfk3cUhOz1746171435.png", "https://image.prepladder.com/content/HINbsRTzPNw86wwYNAY01746171435.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:747px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Epidural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (EDH)</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subdural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (SDH) </strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rupture of an artery, often the <strong>middle meningeal artery, </strong>usually due to a skull fracture, commonly in the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Two contexts:</strong></p>\n<ul>\n<li>High-energy injury: <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">Rupture</span> of <strong>cortical surface vessels.</strong></li>\n<li>Low-energy injury: <strong>Venous bleeding,</strong> common in older adults on anticoagulants.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Classic: Transient loss of consciousness, <span class=\"customMeta\" data-dictid=\"10b50278251692777191a626ee1604\">lucid</span> interval, rapid neurological decline.</li>\n<li>Headaches are common.</li>\n<li>Brain <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> signs: Contralateral hemiparesis, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> consciousness, <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> pupillary dilation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Variable presentation depending on injury severity and timing.</li>\n<li>Signs of raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure: Headache, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> consciousness, <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lentiform</strong> (lens-shaped or biconvex) <span class=\"customMeta\" data-dictid=\"1dfb6906b91692777189e0acce4f86\">hyperdense</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> between the skull and the brain.</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Epidural_hematoma\" data-tags=\"\" height=\"518\" src=\"https://image.prepladder.com/content/tuiMAZvqz24hfYJHXN561746171435.png\" width=\"426\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diffuse <strong>concave </strong>hyperdense (acute), <span class=\"customMeta\" data-dictid=\"7f06e594de1692777190bfb4be030b\">isodense</span> (subacute), or <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> (chronic) <strong>crescent-shaped</strong> lesions over the brain surface, often crossing <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines.</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subdural_hematoma\" data-tags=\"\" height=\"492\" src=\"https://image.prepladder.com/content/Y5FGJOcmUdy2P9CZ4i4A1746171435.png\" width=\"396\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurosurgical emergency; requires immediate evacuation, usually by craniotomy.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Depends on size, location, and clinical status:</p>\n<p>1. Large or worsening hematomas: Urgent <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> by <span class=\"customMeta\" data-dictid=\"cecf1b86e61692777185f281991f2d\">craniotomy</span> or craniectomy.</p>\n<p>2. Smaller, stable bleeds: Conservative management initially, with surgery if needed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Summary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>EDH often follows a predictable course with a <span class=\"customMeta\" data-dictid=\"10b50278251692777191a626ee1604\">lucid</span> interval.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>SDH has a more variable presentation and distinct CT appearance.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-month-old infant is brought to the pediatrician due to feeding difficulties, vomiting, and failure to thrive. The child's history reveals that the infant was born full-term and had a normal birth weight. On physical examination, the infant appears jaundiced, and the liver is palpable below the costal margin. Oil drop Cataracts are also noted on eye examination. Laboratory tests show elevated levels of galactose in the blood and urine. Based on these clinical findings, which enzyme deficiency is most likely responsible for this presentation?", "options": [{"label": "A", "text": "G6PD (Glucose-6-phosphate dehydrogenase)", "correct": false}, {"label": "B", "text": "GALT (Galactose-1-phosphate uridylyltransferase)", "correct": true}, {"label": "C", "text": "ALDH (Aldehyde dehydrogenase)", "correct": false}, {"label": "D", "text": "PKU (Phenylalanine hydroxylase)", "correct": false}], "correct_answer": "B. GALT (Galactose-1-phosphate uridylyltransferase)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/16lx7V8HdNYjyjEvpCJn1746171468.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Galactose-1-phosphate Uridyltransferase (GALT) Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Severely deficient in individuals with <strong>Classic Galactosemia</strong> in which galactose-1-phosphate and, therefore, <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> accumulate. <strong>(Option A)</strong></li>\n<li>It Is an <span class=\"customMeta\" data-dictid=\"22a6157d6316927771903de900ec5e\">inborn</span> error of metabolism</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Accumulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Accumulated <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> is shunted into side pathways like <strong>galactitol </strong>production. <strong>Aldose reductase</strong> catalyzes it.</li>\n<li>Galactose-1 <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> accumulates in the liver, <strong>inhibiting <span class=\"customMeta\" data-dictid=\"0657553117169277718887935b6a43\">galactokinase</span> and <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">glycogen</span> phosphorylase, </strong>leading to <strong>hypoglycemia.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bilirubin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> and conjugation, increasing <strong>unconjugated bilirubin</strong> in blood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypoglycemia, Hypophosphatemia, </strong>Hyperuricemia, <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">Lactic</span> acidosis</p>\n<p>Hepatomegaly, Jaundice,</p>\n<p>Severe <strong>mental retardation</strong></p>\n<p>Galactosuria (galactose excreted in urine)</p>\n<p><strong>Oil drop Cataracts </strong>from <strong>dulcitol accumulation </strong>in the lens</p>\n<p>Tubular damage and generalized aminoaciduria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical manifestations (e.g., <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> cataract), presence of <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and elevated blood <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> levels</li>\n<li>Prenatal diagnosis via amniocentesis</li>\n<li>Detection of heterozygous parents by elevated <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> levels after a <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> load</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications in untreated cases </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> sepsis,</strong></li>\n<li><strong>Fanconi syndrome</strong></li>\n<li>Feeding problems,</li>\n<li>Failure to thrive,</li>\n<li>Hepatocellular damage,</li>\n<li>Bleeding</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdrawal of <strong>galactose and lactose</strong> from the diet.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GALT <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> is a part of the <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> screening panel</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old patient who is a chronic tobacco chewer presents with a whitish lesion on the gingivobuccal sulcus for 7 months. What is the next best step in the management of this condition?", "options": [{"label": "A", "text": "Local excision and biopsy", "correct": true}, {"label": "B", "text": "Avoid smoking + Wait and watch", "correct": false}, {"label": "C", "text": "Steroidal injection", "correct": false}, {"label": "D", "text": "Sclerotherapy", "correct": false}], "correct_answer": "A. Local excision and biopsy", "question_images": ["https://image.prepladder.com/content/PxcoNCGs7xiVVLAPRt3Y1746171515.png"], "explanation_images": ["https://image.prepladder.com/content/OBFU3UFwdBxF1HzacKq81746171542.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>It is a progressive condition involving deep <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> in the oral mucosa, characterized by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> bands and considered a precancerous lesion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypersensitivity to tobacco, <span class=\"customMeta\" data-dictid=\"4b63b4a64c1692777182b509b257e2\">betel</span> nut, <strong>chilli</strong>, <span class=\"customMeta\" data-dictid=\"14dc9988461692777182be518d4bb7\">areca</span> nut, vitamin deficiencies, localised <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> disorders.</li>\n<li>Leads to alteration of <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> causing juxtaepithelial progressive <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> of the submucosa.</li>\n<li>This leads to <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> and dysplasia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common in Asians</li>\n<li>Males and females are equally affected.</li>\n<li>Soreness in the mouth more during meals</li>\n<li>Burning, also more while eating</li>\n<li>Vesicular eruptions</li>\n<li>Trismus</li>\n<li>Difficulty in protruding tongue</li>\n<li>Fibrosis and scarring</li>\n<li>Ankylosing glossitis</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cessation of <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> factors(tobacco, chilli, <span class=\"customMeta\" data-dictid=\"14dc9988461692777182be518d4bb7\">areca</span> nut)</li>\n<li>Oral hygiene</li>\n<li>Dexamethasone local injections</li>\n<li>Hydrocortisone</li>\n<li>HCG <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> injection</li>\n<li>Vitamin and iron supplementation</li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with graft</li>\n<li>Stem cell therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male patient presents with ptosis and muscle weakness, which reportedly worsens in the evening and improves in the morning. This is relieved by neostigmine. What is the likely diagnosis?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": true}, {"label": "B", "text": "Huntington chorea", "correct": false}, {"label": "C", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "D", "text": "External ophthalmoplegia", "correct": false}], "correct_answer": "A. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\"&gt;Myasthenia&lt;/span&gt; gravis:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Autoimmune disease is caused by antibodies <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> receptors at the <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> junction.</p>\n<p>Disruption in <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> transmission occurs through:</p>\n<ul>\n<li>Blockage of <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> receptors.</li>\n<li>Complement-mediated <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> leads to:\n\t\t\t\t<ul>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> count.</li>\n<li>Damage to the end plate.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fatigable muscle weakness: <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">Muscle strength</span> decreases with continued use, especially:\n\t\t\t\t<ul>\n<li>Later in the day</li>\n<li>After exercise</li>\n</ul>\n</li>\n<li>No <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> or <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> involvement, distinguishing it from other neurological disorders.</li>\n</ul>\n<p><strong>Common Initial Symptoms:</strong></p>\n<ul>\n<li>Ptosis (drooping eyelid)</li>\n<li>Diplopia (double vision)</li>\n<li>Weakness can spread to:\n\t\t\t\t<ul>\n<li>Chewing, swallowing, and speaking muscles</li>\n<li>Limb muscles</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tensilon (edrophonium) Test</strong></p>\n<ul>\n<li>This involves the <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> of Edrophonium (a short-acting <span class=\"customMeta\" data-dictid=\"16b654488116927771813c39bf19e7\">anticholinesterase</span> agent) into individuals with a <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> receptors at the <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> junction.</li>\n<li><strong>Steps: </strong>2 mg i.v. Edrophonium → Observe for any adverse reactions → If no adverse reactions occur after 30–60 seconds, the remaining 8 mg is injected.</li>\n</ul>\n<ul>\n<li>If <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> improves after the administration of edrophonium, it indicates the presence of <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">Myasthenia</span> Gravis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anticholinesterase agents (inhibit the <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of <span class=\"customMeta\" data-dictid=\"fba05f424716927771802b63f6c392\">ACh</span> by <span class=\"customMeta\" data-dictid=\"63b92227451692777180db3901b72f\">acetylcholinesterase</span> and increase <span class=\"customMeta\" data-dictid=\"e91c7a22e71692777196ef9e02b8c0\">presynaptic</span> levels of ACh, allowing for muscle contraction).</p>\n<ul>\n<li>Pyridostigmine (drug of choice)</li>\n<li>Neostigmine</li>\n<li>Ambenonium</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn infant is brought to the clinic with jaundice and a white, punctate, and scattered opacity in the central lens. The condition is consistent with Oil drop cataract. Which of the following metabolic disorders is most likely responsible for this presentation?", "options": [{"label": "A", "text": "Phenylketonuria (PKU)", "correct": false}, {"label": "B", "text": "Maple syrup urine disease", "correct": false}, {"label": "C", "text": "Galactosemia", "correct": true}, {"label": "D", "text": "Wilson's disease", "correct": false}], "correct_answer": "C. Galactosemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9jAfJSG11BpjuXJfCBIN1746171707.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Galactose-1-phosphate Uridyltransferase (GALT) Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Severely deficient in individuals with <strong>Classic Galactosemia</strong> in which galactose-1-phosphate and, therefore, <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> accumulate. <strong>(Option A)</strong></li>\n<li>It Is an <span class=\"customMeta\" data-dictid=\"22a6157d6316927771903de900ec5e\">inborn</span> error of metabolism</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Accumulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Accumulated <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> is shunted into side pathways like <strong>galactitol </strong>production. <strong>Aldose reductase</strong> catalyzes it.</li>\n<li>Galactose-1 <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> accumulates in the liver, <strong>inhibiting <span class=\"customMeta\" data-dictid=\"0657553117169277718887935b6a43\">galactokinase</span> and <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">glycogen</span> phosphorylase, </strong>leading to <strong>hypoglycemia.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bilirubin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> and conjugation, increasing <strong>unconjugated bilirubin</strong> in blood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hypoglycemia, Hypophosphatemia, </strong>Hyperuricemia, <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">Lactic</span> acidosis</li>\n<li>Hepatomegaly, Jaundice,</li>\n<li>Severe <strong>mental retardation</strong></li>\n<li>Galactosuria (galactose excreted in urine)</li>\n<li><strong>Oil drop Cataracts </strong>from <strong>dulcitol accumulation </strong>in the lens, <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> cataract</li>\n<li>Tubular damage and generalized aminoaciduria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical manifestations (e.g., <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> cataract), presence of <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and elevated blood <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> levels</li>\n<li>Prenatal diagnosis via amniocentesis</li>\n<li>Detection of heterozygous parents by elevated <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> levels after a <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> load</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications in untreated cases </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> sepsis,</strong></li>\n<li><strong>Fanconi syndrome</strong></li>\n<li>Feeding problems,</li>\n<li>Failure to thrive,</li>\n<li>Hepatocellular damage,</li>\n<li>Bleeding</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdrawal of <strong>galactose and lactose</strong> from the diet.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GALT <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> is a part of the <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> screening panel</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of dicumarol?", "options": [{"label": "A", "text": "Activates antithrombin III", "correct": false}, {"label": "B", "text": "Inhibits vitamin K-dependent clotting factors", "correct": true}, {"label": "C", "text": "Inhibits tissue plasminogen activator", "correct": false}, {"label": "D", "text": "Inhibitor of factor Xa", "correct": false}], "correct_answer": "B. Inhibits vitamin K-dependent clotting factors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Inhibits &lt;span class=\"customMeta\" data-dictid=\"71c2092f15169277720243eb1590b0\"&gt;vitamin K&lt;/span&gt; dependent &lt;span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\"&gt;Clotting&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Oxaloacetate is produced from which of the following amino acid?", "options": [{"label": "A", "text": "Alanine", "correct": false}, {"label": "B", "text": "Lysine", "correct": false}, {"label": "C", "text": "Leucine", "correct": false}, {"label": "D", "text": "Aspartate", "correct": true}], "correct_answer": "D. Aspartate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old smoker presents with sudden, severe, tearing chest pain radiating to his back, shortness of breath, and mild nausea. His BP is 190/110 mmHg, and heart rate is 105 bpm. What is the initial management?", "options": [{"label": "A", "text": "Control blood pressure", "correct": true}, {"label": "B", "text": "Urgent surgery", "correct": false}, {"label": "C", "text": "Wait and watch", "correct": false}, {"label": "D", "text": "Blood transfusion", "correct": false}], "correct_answer": "A. Control blood pressure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/R2uQPzOEKRRxtDDDFmG01746171773.png", "https://image.prepladder.com/content/7yeYvcqOGBWqWi5x19tN1746171773.png", "https://image.prepladder.com/content/jYf66zaUMPMebbmmjqkR1746171808.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:726px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>It occurs when a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> or a <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> occurs in the aorta, resulting in blood <span class=\"customMeta\" data-dictid=\"ebb0986d331692777200ab09e1b2e8\">tracking</span> into aortic tissues, <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> layer, and creating a false lumen.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"552\" src=\"https://image.prepladder.com/content/R2uQPzOEKRRxtDDDFmG01746171773.png\" width=\"531\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden onset of severe, tearing chest, radiating to the <span class=\"customMeta\" data-dictid=\"3f66fcdaed169277719097d866e755\">interscapular</span> region</li>\n<li>Renal pain and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Paraplegia</li>\n<li>Syncope</li>\n<li>Weakness</li>\n<li>Hypotension or shock</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Stable Patient: </strong>CT angiography<strong> </strong>is the standard investigation of choice.</li>\n<li><strong>Unstable Patients </strong>(SBP&lt;100 mm of HG, HR&gt;100 bpm)<strong>:</strong> TEE (TransEsophageal Echocardiography) (preferred investigation of choice)</li>\n<li>MRI can also be done if CT is unequivocal.</li>\n<li>Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">x-ray</span> reveals widening of <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> along with left-sided pleural effusion</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Thielmann, Matthias &amp; Melzer, Andreas &amp; Benedik, Jaroslav &amp; Droc, Ionel &amp; Tsagakis, Konstantinos &amp; Dohle, Daniel &amp; Jakob, Heinz &amp; Abele, John.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/TEE-of-an-aortic-dissection-within-the-descending-part-indicates-the-flow-within-the_fig5_256075293\" data-tags=\"\" height=\"505\" src=\"https://image.prepladder.com/content/7yeYvcqOGBWqWi5x19tN1746171773.png\" width=\"703\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>TEE of an <span class=\"customMeta\" data-dictid=\"b95d9432b316927771811d2040b80c\">aortic dissection</span> within the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> part</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial Management: </strong>Initial management of all types of <span class=\"customMeta\" data-dictid=\"b95d9432b316927771811d2040b80c\">aortic dissection</span> includes:</p>\n<ul>\n<li>Blood pressure control (which is usually high at presentation) <strong>(Option A)</strong></li>\n<li>Strict pain management,</li>\n<li>Prompt referral for specialist management</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type A (or type I and II) dissections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type B (or type III) dissections</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Those involving the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> usually require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention.</p>\n<ul>\n<li>Synthetic <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> if needed</li>\n<li>Anastomosis</li>\n</ul>\n<p> </p>\n<p>Endovascular stenting of type A dissections.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial management: </strong></p>\n<ul>\n<li>Antihypertensive drugs</li>\n<li>Monitoring on an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> care unit</li>\n</ul>\n<p> </p>\n<p><strong>Complicated cases: </strong>If pain worsens, fails to resolve, or <span class=\"customMeta\" data-dictid=\"17038bf8a916927771917e8b246cfe\">malperfusion</span> signs appear (e.g., organ, limb, or neurological symptoms)</p>\n<ul>\n<li>Percutaneous <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> stents <strong> </strong></li>\n<li>Surgery (rarely used)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>DeBakey Classification</strong></p>\n<p>(Based on the pattern of dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> are involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stanford <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> </strong></p>\n<p>(Based on whether the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved in aortic dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type A </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> or both <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved.</p>\n<p>(It includes both Type I and Type II of DeBakey’s classification)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type B</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved.</p>\n<p>(It includes Type III of DeBakey’s classification)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of hypertension is given the drug ‘X’. Identify ‘X’?", "options": [{"label": "A", "text": "Captopril", "correct": false}, {"label": "B", "text": "Spironolactone", "correct": false}, {"label": "C", "text": "Aliskiren", "correct": true}, {"label": "D", "text": "Losartan", "correct": false}], "correct_answer": "C. Aliskiren", "question_images": ["https://image.prepladder.com/notes/EOE7jsFvXRLFfak8aUDT1747395089.png"], "explanation_images": ["https://image.prepladder.com/content/OmHIjqA0rvyTvdwnYs9g1746171886.png"], "explanation": "<p>Correct Answer C - Alisk\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presented with complaints of hematuria and recurrent urinary tract infection. You notice the following finding in his CT. What is the likely condition indicated by the arrow in the image?", "options": [{"label": "A", "text": "Polycystic kidney disease", "correct": false}, {"label": "B", "text": "Horseshoe kidney", "correct": true}, {"label": "C", "text": "Hydronephrosis", "correct": false}, {"label": "D", "text": "Pancake kidney", "correct": false}], "correct_answer": "B. Horseshoe kidney", "question_images": ["https://image.prepladder.com/notes/qIt24BcRGkBB15kAXHUr1747395962.png"], "explanation_images": ["https://image.prepladder.com/content/qVyxE5oRWl7pw7BonufD1746171893.png", "https://image.prepladder.com/content/6au0oupvcYGh0f2HrIDD1746171893.png", "https://image.prepladder.com/content/TcN4zvpbpUgCdPqrWWJJ1746171893.png", "https://image.prepladder.com/content/wworwKsv8VjCL0UfhOU71746171893.png", "https://image.prepladder.com/content/Vzs1AN436ifUQnC1tj5j1746171893.png", "https://image.prepladder.com/content/xxn0s8TtwuSFMeUE61mn1746171893.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Horseshoe Kidney</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> condition in which the two kidneys are fused at the lower ends, forming a U-shaped structure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>During <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development the kidneys <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> at their lower poles, forming a U-shaped structure.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> results in the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> mesenteric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> preventing the ascent of the <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> to its normal position in the abdomen, leading to an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> location lower in the abdomen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mostly<strong> </strong>asymptomatic.</li>\n<li>Pain: due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> stones.</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections (UTIs)</li>\n<li>Hydronephrosis</li>\n<li>Hematuria</li>\n<li><strong>Rovsing's syndrome:</strong> Hyperextension of the spine- nausea, vomiting, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CT Angiography (CT Angio):</strong> This is the investigation of choice for diagnosing a horseshoe kidney, as it allows for detailed <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> anatomy, the <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> supply, and associated complications.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:HorseshoeKid2Mark.png\" data-tags=\"\" height=\"549\" src=\"https://image.prepladder.com/content/qVyxE5oRWl7pw7BonufD1746171893.png\" width=\"684\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>CT <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">Abdomen</span> showing Horseshoe kidney</strong></p>\n<ul>\n<li><strong>Contrast-Enhanced CT (CECT): </strong>Used when CT Angio is not available</li>\n<li><strong>Intravenous Pyelogram (IVP) - </strong>characteristic findings include<strong>:</strong>\n<ul>\n<li>Medial Orientation of Calyces: Referred to as the \"<strong>Hand Joining Sign</strong>.\"</li>\n<li>High Insertion of Ureters with Anterior Transposition: This creates a <strong>\"Flower Vase\" appearance of the ureters.</strong></li>\n</ul>\n</li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Natsis, Konstantinos &amp; Piagkou, Maria &amp; Skotsimara, Antonia &amp; Protogerou, Vassilis &amp; Tsitouridis, Ioannis &amp; Skandalakis, Panagiotis. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/ntravenous-pyelogram-IVP-in-a-male-patient-demonstrating-a-horseshoe-kidney_fig2_277016641\" data-tags=\"\" height=\"495\" src=\"https://image.prepladder.com/content/6au0oupvcYGh0f2HrIDD1746171893.png\" width=\"360\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Aditya Shetty\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/horseshoe-kidney-intravenous-urogram\" data-tags=\"\" height=\"491\" src=\"https://image.prepladder.com/content/TcN4zvpbpUgCdPqrWWJJ1746171893.png\" width=\"385\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Asymptomatic Patients:</strong> Typically do not require treatment, but should be monitored periodically.</li>\n<li><strong>Symptomatic Patients:</strong>\n<ul>\n<li><strong>UPJ Obstruction:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention such as pyeloplasty</li>\n<li><strong>Kidney Stones:</strong> Management may include conservative measures like increased fluid intake, medical therapy, or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> removal</li>\n<li><strong>UTIs:</strong> Treated with antibiotics, and <span class=\"customMeta\" data-dictid=\"e684325d851692777196af9e64013b\">preventive</span> measures may be considered if infections are recurrent.</li>\n<li><strong>Isthmus Management:</strong> The <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> of the <span class=\"customMeta\" data-dictid=\"2c8df9337316927771897a1681efe1\">horseshoe kidney</span> should not be divided surgically as it contains functional <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tissue.</li>\n<li><strong>Pregnancy Considerations:</strong> A <span class=\"customMeta\" data-dictid=\"2c8df9337316927771897a1681efe1\">horseshoe kidney</span> can lead to <span class=\"customMeta\" data-dictid=\"e700acb813169277718658466e6e33\">dystocia</span> (difficult labor) due to the kidney's <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> position.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following minerals is best known for insulin secretion stabilisation?", "options": [{"label": "A", "text": "Cadmium", "correct": false}, {"label": "B", "text": "Copper", "correct": false}, {"label": "C", "text": "Iron", "correct": false}, {"label": "D", "text": "Zinc", "correct": true}], "correct_answer": "D. Zinc", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Dietary Sources</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Grains, beans, nuts, cheese, meat, shellfish.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Therapeutic Use</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Zinc reduces <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> in Wilson’s disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Zinc-Dependent Enzymes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carboxypeptidase</li>\n<li>Carbonic anhydrase</li>\n<li>Alkaline phosphatase</li>\n<li>Lactate dehydrogenase</li>\n<li>Ethanol dehydrogenase</li>\n<li>Glutamate dehydrogenase</li>\n<li>RNA <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> (required for protein biosynthesis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Functions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Antioxidant RoleExtracellular <span class=\"customMeta\" data-dictid=\"7d51964ce51692777199dedcf19fc3\">superoxide</span> dismutase is zinc-dependent, contributing to zinc’s <span class=\"customMeta\" data-dictid=\"1f3c08447d16927771819ccd566468\">antioxidant</span> properties.</li>\n<li>Insulin and ZincZinc stabilizes <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> in <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cells of the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> but is not present in released insulin.</li>\n<li>Taste Sensation Gusten, a zinc-containing protein in saliva, is important for taste sensation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deficiency Manifestations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Poor wound healing</li>\n<li>Skin lesions, hyperkeratosis, dermatitis, alopecia</li>\n<li>Impaired spermatogenesis</li>\n<li>Reduced T and B <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> numbers, impaired <span class=\"customMeta\" data-dictid=\"2748357f451692777191377abbe2a6\">macrophage</span> function</li>\n<li>Psychiatric disorders: depression, dementia, and cognitive decline (e.g., Alzheimer's)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acrodermatitis Enteropathica</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acrodermatitis (inflammation around mouth, nose, fingers, etc.)</li>\n<li>Diarrhea, alopecia, ophthalmoplegia, hypogonadism</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Toxicity Manifestations</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic Toxicity: <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">Gastric</span> ulcers, pancreatitis, anemia, nausea, vomiting, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis</li>\n<li>Acute Toxicity: Fever, excessive salivation, headache, anemia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of graft is used when a patient undergoes skin grafting following a road traffic accident in which the graft is harvested from the patient's own body?", "options": [{"label": "A", "text": "Autograft", "correct": true}, {"label": "B", "text": "Xenograft", "correct": false}, {"label": "C", "text": "Allograft", "correct": false}, {"label": "D", "text": "Isograft", "correct": false}], "correct_answer": "A. Autograft", "question_images": ["https://image.prepladder.com/content/ATIsncjgWlhK08HgQfYd1746171980.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Graft Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Source</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Autograft</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Tissue from one site to another on the same individual</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>No risk of immune rejection; high success rate</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Requires a donor site, additional morbidity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Allograft</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Tissue from another individual of the same species</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Availability of larger tissue amounts</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Risk of immune rejection; needs immunosuppression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Xenograft</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Tissue from a different species (e.g., pig to human)</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Readily available; used as temporary grafts</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>High risk of immune rejection; often temporary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p><strong>Isograft</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Tissue between genetically identical individuals</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>No risk of immune <span class=\"customMeta\" data-dictid=\"49e378f9f71692777197bc5e458569\">rejection</span> due to genetic identity</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Limited availability; specific to identical twins</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which organelle is DNA present?", "options": [{"label": "A", "text": "Mitochondria", "correct": true}, {"label": "B", "text": "Lysosome", "correct": false}, {"label": "C", "text": "Endoplasmic reticulum", "correct": false}, {"label": "D", "text": "Cytoplasm", "correct": false}], "correct_answer": "A. Mitochondria", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the true statement about the given dose-response curve.", "options": [{"label": "A", "text": "Drug C is the most potent", "correct": false}, {"label": "B", "text": "Drug B is the most efficacious", "correct": true}, {"label": "C", "text": "Drug C is as efficacious as drug D", "correct": false}, {"label": "D", "text": "Drug D is more potent than drug C", "correct": false}], "correct_answer": "B. Drug B is the most efficacious", "question_images": ["https://image.prepladder.com/notes/Hgci8fGLrxXzS80g7EUl1747395229.png"], "explanation_images": ["https://image.prepladder.com/notes/Hgci8fGLrxXzS80g7EUl1747395229.png"], "explanation": "<p>Correct Answer B - Drug B is the most efficaciou\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please determine the instrument provided.", "options": [{"label": "A", "text": "Linear stapler", "correct": true}, {"label": "B", "text": "Skin stapler", "correct": false}, {"label": "C", "text": "Circular stapler", "correct": false}, {"label": "D", "text": "Curved stapler", "correct": false}], "correct_answer": "A. Linear stapler", "question_images": ["https://image.prepladder.com/notes/xdAzI44TSejZQig9VzH61747400843.png"], "explanation_images": ["https://image.prepladder.com/notes/e9Hts3IplcbamH3gvf3Q1747382931.png", "https://image.prepladder.com/notes/ys81WcK211qGlSNSDx1Q1747383038.png", "https://image.prepladder.com/notes/NiT9wjanz88th8kiFYwQ1747407757.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug elicits the following response on blood pressure and heart rate, as shown in the image?", "options": [{"label": "A", "text": "Norepinephrine", "correct": true}, {"label": "B", "text": "Isoproterenol", "correct": false}, {"label": "C", "text": "Epinephrine", "correct": false}, {"label": "D", "text": "Dopamine", "correct": false}], "correct_answer": "A. Norepinephrine", "question_images": ["https://image.prepladder.com/notes/eNotMVHhFqCwIGkQ0lnI1747395385.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - Norepinephrine</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Norepinephrine, or noradrenaline, is a <span class=\"customMeta\" data-dictid=\"504306528f1692777199a0b2437267\">sympathomimetic</span> drug used primarily as a vasopressor.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of Action (MOA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It acts on α1 and β1 <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> receptors and has some <span class=\"customMeta\" data-dictid=\"227269f3ec1692777180d76a7898dd\">affinity</span> for alpha-2 receptors.</p>\n<ul>\n<li>Activation of α1 receptors causes vasoconstriction, increasing <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> resistance and blood pressure.</li>\n<li>Activation of β1 receptors increases heart rate and myocardial contractility.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Treatment of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> (e.g., <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock, <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> shock).</li>\n<li>Cardiac arrest.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardiovascular: Arrhythmias, bradycardia, hypertension.</li>\n<li>CNS: Anxiety, headache, tremor.</li>\n<li>Gastrointestinal: Nausea, vomiting.</li>\n<li>Respiratory: Respiratory difficulty, dyspnea.</li>\n<li>Metabolic: Hyperglycemia, <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> (risk of ischemia).</li>\n<li>During <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> with <span class=\"customMeta\" data-dictid=\"d85814684116927771852e645f8a96\">cyclopropane</span> or <span class=\"customMeta\" data-dictid=\"c65071bcf116927771888d40d93bf3\">halothane</span> (due to the risk of arrhythmias).</li>\n<li>Hypotension is due to <span class=\"customMeta\" data-dictid=\"b9b690b70c16927771833aae799b33\">blood volume</span> deficits (hypovolemia) until an adequate fluid replacement.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hormone-sensitive lipase is activated by all of the following EXCEPT?", "options": [{"label": "A", "text": "Glucagon", "correct": false}, {"label": "B", "text": "Epinephrine", "correct": false}, {"label": "C", "text": "ACTH", "correct": false}, {"label": "D", "text": "Insulin", "correct": true}], "correct_answer": "D. Insulin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8hqxC6T82aBjPCEcgsm41746172136.png"], "explanation": "<p>Correct Option D) Insu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man came with complaints of recurrent discharge and pain due to lesions around the anus for 3 years. A diagnosis of fistula-in-ano is made. What is the gold standard investigation for this condition?", "options": [{"label": "A", "text": "Fistulogram", "correct": false}, {"label": "B", "text": "USG", "correct": false}, {"label": "C", "text": "CECT", "correct": false}, {"label": "D", "text": "MRI", "correct": true}], "correct_answer": "D. MRI", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/63lPWWY0F9Z4mjNlhhdD1746172222.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fistula-in-Ano</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A chronic <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> communication between the <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> (internal opening) and an external opening on the skin of the perineum, buttock, or, rarely, the <span class=\"customMeta\" data-dictid=\"8537d8358c169277720162f2f6971b\">vagina</span> in women.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Idiopathic/Cryptoglandular: The most common cause, often associated with prior <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> sepsis.</li>\n<li>Associated Conditions:\n\t\t\t\t<ul>\n<li>Crohn’s disease</li>\n<li>Tuberculosis</li>\n<li>Lymphogranuloma venereum</li>\n<li>Actinomycosis</li>\n<li>Rectal duplication</li>\n<li>Foreign bodies</li>\n<li>Malignancy (rare, can develop within a longstanding fistula)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intermittent <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge: This may be bloody and purulent. Discomfort typically increases until the <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> discharges, providing temporary relief.</li>\n<li>Previous history of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">Anorectal</span> abscess</li>\n<li>Passage of <span class=\"customMeta\" data-dictid=\"c952bab9c2169277720207dd4f48d0\">flatus</span> or faeces: Through the external opening, (indicative of a rectal rather than an anal internal opening).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>MRI: </strong>Maps the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel and provides detailed images of the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> muscle and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> floor structures. (Investigation of choice) <strong>(Option D)</strong></li>\n<li><strong>Endoscopic Ultrasound: </strong>It uses high-frequency sound waves to identify the fistula, <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> muscles, and surrounding tissues.</li>\n<li><strong>Fistulography: </strong>An X-ray procedure using <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> contrast to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the anal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel. (1st investigation) <strong>(Option A ruled out)</strong></li>\n<li><strong>Examination Under Anesthesia: </strong>Allows for thorough evaluation of the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel and identification of potential complications.</li>\n<li><strong>Fistula Probe: </strong>A specialized instrument is inserted through the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> to identify the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> tunnel.</li>\n<li><strong>Anoscopy: </strong>A small <span class=\"customMeta\" data-dictid=\"e3a3b038c216927771875644f31cc5\">endoscope</span> is used to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> for assessment of fistulas during anoscopy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fistulotomy </strong></p>\n<ul>\n<li>Opening the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> to heal by secondary intention.</li>\n<li>Used for <span class=\"customMeta\" data-dictid=\"93ba3eaf7f1692777190664288c3a2\">intersphincteric</span> and trans-sphincteric <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> involving &lt;30% of external sphincter; not for <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> in women.</li>\n</ul>\n<p><strong>Fistulectomy </strong></p>\n<ul>\n<li>Removal of the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> using <span class=\"customMeta\" data-dictid=\"24bfc6e0cc16927771862d94b32d73\">diathermy</span> <span class=\"customMeta\" data-dictid=\"be6cf382f3169277718394516c7ca1\">cautery</span> for better <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of anatomy.</li>\n<li>Effective for understanding the fistula's <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and extensions.</li>\n</ul>\n<p><strong>Setons</strong></p>\n<ul>\n<li>Materials are inserted into the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> for <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> or gradual cutting.</li>\n<li>Loose setons promote drainage; tight/cutting setons cut through muscle over time.</li>\n</ul>\n<p><strong>Advancement Flaps</strong></p>\n<ul>\n<li>Closing the internal opening with a <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> is used when the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> complex is not extensively indurated.</li>\n<li>Effective for certain <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> configurations.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type 1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Inter- sphincteric (most common, 70%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trans- sphincteric (25%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supra- sphincteric (4%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 4 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extra- sphincteric (1%)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs increases uric acid in urine?", "options": [{"label": "A", "text": "Colchicine", "correct": false}, {"label": "B", "text": "Febuxostat", "correct": false}, {"label": "C", "text": "Probenecid", "correct": true}, {"label": "D", "text": "Allopurinol", "correct": false}], "correct_answer": "C. Probenecid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"2ee374b25c16927771963eae834a26\"&gt;Probenecid&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uricosuric drugs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit OAPT transporter/ URAT-1 in <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> ⇒ Inhibits <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> ⇒ Increase <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. Probenecid: </strong></p>\n<ul>\n<li>Side effects: diarrhoea, hypersensitivity, <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid stones</li>\n<li>Contraindication: nephrolithiasis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Precaution: take plenty of oral fluids</li>\n<li>Concomitant <span class=\"customMeta\" data-dictid=\"e6c39cccfc1692777184f4ea5296e6\">colchicine</span> or NSAIDs indicated in attack of gout</li>\n</ul>\n<p><strong>2. Sulphinpyrazole:</strong></p>\n<ul>\n<li>Non-steroidal anti-inflammatory drug</li>\n<li>Recommended in both <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> and chronic gout</li>\n</ul>\n<p><strong>3. Benzbromarone:</strong></p>\n<ul>\n<li>Safe in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Contraindication – Liver diseases</li>\n</ul>\n<p><strong>4. Lesinurad</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attack of gout</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>DOC- NSAIDS (All types) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Except for <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> and paracetamol</li>\n<li>Anti-inflammatory</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Colchicine (spindle poison) (Option A) </strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MOA: <span class=\"customMeta\" data-dictid=\"ef00bb99bd1692777192dbc816b3d4\">microtubule</span> inhibitor</li>\n<li>Used in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks of <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> and <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> Mediterranean fever and is also the <span class=\"customMeta\" data-dictid=\"357ecf18f2169277718661a76111ea\">DOC</span> for karyotyping</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Corticosteroids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intra <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> injections, avoid oral route</li>\n<li>Immunosuppressive and anti-inflammatory</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs for chronic gout</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Xanthine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> inhibitors</strong></p>\n<ul>\n<li>Allopurinol (DOC) <strong>(Option D)</strong></li>\n<li>Oxipurinol</li>\n<li>Febuxostat <strong>(Option B) </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MOA: Blocks <span class=\"customMeta\" data-dictid=\"c9a23eabc41692777202d1d98467d5\">xanthine</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> → Inhibits the conversion of <span class=\"customMeta\" data-dictid=\"304c30e55316927771895062b17e8b\">hypoxanthine</span> to <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid in the liver.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uric acid <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> enzyme</strong></p>\n<ul>\n<li>Pegloticase</li>\n<li>Rasburicase</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MOA: <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">Uric</span> acid is converted to <span class=\"customMeta\" data-dictid=\"eae976dfa31692777181804c2b20e7\">allantoin</span> and excreted in urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uricosuric agents</strong></p>\n<ul>\n<li>Probenecid <strong>(OptionC)</strong></li>\n<li>Benzbromaron</li>\n<li>Sulfinpyrazone</li>\n<li>Lesinurad</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MOA: <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">Inhibit</span> OATP transporter/URAT-1 in the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> → inhibits <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid → increased <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid.</p>\n<p>(OATP - Organic <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> transport protein, URAT-1 - <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">Uric</span> acid transporter)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old female presented to a psychiatrist with symptoms of low mood, loss of interest, loss of appetite, and difficulty sleeping for 2 months. The psychiatrist makes the diagnosis of a major depressive disorder. Which drug is best for the disorder, as mentioned earlier?", "options": [{"label": "A", "text": "Buspirone", "correct": false}, {"label": "B", "text": "Lithium", "correct": false}, {"label": "C", "text": "Divalproex", "correct": false}, {"label": "D", "text": "Fluoxetine", "correct": true}], "correct_answer": "D. Fluoxetine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Flu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Major classes of medications used in treating depression</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>SSRIs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluoxetine, Sertraline, Escitalopram, Citalopram, Paroxetine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First-line due to safety and tolerability</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>SNRIs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Venlafaxine, Duloxetine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For those not responding to SSRIs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Atypical Antidepressants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bupropion, Mirtazapine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less sexual <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (Bupropion); helps <span class=\"customMeta\" data-dictid=\"04b9e17b411692777190d32aceafae\">insomnia</span> (Mirtazapine)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tricyclic Antidepressants (TCAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Amitriptyline, Nortriptyline</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For treatment-resistant cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monoamine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> inhibitors (MAOIs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Phenelzine, Tranylcypromine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reserved for severe, resistant depression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adjunct Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atypical antipsychotics, Lithium</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For treatment-resistant depression</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Duration:</strong></p>\n<ul>\n<li>Acute Phase: Minimum of 6 months or length of previous episode (whichever is longer)</li>\n<li>Maintenance/Prophylaxis: Indicated for 3+ episodes or chronic depression (&gt;2 years)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with a history of chronic alcohol consumption is admitted to the hospital with features of confusion, vision loss and an unsteady gait. He is unable to remember the most recent incidents. Which vitamin deficiency is responsible for his symptoms?", "options": [{"label": "A", "text": "Ascorbic acid", "correct": false}, {"label": "B", "text": "Retinol", "correct": false}, {"label": "C", "text": "Thiamine", "correct": true}, {"label": "D", "text": "Folate", "correct": false}], "correct_answer": "C. Thiamine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\"&gt;Thiamine&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Wernicke's Encephalopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Korsakoff Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic often follows Wernicke's</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Global Confusion</li>\n<li>Ocular abnormalities (nystagmus, gaze palsy)</li>\n<li>Ataxia (especially gait)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"6f04a43a8c16927771816dd61a4f17\">anterograde</span> amnesia</li>\n<li>Retrograde amnesia</li>\n<li>Confabulation (in some cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thiamine deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuropathological lesions</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symmetrical and paraventricular, involving <span class=\"customMeta\" data-dictid=\"06d33302e016927771911f7ef71255\">mammillary</span> bodies, thalamus, hypothalamus, midbrain, pons, medulla, fornix, and cerebellum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate IV thiamine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Long-term <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> supplementation, supportive care</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potentially <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> with prompt treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often irreversible, only about 20% recover</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which antidepressant would you recommend for a 38-year-old professor experiencing depression who is concerned about potential sexual dysfunction as a side effect?", "options": [{"label": "A", "text": "Bupropion", "correct": true}, {"label": "B", "text": "Escitalopram", "correct": false}, {"label": "C", "text": "Venlafaxine", "correct": false}, {"label": "D", "text": "Fluoxetine", "correct": false}], "correct_answer": "A. Bupropion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Bu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3 style=\"text-align: center;\"><strong>Antidepressant Classes and Their Side Effects</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Common Side Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Selective <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">Serotonin</span> <span class=\"customMeta\" data-dictid=\"42c441fad11692777197258f322307\">Reuptake</span> Inhibitors (SSRIs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluoxetine, Escitalopram, Sertraline</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> reuptake, increasing its availability</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea</li>\n<li>Insomnia</li>\n<li>Sexual dysfunction</li>\n<li>Weight gain</li>\n<li>Emotional blunting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Serotonin-Norepinephrine <span class=\"customMeta\" data-dictid=\"42c441fad11692777197258f322307\">Reuptake</span> Inhibitors (SNRIs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Venlafaxine, Duloxetine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit <span class=\"customMeta\" data-dictid=\"42c441fad11692777197258f322307\">reuptake</span> of <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> and norepinephrine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypertension (dose-dependent)</li>\n<li>Nausea</li>\n<li>Insomnia</li>\n<li>Sexual dysfunction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Atypical Antidepressants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bupropion, Mirtazapine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varies by drug: e.g., Bupropion (NDRI) increases <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">norepinephrine</span> and dopamine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bupropion: Dry mouth, insomnia, low risk of sexual dysfunction</li>\n<li>Mirtazapine: Sedation, weight gain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tricyclic Antidepressants (TCAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Amitriptyline, Nortriptyline</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> and <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">norepinephrine</span> reuptake; block muscarinic, histaminic, and <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> receptors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sedation</li>\n<li>Weight gain</li>\n<li>Dry mouth</li>\n<li>Orthostatic hypotension</li>\n<li>Cardiotoxicity (in overdose)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Monoamine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">Oxidase</span> Inhibitors (MAOIs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Phenelzine, Tranylcypromine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit <span class=\"customMeta\" data-dictid=\"f214e1c23316927771928fe9222ddc\">monoamine</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> enzyme, preventing the <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of serotonin, dopamine, and norepinephrine.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypertensive crisis (with tyramine-containing foods)</li>\n<li>Insomnia</li>\n<li>Hypotension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Serotonin Modulators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trazodone, Vilazodone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Modulate <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> receptors and/or reuptake.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trazodone: Sedation, priapism</li>\n<li>Vilazodone: GI upset, less sexual <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> than SSRIs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Noradrenaline and Specific <span class=\"customMeta\" data-dictid=\"ff0f0a7e341692777198133f3861c7\">Serotonergic</span> Antidepressants (NaSSAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mirtazapine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enhances <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">norepinephrine</span> and <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> transmission by antagonising alpha-2 receptors.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sedation (dose-dependent)</li>\n<li>Weight gain</li>\n<li>Low risk of sexual dysfunction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which mental functions are examined in the Mental State Examination (100-7)?", "options": [{"label": "A", "text": "Judgment", "correct": false}, {"label": "B", "text": "Language", "correct": false}, {"label": "C", "text": "Orientation", "correct": false}, {"label": "D", "text": "Concentration", "correct": true}], "correct_answer": "D. Concentration", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UHHRREnlWQchQKB0c35j1746173113.png"], "explanation": "<p>Correct Answer D - Concentration</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>General description:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Appearance and behaviour</strong></li>\n<li><strong>Motor activity Speech </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Emotional state:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Mood:</strong> <span class=\"customMeta\" data-dictid=\"d2a2319d681692777199792417b5e2\">subjective</span> experience of patient’s internal and sustained emotional state</li>\n<li><strong>Affect: </strong>expression of mood (that appears to the clinician) <strong> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thinking</strong>:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thought content</li>\n<li>Thought process</li>\n<li>Perceptual disturbances</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cognition (higher mental function):</strong> most commonly evaluated by <strong>Mini-Mental Status Examination (MMSE)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Orientation</li>\n<li>Registration</li>\n<li>Attention &amp; calculation</li>\n<li>Memory (immediate, recent &amp; long term)</li>\n<li>Abstract reasoning</li>\n<li>Insight &amp; Judgement</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the predominant manifestation experienced with cannabis consumption?", "options": [{"label": "A", "text": "Anxiety", "correct": false}, {"label": "B", "text": "Depressed mood", "correct": false}, {"label": "C", "text": "Dream-like state", "correct": true}, {"label": "D", "text": "Decreased appetite", "correct": false}], "correct_answer": "C. Dream-like state", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cannabis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Over 400 compounds</li>\n<li>Includes cannabinoids, flavonoids, and terpenoids</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"e2c6e8efa0169277719634dd633fd5\">psychoactive</span> component: <strong>Tetrahydrocannabinol (THC)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Forms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dried plant material (marijuana)</li>\n<li>Bhang (Derived from dried leaves)</li>\n<li>Ganja (derived from flowering stem)</li>\n<li>Hashish (concentrated resin)</li>\n<li>Oils and extracts (Hash oil)</li>\n<li>Edibles</li>\n<li>Topical preparations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Receptors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CB1 and CB2 (G-protein coupled receptors- <strong>Gi subtype</strong>)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Methods of Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Smoking <strong>(most common)</strong></li>\n<li>Vaporizing</li>\n<li>Oral ingestion</li>\n<li>Sublingual administration</li>\n<li>Topical application</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features of Intoxication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tachycardia</li>\n<li>Conjunctival injection</li>\n<li>Anxiety or euphoria</li>\n<li>Slowness of time</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"66a72871741692777184da29e3ed5d\">cognition</span> and motor coordination</li>\n<li>Dry mouth</li>\n<li>Increased appetite</li>\n<li>Nystagmus</li>\n<li>Postural hypotension</li>\n<li>Delirium (especially at high doses)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Onset and Duration of Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Smoking:</strong> Rapid onset (minutes), duration 2-3 hours</li>\n<li><strong>Oral ingestion:</strong> Delayed onset (30-90 minutes), duration 4-12 hours</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not suggest a medical cause of mental illness?", "options": [{"label": "A", "text": "Elderly age", "correct": false}, {"label": "B", "text": "Loss of consciousness", "correct": false}, {"label": "C", "text": "Auditory hallucination", "correct": true}, {"label": "D", "text": "Acute onset", "correct": false}], "correct_answer": "C. Auditory hallucination", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\"&gt;Auditory&lt;/span&gt; hallu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a middle-aged man who visits the psychiatry OPD claiming that he has been hearing voices from aliens instructing him to harm his family members for the last seven months?", "options": [{"label": "A", "text": "Mania", "correct": false}, {"label": "B", "text": "Delusional disorder", "correct": false}, {"label": "C", "text": "Schizophrenia", "correct": true}, {"label": "D", "text": "Brief psychotic disorder", "correct": false}], "correct_answer": "C. Schizophrenia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Schizophrenia</p>\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p><strong>Type of Schizophrenia</strong></p>\n</td>\n<td>\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Paranoid <span class=\"customMeta\" data-dictid=\"d844b672a616927771988fee71197b\">Schizophrenia</span> </strong></p>\n</td>\n<td>\n<ul>\n<li>Characterised by<strong> delusions </strong>and <strong>hallucinations.</strong></li>\n<li>Individuals may have a fixed belief that others are out to harm them, often leading to mistrust and vigilance.</li>\n<li><strong>Cognitive functions usually remain intac</strong>t, while emotional responses may be inappropriate.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Catatonic <span class=\"customMeta\" data-dictid=\"d844b672a616927771988fee71197b\">Schizophrenia</span> </strong></p>\n<p> </p>\n</td>\n<td>\n<p>Characterised by <strong>three or more </strong>of the following symptoms:</p>\n<ul>\n<li>Motor <span class=\"customMeta\" data-dictid=\"d9d99d2177169277718940abaf77fb\">immobility</span> ( stupor)</li>\n<li>Excessive, odd movement (stereotypies or mannerisms)</li>\n<li>Waxy flexibility (bending like a <span class=\"customMeta\" data-dictid=\"9eae373ada1692777202074bbc0222\">wax</span> candle)</li>\n<li>Extreme <span class=\"customMeta\" data-dictid=\"e06f61f915169277719362150d287c\">negativism</span> (resisting instructions or maintaining rigidity)</li>\n<li>Unusual postures (bizarre posturing, catalepsy)</li>\n<li>Echolalia or <span class=\"customMeta\" data-dictid=\"12f7ccacb21692777186ad7bbad4a3\">echopraxia</span> (Mimicking speech or movements)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Disorganised (Hebephrenic) Schizophrenia</strong></p>\n</td>\n<td>\n<ul>\n<li>Involves disorganised speech and behavior.</li>\n<li>Inappropriate emotional responses and poor functioning.</li>\n<li>Typically associated with a poorer prognosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Residual Schizophrenia</strong></p>\n</td>\n<td>\n<ul>\n<li>History of <span class=\"customMeta\" data-dictid=\"d844b672a616927771988fee71197b\">schizophrenia</span> with delusions and hallucinations (in the past 1 year) with lingering negative symptoms but minimal or no positive symptoms at present.</li>\n<li>No prominent delusions or hallucinations</li>\n<li>Individuals may exhibit social withdrawal and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> emotional expression.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Simple Schizophrenia</strong></p>\n</td>\n<td>\n<p>Involves prominent negative symptoms</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Undifferentiated Schizophrenia</strong></p>\n</td>\n<td>\n<p>Diagnosis for patients who do not fit into other categories presenting a mix of symptoms.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the rate-limiting enzyme of heme synthesis pathway?", "options": [{"label": "A", "text": "HMB synthase", "correct": false}, {"label": "B", "text": "δ Amino-Levulinic Acid dehydratase", "correct": false}, {"label": "C", "text": "δ Amino-Levulinic Acid synthase", "correct": true}, {"label": "D", "text": "Ferrochelatase", "correct": false}], "correct_answer": "C. δ Amino-Levulinic Acid synthase", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/A1MYkjlg699xd7DHx7a51747389565.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Succinyl CoA + <span class=\"customMeta\" data-dictid=\"6df8c5de5016927771881dc6865f2e\">Glycine</span> → Delta-aminolevulinic acid (ALA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ALA <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">Synthase</span> <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rate-limiting step</strong>; requires <span class=\"customMeta\" data-dictid=\"ad5806d5ad1692777196f1158adc4e\">pyridoxal</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> as a cofactor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 ALA → Porphobilinogen (PBG)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ALA Dehydratase <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It involves removal of 2 molecules of water; the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> contains <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> and is inhibited by lead</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 PBG → Hydroxymethylbilane (HMB)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uroporphyrinogen I Synthase/ HMB <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">synthase</span> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HMB → Uroporphyrinogen I</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous cyclization</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HMB → Uroporphyrinogen III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uroporphyrinogen III Synthase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uroporphyrinogen III → Coproporphyrinogen III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uroporphyrinogen Decarboxylase</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decarboxylation, removal of 4 molecules of CO2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coproporphyrinogen III → Protoporphyrinogen III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coproporphyrinogen Oxidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protoporphyrinogen III → Protoporphyrin III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protoporphyrinogen Oxidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>8</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protoporphyrin III → Heme</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ferrochelatase</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Insertion of Fe2+</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with CAD comes to the physician for a follow-up examination. His blood pressure is 130/80 mm Hg, height of 182 cm, weight of 85 kg, and a BMI of 25 kg/m². Serum studies show a glucose concentration of 95 mg/dL and homocysteine concentration of 19.3 μmol/L (N=5–15). Serum lipid concentrations are within the normal range. Which of the following enzyme deficiencies is most likely to be found in this patient?", "options": [{"label": "A", "text": "Homogentisate oxidase", "correct": false}, {"label": "B", "text": "Cystathionine beta synthase", "correct": true}, {"label": "C", "text": "Cystathionine gamma synthase", "correct": false}, {"label": "D", "text": "HGPRTase", "correct": false}], "correct_answer": "B. Cystathionine beta synthase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KmURoxK8UtLRK9XmnTfu1746177699.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:635px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type - I Homocystinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type - II Homocystinuria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cystathionine beta-synthase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Methionine synthase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">Pathway</span> Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Homocysteine to cystathionine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Homocysteine to methionine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Elevated Metabolites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Homocysteine and methionine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Homocysteine and elevated levels of methionine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Biochemical Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low levels of cysteine.</li>\n<li>High levels of methionine.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High levels of cysteine.</li>\n<li>Low levels of methionine.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vitamin B6 (pyridoxine) supplementation; low-methionine diet; <span class=\"customMeta\" data-dictid=\"dabfa103741692777185dac756c49b\">cysteine</span> supplementation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitamin B12 and <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> supplementation; low-methionine diet</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 13-year-old boy who accompanied his father to a fish farming region in his hometown accidentally consumes a white odourless chemical. He was under some medication and post-meal he developed toxicity of the drug. Which of the following toxin is most likely to cause this condition?", "options": [{"label": "A", "text": "Alkyl guanides", "correct": false}, {"label": "B", "text": "BAL", "correct": false}, {"label": "C", "text": "Antimycin A", "correct": false}, {"label": "D", "text": "Rotenone", "correct": true}], "correct_answer": "D. Rotenone", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old female came to the emergency department with a bleeding condition and dental caries. Which vitamin supplementation from the list below would be best for treating this condition?", "options": [{"label": "A", "text": "Vitamin B1", "correct": false}, {"label": "B", "text": "Vitamin B9", "correct": false}, {"label": "C", "text": "Vitamin D", "correct": false}, {"label": "D", "text": "Vitamin K", "correct": true}], "correct_answer": "D. Vitamin K", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In all types of shock, which of the following is observed?", "options": [{"label": "A", "text": "Reduced tissue perfusion", "correct": true}, {"label": "B", "text": "Increased peripheral resistance", "correct": false}, {"label": "C", "text": "Decreased respiratory rate", "correct": false}, {"label": "D", "text": "Cold clammy skin", "correct": false}], "correct_answer": "A. Reduced tissue perfusion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypovolemic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduced circulating blood volume</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hemorrhage, Dehydration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiogenic Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Failure of the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> pump</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Myocardial Infarction, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Dysrhythmias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Obstructive Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mechanical <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> filling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cardiac Tamponade, Tension Pneumothorax</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distributive Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systemic <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> leading to organ hypoperfusion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Septic Shock, Anaphylactic Shock</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endocrine Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Combination of hypovolemic, cardiogenic, or distributive shock mechanisms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Addisonian Crisis, <span class=\"customMeta\" data-dictid=\"a856fbe9fc1692777193631fa87f91\">Myxedema</span> Coma</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cardiac Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mean Arterial Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distributive(Septic, anaphylactic, neurogenic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ or N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Obstructive (pulmonary embolism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, tension pneumothorax)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female was diagnosed with lead poisoning. What is the probable enzyme defect responsible for her condition?", "options": [{"label": "A", "text": "ALA synthase", "correct": false}, {"label": "B", "text": "ALA dehydratase", "correct": true}, {"label": "C", "text": "Heme synthase", "correct": false}, {"label": "D", "text": "Coproporphyrinogen oxidase", "correct": false}], "correct_answer": "B. ALA dehydratase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme inhibited</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ALA dehydratase<strong> (Primarily inhibited)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ALA elevation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coproporphyrinogen oxidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coproporphyrin elevation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ferrochelatase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">Zinc</span> <span class=\"customMeta\" data-dictid=\"510ec2d8ea1692777196c492eae686\">protoporphyrin</span> levels<strong> (Most sensitive marker)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following procedures has the highest risk of causing the recurrence of duodenal ulcers?", "options": [{"label": "A", "text": "Selective Vagotomy", "correct": false}, {"label": "B", "text": "Highly selective vagotomy", "correct": true}, {"label": "C", "text": "Truncal vagotomy", "correct": false}, {"label": "D", "text": "Truncal Vagotomy with Antrectomy", "correct": false}], "correct_answer": "B. Highly selective vagotomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/irgza2k1YNZU95GwK7V01747400967.png", "https://image.prepladder.com/notes/mnfPlfL9rZ6oUOA5FQGi1747401080.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Truncal Vagotomy</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Truncal <span class=\"customMeta\" data-dictid=\"3dea30c6a4169277720134cd67a1e1\">Vagotomy</span> with Antrectomy</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Selective Vagotomy</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Highly Selective Vagotomy</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:none\">\n<p><strong>Nerves Divided</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Left and right <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> above <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> and <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> branches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Truncal <span class=\"customMeta\" data-dictid=\"3dea30c6a4169277720134cd67a1e1\">vagotomy</span> plus removal of the antrum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Main right and left <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> and <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> branches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Only nerves to the acid-producing portion (all branches to the <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> and body) of the stomach</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:none\">\n<p><strong>Drainage Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Usually required</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Not applicable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Required</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Not required</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:none\">\n<p><strong>Acid Reduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>~50%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>~85%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>&lt;50%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>Variable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:none\">\n<p><strong>Ulcer Recurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>2-7%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>5-10%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>2-10%%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #29261b; border-left:1px solid #29261b; border-right:1px solid #29261b; border-top:none\">\n<p><strong>Significant side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>10-20%</p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>10-20%</p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>10-20%</p>\n</td>\n<td style=\"border-bottom:1px solid #29261b; border-left:none; border-right:1px solid #29261b; border-top:none\">\n<p>&lt;5%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following locations can cardiolipin be found?", "options": [{"label": "A", "text": "Outer mitochondrial membrane", "correct": false}, {"label": "B", "text": "Inner mitochondrial membrane", "correct": true}, {"label": "C", "text": "Cytosol", "correct": false}, {"label": "D", "text": "Mitochondrial matrix", "correct": false}], "correct_answer": "B. Inner mitochondrial membrane", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient has limited hip movement and complains of pain and discomfort in the hip region. Which of the following tests is done to identify flexion deformity at the hip?", "options": [{"label": "A", "text": "Thomas test", "correct": true}, {"label": "B", "text": "Lasegue test", "correct": false}, {"label": "C", "text": "Telescopy", "correct": false}, {"label": "D", "text": "McMurray test", "correct": false}], "correct_answer": "A. Thomas test", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is referred to a higher center with the diagnosis of fracture. On examination, the forearm pulses were not palpable. An upper arm X-ray was done, which is given below. Which artery is most likely to be injured in this condition?", "options": [{"label": "A", "text": "Radial artery", "correct": false}, {"label": "B", "text": "Ulnar artery", "correct": false}, {"label": "C", "text": "Brachial artery", "correct": true}, {"label": "D", "text": "Anterior interosseous artery", "correct": false}], "correct_answer": "C. Brachial artery", "question_images": ["https://image.prepladder.com/content/ozKBj40IUxZx4P2KVgWz1746178544.png"], "explanation_images": ["https://image.prepladder.com/notes/gL6bIZJJHNZ6ixogkK181747396185.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of displacement is most likely observed in a 60-year-old female patient who presents with pain and swelling in her left wrist after falling on an outstretched hand, and exhibits a dinner fork deformity upon examination?", "options": [{"label": "A", "text": "Proximal and ventral displacement of radius", "correct": false}, {"label": "B", "text": "Supination and dorsal displacement of radius", "correct": true}, {"label": "C", "text": "Proximal and dorsal displacement of ulna", "correct": false}, {"label": "D", "text": "Proximal and ventral displacement of ulna", "correct": false}], "correct_answer": "B. Supination and dorsal displacement of radius", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dBYwBJUbNUvOcugiZhUM1746178476.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "To what level of vertebrae does the marked structure correspond?", "options": [{"label": "A", "text": "At the junction of L1 &amp;amp; L2", "correct": false}, {"label": "B", "text": "At the junction of L2 &amp;amp; L3", "correct": false}, {"label": "C", "text": "At the junction of T12 &amp;amp; L1", "correct": false}, {"label": "D", "text": "At the junction of L3 &amp;amp; L4", "correct": true}], "correct_answer": "D. At the junction of L3 &amp; L4", "question_images": ["https://image.prepladder.com/notes/lzCII0Fr2h7Ak0GsZXg21747377710.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male patient after an injury presented with a deformity as shown in the image. Which nerve will be damaged in the given condition?", "options": [{"label": "A", "text": "Ulnar Nerve", "correct": false}, {"label": "B", "text": "Radial Nerve", "correct": true}, {"label": "C", "text": "Median Nerve", "correct": false}, {"label": "D", "text": "Musculocutaneous Nerve", "correct": false}], "correct_answer": "B. Radial Nerve", "question_images": ["https://image.prepladder.com/content/J8kuxCrQrRWp45K5o7Lz1746178748.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Root origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Common causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Radial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C5-T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Compression in <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> (crutches, \"Saturday night palsy\")</li>\n<li>Midshaft <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of humerus</li>\n<li>Repetitive pronation/supination (screwdriver use, \"finger drop\")</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Above elbow injury:</p>\n<ul>\n<li>Loss of sensation over <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arm/forearm and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> hand</li>\n<li>Wrist drop (loss of elbow, wrist, and finger extension)</li>\n<li>Decreased grip strength (wrist extension necessary for <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> action of flexors)</li>\n</ul>\n<p>Below elbow injury:</p>\n<ul>\n<li>Distal paresthesias without wrist drop</li>\n</ul>\n<p>Midshaft fracture:</p>\n<ul>\n<li>Tricep function and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> arm sensation spared</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person who had a road traffic accident presented to ER with injury to bulbar urethra. What can be the location of collection of the urine due to this injury?", "options": [{"label": "A", "text": "Inguinal pouch", "correct": false}, {"label": "B", "text": "Peritoneal cavity", "correct": false}, {"label": "C", "text": "Ischiorectal fossa", "correct": false}, {"label": "D", "text": "Anterior abdominal wall", "correct": true}], "correct_answer": "D. Anterior abdominal wall", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old male was climbing the stair, suddenly he fell &amp;amp; an iron nail hit on his neck. After the injury, the patient is having a hard time shrugging his shoulders and he is having difficulty turning his head. This might be due to an injury to?", "options": [{"label": "A", "text": "Spinal accessory Nerve", "correct": true}, {"label": "B", "text": "Deltoid Muscle", "correct": false}, {"label": "C", "text": "Sternocleidomastoid Muscle", "correct": false}, {"label": "D", "text": "Long thoracic Nerve", "correct": false}], "correct_answer": "A. Spinal accessory Nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 17-year-old male patient who visits the clinic with a painless lump on the outer side of his left knee, as depicted in the radiograph provided?", "options": [{"label": "A", "text": "Enchondroma", "correct": false}, {"label": "B", "text": "Chondroblastoma", "correct": false}, {"label": "C", "text": "Osteochondroma", "correct": true}, {"label": "D", "text": "Giant cell tumor", "correct": false}], "correct_answer": "C. Osteochondroma", "question_images": ["https://image.prepladder.com/content/yuTsJBFYiNDgJPxzUG761746178694.png"], "explanation_images": ["https://image.prepladder.com/content/3e8SAMNfQhsIOk0GMJlY1746178748.png", "https://image.prepladder.com/content/YArvGjQ7VgZSB1QCg5PL1746178748.png", "https://image.prepladder.com/content/j5MQFJ44mtXBDuuR1IO81746178748.png", "https://image.prepladder.com/content/y6VfvG3VZRZqvERBhwkE1746178748.png", "https://image.prepladder.com/content/s71uI7mBjtJYenkpsysl1746178748.png", "https://image.prepladder.com/content/JDZn2tIgs47LvjVoW6181746178748.png", "https://image.prepladder.com/content/1qewvm5orYCmYRAAV9hB1746178748.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Painful <span class=\"customMeta\" data-dictid=\"305c26a07b1692777183e163c48e3c\">bursa</span> formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> over the osteochondroma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Activity-related discomfort</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>General discomfort with movement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nerve compression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare, may cause neuropathic symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uncommon, results in sudden pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignant transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to chondrosarcoma, more likely with a <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> cap &gt;1.5 cm.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly patient with the presented deformity was brought to the outpatient department (OPD). What is the likely diagnosis?", "options": [{"label": "A", "text": "Rickets", "correct": false}, {"label": "B", "text": "Osteomalacia", "correct": false}, {"label": "C", "text": "Osteoarthritis", "correct": false}, {"label": "D", "text": "Rheumatoid arthritis", "correct": true}], "correct_answer": "D. Rheumatoid arthritis", "question_images": ["https://image.prepladder.com/content/ONbAPTj5OlEHgX7nJRfr1746179018.png"], "explanation_images": ["https://image.prepladder.com/content/KZIBmGzbMSNmTdKC8l2r1746179347.png", "https://image.prepladder.com/content/sIFVBreCgf1T0eFieOlb1746179342.png", "https://image.prepladder.com/content/l9afBF87vmuHdP3oeV4w1746179337.png", "https://image.prepladder.com/content/GSs0kzoBewKcnmSesy4Z1746179332.png", "https://image.prepladder.com/content/zgIOzsr2AUHMPS6hg7tx1746179325.png", "https://image.prepladder.com/content/w7mSDCmETHXdWTY6Ecof1746179320.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:389px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Joints affected</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MP joints of the hand</li>\n<li>PIP joints of fingers</li>\n<li>Wrists, knees, elbows, ankles</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hip joint</li>\n<li>Temporo-mandibular joint</li>\n<li>Spares <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"8571221d1416927771909046a403e4\">inter</span> <span class=\"customMeta\" data-dictid=\"b9f9358d0d1692777195323daee87f\">phalangeal</span> joints.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\"><strong>Deformities in <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> arthritis</strong></td>\n</tr>\n<tr>\n<td colspan=\"2\">Hand</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:162px; vertical-align:top; width:240px\">\n<ul>\n<li>Ulnar <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the hand</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Andreas L Birkenfeld Ute Kettritz Jan Hinrich Bräsen Ursula Göbel\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Rheumatoid-arthritis-with-ulnar-deviation-of-the-metacarpal-phalangeal-joints-button_fig1_325272407\" data-tags=\"\" height=\"213\" src=\"https://image.prepladder.com/content/KZIBmGzbMSNmTdKC8l2r1746179347.png\" width=\"432\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<ul>\n<li>Swan neck deformity</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"User:Phoenix119 \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Swan_neck_deformity#/media/File:Swan_neck_deformity_in_a_65_year_old_Rheumatoid_Arthritis_patient-_2014-05-27_01-49.jpg\" data-tags=\"\" height=\"277\" src=\"https://image.prepladder.com/content/sIFVBreCgf1T0eFieOlb1746179342.png\" width=\"402\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<ul>\n<li>Boutonniere deformity</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"John Kiel\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikism.org/File:Boutonniere_Deformity_Clinical_Image.jpg\" data-tags=\"\" height=\"305\" src=\"https://image.prepladder.com/content/l9afBF87vmuHdP3oeV4w1746179337.png\" width=\"406\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<p>Elbow: Flexion deformity</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">Knee</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<ul>\n<li>Valgus deformity</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"BioMed central\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/Valgus_deformity#/media/File:Valgus.jpg\" data-tags=\"\" height=\"281\" src=\"https://image.prepladder.com/content/GSs0kzoBewKcnmSesy4Z1746179332.png\" width=\"404\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">Ankle: Equinus deformity</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">Foot</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<ul>\n<li>Hallux valgus</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Cyberprout\" data-hash=\"\" data-license=\"CC BY SA 1.0\" data-source=\"https://en.wikipedia.org/wiki/Bunion#/media/File:Hallux_Valgus-Aspect_pr%C3%A9_op_d%C3%A9charge.JPG\" data-tags=\"\" height=\"385\" src=\"https://image.prepladder.com/content/zgIOzsr2AUHMPS6hg7tx1746179325.png\" width=\"303\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:19px; vertical-align:top; width:240px\">\n<ul>\n<li>Hammer toe</li>\n</ul>\n</td>\n<td>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Wwcmdmsha\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Hammer_toe#/media/File:Hammer_toes.jpg\" data-tags=\"\" height=\"366\" src=\"https://image.prepladder.com/content/w7mSDCmETHXdWTY6Ecof1746179320.png\" width=\"343\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Medical termination of pregnancy can be done upto 24 weeks in case of?", "options": [{"label": "A", "text": "Congenital malformation", "correct": false}, {"label": "B", "text": "Minors", "correct": false}, {"label": "C", "text": "Contraception failure", "correct": false}, {"label": "D", "text": "Rape victim", "correct": true}], "correct_answer": "D. Rape victim", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Rape victim</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>MTP Act 1971</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>The <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> Amendment Act 2021</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications (Contraceptive failure)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Only applies to married women.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Unmarried women are also covered</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gestational Age Limit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>20 weeks for all indications</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>24 weeks for rape survivors.</li>\n<li>Beyond 24 weeks for substantial <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> abnormalities</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical practitioner opinions required before termination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>One <span class=\"customMeta\" data-dictid=\"60461869c01692777197bef3f17f7b\">RMP</span> till 12 weeks</li>\n<li>Two RMPs till 20 weeks</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>One <span class=\"customMeta\" data-dictid=\"60461869c01692777197bef3f17f7b\">RMP</span> till 20 weeks</li>\n<li>Two RMPS 20-24 weeks</li>\n<li>Medical Board approval after 24 weeks</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Breach of the woman's confidentiality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fine up to Rs 1000</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fine and/or Imprisonment of 1 year.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old female, who works as a maid complained of knee pain and swelling. Which of the following area gets damaged in Housemaid’s knee?", "options": [{"label": "A", "text": "A", "correct": false}, {"label": "B", "text": "B", "correct": true}, {"label": "C", "text": "C", "correct": false}, {"label": "D", "text": "D", "correct": false}], "correct_answer": "B. B", "question_images": ["https://image.prepladder.com/notes/gxZMXYaiKrI9mUimCROt1747377900.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old patient presents with painful swelling in the index finger around the proximal phalanx. An X-ray was done, and it is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing's Sarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": false}, {"label": "D", "text": "Enchondroma", "correct": true}], "correct_answer": "D. Enchondroma", "question_images": ["https://image.prepladder.com/content/XKkZSQmkQtlHqFtANK211746179533.png"], "explanation_images": ["https://image.prepladder.com/content/6XTiEnPGfuJX8zbnoovZ1746179567.png", "https://image.prepladder.com/content/dE6m89Ab9DAPLbdw1kJs1746179601.png", "https://image.prepladder.com/content/m62EPiVgFlQuNGaNOqJV1746179601.png", "https://image.prepladder.com/content/YEBbqIvgbGQgOYX5EfLY1746179601.png", "https://image.prepladder.com/content/N68FTz7awDH1MP1wyjXT1746179601.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A doctor was summoned as a public witness to appear and record his evidence in court. What is correct about this witness?", "options": [{"label": "A", "text": "Oral evidence", "correct": false}, {"label": "B", "text": "Common witness", "correct": false}, {"label": "C", "text": "Expert witness", "correct": true}, {"label": "D", "text": "Hostile witness", "correct": false}], "correct_answer": "C. Expert witness", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - E\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 80-year-old woman slipped and fell in the bathroom, experiencing pain and an inability to walk due to a left hip injury, without any prior osteoarthritis history, and with an observation of a shortened and externally rotated left lower limb according to X-ray findings, how would you plan to manage her condition?", "options": [{"label": "A", "text": "Internal fixation with cancellous screws", "correct": false}, {"label": "B", "text": "Meyer's operation", "correct": false}, {"label": "C", "text": "Hemiarthroplasty", "correct": true}, {"label": "D", "text": "McMurray's osteotomy", "correct": false}], "correct_answer": "C. Hemiarthroplasty", "question_images": ["https://image.prepladder.com/notes/st0oL6cm3pZoppHvEy4u1747384488.png"], "explanation_images": ["https://image.prepladder.com/notes/TmHqwxyKhYrjAUFTrzze1747384560.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old female who had the extraction of her 3rd molar tooth reported loss of sensation in the anterior 2/3rd of the tongue and floor of the mouth. Which nerve is most likely to be damaged?", "options": [{"label": "A", "text": "Lingual Nerve", "correct": true}, {"label": "B", "text": "Glossopharyngeal Nerve", "correct": false}, {"label": "C", "text": "Spinal Accessory Nerve", "correct": false}, {"label": "D", "text": "Chorda Tympani Nerve", "correct": false}], "correct_answer": "A. Lingual Nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Anterior two-thirds of tongue-derived from 1st arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Posterior one-third of tongue-from 3rd arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>From the epiglottis-from 4th arch</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>General sensory</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lingual nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glossopharyngeal nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Internal laryngeal branch of superior laryngeal nerve (vagus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Special sensory</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Except <span class=\"customMeta\" data-dictid=\"70e388d8381692777184989a1e1127\">circumvallate</span> <span class=\"customMeta\" data-dictid=\"c948d4dca7169277719474a468ff5e\">papillae</span> by <span class=\"customMeta\" data-dictid=\"2085e5a8be169277718425bdd931cb\">chorda</span> tympani (facial nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Including <span class=\"customMeta\" data-dictid=\"70e388d8381692777184989a1e1127\">circumvallate</span> <span class=\"customMeta\" data-dictid=\"c948d4dca7169277719474a468ff5e\">papillae</span> by <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Internal laryngeal branch of superior laryngeal nerve (vagus)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Post-mortem examination of a dead body reveals contraction of the hands with absent primary relaxation. What is this suggestive of?", "options": [{"label": "A", "text": "Rigor Mortis", "correct": false}, {"label": "B", "text": "Livor Mortis", "correct": false}, {"label": "C", "text": "Cadaveric spasm", "correct": true}, {"label": "D", "text": "Algor Mortis", "correct": false}], "correct_answer": "C. Cadaveric spasm", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HNYTX3VlRK9fDYB0HyLt1746179996.png"], "explanation": "<p>Correct Answer C - Cadav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which bone is most likely to be fractured in an injury to the anatomical snuff box?", "options": [{"label": "A", "text": "Scaphoid", "correct": true}, {"label": "B", "text": "Lunar", "correct": false}, {"label": "C", "text": "Cuboid", "correct": false}, {"label": "D", "text": "Trapezius", "correct": false}], "correct_answer": "A. Scaphoid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nAJiEUxAvLacTPMb8NVm1746180065.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old factory worker was brought to the emergency room with complaints of headache, vomiting and blurring of vision after he consumed local spirit. Which of the following is used for the treatment of his condition?", "options": [{"label": "A", "text": "Fomepizole", "correct": true}, {"label": "B", "text": "Flumazenil", "correct": false}, {"label": "C", "text": "N-acetylcysteine", "correct": false}, {"label": "D", "text": "Naloxone", "correct": false}], "correct_answer": "A. Fomepizole", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - F\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The given finding is associated with?", "options": [{"label": "A", "text": "Trisomy 13", "correct": false}, {"label": "B", "text": "Trisomy 21", "correct": true}, {"label": "C", "text": "Klinefelter’s", "correct": false}, {"label": "D", "text": "Trisomy 18", "correct": false}], "correct_answer": "B. Trisomy 21", "question_images": ["https://image.prepladder.com/notes/NwfD36AbnhMeZ1JTDVhV1747378141.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the vertebral level shown by the arrow in the image?", "options": [{"label": "A", "text": "L2-L3", "correct": false}, {"label": "B", "text": "L4-L5", "correct": true}, {"label": "C", "text": "L5-S1", "correct": false}, {"label": "D", "text": "L3-L4", "correct": false}], "correct_answer": "B. L4-L5", "question_images": ["https://image.prepladder.com/notes/vrmru4nfKsRSRee7p5bd1747378267.png"], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ If the blue line is at the L4-L5 level, then this option is correct. L4-L5 refers to the intervertebral space between the fourth lumbar vertebra (L4) and the fifth lumbar vertebra (L5). This is a common area for vertebral numbering and is often used as a reference point in medical and anatomical contexts.</li><li>↳ L2-L3 (Option A): This option is incorrect as the blue line is at the L4-L5 level. The L2-L3 level would be higher up on the spine, and if the blue line is visibly at L4-L5, then this option is not the correct answer.</li><li>↳ L2-L3 (Option A):</li><li>↳ L5-S1 (Option C): This option is incorrect as the blue line is at the L4-L5 level. L5-S1 refers to the intervertebral space between the fifth lumbar vertebra (L5) and the first sacral vertebra (S1), which is lower down the spine. If the blue line is at L4-L5, then this option is not the correct answer.</li><li>↳ L5-S1 (Option C):</li><li>↳ L3-L4 (Option D): This option is incorrect as the blue line is at the L4-L5 level. L3-L4 refers to the intervertebral space between the third lumbar vertebra (L3) and the fourth lumbar vertebra (L4). If the blue line is visible at the L4-L5 level, then this option is not the correct answer.</li><li>↳ L3-L4 (Option D):</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old man presented with swelling due to a collection of blood around the eyes after sustaining a head injury. Which structural attachment is the cause of this condition?", "options": [{"label": "A", "text": "Aponeurosis attachment", "correct": true}, {"label": "B", "text": "Periosteum", "correct": false}, {"label": "C", "text": "Cellulitis", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Aponeurosis attachment", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4andOQXRyqG7iVyWLndW1746180354.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a symptom associated with chronic cocaine abuse?", "options": [{"label": "A", "text": "Nasal/palatal perforation.", "correct": false}, {"label": "B", "text": "Black tongue and teeth.", "correct": false}, {"label": "C", "text": "Dilated pupils, rapid pulse and sweating.", "correct": true}, {"label": "D", "text": "Hallucination of insects crawling on the skin (formication).", "correct": false}], "correct_answer": "C. Dilated pupils, rapid pulse and sweating.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Dilated pupils, rapid pulse and sweating.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which co-transporter is primarily responsible for facilitating glucose absorption across the basolateral membrane of an enterocyte?", "options": [{"label": "A", "text": "SGLT1", "correct": false}, {"label": "B", "text": "GLUT2", "correct": true}, {"label": "C", "text": "GLUT5", "correct": false}, {"label": "D", "text": "SGLT2", "correct": false}], "correct_answer": "B. GLUT2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Transporter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tissue Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Functions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>GLUT 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Brain, kidney, colon, placenta, erythrocytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Facilitates <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> uptake</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>GLUT 2 (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver, pancreatic β cells, small intestine, kidney</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enables rapid <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> or release</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>GLUT 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Brain, kidney, placenta</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assists in <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> uptake</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>GLUT 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heart and skeletal muscle, <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mediates insulin-stimulated <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> uptake</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>GLUT 5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small intestine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Facilitates <span class=\"customMeta\" data-dictid=\"d5bac53d50169277720363f48a6b3a\">fructose</span> absorption</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>SGLT 1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> and kidney</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Actively transports <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> against a concentration gradient</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old patient presents with a swelling below the ear and complains of pain in the lobule of the ear. The patient also reports difficulty in completely closing the left eye and experiences trouble while eating food. What nerve is most likely to be damaged in this case?", "options": [{"label": "A", "text": "Greater Auricular nerve", "correct": false}, {"label": "B", "text": "Auriculotemporal nerve", "correct": false}, {"label": "C", "text": "Facial nerve", "correct": true}, {"label": "D", "text": "Vagus nerve", "correct": false}], "correct_answer": "C. Facial nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/xyaw7U8zAy03bT5qYAmn1747396315.png", "https://image.prepladder.com/content/m2oNUI9iRldXhI7ehrVc1746180454.png", "https://image.prepladder.com/content/4GwGtYckH9WDiz5dFASw1746180454.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Auricle (Pinna)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>External Auditory Meatus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elastic cartilage, except <span class=\"customMeta\" data-dictid=\"633bbec0f916927771913a073bbea5\">lobule</span> (fibrofatty tissue)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cartilaginous part (Outer 1/3)</strong> with hair and ceruminous glands</li>\n<li><strong>Bony part (Inner 2/3),</strong> with thin skin continuous with the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane, lacks hair and glands.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Concha </strong>(Depression leading to the external meatus)</li>\n<li><strong>Helix</strong> (Prominent rim with <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> limbs)</li>\n<li><strong>Antihelix (</strong>Parallel ridge to the helix)</li>\n<li><strong>Tragus &amp; Antitragus</strong> (Separated by inter-tragic notch)</li>\n<li><strong>Cymba Conchae</strong> (Above <span class=\"customMeta\" data-dictid=\"653381031a1692777185f2d7287a66\">crus</span> of helix)</li>\n<li><strong>Lobule</strong> (Soft, <span class=\"customMeta\" data-dictid=\"384d0cc3641692777202e927a4d222\">fleshy</span> part below antitragus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nerve Supply </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral Surface</strong></p>\n<ul>\n<li>Lower third: <strong>Great <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> nerve (C2, C3)</strong></li>\n<li>Upper two-thirds:<strong> Auriculotemporal nerve (CN V3)</strong></li>\n<li>Concha:<strong> <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">Auricular</span> branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> (CN X) (Alderman’s Nerve)</strong></li>\n</ul>\n<p> </p>\n<p><strong>Medial Surface</strong></p>\n<ul>\n<li>Lower third: <strong>Great <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> nerve</strong></li>\n<li>Upper two-thirds:<strong> Lesser <span class=\"customMeta\" data-dictid=\"77dc7a0ab81692777194dba7ab78ab\">occipital</span> nerve (C2)</strong></li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Roof &amp; <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> Wall: </strong>Auriculotemporal nerve (CN V3)</li>\n<li><strong>Floor &amp; <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> Wall: </strong>Auricular branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> (CN X)</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Relevance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>McEwen’s <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> (Cymba Conchae)</p>\n<ul>\n<li>It is a <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> landmark on the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone to locate the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> antrum.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Furuncles (cartilaginous part) <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> to infections</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The court summons a member of the public who witnessed the incident to provide testimony and document their account. What kind of evidence does the witness offer to the court?", "options": [{"label": "A", "text": "Oral evidence", "correct": true}, {"label": "B", "text": "Hearsay evidence", "correct": false}, {"label": "C", "text": "Subpoena", "correct": false}, {"label": "D", "text": "Circumstantial evidence", "correct": false}], "correct_answer": "A. Oral evidence", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Oral ev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old person presents to the outpatient department with a 6-month history of increased urine output and increased water intake. On investigation, the following results are obtained: HbA1C - 5.5%, Blood glucose - 80 mg/dL, Postprandial glucose - 130 mg/dL, and decreased urine osmolarity. What would be the most probable diagnosis for this given condition?", "options": [{"label": "A", "text": "DM", "correct": false}, {"label": "B", "text": "Diabetes Insipidius", "correct": true}, {"label": "C", "text": "Conn's Disease", "correct": false}, {"label": "D", "text": "Addison disease", "correct": false}], "correct_answer": "B. Diabetes Insipidius", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/F3JA278xPcC9wHLytbmw1746180532.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following changes occur in chronic starvation except?", "options": [{"label": "A", "text": "Hyperthermia", "correct": true}, {"label": "B", "text": "Exhaustion", "correct": false}, {"label": "C", "text": "Heart atrophy", "correct": false}, {"label": "D", "text": "Hypotension", "correct": false}], "correct_answer": "A. Hyperthermia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Hyperth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the adjacent graph, plateau phase represents which one of the following properties?", "options": [{"label": "A", "text": "Elasticity", "correct": false}, {"label": "B", "text": "Plasticity", "correct": true}, {"label": "C", "text": "Contractility", "correct": false}, {"label": "D", "text": "Automaticity", "correct": false}], "correct_answer": "B. Plasticity", "question_images": ["https://image.prepladder.com/notes/9oxwvi2ovsXAKvnkm7sZ1747395558.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which poisoning is cherry red hypostasis seen on post-mortem examination?", "options": [{"label": "A", "text": "CO Poisoning", "correct": true}, {"label": "B", "text": "Hydrogen sulphide", "correct": false}, {"label": "C", "text": "Yellow phosphorus", "correct": false}, {"label": "D", "text": "Hydrogen cyanide", "correct": false}], "correct_answer": "A. CO Poisoning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"44758fcec31692777184e24fa84582\"&gt;CO&lt;/span&gt; Poisoning\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the law, nothing is an offense if a person is of an unsound mind and is not able to understand that the nature and consequences of his/her act are wrong. Which rule of insanity applies in this case?", "options": [{"label": "A", "text": "Durham's rule", "correct": false}, {"label": "B", "text": "Mc Naughton's rule", "correct": true}, {"label": "C", "text": "Curren's rule", "correct": false}, {"label": "D", "text": "Irresistible impulse rule", "correct": false}], "correct_answer": "B. Mc Naughton's rule", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Mc Naughton's ru\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient underwent an endoscopic examination of the gastrointestinal tract due to recurrent abdominal discomfort and altered bowel habits. Identify the arrow-marked structure in the given image.", "options": [{"label": "A", "text": "Bruner gland", "correct": true}, {"label": "B", "text": "Interstitial cells of kajal", "correct": false}, {"label": "C", "text": "Crypts of lieberkuhn", "correct": false}, {"label": "D", "text": "Peyer's patch", "correct": false}], "correct_answer": "A. Bruner gland", "question_images": ["https://image.prepladder.com/notes/Hp0u3VsuyyPYtiYgNBGF1747378732.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of homicide:", "options": [{"label": "A", "text": "Mugging", "correct": false}, {"label": "B", "text": "Burking", "correct": true}, {"label": "C", "text": "Garrotting", "correct": false}, {"label": "D", "text": "Bansdola", "correct": false}], "correct_answer": "B. Burking", "question_images": ["https://image.prepladder.com/notes/RtoW016uMkrMbHsU7YMR1747391223.png"], "explanation_images": ["https://image.prepladder.com/notes/RtoW016uMkrMbHsU7YMR1747391223.png"], "explanation": "<p>Correct Answer B - Burking\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following functions is NOT attributed to the intestinal epithelium?", "options": [{"label": "A", "text": "Absorption of the ions", "correct": false}, {"label": "B", "text": "Bile salts secretion", "correct": true}, {"label": "C", "text": "Mucous secretion", "correct": false}, {"label": "D", "text": "Secretion of digestive enzyme", "correct": false}], "correct_answer": "B. Bile salts secretion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Who is responsible for handling the investigation in the case of a custodial death?", "options": [{"label": "A", "text": "Police inspector", "correct": false}, {"label": "B", "text": "Jail superintendent", "correct": false}, {"label": "C", "text": "Superintendent of Police", "correct": false}, {"label": "D", "text": "Judicial magistrate", "correct": true}], "correct_answer": "D. Judicial magistrate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Judicial magistrate</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Police Inquest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Magistrate Inquest</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">174 CrPC</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">176 CrPC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Most common <span class=\"customMeta\" data-dictid=\"ab7665b07e1692777190e4d2f4bc82\">inquest</span> in India</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Best Inquest</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Judicial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Executive</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>In the court of law (for conducting trial)</li>\n<li>Appointed by high court</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>In maintaining law &amp; Order in the society</li>\n<li>Appointed by state Govt.</li>\n<li>Designated as District Magistrate (DM)</li>\n</ul>\n<p> </p>\n<p><strong>Following govt officials can be appointed as executive magistrate: </strong></p>\n<ul>\n<li>District Collector</li>\n<li>Tehsildar</li>\n<li>RDO</li>\n<li>Deputy collector</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Kartagener syndrome is associated with defects in which of the following structures?", "options": [{"label": "A", "text": "Microvilli", "correct": false}, {"label": "B", "text": "Microtubules", "correct": false}, {"label": "C", "text": "Cilia", "correct": true}, {"label": "D", "text": "Microfilaments", "correct": false}], "correct_answer": "C. Cilia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic sinusitis</li>\n<li>Bronchiectasis</li>\n<li>Situs inversus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"d90d813c741692777193a2b52ba508\">mucociliary</span> <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> → <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections.</li>\n<li>Embryonic nodal <span class=\"customMeta\" data-dictid=\"c3ceefdd5c16927771840391a4a4a4\">cilia</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> → <span class=\"customMeta\" data-dictid=\"35a2ef94341692777198d9bf1cd98e\">situs</span> inversus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections</li>\n<li>Chronic productive cough</li>\n<li>Nasal polyps</li>\n<li>Otitis media with hearing loss</li>\n<li>Male <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> (immotile sperm)</li>\n<li>Female <span class=\"customMeta\" data-dictid=\"790585287b169277719995a5fe1e1a\">subfertility</span> (impaired <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube cilia)</li>\n<li>Neonatal <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient underwent an endoscopic examination of the gastrointestinal tract due to recurrent abdominal discomfort and altered bowel habits. Identify the arrow-marked structure in the given image.", "options": [{"label": "A", "text": "Brunner’s gland", "correct": true}, {"label": "B", "text": "Intestinal cells of kajal", "correct": false}, {"label": "C", "text": "Crypts of lieberkuhn", "correct": false}, {"label": "D", "text": "Peyer's patch", "correct": false}], "correct_answer": "A. Brunner’s gland", "question_images": ["https://image.prepladder.com/notes/6o206Un4QtYWL8RLzbBi1747396602.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:452px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Duodenum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Jejunum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Ileum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Villi</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Brunner's Glands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Peyer's Patches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The first heart sound coincides with which phase of cardiac cycle?", "options": [{"label": "A", "text": "Rapid atrial filling", "correct": false}, {"label": "B", "text": "Aortic ejection", "correct": false}, {"label": "C", "text": "Isovolumetric contraction", "correct": true}, {"label": "D", "text": "Isovolumetric relaxation", "correct": false}], "correct_answer": "C. Isovolumetric contraction", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Sub-Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:bottom\">\n<p><strong>Key Events</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p>Systole</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p>Isovolumetric <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">Contraction</span> <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Ventricles begin to contract</li>\n<li>Ranges from <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of AV valves (mitral and tricuspid) till opening of <span class=\"customMeta\" data-dictid=\"7a23f5d3cd16927771982eb39c68c1\">semilunar</span> valves.</li>\n<li><strong>First heart sound appears.</strong></li>\n<li>No <span class=\"customMeta\" data-dictid=\"b9b690b70c16927771833aae799b33\">blood volume</span> change in ventricles</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p>Ventricular Ejection</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Has 2 phases- Rapid <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> phase and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">Reduced</span> <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> phase.</li>\n<li>Ventricular pressure exceeds aortic and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> pressure</li>\n<li>Aortic and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> valves open</li>\n<li>Blood ejected into <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery<strong> (Option B ruled out)</strong></li>\n<li>Ventricular volume decreases</li>\n<li>Ends with the <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the aortic valve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p>Diastole</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p>Isovolumetric <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">Relaxation</span> <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Ventricles relax</li>\n<li>Ventricular pressure drops</li>\n<li>Aortic and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> valves close</li>\n<li>No <span class=\"customMeta\" data-dictid=\"b9b690b70c16927771833aae799b33\">blood volume</span> change in ventricles</li>\n<li><strong>Second <span class=\"customMeta\" data-dictid=\"3ca731b15316927771898437884f89\">heart sounds</span> appears.</strong></li>\n<li>Ends with the opening of AV valves.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p>Rapid Filling</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>AV valves (mitral and tricuspid) open</li>\n<li>Blood flows rapidly from <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> to ventricles</li>\n<li>Ventricular volume increases rapidly</li>\n<li>Third heart sound appears.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p>Diastasis</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Blood flow from <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> to ventricles slows</li>\n<li>No change in the atrial and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> pressure.</li>\n<li>Ventricular volume increases slowly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid #cccccc; border-top:none; vertical-align:bottom\">\n<p>Atrial Systole</p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Atria contract</li>\n<li>Additional blood pushed into ventricles</li>\n<li>Ventricular volume increases slightly</li>\n<li>End-diastolic volume (EDV) reached</li>\n<li>Fourth heart sound is produced.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which change is least likely to occur among a group of colleagues taking an excursion to a high-altitude mountain region?", "options": [{"label": "A", "text": "Increase PaO2", "correct": true}, {"label": "B", "text": "Increase in RBC &amp;amp; Hb", "correct": false}, {"label": "C", "text": "Increased mitochondria", "correct": false}, {"label": "D", "text": "Hyperventilation", "correct": false}], "correct_answer": "A. Increase PaO2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Changes during <span class=\"customMeta\" data-dictid=\"4ceeb0cef2169277718080f29afe8d\">Acclimatization</span> in high altitudes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>At high altitudes, lower oxygen levels stimulate <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> chemoreceptors, increasing <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> ventilation. <strong>(Option D ruled out)</strong></li>\n<li>This leads to enhanced CO2 removal, causing <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> alkalosis.</li>\n<li>Kidneys respond by excreting more <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> to stabilize blood pH, causing a sustained increase in <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> and supporting prolonged acclimatization.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Haematological</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>At high altitudes, lower PO2 boosts <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">erythropoietin</span> production, increasing <span class=\"customMeta\" data-dictid=\"248111ded81692777197946454db52\">red blood cell</span> count. <strong>(Option B ruled out)</strong></li>\n<li>This also raises <span class=\"customMeta\" data-dictid=\"d86c8e863216927771855ee709d548\">2,3-diphosphoglycerate</span> (2,3-DPG) levels in red blood cells.</li>\n<li>Initially, <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> shifts the <span class=\"customMeta\" data-dictid=\"fe0bb103fc1692777194ee9f85bd86\">oxyhemoglobin</span> <span class=\"customMeta\" data-dictid=\"18fb34ab321692777186e9bc95a726\">dissociation</span> curve to the left but increased 2,3-DPG shifts it to the right, improving oxygen release to tissues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cardiovascular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypoxia activates the <span class=\"customMeta\" data-dictid=\"e7b585936a16927771994fc66d486f\">sympathoadrenal</span> axis, increasing heart rate, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output, and blood pressure.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output leads to an increase in blood flow, and <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> causes <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> in the <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> circulation, further contributing to increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and oxygen supply to the tissues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>In acclimatization, skeletal muscles undergo several changes, including an increase in the number of capillaries and <span class=\"customMeta\" data-dictid=\"18c9e7b9721692777192bd042528cc\">mitochondria</span> and an increase in <span class=\"customMeta\" data-dictid=\"42cd6f8fc316927771931f5a10bb5f\">myoglobin</span> content. <strong>(Option C ruled out)</strong></li>\n<li>Further, chemicals released from the hypoxic tissues stimulate angiogenesis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of death in pediatric patients with Diabetic Ketoacidosis?", "options": [{"label": "A", "text": "Sepsis", "correct": false}, {"label": "B", "text": "Dehydration", "correct": false}, {"label": "C", "text": "Hypokalemia", "correct": false}, {"label": "D", "text": "Cerebral edema", "correct": true}], "correct_answer": "D. Cerebral edema", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The presence of a prominent 'v' wave of jugular venous pulse is suggestive of?", "options": [{"label": "A", "text": "Tricuspid regurgitation", "correct": true}, {"label": "B", "text": "Cardiomyopathy", "correct": false}, {"label": "C", "text": "Tricuspid stenosis", "correct": false}, {"label": "D", "text": "Atrial fibrillation", "correct": false}], "correct_answer": "A. Tricuspid regurgitation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JAW193WUt74PwWhWQQa81746181673.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Abnormalities</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>a wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Caused by atrial systole.</li>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> results in a temporary halt in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> inflow.</li>\n<li>Some blood flows back into the veins, causing a rise in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prominent a Wave: <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">Tricuspid</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> <strong>(Option C ruled out)</strong>, right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension.</p>\n<p>Absent a Wave: <span class=\"customMeta\" data-dictid=\"e6a04221a41692777182825f0f08da\">Atrial fibrillation</span> <strong>(Option D ruled out)</strong></p>\n<p>Cannon a Wave: Atrial <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> against a closed <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>c wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Arises from the increase in atrial pressure during isovolumetric <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> contraction.</li>\n<li>Pressure is transmitted through the closed and bulging <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>x descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ventricular <span class=\"customMeta\" data-dictid=\"13941ea4ec1692777199fc8cfd1a7a\">systole</span> pulls the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> down</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Steep x Descent: <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">Constrictive</span> pericarditis, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>v wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corresponds to the rise in atrial pressure as blood fills the atria.</li>\n<li>Occurs during <span class=\"customMeta\" data-dictid=\"11d448b6c4169277718635a922383c\">diastole</span> while the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> is still closed.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prominent v Wave: <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">Tricuspid</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>y descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Opening of <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> causing <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> of right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> into ventricle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Steep y Descent: Rapid <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> due to high atrial pressure.</p>\n<p> </p>\n<p>Absent y Descent: <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> to <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> (severe hypertrophic cardiomyopathy) <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the principal constituent of serum osmolality?", "options": [{"label": "A", "text": "Potassium", "correct": false}, {"label": "B", "text": "Sodium", "correct": true}, {"label": "C", "text": "Bicarbonate", "correct": false}, {"label": "D", "text": "Hydrogen ions", "correct": false}], "correct_answer": "B. Sodium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is accurate regarding creatinine clearance?", "options": [{"label": "A", "text": "Equal to inulin clearance", "correct": false}, {"label": "B", "text": "Less than inulin clearance", "correct": false}, {"label": "C", "text": "Greater than inulin clearance", "correct": true}, {"label": "D", "text": "Equal to renal plasma flow", "correct": false}], "correct_answer": "C. Greater than inulin clearance", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Inulin Clearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Used to measure <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">Glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">Filtration</span> Rate (GFR) as it is freely filtered but not reabsorbed or secreted.</li>\n<li>Not ideal for routine use due to <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> administration.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Creatinine Clearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Estimates <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> using creatinine, which is primarily filtered by the glomeruli.</li>\n<li>Slightly inaccurate due to <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> secretion, but practical for clinical settings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PAH Clearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Estimates <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> Flow (RPF).</li>\n<li>PAH is cleared through both <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> and <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> secretion.</li>\n<li>Correction for <span class=\"customMeta\" data-dictid=\"510f327287169277719462cb0ddbff\">PAH</span> <span class=\"customMeta\" data-dictid=\"00456bf7d8169277718782edf9fa2c\">extraction</span> ratio improves accuracy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The involvement of which of the following results in the given condition below?", "options": [{"label": "A", "text": "Arteries", "correct": false}, {"label": "B", "text": "Vein", "correct": false}, {"label": "C", "text": "Lymphatics", "correct": true}, {"label": "D", "text": "DVT", "correct": false}], "correct_answer": "C. Lymphatics", "question_images": ["https://image.prepladder.com/content/hqi8Tt9FGoKuqb9TwgQW1746181755.png"], "explanation_images": [], "explanation": "<p>Correct Answer C - Lymphatics</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lymphedema (Elephantiasis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphatic <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (Filariasis, malignancy, surgery, <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> defects)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Massive swelling, skin thickening, warty texture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"a8c53e6875169277719588cd709854\">Pitting</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (early) 2. Non-pitting <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (late) 3. <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">Fibrosis</span> &amp; skin changes (severe)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin infections, ulceration, restricted mobility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical examination, ultrasound, lymphoscintigraphy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limb elevation, <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> therapy, antibiotics for infections, diethylcarbamazine (for filariasis)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hand washing during COVID-19 is what level of prevention?", "options": [{"label": "A", "text": "Primordial prevention", "correct": false}, {"label": "B", "text": "Primary prevention", "correct": true}, {"label": "C", "text": "Secondary prevention", "correct": false}, {"label": "D", "text": "Tertiary prevention", "correct": false}], "correct_answer": "B. Primary prevention", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A government plans to outline tobacco control laws. What is the level of prevention here?", "options": [{"label": "A", "text": "Primordial prevention", "correct": false}, {"label": "B", "text": "Primary prevention", "correct": true}, {"label": "C", "text": "Secondary prevention", "correct": false}, {"label": "D", "text": "Tertiary prevention", "correct": false}], "correct_answer": "B. Primary prevention", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby presents to the OPD; the image below shows the findings. What is the probable diagnosis?", "options": [{"label": "A", "text": "Portwine stain", "correct": false}, {"label": "B", "text": "Cavernous hemangioma", "correct": false}, {"label": "C", "text": "Naevus simplex", "correct": false}, {"label": "D", "text": "Capillary hemangioma", "correct": true}], "correct_answer": "D. Capillary hemangioma", "question_images": ["https://image.prepladder.com/notes/42qZ44lDFXJyelhLyRpA1747389781.png"], "explanation_images": ["https://image.prepladder.com/content/2e70BUVHMeSqYjrHTtbK1746182008.png", "https://image.prepladder.com/content/9PkWtEOZvo5gbUeiuXEn1746182158.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Capillary Hemangioma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proliferation of <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> endothelial cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bright red, raised <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with a well-demarcated border</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Appears within first few weeks after birth</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Growth Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid growth for months, then gradual involution</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>90% regress by 5–7 years of age</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Observation, <span class=\"customMeta\" data-dictid=\"082f7143eb1692777196df69a3b6cb\">propranolol</span> (if complications occur)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old female patient with a known case of ovarian cancer presents with difficulty in activities like climbing stairs, getting up from a chair, combing hair, etc. The following characteristic sign was found on examination. The most probable diagnosis is:", "options": [{"label": "A", "text": "Systemic lupus erythematosus", "correct": false}, {"label": "B", "text": "Dermatomyositis", "correct": true}, {"label": "C", "text": "Systemic sclerosis", "correct": false}, {"label": "D", "text": "Cushing syndrome", "correct": false}], "correct_answer": "B. Dermatomyositis", "question_images": ["https://image.prepladder.com/content/7IMTzynbt0qmgLa2kMsd1746182228.png", "https://image.prepladder.com/content/N3MTy6c9ocbuHpmZLFxv1746182245.png"], "explanation_images": ["https://image.prepladder.com/content/WliFgDyi6LdrGn3A8tyS1746182344.png", "https://image.prepladder.com/content/u6NJQip8aACAeElliCdl1746182348.png", "https://image.prepladder.com/content/cGLZqjzrOahr8WyM7pPs1746182353.png", "https://image.prepladder.com/content/726SfdiXt7QFSJZc4x2q1746182359.png", "https://image.prepladder.com/content/iKa4KoikGIaQTT0EMNzS1746182368.png", "https://image.prepladder.com/content/EOQEg3CwbdpcpmAZYyfL1746182378.png"], "explanation": "<p>Correct Answer B - Dermatomyositis</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Dermatomyositis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autoimmune <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> myopathy, often paraneoplastic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscle Weakness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symmetrical, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> muscle weakness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic Rashes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Heliotrope <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> (around eyes)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dermatomyositis10.jpg\" data-tags=\"\" height=\"224\" src=\"https://image.prepladder.com/content/WliFgDyi6LdrGn3A8tyS1746182344.png\" width=\"507\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Gottron’s papules</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dermatomyositis2.jpg\" data-tags=\"\" height=\"228\" src=\"https://image.prepladder.com/content/u6NJQip8aACAeElliCdl1746182348.png\" width=\"420\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Shawl sign</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Krishna Adhikari Prashant Pant Sanjeev Bhandari Sandip Paudel Buddhi Prasad Paudyal Lucky Sharma Keshav Raj Sigdel Rojina Subedi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/A-Figures-showing-V-sign-B-Shawl-sign-and-C-Holster-sign-respectively_fig2_375774466\" data-tags=\"\" height=\"396\" src=\"https://image.prepladder.com/content/cGLZqjzrOahr8WyM7pPs1746182353.png\" width=\"352\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>V-sign</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Didona, Dario &amp; Fania, Luca &amp; Didona, Biagio &amp; Eming, Rüdiger &amp; Hertl, Michael &amp; Di Zenzo, Giovanni.\" data-hash=\"\" data-license=\" CC BY\" data-source=\"https://www.researchgate.net/figure/Paraneoplastic-dermatomyositis-V-sign-Erythematous-maculopapular-rash-of-the-V-area_fig5_340099670\" data-tags=\"\" height=\"299\" src=\"https://image.prepladder.com/content/726SfdiXt7QFSJZc4x2q1746182359.png\" width=\"384\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Mechanic’s hand</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hanlin Yin Bei Liu Liangjing Lu\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/Clinical-manifestations-of-the-patients-A-C-mechanics-hands-D-aligned_fig1_357079256\" data-tags=\"\" height=\"544\" src=\"https://image.prepladder.com/content/iKa4KoikGIaQTT0EMNzS1746182368.png\" width=\"454\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Holster sign</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Porter, Emma &amp; Byrne, Berbie &amp; Sarfaraz, Sumreen &amp; Leonard, Niamh &amp; Field, Sinead\" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Symmetrical-ill-defined-erythema-of-the-lateral-thighs-consistent-with-Holster-sign_fig2_369461085\" data-tags=\"\" height=\"277\" src=\"https://image.prepladder.com/content/EOQEg3CwbdpcpmAZYyfL1746182378.png\" width=\"404\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paraneoplastic Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ovarian, lung, breast, and <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> cancers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated CPK, anti-Mi-2, anti-Jo-1, muscle biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corticosteroids, immunosuppressants, cancer screening</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old male presented with erythematous plaques covered with silvery scales over the extensor surfaces of both arms. Punctate pitting was noted on examining the nails. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Psoriasis", "correct": true}, {"label": "B", "text": "Lichen planus", "correct": false}, {"label": "C", "text": "Eczema", "correct": false}, {"label": "D", "text": "Pityriasis rosea", "correct": false}], "correct_answer": "A. Psoriasis", "question_images": ["https://image.prepladder.com/notes/G1gVOogFCYhUq3znqhel1747389962.png"], "explanation_images": ["https://image.prepladder.com/content/l2WQfpfYTbWH6EISu8Aj1746182590.png"], "explanation": "<p>Correct Answer A - Psoriasis</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Psoriasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extensor surfaces (elbows, knees), scalp, lower back</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lesion Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Well-demarcated, erythematous plaques with silvery scales</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Koebner Phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lesions appear at sites of trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nail Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pitting, onycholysis, oil-drop sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Topical steroids, vitamin D analogs, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> biologics in severe cases</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:522px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Candle-Grease Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Silvery-white, shiny scales appear on scraping.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Last Häutchen Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thin <span class=\"customMeta\" data-dictid=\"fb59d538e21692777200b3702d4802\">transparent</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> seen after scale removal.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Auspitz Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pinpoint <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> after removing the last membrane.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Koebner Phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Psoriatic lesions appear at sites of trauma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Woronoff Ring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pale ring around <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> psoriatic plaques.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with itchy lesions, as shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Scabies", "correct": false}, {"label": "B", "text": "Lichen planus", "correct": true}, {"label": "C", "text": "Psoriasis", "correct": false}, {"label": "D", "text": "Warts", "correct": false}], "correct_answer": "B. Lichen planus", "question_images": ["https://image.prepladder.com/content/LJoXOtiJwNkPs8uDRgtg1746182769.png"], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\"&gt;Lichen&lt;/span&gt; Planus</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lichen Planus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Autoimmune, drug-induced (ACE inhibitors, NSAIDs), Hepatitis C association</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Purple, pruritic, polygonal, <span class=\"customMeta\" data-dictid=\"da48d0e44c1692777195a5c11d7545\">planar</span> papules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Common Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Wrists, ankles, oral mucosa, nails</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Koebner Phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Lesions at sites of trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Wickham Striae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Fine white lacy network over papules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nail Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Longitudinal ridging, nail thinning</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Topical steroids, antihistamines, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> therapy in severe cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old truck driver with a history of multiple sex partners presented to the dermatological department, as shown below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Secondary syphilis", "correct": true}, {"label": "B", "text": "Lichen planus", "correct": false}, {"label": "C", "text": "Scabies", "correct": false}, {"label": "D", "text": "Psoriasis", "correct": false}], "correct_answer": "A. Secondary syphilis", "question_images": ["https://image.prepladder.com/content/ACQ1c2JCs29R4mTksgKO1746183020.png"], "explanation_images": ["https://image.prepladder.com/content/eEz80P8TV925xN6m1Vyg1746183063.png", "https://image.prepladder.com/content/6AYvqyrXkp6pqeMIO8FZ1746183092.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Secondary Syphilis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treponema <span class=\"customMeta\" data-dictid=\"21d1ab68e116927771947438d672b8\">pallidum</span> (spirochete)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sexual contact, vertical transmission</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maculopapular <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> on palms/soles, <span class=\"customMeta\" data-dictid=\"7ab4ca4b6116927771849356a0f8d2\">condylomata</span> lata, lymphadenopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fever, malaise, <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> throat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serology (VDRL, RPR, FTA-ABS, TPPA)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benzathine <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> G (single dose IM)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following mineral deficiency is associated with poor wound healing, dermatitis, diarrhoea and alopecia?", "options": [{"label": "A", "text": "Iron", "correct": false}, {"label": "B", "text": "Calcium", "correct": false}, {"label": "C", "text": "Magnesium", "correct": false}, {"label": "D", "text": "Zinc", "correct": true}], "correct_answer": "D. Zinc", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Zinc</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Zinc Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poor diet, <span class=\"customMeta\" data-dictid=\"819ebcc6691692777191f968d41a03\">malabsorption</span> (Crohn’s, celiac), chronic diarrhea, alcoholism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poor wound healing, dermatitis, alopecia, diarrhea, immune dysfunction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dermatological Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eczematous plaques, <span class=\"customMeta\" data-dictid=\"273e797c381692777195e7dc7a1104\">periorificial</span> dermatitis, nail dystrophy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> zinc, clinical presentation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Zinc supplementation (oral <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> sulfate)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old patient presents with the following skin lesions characterized by red and scaly patches. The patient also complains of a painful and swollen finger joint. On examination, the finger joint appears inflamed and tender to touch. What is the most likely diagnosis for this patient's condition?", "options": [{"label": "A", "text": "Psoriatic Arthritis", "correct": true}, {"label": "B", "text": "Pseudo gout", "correct": false}, {"label": "C", "text": "Osteoarthritis", "correct": false}, {"label": "D", "text": "Reactive arthritis", "correct": false}], "correct_answer": "A. Psoriatic Arthritis", "question_images": ["https://image.prepladder.com/notes/EWwNYmZNJ1r99bUMGJyx1747390168.png"], "explanation_images": ["https://image.prepladder.com/content/dT6dZaj0ikARCWVwwqqf1746183371.png"], "explanation": "<p>Correct Answer A - Psoriatic Arthritis</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Psoriatic Arthritis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autoimmune, associated with <strong>HLA-B27</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Joint Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymmetrical, affects <strong>DIP, PIP, and spine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dactylitis (sausage digit), enthesitis, nail pitting, onycholysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Skin Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Psoriasis (scaly plaques on <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> surfaces)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CASPAR criteria</strong>, RF negative, elevated ESR/CRP</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>NSAIDs, DMARDs (Methotrexate, Sulfasalazine), Biologics (TNF-α inhibitors)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Infant mortality rate is typically stated as a rate per how many live births.?", "options": [{"label": "A", "text": "100", "correct": false}, {"label": "B", "text": "1000", "correct": true}, {"label": "C", "text": "10,000", "correct": false}, {"label": "D", "text": "1,00,000", "correct": false}], "correct_answer": "B. 1000", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to WHO, what proportions of GNP should be spent on health services?", "options": [{"label": "A", "text": "2%", "correct": false}, {"label": "B", "text": "2.5%", "correct": false}, {"label": "C", "text": "3.5%", "correct": false}, {"label": "D", "text": "5%", "correct": true}], "correct_answer": "D. 5%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "School health program is under:", "options": [{"label": "A", "text": "PHC", "correct": true}, {"label": "B", "text": "CHC", "correct": false}, {"label": "C", "text": "DH", "correct": false}, {"label": "D", "text": "Health and wellness centres", "correct": false}], "correct_answer": "A. PHC", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following should not be included in the school health service?", "options": [{"label": "A", "text": "Education of handicapped children", "correct": false}, {"label": "B", "text": "Doctor on premises", "correct": true}, {"label": "C", "text": "Dental and eye health services", "correct": false}, {"label": "D", "text": "School health records", "correct": false}], "correct_answer": "B. Doctor on premises", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with seizures. CT head imaging reveals multiple calcified parenchymal cysts. Which of the following is the correct approach to management?", "options": [{"label": "A", "text": "Steroids followed by antiparasitic drugs", "correct": false}, {"label": "B", "text": "Antiparasitic drugs followed by steroids", "correct": false}, {"label": "C", "text": "Steroids before antiepileptics", "correct": false}, {"label": "D", "text": "Continue antiepileptics", "correct": true}], "correct_answer": "D. Continue antiepileptics", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RbwZ3oSGijPFlCc7CdVz1746186128.png", "https://image.prepladder.com/content/1MxT6gUqrXdKSML5odrZ1746186128.png", "https://image.prepladder.com/content/U6UwxoeMThUKsrJwPCd81746186128.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old male presents with fever, abdominal pain, and diarrhea for 3 days. He reports consuming raw fish prior to symptom onset. He is hemodynamically stable, and stool examination reveals no pus cells. Culture grows on Wagatsuma agar. What is the most likely causative agent?", "options": [{"label": "A", "text": "Vibrio cholerae", "correct": false}, {"label": "B", "text": "Salmonella typhi", "correct": false}, {"label": "C", "text": "Shigella sonnei", "correct": false}, {"label": "D", "text": "Vibrio parahaemolyticus", "correct": true}], "correct_answer": "D. Vibrio parahaemolyticus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rF3e8SPc1WOTGiy2yjT31746186585.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which culture medium is used to distinguish lactose fermenters from non-lactose fermenters?", "options": [{"label": "A", "text": "Bile salt agar", "correct": false}, {"label": "B", "text": "Thayer-Martin agar", "correct": false}, {"label": "C", "text": "Sabouraud Dextrose Agar", "correct": false}, {"label": "D", "text": "MacConkey agar", "correct": true}], "correct_answer": "D. MacConkey agar", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wOiDRjKyoj70oVmmktgU1746186678.png"], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man with multiple sexual partners presents with a palmoplantar rash. On examination, he has mucocutaneous papules on the scrotum and lymphadenopathy. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Psoriasis", "correct": false}, {"label": "B", "text": "Secondary syphilis", "correct": true}, {"label": "C", "text": "Primary syphilis", "correct": false}, {"label": "D", "text": "Tertiary syphilis", "correct": false}], "correct_answer": "B. Secondary syphilis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/H3z15tjU3GlO2LssCseX1746186764.png", "https://image.prepladder.com/content/YgRo7SMm3S0QG1FcUIzO1746186764.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following parasites invade the skin directly?", "options": [{"label": "A", "text": "Schistosoma mansoni", "correct": true}, {"label": "B", "text": "Clonorchis sinensis", "correct": false}, {"label": "C", "text": "Wuchereria bancrofti", "correct": false}, {"label": "D", "text": "Diphyllobothrium latum", "correct": false}], "correct_answer": "A. Schistosoma mansoni", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3JedJ8Q3LyNcpmnR7kDi1746186844.png", "https://image.prepladder.com/content/qJTTFf3OvuXpukoWr30T1746186844.png", "https://image.prepladder.com/content/BgOLkBlbS6uOCGpsCk3A1746186844.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Species </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Schistosoma haematobium (Africa, Near East, Middle East, India)</li>\n<li>Schistosoma mansoni (Africa, South America)</li>\n<li>Schistosoma japonicum (China, Japan, Far East)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Habitat </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>S. haematobium: Veins of <span class=\"customMeta\" data-dictid=\"5dad1358d7169277720161bd00a450\">vesical</span> and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> plexuses</li>\n<li>S. mansoni: Inferior mesenteric vein</li>\n<li>S. japonicum: Superior mesenteric vein</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definitive Host</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Man</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intermediate Host</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Snail</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mode of Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> by cercaria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infective form</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cercaria larva</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eggs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Has characteristic <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> spine.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"307\" src=\"https://image.prepladder.com/content/3JedJ8Q3LyNcpmnR7kDi1746186844.png\" width=\"307\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Larva </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Has following stages:</p>\n<ul>\n<li>Miracida</li>\n<li>Sporocysts</li>\n<li>Cercaria: Has elongated <span class=\"customMeta\" data-dictid=\"879f3da46a169277719497d18b5251\">ovoid</span> body and forked tail.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"315\" src=\"https://image.prepladder.com/content/qJTTFf3OvuXpukoWr30T1746186844.png\" width=\"315\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adult worm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sexes are <strong>separate</strong>.</li>\n<li>Has 2 <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> suckers: Oral and <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> sucker</li>\n<li>Gynecophoric <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> begins behind the <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> sucker, where the female <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">worm</span> is held.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following culture media is used in the identification of Salmonella?", "options": [{"label": "A", "text": "PLET medium", "correct": false}, {"label": "B", "text": "BCYE medium", "correct": false}, {"label": "C", "text": "Wilson &amp;amp; Blair medium", "correct": true}, {"label": "D", "text": "Stuart's medium", "correct": false}], "correct_answer": "C. Wilson &amp; Blair medium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A cattle farmer presented with a lesion on the arm as shown below. Gram staining showed gram-positive rods as shown below. Identify the organism.", "options": [{"label": "A", "text": "Bacillus cereus", "correct": false}, {"label": "B", "text": "Bacillus anthracis", "correct": true}, {"label": "C", "text": "Pseudomonas aeruginosa", "correct": false}, {"label": "D", "text": "Brucella abortus", "correct": false}], "correct_answer": "B. Bacillus anthracis", "question_images": ["https://image.prepladder.com/content/YQNx1ovjszZDbJP9138D1746186972.png", "https://image.prepladder.com/content/qJFuPaCIkwIicev4Hub71746186972.png"], "explanation_images": ["https://image.prepladder.com/content/Nta0U7AR4z8P5Pb1KbVq1746187004.png", "https://image.prepladder.com/content/WhN7jqLGKVyWJxU1VlGU1746187004.png", "https://image.prepladder.com/content/2Dc3cIRR4UdqVLLdKWZO1746187028.png", "https://image.prepladder.com/content/AJ83zE2GtuVqmMUGZhuG1746187028.png", "https://image.prepladder.com/content/NJW2Tr0c0BZ4C5XF2M4v1746187028.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>a. Bacillus Anthracis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"BruceBlaus\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bacillus_Anthracis.png\" data-tags=\"\" height=\"216\" src=\"https://image.prepladder.com/content/WhN7jqLGKVyWJxU1VlGU1746187004.png\" width=\"216\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bacillus anthracis appears as <strong>large (3-10 µm x 1-1.6 µm), rectangular, rod-shaped </strong>bacteria (<strong>“box-car appearance”</strong>), often arranged in chains. It is Gram-positive.</p>\n<p>It is</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Blood Agar</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sidwa, Tom &amp; Salzer, Johanna &amp; Traxler, Rita &amp; Swaney, Erin &amp; Sims, Marcus &amp; Bradshaw, Pam &amp; O’Sullivan, Briana &amp; Parker, Kathy &amp; Waldrup, Kenneth &amp; Bower, William &amp; Hendricks, Kate.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Bacillus-anthracis-24-hour-growth-on-sheep-blood-agar-from-a-swab-of-a-cutaneous-anthrax_fig3_346840702\" data-tags=\"\" height=\"173\" src=\"https://image.prepladder.com/content/2Dc3cIRR4UdqVLLdKWZO1746187028.png\" width=\"177\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Large (2 to 5 mm), grey, flat,<strong> non-hemolytic</strong> colonies with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> margins- giving a <strong>frosted glass appearance</strong>.</li>\n<li>Tenacious <span class=\"customMeta\" data-dictid=\"bb67ce71481692777185f0e078535f\">consistency</span> firmly adheres to agar.</li>\n<li><strong>\"Medusa head\" appearance</strong> under microscope.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Agar with Penicillin</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Megan Mathias and J. Todd Parker, USCDCP\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bacillus_anthracis_plate.jpg\" data-tags=\"\" height=\"160\" src=\"https://image.prepladder.com/content/AJ83zE2GtuVqmMUGZhuG1746187028.png\" width=\"178\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Susceptible to penicillin.</li>\n<li>Grows large, spherical cells in 3-6 hours on media with 0.05-0.50 units of penicillin/ml.</li>\n<li>Forms <strong>\"string of pearls\"</strong> chains.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Gelatin Liquefaction</p>\n<p> </p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.brainkart.com/article/Properties-of-the-Bacteria-Bacillus-anthracis_18066/#google_vignette\" data-tags=\"\" height=\"147\" src=\"https://image.prepladder.com/content/NJW2Tr0c0BZ4C5XF2M4v1746187028.png\" width=\"177\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Obligate aerobe.</li>\n<li>More growth and energy production at the surface.</li>\n<li>Liquefaction starts from the top, resembling an <strong>\"inverted fir tree\". </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>PLET Medium</p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Contains polymyxin, lysozyme, EDTA, and <span class=\"customMeta\" data-dictid=\"7a2238c8b81692777200f92806ac4f\">thallous</span> <span class=\"customMeta\" data-dictid=\"47765053a81692777180738f50cd4e\">acetate</span> in heart <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> (PLET)</li>\n<li>Selective for isolating B. anthracis from samples with other spore-forming bacilli.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Serology</p>\n<p> </p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Ascoli's Thermoprecipitin Test: Detects <span class=\"customMeta\" data-dictid=\"00f05eda23169277718196fcb2f71f\">anthrax</span> antigens in tissue extracts.</li>\n<li>DFA: Detects antibodies against B. anthracis; confirms presence via <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> <span class=\"customMeta\" data-dictid=\"aea912322316927771960b320d4f65\">polysaccharide</span> and <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> antigens.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Laboratory Safety Note</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>High risk of infection from spores.</li>\n<li>Caution is advised when handling B.anthracis isolates.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the context of a national public health initiative aimed at addressing anemia, which of the following programs follows the \"6x6x6 strategy\"?", "options": [{"label": "A", "text": "Anemia mukt bharat", "correct": true}, {"label": "B", "text": "Poshan Abhiyan", "correct": false}, {"label": "C", "text": "Kishori Shakti Yojana", "correct": false}, {"label": "D", "text": "None of these", "correct": false}], "correct_answer": "A. Anemia mukt bharat", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Plasma sterilization is done by", "options": [{"label": "A", "text": "Ethylene oxide", "correct": false}, {"label": "B", "text": "Gamma rays", "correct": false}, {"label": "C", "text": "Hydrogen peroxide", "correct": true}, {"label": "D", "text": "Ultraviolet radiation", "correct": false}], "correct_answer": "C. Hydrogen peroxide", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:662px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risk category </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Recommended method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Medical device/Equipment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. Critical device</strong> (high risk): Items that enter a <strong>normally <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> site</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sterilisation</strong></p>\n<ul>\n<li>If<strong> heat resistant</strong>: Hot air oven or autoclave</li>\n<li>If <strong>heat-sensitive</strong>: Ionising radiation or <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">ethylene</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> sterilisation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical instruments</strong>, <strong>implants</strong>/prostheses, <strong>rigid endoscopes</strong>, syringes, needles, CuT, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> catheter</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2. <strong>Semi-critical device </strong>(intermediate risk):</p>\n<p>Items in contact with <strong>mucous membranes</strong> or<strong> body fluids</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High-level <span class=\"customMeta\" data-dictid=\"6c1d540906169277718659e8eb7f9c\">disinfection</span> (HLD)</strong>:</p>\n<p>Such as <strong>glutaraldehyde</strong>, ortho-phthalaldehyde, <span class=\"customMeta\" data-dictid=\"59e3af5975169277720384661ff5bf\">formaldehyde</span> and <strong>hydrogen peroxide</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory equipment</strong>, non-invasive flexible endoscopes, <strong>bedpans</strong>, <strong>urine bottles </strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3. <strong>Non-critical (low-risk)</strong></p>\n<p>Items in contact with <strong>intact skin.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intermediate </strong>or<strong> Low-level <span class=\"customMeta\" data-dictid=\"6c1d540906169277718659e8eb7f9c\">disinfection</span> </strong>(ILD or LLD):</p>\n<p>Such as<strong> phenols</strong>, chlorhexidine, <strong>isopropyl alcohol</strong>, <strong>povidone-iodine</strong>, etc</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Patient items include <strong>blood pressure cuffs</strong>, <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> electrodes, <strong>thermometer</strong> and <strong>stethoscopes</strong>.</p>\n<p> </p>\n<p>Environmental surfaces include computers, <strong>bed rails</strong>, food utensils, <strong>bedside tables</strong>, patient furniture and floor.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following dimorphic fungi causes subcutaneous mycosis?", "options": [{"label": "A", "text": "Sporothrix schenckii", "correct": true}, {"label": "B", "text": "Histoplasma capsulatum", "correct": false}, {"label": "C", "text": "Blastomyces dermatitidis", "correct": false}, {"label": "D", "text": "Penicllium marneffei", "correct": false}], "correct_answer": "A. Sporothrix schenckii", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vXb3XNyStcI1a4m0Q2jh1746187293.png", "https://image.prepladder.com/content/2oedoduyKNrgetfw8Wso1746187293.png", "https://image.prepladder.com/content/cDkYvyT0RpkwV8OnzXLJ1746187293.png", "https://image.prepladder.com/content/COue7jRWBOuGTaO2rRUb1746187293.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sporotrichosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dimorphic <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> <em>Sporothrix schenckii</em>.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common in <strong>gardeners, forest workers</strong>, and manual labourers.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Route of transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minor trauma or thorn prick.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic infection affects cutaneous, subcutaneous, and <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> tissue.</li>\n<li>Lesions <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> at sites of minor trauma or thorn pricks, starting as nodules.</li>\n<li>Nodules <span class=\"customMeta\" data-dictid=\"8ff7e19ae9169277720147c54e6777\">ulcerate</span> and necrose; infection spreads through <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> channels.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Fichman, Vivian &amp; Valle, Antonio &amp; de Macedo, Priscila &amp; Freitas, Dayvison &amp; Oliveira, Manoel &amp; Paes, Rodrigo &amp; Galhardo, Maria Clara.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/a-Case-2-presenting-lymphocutaneous-sporotrichosis-in-the-arm-b-The-same-patient-with_fig1_324711040\" data-tags=\"\" height=\"236\" src=\"https://image.prepladder.com/content/vXb3XNyStcI1a4m0Q2jh1746187293.png\" width=\"251\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Lymphocutaneous sporotrichosis: Secondary ulcers on <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes; lymphatics become hardened and cord-like.</li>\n<li>Systemic dissemination: Can affect bones, joints, and meninges.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Specimens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aspiration from nodules and <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> material.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopy:</strong></p>\n<ul>\n<li>KOH mounts or histopathological sections stained by <span class=\"customMeta\" data-dictid=\"cb3712727816927771925665b0b1e0\">methenamine</span> silver <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> show <strong>asteroid bodies (Splendore hoeppli phenomenon)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Asteroid_bodies_high_mag_cropped.jpg\" data-tags=\"\" height=\"267\" src=\"https://image.prepladder.com/content/2oedoduyKNrgetfw8Wso1746187293.png\" width=\"209\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Yeast phase: Cigar-shaped cells. </strong></li>\n</ul>\n<p> </p>\n<p><strong>Culture:</strong> Thin <span class=\"customMeta\" data-dictid=\"55f411a4ea1692777198d8f2de73b0\">septate</span> hyphae with flower-like clusters of small conidia; <strong>pear-shaped <span class=\"customMeta\" data-dictid=\"774c1b33a916927771844f6c75dcff\">conidia</span> in rosette-like clusters</strong> in mycelial phase.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC/Dr. Libero Ajello\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Conidiophores_and_conidia_of_the_fungus_Sporothrix_schenckii_PHIL_4208_lores.jpg\" data-tags=\"\" height=\"188\" src=\"https://image.prepladder.com/content/cDkYvyT0RpkwV8OnzXLJ1746187293.png\" width=\"282\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<p>Serological tests: Helpful for extracutaneous or <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> infections.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medications:</p>\n<ul>\n<li>Itraconazole</li>\n<li>Terbinafine</li>\n<li>Amphotericin B: For <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> infection</li>\n</ul>\n<p>Cryotherapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following immunoglobulins shows the highest concentration in serum?", "options": [{"label": "A", "text": "IgG", "correct": true}, {"label": "B", "text": "IgM", "correct": false}, {"label": "C", "text": "IgA", "correct": false}, {"label": "D", "text": "IgE", "correct": false}], "correct_answer": "A. IgG", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/4G8LkfWx9V0211m3FRmw1747389146.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The stain used for identifying Cryptococcus is?", "options": [{"label": "A", "text": "Albert's stain", "correct": false}, {"label": "B", "text": "Silver stain", "correct": false}, {"label": "C", "text": "India ink stain", "correct": true}, {"label": "D", "text": "Auramine-rhodamine stain", "correct": false}], "correct_answer": "C. India ink stain", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wd6kmqsAWX2vnSVH0TtH1746187492.png", "https://image.prepladder.com/content/N8xr2rF5STH6Xmao0Nij1746187492.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:662px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cryptococcus Spp. </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cryptococcus is a true yeast.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Capsule</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polysaccharide <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> - helps in serotyping and protection against phagocytosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serotypes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A, D, AD serotypes - Cryptococcus variety neoformans<strong> </strong></p>\n<p>B, C serotypes -Cryptococcus variety gattii</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Virulence factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Polysaccharide Capsule</strong>: The primary <span class=\"customMeta\" data-dictid=\"d325b5afd71692777202405d5f5c59\">virulence</span> factor. It helps the <span class=\"customMeta\" data-dictid=\"ed4634701d16927771942c4408495f\">pathogen</span> evade <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> and suppresses the host’s local immune responses, enabling the organism to survive and spread.</li>\n</ul>\n<ul>\n<li><strong>Melanin Production</strong>: <em>Cryptococcus</em> produces <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> via the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> oxidase, which contributes to its <span class=\"customMeta\" data-dictid=\"d325b5afd71692777202405d5f5c59\">virulence</span> by protecting the <span class=\"customMeta\" data-dictid=\"ed4634701d16927771942c4408495f\">pathogen</span> from <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> stress and immune defenses.</li>\n<li><strong>Enzyme Production</strong>: The <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> secretes several enzymes, including:\n\t\t\t\t<ul>\n<li><strong>Phospholipase</strong>: Aids in tissue invasion and damage.</li>\n<li><strong>Urease</strong>: Helps the <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> survive in the host environment by neutralizing <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> conditions, enhancing its ability to colonize and spread.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk of infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<h3><strong>Immunocompromised States:</strong></h3>\n<ul>\n<li>\n<ul>\n<li>HIV/AIDS, cancer, organ transplant recipients, those on <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> therapies, extremes of age are at higher risk.</li>\n</ul>\n</li>\n</ul>\n<p><strong>Geographic Location:</strong></p>\n<ul>\n<li>\n<ul>\n<li>Exposure to environments where Cryptococcus gattii is endemic, such as tropical and subtropical regions</li>\n</ul>\n</li>\n</ul>\n<p><strong>Environmental Exposure:</strong></p>\n<ul>\n<li>\n<ul>\n<li>Exposure to bird droppings or decaying wood can increase the likelihood of infection, especially with C. neoformans.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:761px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management</strong><strong> of cryptococcosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<ul>\n<li><strong>India ink</strong>- Demonstrates the capsule, which appears as clear space surrounding the round <span class=\"customMeta\" data-dictid=\"38e3eb755216927771834bb7e72a61\">budding</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" CDC/Dr. Leanor Haley\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Cryptococcus_neoformans_using_a_light_India_ink_staining_preparation_PHIL_3771_lores.jpg\" data-tags=\"\" height=\"236\" src=\"https://image.prepladder.com/content/wd6kmqsAWX2vnSVH0TtH1746187492.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>\n<ul>\n<li><strong>Mucicarmine stain:</strong> It stains the carminophilic <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> of C. neoformans</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<ul>\n<li><strong>Sabouraud Dextrose Agar</strong>, forming smooth, mucoid, cream-coloured colonies.</li>\n<li><strong>Niger seed <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> </strong>and <strong>bird seed agar</strong>: Demonstrates <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> production (brown colored colonies) due to <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> oxidase/laccase enzyme.</li>\n<li>The ability to grow at <strong>37°C</strong> and <strong>hydrolyse <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> </strong>differentiates C. neoformans from non-pathogenic cryptococci</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dhoubhadel, Bhim &amp; Laghu, Ujjwal &amp; Paudel, Raju &amp; Morimoto, Konosuke &amp; Ariyoshi, Koya.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Culture-of-CSF-showing-white-smooth-colonies-of-Cryptococcus-neoformans-in-Sabouraud_fig2_353574146\" data-tags=\"\" height=\"235\" src=\"https://image.prepladder.com/content/N8xr2rF5STH6Xmao0Nij1746187492.png\" width=\"285\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antigen <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Demonstration of the capsular <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> by <strong>Precipitation </strong>and <strong>Latex agglutination</strong> <strong>test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial Treatment with <strong>liposomal Amphotericin B </strong>and <strong>Flucytosine</strong></li>\n<li>Maintenance Therapy<strong> </strong>with <strong>Fluconazole</strong> for 6-12 months, depending on immune status.</li>\n</ul>\n<ul>\n<li>Monitoring: Regularly check CSF for fungal clearance, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, and electrolytes.</li>\n</ul>\n<ul>\n<li>Management of Underlying Conditions: Optimize ART to reduce <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an acid-fast organism?", "options": [{"label": "A", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "B", "text": "Escherichia coli", "correct": false}, {"label": "C", "text": "Mycobacterium avium", "correct": true}, {"label": "D", "text": "Actinomyces", "correct": false}], "correct_answer": "C. Mycobacterium avium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient comes with a history of category 3 dog bites. He received prophylaxis for a monkey bite 6 months back. What is the next step in management?", "options": [{"label": "A", "text": "Wound cleaning only", "correct": false}, {"label": "B", "text": "Wound cleaning + rabies vaccine on day 0 &amp;amp; 3", "correct": true}, {"label": "C", "text": "Wound cleaning+rabies vaccine on day 0,3 &amp;amp; 7", "correct": false}, {"label": "D", "text": "Wound cleaning+IM vaccine +RIG", "correct": false}], "correct_answer": "B. Wound cleaning + rabies vaccine on day 0 &amp; 3", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which medical condition is a ground-glass appearance observed on high-resolution computed tomography (HRCT)?", "options": [{"label": "A", "text": "Asbestosis", "correct": false}, {"label": "B", "text": "Silicosis", "correct": true}, {"label": "C", "text": "Anthracosis", "correct": false}, {"label": "D", "text": "Bagassosis", "correct": false}], "correct_answer": "B. Silicosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a component of Child-Pugh scoring?", "options": [{"label": "A", "text": "Albumin", "correct": false}, {"label": "B", "text": "Bilirubin", "correct": false}, {"label": "C", "text": "Prothrombin Time", "correct": false}, {"label": "D", "text": "LFT", "correct": true}], "correct_answer": "D. LFT", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - LFT</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Child-Pugh classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Encephalopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Grade 1-2</p>\n<p style=\"text-align: center;\">(Minimal)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Grade 3-4</p>\n<p style=\"text-align: center;\">(Advanced)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Mildly controlled</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Poorly controlled</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bilirubin (mg/dL) (Option B Ruled Out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2 - 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Albumin (g/dL) (Option A Ruled Out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">3 - 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 3.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>INR (Option C Ruled Out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 1.7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1.7 - 2.3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 2.3</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Child-Pugh Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Child-Turcotte-Pugh Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1-Year Survival Rate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">5-6 (Compensated cirrhosis)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">100%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">7-9 (Decompensated cirrhosis)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">81%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 10</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">45%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with a fever for 11 days with neck rigidity. A lumbar puncture was done, and it showed predominantly lymphocytes, sugar- 50mg, and protein- 3000mg/dl. Cobweb coagulum was noted. Gram-staining was negative. The patient's chest X-ray shows upper lobe involvement with hilar lymph node enlargement.", "options": [{"label": "A", "text": "Tuberculous meningitis", "correct": true}, {"label": "B", "text": "Bacterial meningitis", "correct": false}, {"label": "C", "text": "Fungal meningitis", "correct": false}, {"label": "D", "text": "Viral meningitis", "correct": false}], "correct_answer": "A. Tuberculous meningitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/a3EMLFScCiRRxQgk2lNH1746188962.png", "https://image.prepladder.com/content/Yz8DGL2bN8FqpeYrp6mC1746188971.png"], "explanation": "<p>Correct Answer A- &lt;span class=\"customMeta\" data-dictid=\"a50c41365a1692777201501cb6b378\"&gt;Tuberculous&lt;/span&gt; meningitis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tuberculous Meningitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms and Clinical Features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Headache</strong>, slight <strong>mental changes</strong>, and <strong>low-grade fever</strong> can develop over weeks, often accompanied by <strong>malaise</strong>, <strong>anorexia</strong>, and <strong>irritability</strong>.</p>\n</li>\n<li>\n<p>More severe cases present with <strong>confusion</strong>, <strong>lethargy</strong>, <strong>neck rigidity</strong>, and <strong>altered sensorium</strong>.</p>\n</li>\n<li>\n<p>Disease progression: evolves over 1–2 weeks, longer than bacterial meningitis.</p>\n</li>\n<li>\n<p><strong>Cranial nerve palsies</strong>, especially <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> nerves, are common due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> at the base of the brain.</p>\n</li>\n<li>\n<p>May result in <strong>coma</strong>, <strong>hydrocephalus</strong>, and <strong>intracranial hypertension</strong> if untreated.</p>\n</li>\n<li>\n<p><strong>Cerebral ischemia</strong> can result from the involvement of cerebral arteries.</p>\n</li>\n<li>\n<p><strong>Tuberculoma</strong> (space-occupying lesion) may cause seizures and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological signs.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CSF Findings:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Elevated <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> count</strong> (up to 1000/μL, predominantly lymphocytes).</p>\n</li>\n<li>\n<p><strong>High protein content</strong> (1–8 g/L).</p>\n</li>\n<li>\n<p><strong>Cobweb Coagulum: </strong>Clear fluid in a test tube with a cobweb at the bottom</p>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"557\" src=\"https://image.prepladder.com/content/a3EMLFScCiRRxQgk2lNH1746188962.png\" width=\"557\"/></p>\n<ul>\n<li>\n<p><strong>Low <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> concentration</strong>.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation of Choice:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Culture of CSF</strong> (gold standard, takes 4–8 weeks, positive in ~50%).</p>\n</li>\n<li>\n<p><strong>Smear for <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB)</strong> (low sensitivity, positive in 10–40%).</p>\n</li>\n<li>\n<p><strong>PCR</strong> for Mycobacterium <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> DNA (variable sensitivity).</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging:</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>CT/MRI</strong> may show <strong>hydrocephalus</strong> and <strong>abnormal enhancement</strong> of <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cisterns or ependyma.</p>\n</li>\n<li>\n<p><strong>Tuberculomas</strong> appear as contrast-enhanced ring lesions on imaging.</p>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Morteza Sanei Taheri, Mohammad Ali Karimi, Hamidreza Haghighatkhah, Ramin Pourghorban, Mohammad Samadian, Hosein Delavar Kasmaei\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2015/202806\" data-tags=\"\" height=\"405\" src=\"https://image.prepladder.com/content/Yz8DGL2bN8FqpeYrp6mC1746188971.png\" width=\"355\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>MRI showing ring-enhanced lesions -tuberculoma </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Empirical therapy</strong> is often initiated based on suspicion.</p>\n</li>\n<li>\n<p><strong>Initial drug regimen</strong>: isoniazid, rifampin, pyrazinamide, ethambutol, and pyridoxine.</p>\n</li>\n<li>\n<p><strong>Duration</strong>: 6–12 months depending on response.</p>\n</li>\n<li>\n<p><strong>Dexamethasone</strong> (12–16 mg/day) for 3 weeks, tapered for 3 more weeks (recommended for HIV-negative patients).</p>\n</li>\n<li>\n<p><strong>Tuberculoma</strong> may require a <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> for diagnosis.</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman with a 2-year-old child gives a history of completing required antenatal vaccinations during her previous pregnancy. Which of the following would you recommend for her current pregnancy?", "options": [{"label": "A", "text": "Give a booster dose of TT", "correct": false}, {"label": "B", "text": "Give a booster dose of Td", "correct": true}, {"label": "C", "text": "Give 2 doses of TT", "correct": false}, {"label": "D", "text": "Give 2 doses of Td", "correct": false}], "correct_answer": "B. Give a booster dose of Td", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When should a primigravida initiate breastfeeding after a normal delivery of a healthy baby?", "options": [{"label": "A", "text": "Within 1 hour", "correct": true}, {"label": "B", "text": "After 1 hour", "correct": false}, {"label": "C", "text": "After 4-6 hours", "correct": false}, {"label": "D", "text": "After 24 hours", "correct": false}], "correct_answer": "A. Within 1 hour", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient presents with a severe headache. He has never experienced a headache of this severity before. He has hypertension and nuchal rigidity on examination. Which of the following could be the diagnosis?", "options": [{"label": "A", "text": "Cluster headache", "correct": false}, {"label": "B", "text": "Subarachnoid haemorrhage", "correct": true}, {"label": "C", "text": "Encephalitis", "correct": false}, {"label": "D", "text": "Meningitis", "correct": false}], "correct_answer": "B. Subarachnoid haemorrhage", "question_images": ["https://image.prepladder.com/content/LJwnJvESxw27H5DP8wlw1746189105.png"], "explanation_images": ["https://image.prepladder.com/content/EGVS1inb7DWN05YHQTla1746189320.png"], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\"&gt;Subarachnoid&lt;/span&gt; haemorrhage</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subarachnoid hemorrhage- Etiology, Risk factors and Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Subarachnoid <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">Hemorrhage</span> (SAH): Blood accumulation in the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space.</p>\n</li>\n<li>\n<p>Causes: Often due to <strong>aneurysm <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> (~85%) </strong>or <strong>trauma</strong>.</p>\n</li>\n<li>\n<p><strong>Non-traumatic SAH</strong> is most commonly caused by the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of a <strong>saccular aneurysm</strong>.</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Clinical Impact: High mortality and morbidity; often presents with a sudden, severe headache <strong>(worst headache of life).</strong></p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Complications: Seizures, vasospasm, hydrocephalus, and delayed <span class=\"customMeta\" data-dictid=\"1d859d0b0416927771841b2915a839\">cerebral ischemia</span> (DCI).</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Age: Most aSAH occurs between ages 40-60, mean <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> age 50-55 and slightly more prevalent in females.</p>\n</li>\n<li>\n<p>Risk Factors: Smoking and history of ruptured aneurysms increase SAH risk.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Aneurysmal SAH (aSAH):</strong></p>\n<ul>\n<li>\n<p>Risk Factors: <strong>Hypertension</strong>, <strong>smoking</strong>, family history, <strong>alcohol </strong>use, <strong>sympathomimetic drugs</strong>, and <strong>estrogen deficiency</strong>.</p>\n</li>\n<li>\n<p>Rupture Risk: <strong>(Option D)</strong></p>\n<ul>\n<li>\n<p>Age &gt;60</p>\n</li>\n<li>\n<p>Posterior <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> aneurysms</p>\n</li>\n<li>\n<p>Atherosclerosis</p>\n</li>\n<li>\n<p>Aneurysm size</p>\n<ul>\n<li>\n<p>Aneurysms &lt;10 mm: ~0.1% annual <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> risk.</p>\n</li>\n<li>\n<p>Aneurysms ≥10 mm: 0.5–1% annual <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> risk.</p>\n</li>\n<li>\n<p>Giant aneurysms (&gt;2.5 cm): ~6% <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> risk in first year.</p>\n</li>\n</ul>\n</li>\n<li>\n<p>Family history</p>\n</li>\n<li>\n<p>Previous SAH</p>\n</li>\n<li>\n<p>ADPKD</p>\n</li>\n</ul>\n</li>\n</ul>\n</li>\n<li>\n<p><strong>Nonaneurysmal SAH (NASAH):</strong></p>\n<ul>\n<li>\n<p><strong>Perimesencephalic NASAH</strong>: Localized blood in perimesencephalic cisterns, normal angiography, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> course.</p>\n</li>\n<li>\n<p><strong>Occult Aneurysm</strong>: Small aneurysms missed on initial angiography, detectable on repeat imaging.</p>\n</li>\n<li>\n<p><strong>Vascular Malformations:</strong> Includes <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> malformations (AVM) and <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> fistulae. Treated with surgery or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> interventions.</p>\n</li>\n<li>\n<p><strong>Intracranial Arterial Dissection:</strong> Diagnosed by angiography, causes severe bleeding, treated with surgery or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> methods.</p>\n</li>\n<li>\n<p>Other Causes: <strong>Cocaine abuse,</strong> <strong>cerebral <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> angiopathy, cerebral <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> thrombosis, sickle cell disorders, moyamoya disease, cerebral vasculitis, <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorders.</strong></p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p><strong>Hemodynamic Stress</strong>: Central to <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> formation, especially at arterial bifurcations.</p>\n</li>\n<li>\n<p><strong>Aneurysm Rupture:</strong> Causes neurological damage through <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of adjacent brain tissue and <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> from <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood flow.</p>\n<ul>\n<li>\n<p>Mechanisms: Hemodynamic stress and <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> (matrix <strong>metalloproteinase (MMP)-mediated <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> of <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> matrix) </strong>weaken the arterial wall, promoting <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> formation and rupture.</p>\n</li>\n<li>\n<p>Inflammatory Response: Macrophages and smooth muscle cells drive these degenerative processes.</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>\"Thunderclap headache\" - <strong>worst headache of life</strong></p>\n</li>\n<li>\n<p>Sudden onset severe headache</p>\n</li>\n<li>\n<p>Vomiting</p>\n</li>\n<li>\n<p>Variable LOC</p>\n</li>\n<li>\n<p>Meningismus</p>\n</li>\n<li>\n<p>Retinal hemorrhages</p>\n</li>\n<li>\n<p>Focal neurologic deficits</p>\n</li>\n<li>\n<p>Nuchal rigidity</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD \" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subarachnoid_hemorrhage#/media/File:SubarachnoidP.png\" data-tags=\"\" height=\"418\" src=\"https://image.prepladder.com/content/EGVS1inb7DWN05YHQTla1746189320.png\" width=\"373\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>CT Head</strong></p>\n<ul>\n<li>\n<p>Non-contrast CT is first-line</p>\n</li>\n<li>\n<p><strong>\"Star sign\" - blood in <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cisterns</strong></p>\n</li>\n<li>\n<p>Sensitivity: 98-100% in first 12 hours</p>\n</li>\n</ul>\n<p><strong>Lumbar Puncture</strong></p>\n<ul>\n<li>\n<p>If CT negative</p>\n</li>\n<li>\n<p>Xanthochromia (takes 12h to develop)</p>\n</li>\n<li>\n<p>Elevated opening pressure</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a cause of exudative pleural effusion?", "options": [{"label": "A", "text": "Heart failure", "correct": false}, {"label": "B", "text": "Liver failure", "correct": false}, {"label": "C", "text": "Rheumatoid arthritis", "correct": true}, {"label": "D", "text": "Nephrotic syndrome", "correct": false}], "correct_answer": "C. Rheumatoid arthritis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- &lt;span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\"&gt;Rheumatoid&lt;/span&gt; arthritis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes of pleural effusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tranudative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Exudative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Both</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Congestive <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> <strong>(Option A)</strong></p>\n</li>\n<li>\n<p>Cirrhosis</p>\n</li>\n<li>\n<p>Liver failure <strong>(Option B)</strong></p>\n</li>\n<li>\n<p>Nephrotic syndrome <strong>(Option D)</strong></p>\n</li>\n<li>\n<p>Peritoneal dialysis</p>\n</li>\n<li>\n<p>SVC obstruction</p>\n</li>\n<li>\n<p>Myxedema</p>\n</li>\n<li>\n<p>Urinothorax</p>\n</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Malignancies</p>\n</li>\n<li>\n<p>Tuberculosis</p>\n</li>\n<li>\n<p>Pneumonia</p>\n</li>\n<li>\n<p>Esophageal perforation</p>\n</li>\n<li>\n<p>Pancreatic disease</p>\n</li>\n<li>\n<p>Rheumatoid <span class=\"customMeta\" data-dictid=\"fa734f0ec81692777195c12e3e6a7c\">pleuritis</span> <strong>(Option C)</strong></p>\n</li>\n<li>\n<p>Collagen <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> diseases:</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</p>\n</li>\n<li>\n<p>Sjögren syndrome</p>\n</li>\n<li>\n<p>Wegener Granulomatosis</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary embolism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs induced</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Nitrofurantoin</p>\n</li>\n<li>\n<p>Dantrolene</p>\n</li>\n<li>\n<p>Methysergide</p>\n</li>\n<li>\n<p>Bromocriptine</p>\n</li>\n<li>\n<p>Procarbazine</p>\n</li>\n<li>\n<p>Amiodarone</p>\n</li>\n<li>\n<p>Dasatinib</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old male with a history of respiratory tract infection 4 weeks ago is unable to stand or walk for the past 2 weeks and the weakness is progressive, ascending, and symmetrical in nature. The lower limbs were involved before and gradually the upper limbs were also affected. On examination you note areflexia. Pain and proprioception are preserved. Which of the following could be the diagnosis?", "options": [{"label": "A", "text": "Guillain-Barré syndrome", "correct": true}, {"label": "B", "text": "Myasthenia gravis", "correct": false}, {"label": "C", "text": "Polymyositis", "correct": false}, {"label": "D", "text": "Multiple sclerosis", "correct": false}], "correct_answer": "A. Guillain-Barré syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Guillain-Barré syndrome</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Motor Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Progressive <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> paralysis</strong> (distal to proximal)</li>\n<li><strong>Areflexia</strong></li>\n<li>Weakness in legs causing rubbery legs and <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> to stand</li>\n<li>Truncal paralysis, quadriplegia, neck floppiness</li>\n<li>Bilateral 7th nerve palsy</li>\n<li>Bulbar palsy\n\t\t\t\t<ul>\n<li>Difficulty in handling secretions leading to <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> pneumonia</li>\n<li>A leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> involvement.</li>\n</ul>\n</li>\n<li>Diaphragmatic paralysis\n\t\t\t\t<ul>\n<li>Ventilatory support is required in 30% of cases.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"c32b3a9fac16927771831530888fdf\">carbon dioxide</span> levels.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Sensory Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Glove-and-stocking distribution paresthesias</li>\n<li>Proprioception loss\n\t\t\t\t<ul>\n<li>Difficulty in climbing stairs</li>\n<li>Pain in the neck/arm/shoulder is similar to over-exercised muscle</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Sensory manifestations can occur before or along with motor manifestations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Autonomic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"3704fc52401692777186c42775c9fb\">dysregulation</span> (e.g., <span class=\"customMeta\" data-dictid=\"32742bce4316927771941ff62a9db7\">orthostatic</span> hypotension, bladder/bowel sparing/transient involvement)</li>\n<li>Wide fluctuations of blood pressure, arrhythmias, postural hypotension</li>\n<li>Reduced heart rate and blood pressure, <span class=\"customMeta\" data-dictid=\"fec88fc386169277719326fdef547f\">neurogenic</span> shock.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An HIV-positive man presents with a high-grade fever. Examination reveals a positive Kernig's sign. CSF shows reduced glucose, increased protein, and increased leukocytes. A diagnosis of cryptococcal meningitis is made. What is the appropriate management for this patient?", "options": [{"label": "A", "text": "Vancomycin", "correct": false}, {"label": "B", "text": "High dose fluconazole with flucytosine", "correct": false}, {"label": "C", "text": "Voriconazole", "correct": false}, {"label": "D", "text": "Liposomal amphotericin B", "correct": true}], "correct_answer": "D. Liposomal amphotericin B", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pBGxg8aAn0A8UJiKMVfp1746189641.png"], "explanation": "<p>Correct Answer D- Liposomal amphotericin B</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>The leading <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> cause of <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> in AIDS patients is primarily due to <em>Cryptococcus neoformans</em> (C. neoformans); <em>C. gattii</em> accounts for up to 12%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Presentation</strong></p>\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms include fever, nausea, vomiting, altered mental status, headache, and meningeal signs.</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of seizures and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits.</li>\n<li><strong>Kernig’s Sign- </strong>Positive when <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> extension of the knee elicits pain; indicative of meningeal irritation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CSF Profile</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It may be normal or show modest elevations in WBC and protein levels.</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels may be observed.</li>\n<li>Elevated CSF opening pressure is typical.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Identification of organisms via India ink examination of CSF.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Huang, Jinbao &amp; Li, Hongyan &amp; Lan, Changqing &amp; Weng, Heng\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/India-ink-examination-of-a-CSF-specimen-demonstrating-the-typical-transparent-thick_fig2_367498636\" data-tags=\"\" height=\"317\" src=\"https://image.prepladder.com/content/pBGxg8aAn0A8UJiKMVfp1746189641.png\" width=\"452\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li>Detection of <span class=\"customMeta\" data-dictid=\"6bd3522c4516927771855962983e97\">cryptococcal</span> <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> in CSF or blood.</li>\n<li>Blood cultures for <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> are often positive.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> may be necessary for diagnosing CNS <span class=\"customMeta\" data-dictid=\"3963c4741d1692777185554f5ff7c6\">cryptococcoma</span> and to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> it from immune <span class=\"customMeta\" data-dictid=\"13783dcacb1692777197d7062e0d6e\">reconstitution</span> syndrome.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Induction therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>IV amphotericin B (0.7 mg/kg daily) or liposomal amphotericin (4–6 mg/kg daily) plus <span class=\"customMeta\" data-dictid=\"bb3e410d281692777202dc2b43aaf7\">flucytosine</span> (25 mg/kg qid) for at least 2 weeks.</li>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function to avoid <span class=\"customMeta\" data-dictid=\"bb3e410d281692777202dc2b43aaf7\">flucytosine</span> toxicity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Maintenance Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Amphotericin should be continued until CSF culture is negative, followed by <span class=\"customMeta\" data-dictid=\"e3d616618b16927772022df400a411\">fluconazole</span> (400 mg/d PO for 8 weeks, then 200 mg/d) until CD4+ T-cell count &gt;200 cells/μL for 6 months.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 29-year-old male patient presents with coarse facial features and gradual enlargement of the hands and feet for the past decade. He has been diagnosed with acromegaly based on elevated levels of IGF-1 and growth hormone that did not suppress after a 75 g glucose challenge test. What drug is recommended for treatment?", "options": [{"label": "A", "text": "Lanreotide depot formulation", "correct": true}, {"label": "B", "text": "Terlipressin", "correct": false}, {"label": "C", "text": "Ketoconazole", "correct": false}, {"label": "D", "text": "Leuprolide", "correct": false}], "correct_answer": "A. Lanreotide depot formulation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Lanreotide &lt;span class=\"customMeta\" data-dictid=\"25116121ed169277718644b8fe30ff\"&gt;depot&lt;/span&gt; formulation</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of Acromegaly</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Surgical Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transsphenoidal <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> resection</strong> is the<strong> preferred treatment,</strong> especially for those with GH-secreting adenomas.</p>\n<p><strong>Post-Surgery:</strong></p>\n<ul>\n<li>Improvement in soft tissue <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and <span class=\"customMeta\" data-dictid=\"eb61b60d6c1692777193b647e170f8\">normalization</span> of GH levels typically occur shortly after surgery</li>\n<li>IGF-1 levels normalize within 3-4 days.</li>\n<li>There is a 10% <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate of <span class=\"customMeta\" data-dictid=\"01f4c8035316927771800b6c1238b0\">acromegaly</span> years later, and up to 15% of patients may develop hypopituitarism.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medical therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preferred in medical therapy if <span class=\"customMeta\" data-dictid=\"0968038e2a1692777185ed087c7fd8\">curative</span> surgery is not feasible or if GH fails to decrease post resection</p>\n<ul>\n<li><strong>Somatostatin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Ligands (SRLs): </strong>\n<ul>\n<li>Long-acting <span class=\"customMeta\" data-dictid=\"c3d7276c3e1692777190b4b6762dd0\">injectable</span> forms <strong>(octreotide, lanreotide)</strong>.</li>\n<li>Normalizes GH and IGF-1 levels in about 50% of patients.</li>\n<li><strong>Side Effects</strong>: GI disturbances, <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> nausea, and <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">gallbladder</span> issues.</li>\n</ul>\n</li>\n<li><strong>GH <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist:</strong>\n<ul>\n<li><strong>Pegvisomant</strong> blocks <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> GH receptors, normalizing IGF-1 levels in about 70% of patients, though GH levels remain elevated. It is administered through daily <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> injections and is used for recurrences or poor responses to SRLs.</li>\n</ul>\n</li>\n<li><strong>Dopamine Agonists: </strong>\n<ul>\n<li>High doses of <span class=\"customMeta\" data-dictid=\"c0cb3cd6081692777183c51f11e182\">cabergoline</span> can provide modest GH suppression.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Radiation Therapy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>External beam radiation therapy</strong> or <span class=\"customMeta\" data-dictid=\"f3333542581692777199584fa789d9\">stereotactic</span> techniques are considered for patients not achieving biochemical control through surgery or medical therapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Elective splenectomy is preferred in which of the following conditions?", "options": [{"label": "A", "text": "G6PD deficiency-Glucose-6-phosphate dehydrogenase deficiency", "correct": false}, {"label": "B", "text": "Paroxysmal nocturnal hemoglobinuria", "correct": false}, {"label": "C", "text": "Hereditary spherocytosis", "correct": true}, {"label": "D", "text": "Hairy cell leukemia", "correct": false}], "correct_answer": "C. Hereditary spherocytosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hgyeqn63oryxF4XjdFAL1746190022.png"], "explanation": "<p>Correct Answer C- Hereditary spherocytosis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management of Hereditary <span class=\"customMeta\" data-dictid=\"d30f4533661692777199385959bd9f\">Spherocytosis</span> (HS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Splenectomy as Primary Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Splenectomy significantly improves <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> by prolonging red cell survival, reducing the need for transfusions, and preventing <span class=\"customMeta\" data-dictid=\"64bbd63a0c1692777190f0c8e06e91\">iron overload</span> and related organ damage.</li>\n<li>Post splenectomy: <span class=\"customMeta\" data-dictid=\"d30f4533661692777199385959bd9f\">Spherocytosis</span> and altered osmotic <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> persist, but <span class=\"customMeta\" data-dictid=\"249592767b16927771976df58de24d\">reticulocyte</span> counts and <span class=\"customMeta\" data-dictid=\"64e0895e441692777187dad4949f29\">erythrocyte</span> lifespan normalize.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood Film Changes Post-Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Features like <strong>Howell-Jolly bodies</strong>, acanthocytes, target cells, <strong>cabot ring</strong> and<strong> Pappenheimer bodies</strong> appear after splenectomy.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\". Paulo Henrique Orlandi Mourao 2.Paulo Henrique Orlandi Mourao 3. Prof. Osaro Erhabor 4. Jarkeld Medical Centre Alkmaar, hematology department of Laboratory for Clinical Chemistry, Hematology and Immunology\" data-hash=\"\" data-license=\"1. CC BY-SA 4.0 2. CC BY SA 3.0 3. CC0 1.0 4. CC BY SA 3.0\" data-source=\"1. https://en.wikipedia.org/wiki/Pappenheimer_bodies 2. https://commons.wikimedia.org/wiki/File:Howell-Jolly_body.png 3. https://commons.wikimedia.org/wiki/File:Target_cells.jpg 4. https://en.wikipedia.org/wiki/Cabot_rings\" data-tags=\"\" height=\"539\" src=\"https://image.prepladder.com/content/hgyeqn63oryxF4XjdFAL1746190022.png\" width=\"824\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications for Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recommended for patients with severe, transfusion-dependent anemia, growth failure, skeletal changes, leg ulcers, or <span class=\"customMeta\" data-dictid=\"0ba1f7edfa1692777187ae6f51e603\">extramedullary</span> <span class=\"customMeta\" data-dictid=\"d2e0ab499c169277718886ab5a46bf\">hematopoietic</span> tumors.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Timing of Splenectomy</strong>:</p>\n<ul>\n<li>Should be <strong>delayed until age 5–9</strong> if possible or at least age 3, to reduce the risk of post-splenectomy <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> while balancing the increased risk of gallstones in older children.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laparoscopic Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Preferred method, with benefits like less discomfort, quicker recovery, and shorter hospital stays. Combined <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> and <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> is an option for patients with <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> gallstones.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Partial Splenectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used in infants or young children to alleviate <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> while preserving some splenic immune function. It reduces <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> needs but may eventually require total <span class=\"customMeta\" data-dictid=\"3c702f2ca816927771998e8ca552e1\">splenectomy</span> in about half of patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pre- and Post-Splenectomy Care</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<ul>\n<li><strong>Vaccination</strong>: Patients should receive vaccines against pneumococcus, <em>Haemophilus influenzae</em> type B, and <span class=\"customMeta\" data-dictid=\"dba7aeeec71692777192ce43dc13f5\">meningococcus</span> before surgery.</li>\n<li><strong>Antibiotic Prophylaxis</strong>: Use of <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> antibiotics post-splenectomy is controversial but recommended by some for at least 5 years or even lifelong.</li>\n<li><strong>Folic Acid</strong>: Continued supplementation (1 mg/day) is recommended to prevent <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> deficiency.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with complaints of sudden onset headache, palpitation, and profuse sweating. The patient has had multiple similar episodes in the past. During these episodes, the patient's blood pressure is elevated. A 24-hour urine metanephrine is elevated. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Addison's disease", "correct": false}, {"label": "B", "text": "Renal artery stenosis", "correct": false}, {"label": "C", "text": "Pheochromocytoma", "correct": true}, {"label": "D", "text": "Hyperthyroidism", "correct": false}], "correct_answer": "C. Pheochromocytoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7HXOtAEz73jWCKkc52HQ1746190217.png", "https://image.prepladder.com/content/GCGlLqrBsVR4SLcL536w1746190225.png"], "explanation": "<p>Correct Answer C - Pheochromocytoma</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pheochromocytoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pheochromocytomas are rare tumors arising from <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells of the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> medulla.</li>\n<li>The clinical features result from excessive <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of catecholamines.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Classical <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> </strong>\n<ul>\n<li>Episode of palpitation</li>\n<li>Headache</li>\n<li>Profuse sweating</li>\n</ul>\n</li>\n<li><strong>Dominant sign is Hypertension</strong></li>\n<li>Tachycardia</li>\n<li>Anxiety</li>\n<li>Subcutaneous neurofibromas</li>\n<li>Cafe-au-lait macules</li>\n<li>Thyroid mass</li>\n<li>Axillary freckling</li>\n<li>Lisch nodules on the iris</li>\n<li>Retinal angiomas</li>\n<li>Abdominal mass</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diagnosis of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> can be established by <strong>biochemical confirmation of <span class=\"customMeta\" data-dictid=\"0f03f178b51692777189f3658408a0\">hypersecretion</span> of metanephrines and catecholamines</strong>.</li>\n</ul>\n<p><strong>24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> test</strong></p>\n<ul>\n<li>Catecholamines</li>\n<li>Fractionated metanephrines</li>\n<li>Total metanephrines</li>\n</ul>\n<p><strong>Imaging</strong>:</p>\n<ul>\n<li>CT scan of the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> to locate the tumor.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Campos A, Weerakkody Y, et al. Pheochromocytoma. Reference article, Radiopaedia.org (Accessed on 29 Nov 2024) https://doi.org/10.53347/rID-8642\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/phaeochromocytoma-1\" data-tags=\"\" height=\"329\" src=\"https://image.prepladder.com/content/7HXOtAEz73jWCKkc52HQ1746190217.png\" width=\"498\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li>18F-FDG PET <span class=\"customMeta\" data-dictid=\"c497b556951692777198b599e4ba86\">scanning</span> is recommended for metastatic disease.</li>\n<li>MIBG scintigraphy</li>\n<li>Somatostatin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> scintigraphy</li>\n<li>Gallium DOTATATE PET scanning</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"orge A. Carrasquillo, Clara C. Chen, Abhishek Jha, Alexander Ling, Frank I. Lin, Daniel A. Pryma and Karel Pacak Journal of Nuclear Medicine August 2021, 62 (8) 1033-1042; DOI: https://doi.org/10.2967/jnumed.120.259689\" data-hash=\"\" data-license=\"NA\" data-source=\"https://jnm.snmjournals.org/content/62/8/1033\" data-tags=\"\" height=\"387\" src=\"https://image.prepladder.com/content/GCGlLqrBsVR4SLcL536w1746190225.png\" width=\"690\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyperthyroidism</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis</li>\n<li>Hyperaldosteronism</li>\n<li>Cardiomyopathy</li>\n<li>Postural <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> syndrome (POTS)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old patient with a smoking history presents with high-grade fever, cough, confusion, and diarrhea. Chest X-ray shows bilateral infiltrates in bilateral lower lung fields. On sputum gram stain, no organisms were detected. Laboratory results reveal Na: 126mEq/L, AST:62, ALT:56, RBS:112 mg/dl, serum bilirubin of 0.8mg%, and a positive HIV test. Which of the following organisms is responsible?", "options": [{"label": "A", "text": "Streptococcus", "correct": false}, {"label": "B", "text": "Legionella", "correct": true}, {"label": "C", "text": "Pneumocystis jiroveci", "correct": false}, {"label": "D", "text": "Klebsiella", "correct": false}], "correct_answer": "B. Legionella", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- Legionella</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Legionnaires' Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>General Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incubation period: 2-10 days</li>\n<li>Non-specific flu-like symptoms initially</li>\n<li>Often more severe than typical pneumonia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory</strong></p>\n<ul>\n<li>Dry cough</li>\n<li>Shortness of breath</li>\n<li>Chest pain</li>\n</ul>\n<p><strong>Systemic</strong></p>\n<ul>\n<li>High fever (102-105°F)</li>\n<li>Headache</li>\n<li>Myalgias</li>\n<li>Fatigue</li>\n</ul>\n<p><strong>Gastrointestinal</strong></p>\n<ul>\n<li>Diarrhea</li>\n<li>Nausea/vomiting</li>\n<li>Abdominal pain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Blood Analysis- Hyponatremia, Elevated Liver Enzymes</strong></li>\n<li><strong>Urinary Antigen-</strong> Most common test, rapid results, detects L. pneumophila serogroup-1</li>\n<li><strong>Culture- </strong>Gold standard, requires special media, takes 3-5 days</li>\n<li>PCR</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging Findings</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chest X-ray: <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">Focal</span> infiltrates/consolidation, <strong>predominantly lower lobes</strong></li>\n<li>CT: <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">Ground-glass</span> opacities, consolidation, pleural effusions possible</li>\n<li>Can be <span class=\"customMeta\" data-dictid=\"cf5b7ec2b51692777193feb17a4888\">multilobar</span> in <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild-Moderate Disease:</p>\n<ul>\n<li>Azithromycin 500mg PO daily</li>\n<li>Levofloxacin 750mg PO daily</li>\n<li>Clarithromycin 500mg PO BID</li>\n</ul>\n<p>Severe Disease:</p>\n<ul>\n<li>Levofloxacin 750mg IV daily</li>\n<li>Azithromycin 500mg IV daily</li>\n<li>Consider combination therapy for severe cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Community-Acquired <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">Pneumonia</span> (CAP)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Atypical Pneumonia</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Outpatients</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hospitalized Patients</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Includes M.pneumoniae C.pneumoniae, and <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common causes:</p>\n<ul>\n<li>S.pneumoniae, M.pneumoniae</li>\n<li>H. influenzae, C.pneumoniae, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> viruses(influenza, RSV).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-ICU</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ICU Patients</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar pathogens to outpatients, plus <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pathogens include</p>\n<p>S.pneumoniae, S. aureus (including MRSA), <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species, <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">gram-negative</span> bacilli, and H. influenzae.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the serial interval?", "options": [{"label": "A", "text": "Time taken to develop a Primary case A", "correct": false}, {"label": "B", "text": "Time gap between entry of organism till maximum infectivity", "correct": false}, {"label": "C", "text": "Interval between Primary and secondary case", "correct": true}, {"label": "D", "text": "Time gap between onset till first detection", "correct": false}], "correct_answer": "C. Interval between Primary and secondary case", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which barrier is the doctor addressing when a male patient expresses concern about potential impotency from the recommended vaccine during a vaccination drive?", "options": [{"label": "A", "text": "Physical barrier", "correct": false}, {"label": "B", "text": "Environmental barrier", "correct": false}, {"label": "C", "text": "Physiological barrier", "correct": false}, {"label": "D", "text": "Cultural barrier", "correct": true}], "correct_answer": "D. Cultural barrier", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which stage of the demographic cycle has the highest birth and death rates?", "options": [{"label": "A", "text": "Stage I", "correct": true}, {"label": "B", "text": "Stage II", "correct": false}, {"label": "C", "text": "Stage III", "correct": false}, {"label": "D", "text": "Stage IV", "correct": false}], "correct_answer": "A. Stage I", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient with a history of smoking a pack of cigarettes for the past 15 years presents with hemoptysis. Chest X-ray shows a 3cm upper lobe mass near the apex of the lung. What is the next best step for managing this patient?", "options": [{"label": "A", "text": "Bronchoscopy", "correct": false}, {"label": "B", "text": "CT-guided biopsy", "correct": true}, {"label": "C", "text": "Sputum cytology", "correct": false}, {"label": "D", "text": "Sputum for AFB", "correct": false}], "correct_answer": "B. CT-guided biopsy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- CT-guided &lt;span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\"&gt;biopsy&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Evaluation for Suspected Lung Mass</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Invasive <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Methods</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sputum Cytology</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Non-invasive initial <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</li>\n<li>Most useful for central lesions<strong> (Option C Ruled Out)</strong></li>\n<li>Higher yield in large, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tumors</li>\n<li>Low sensitivity due to high tissue variability</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CT Chest</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contrast-enhanced</li>\n<li>Extension to upper <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> (adrenal level)</li>\n<li>Sensitivity: 55%, Specificity: 81%</li>\n<li>Identifies tumor location, extent, and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</li>\n<li>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> ≥1cm in short <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> considered suspicious</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PET/PET-CT</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Higher accuracy than CT (Sensitivity: 80%, Specificity: 88%)</li>\n<li>Identifies <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> activity and potential metastases</li>\n<li>Reduces futile thoracotomies</li>\n<li>Helpful in identifying <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> post-therapy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Invasive <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">Staging</span> &amp; <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">Biopsy</span> Methods</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CT-Guided <span class=\"customMeta\" data-dictid=\"d2f68167161692777200f27aa61366\">Transthoracic</span> Biopsy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Preferred for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> lesions (Option A)</strong></li>\n<li>High <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> accuracy</li>\n<li>Minimally Invasive</li>\n<li>Risk of <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> (especially in emphysematous patients)</li>\n<li>Contraindicated if high <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk or severe emphysema</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>EBUS-TBNA</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CP-EBUS: <span class=\"customMeta\" data-dictid=\"9ddd195e9a1692777197bb3f135c2e\">Real-time</span> <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> of mediastinal/hilar nodes</li>\n<li>RP-EBUS: For smaller/peripheral lesions</li>\n<li>Navigation <span class=\"customMeta\" data-dictid=\"f8d4c5c1c01692777183ee445dc295\">bronchoscopy</span> for mapped approach</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endoscopic-TBNA</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Samples through <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall</li>\n<li>Accesses stations 2, 4, 7, 8, 9</li>\n<li>Sensitivity: 89%, Specificity: 100%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mediastinoscopy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used after negative needle technique</li>\n<li>Samples para-tracheal nodes</li>\n<li>Sensitivity: 78%, Specificity: 100%</li>\n<li>Mortality risk: 0.08%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>VATS/RATS</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>For <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> sampling</li>\n<li>Full <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> during lung resection</li>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> approach</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cancer Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Additional Investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Small Cell Lung Cancer (NSCLC) - Adenocarcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral/Outer regions of lung</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CT-guided needle biopsy</li>\n<li>PET-CT scan</li>\n<li>Blood tests for tumor markers (CEA)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Molecular testing (EGFR, ALK, ROS1)</li>\n<li>MRI brain (for staging)</li>\n<li>Pulmonary function tests</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>NSCLC - <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">Squamous</span> Cell</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central/Main bronchi</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bronchoscopy with biopsy</li>\n<li>Chest CT with contrast</li>\n<li>Sputum cytology</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mediastinoscopy</li>\n<li>Bone scan (if symptoms)</li>\n<li>PD-L1 testing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Small Cell Lung Cancer (SCLC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central regions, rapid spread</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CT chest/abdomen/pelvis</li>\n<li>Bronchoscopy</li>\n<li>Blood tests (ProGRP, NSE)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MRI brain (mandatory)</li>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> biopsy</li>\n<li>Nuclear medicine scans</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Large Cell Carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Any location</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>PET-CT scan</li>\n<li>Core needle biopsy</li>\n<li>Immunohistochemistry</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Molecular profiling</li>\n<li>EBUS-TBNA</li>\n<li>Liquid biopsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carcinoid Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually central airways</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Octreotide scan</li>\n<li>Bronchoscopy with biopsy</li>\n<li>24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> 5-HIAA</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chromogranin A levels</li>\n<li>MIBG scan</li>\n<li>Endoscopic ultrasound</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The ideal per capita space for students in a classroom should be", "options": [{"label": "A", "text": "&amp;gt;5 sq. ft.", "correct": false}, {"label": "B", "text": "&amp;gt;10 sq. ft.", "correct": true}, {"label": "C", "text": "&amp;gt;15 sq. ft.", "correct": false}, {"label": "D", "text": "&amp;gt;20 sq. ft.", "correct": false}], "correct_answer": "B. &gt;10 sq. ft.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents with a history of headaches for the past 9 months that worsen in a recumbent position and improves as the day progresses. She also gives a history of taking oral contraceptives. Fundal examination shows papilledema. There are no focal neurological deficits. What is the probable cause of her headaches?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": false}, {"label": "B", "text": "Temporal arteritis", "correct": false}, {"label": "C", "text": "Chronic migraine", "correct": false}, {"label": "D", "text": "Pseudotumor cerebri", "correct": true}], "correct_answer": "D. Pseudotumor cerebri", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D- &lt;span class=\"customMeta\" data-dictid=\"d888653fcd1692777196e08285ad6d\"&gt;Pseudotumor&lt;/span&gt; cerebri</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pseudotumor <span class=\"customMeta\" data-dictid=\"5a4a970c4b1692777184108b0b09c8\">Cerebri</span> / <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">Idiopathic</span> <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">Intracranial</span> Hypertension</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A disorder associated with elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> pressure without obvious cause, commonly affecting young, <span class=\"customMeta\" data-dictid=\"43663fecf11692777194c870d1d548\">obese</span> females</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Headache (worse on waking and with recumbency)</li>\n<li>Visual disturbances (may be transient)</li>\n<li>Can occur without visual problems</li>\n<li>Worse in morning or after lying down</li>\n<li>Pulsatile <span class=\"customMeta\" data-dictid=\"1e668dc8ba1692777200622a8a97f3\">tinnitus</span> may be present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> pressure (&gt;20-25 cm H2O)</li>\n<li>Normal MRI/MRV findings</li>\n<li>Normal neurological examination (except for papilledema)</li>\n<li>Papilledema may be present (but not required for diagnosis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acetazolamide (250-500 mg)</li>\n<li>Weight loss (if overweight)</li>\n<li>Serial <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> punctures may be needed</li>\n<li>Regular ophthalmologic monitoring</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Topiramate</li>\n<li>Other carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> inhibitors</li>\n<li>CSF shunting procedures (if needed)</li>\n<li>Weight loss management programs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Regular <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> testing</li>\n<li>Ophthalmic examination</li>\n<li>CSF pressure monitoring</li>\n<li>Weight monitoring</li>\n<li>Headache diary</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Important Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fundoscopic exam should be performed even without overt <span class=\"customMeta\" data-dictid=\"c09776e61f1692777194db295c590f\">ophthalmic</span> involvement</li>\n<li>Consider diagnosis in chronic <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> cases</li>\n<li>May require long-term management</li>\n<li>Early intervention is crucial for preventing vision loss</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male presented with unexplained fever and prolonged respiratory distress despite appropriate treatment. A diagnosis of cryptic tuberculosis was made. Which of the following is the correct statement related to this condition?", "options": [{"label": "A", "text": "Positive skin tuberculin test and negative chest X-ray", "correct": false}, {"label": "B", "text": "Positive skin tuberculin test and positive chest X-ray", "correct": false}, {"label": "C", "text": "Negative skin tuberculin test and negative chest X-ray", "correct": true}, {"label": "D", "text": "Negative skin tuberculin test and positive chest X-ray", "correct": false}], "correct_answer": "C. Negative skin tuberculin test and negative chest X-ray", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- Negative skin &lt;span class=\"customMeta\" data-dictid=\"0fe92012341692777201bab3db39b1\"&gt;tuberculin&lt;/span&gt; test and negative chest X\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Different Modes of <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> Diagnosis:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mode of Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sputum microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Examination of <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> samples under a <span class=\"customMeta\" data-dictid=\"195d6a11ca16927771927a92617498\">microscope</span> to detect the presence of <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Quick and inexpensive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low sensitivity, especially in cases of <span class=\"customMeta\" data-dictid=\"1fdb5ce91d16927771942d7a784ff5\">paucibacillary</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Culture and drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Growth of TB bacteria in a laboratory setting to determine drug resistance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Highly sensitive and specific</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slow, can take weeks to obtain results</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nucleic acid <span class=\"customMeta\" data-dictid=\"13e14b31b21692777181520d7c651c\">amplification</span> tests (NAATs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polymerase chain reaction (PCR) or other molecular tests to detect TB DNA/RNA in <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> or other clinical specimens</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid results, high sensitivity and specificity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Expensive, may require specialized equipment and training</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imaging of the chest to detect <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> changes in the lungs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-invasive, can detect active TB and TB sequelae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lack of specificity, cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between TB and other lung diseases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tuberculin skin test (TST)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Injection of <span class=\"customMeta\" data-dictid=\"12fb06df001692777196ffe29e8bba\">PPD</span> under the skin, followed by measurement of <span class=\"customMeta\" data-dictid=\"7a14c26a7816927771904fb670c6da\">induration</span> at the <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> site after 48-72 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low cost, widely available</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limited ability to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> and active TB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Interferon-gamma release assays (IGRAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood tests that detect TB-specific immune responses</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> than TST, not affected by <span class=\"customMeta\" data-dictid=\"0743ea5899169277718278d7bc17ba\">BCG</span> vaccination</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher cost, can be affected by <span class=\"customMeta\" data-dictid=\"498d3df3a416927771894f595a597a\">immunosuppression</span> or other medical conditions</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a feature of Gaisböck syndrome?", "options": [{"label": "A", "text": "Hypotension", "correct": true}, {"label": "B", "text": "Erythrocytosis", "correct": false}, {"label": "C", "text": "Normal leukocyte counts", "correct": false}, {"label": "D", "text": "Obesity", "correct": false}], "correct_answer": "A. Hypotension", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Hypotension</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gaisböck syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High <span class=\"customMeta\" data-dictid=\"2e114d4cdc169277718882a0a01076\">hematocrit</span> levels</li>\n<li><strong>Erythrocytosis (Option B Ruled Out)</strong></li>\n<li><strong>Normal <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> counts</strong> <strong>(Option C Ruled Out)</strong></li>\n<li>No splenomegaly</li>\n<li>Hypertension</li>\n<li>Facial rubor</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Patient Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Predominantly affects males</li>\n<li><strong>Obese and anxious personality (Option D Ruled Out)</strong></li>\n<li>Often cigarette smokers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alcoholism</li>\n<li>Diuretic therapy</li>\n<li>Physical &amp; Emotional stress</li>\n<li>Obesity</li>\n<li>Smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiological Mechanisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Psychiatric disorders causing chronic stress</li>\n<li>Volume <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> (diuresis)</li>\n<li>Hypertension</li>\n<li>Nocturnal hypoxemia</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">erythropoietin</span> production</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Formation of microthrombi</li>\n<li>Cerebral infarction</li>\n<li>Vascular disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Management of hypertension</li>\n<li>Weight reduction</li>\n<li>Smoking cessation</li>\n<li>Alcohol reduction/cessation</li>\n<li>Stress management</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with dyspnea and distended neck veins that increase on inspiration. There is no murmur. What is the diagnosis?", "options": [{"label": "A", "text": "Constrictive pericarditis", "correct": true}, {"label": "B", "text": "Aortic regurgitation", "correct": false}, {"label": "C", "text": "Tricuspid stenosis", "correct": false}, {"label": "D", "text": "Pulmonary arterial hypertension", "correct": false}], "correct_answer": "A. Constrictive pericarditis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/iWkS9FFIDamC6d1Bnt9g1747391746.png"], "explanation": "<p>Correct Answer A- Constrictive pericarditis</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Elevated JVP with rapid y descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reflects <strong>rapid early diastolic filling</strong> of the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> due to pressure gradient.</p>\n<p style=\"text-align:center\"><img alt=\"Elevated JVP\" data-author=\"\" data-hash=\"12830\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"209\" src=\"https://image.prepladder.com/notes/iWkS9FFIDamC6d1Bnt9g1747391746.png\" width=\"332\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>atigue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by the heart’s inability to meet <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> demands.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Rapid, low-volume pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Restricted <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> limits stroke volume, weakening the pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pericardial knock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <strong>loud early S3 from the thickened pericardium</strong> during diastolic filling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Kussmaul’s sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paradoxical rise in JVP during inspiration.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hepatomegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> due to i<strong>ncreased <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abdominal fluid accumulation due to <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Peripheral oedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling in the extremities from <strong>fluid retention.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pulsus paradoxus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A fall in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP (10mm Hg) during inspiration, potentially <span class=\"customMeta\" data-dictid=\"8ee21101ac1692777189434bcef126\">impalpable</span> pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Atrial fibrillation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common due to atrial <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> and dilation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child presented with recurrent respiratory infections with thickened sputum. Chest X-ray showed bronchial wall thickening. He has been suffering from steatorrhea since birth. Which of the following is the first differential diagnosis?", "options": [{"label": "A", "text": "Hyaline membrane disease", "correct": false}, {"label": "B", "text": "Cystic fibrosis", "correct": true}, {"label": "C", "text": "Alpha 1 anti-trypsin deficiency", "correct": false}, {"label": "D", "text": "Malabsorption syndrome", "correct": false}], "correct_answer": "B. Cystic fibrosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\"&gt;Cystic&lt;/span&gt; fibrosis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Organ System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Respiratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thick <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> plugging</li>\n<li>Bronchiectasis</li>\n<li>Chronic inflammation</li>\n<li>Submucosal <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> hypertrophy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic productive cough</li>\n<li>Recurrent infections</li>\n<li>Progressive dyspnea</li>\n<li>Digital clubbing</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Obstructive pattern on PFTs</li>\n<li>Bronchiectasis on CT</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pancreatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Duct obstruction</li>\n<li>Acinar cell destruction</li>\n<li>Fibrosis</li>\n<li>Fat replacement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malabsorption</li>\n<li>Steatorrhea</li>\n<li>Failure to thrive</li>\n<li>Fat-soluble vitamin deficiency</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low fecal elastase</li>\n<li>Elevated fecal fat</li>\n<li>Low vitamins A, D, E, K</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sweat Glands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> transport</li>\n<li>Normal <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> structure</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Salty-tasting skin</li>\n<li>Heat intolerance</li>\n<li>Salt depletion</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated sweat chloride</li>\n<li>&gt;60 mEq/L diagnostic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hepatobiliary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bile <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> plugging</li>\n<li>Focal <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> cirrhosis</li>\n<li>Multilobular cirrhosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neonatal cholestasis</li>\n<li>Portal hypertension</li>\n<li>Gallstones</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated liver enzymes</li>\n<li>Ultrasound changes</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 60-year-old male, what is the primary etiology typically associated with Cushing's disease?", "options": [{"label": "A", "text": "Small-cell lung cancer", "correct": false}, {"label": "B", "text": "Adrenal tumor", "correct": false}, {"label": "C", "text": "Ectopic ACTH syndrome", "correct": false}, {"label": "D", "text": "Pituitary microadenoma", "correct": true}], "correct_answer": "D. Pituitary microadenoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Ll9bWgs3cndX9bSLkXY51747391877.png"], "explanation": "<p>Correct Answer D- &lt;span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\"&gt;Pituitary&lt;/span&gt; microadenoma</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cushing's syndrome- Definition and Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cushing's syndrome is a collection of symptoms resulting from prolonged exposure to high levels of glucocorticoids.</li>\n<li>Cushing's disease specifically refers to Cushing's syndrome caused by a <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> <span class=\"customMeta\" data-dictid=\"f2c4d4843f1692777185ca24fa3131\">corticotrope</span> adenoma.</li>\n<li>It is relatively rare, but mild cases may be more common, particularly among those with symptoms like central obesity, <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes and osteoporosis.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Cushing's Syndrome\" data-author=\"Dr. Justin Boey\" data-hash=\"12831\" data-license=\"NA\" data-source=\"https://justinboey.com/there-are-treatments-that-can-lighten-the-skin-cushings-disease-causes-symptoms-and-treatments/\" data-tags=\"May2025\" height=\"473\" src=\"https://image.prepladder.com/notes/Ll9bWgs3cndX9bSLkXY51747391877.png\" width=\"530\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cushing's syndrome can be caused by various factors, categorised as <strong>ACTH-dependent or ACTH-independent.</strong></p>\n<p><strong>I) ACTH-dependent Cushing's Syndrome</strong> accounts for approximately 90% of cases.</p>\n<ul>\n<li><strong>Cushing's disease (ACTH-producing <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> adenoma) is the most common cause.</strong></li>\n<li><strong>Ectopic ACTH syndrome</strong> occurs when a <strong>non-pituitary tumour secretes ACTH</strong>.</li>\n</ul>\n<p><strong>II) ACTH-independent Cushing's Syndrome</strong> constitutes the remaining 10% of cases.</p>\n<ul>\n<li>Adrenocortical <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> is the most prevalent cause, accounting for 5–10% of all cases.</li>\n<li>Rare causes include:\n\t\t\t\t<ul>\n<li><strong>Primary <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"866d89cd5516927771916d5134111d\">macronodular</span> <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (PBMAH) </strong></li>\n<li><strong>Primary <span class=\"customMeta\" data-dictid=\"85dafbf32f1692777195b9d9f035d8\">pigmented</span> <span class=\"customMeta\" data-dictid=\"bfa856c77716927771939978c5afd0\">nodular</span> <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> disease (PPNAD) </strong></li>\n<li>McCune-Albright syndrome</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female patient presented with bone pain and abdominal cramps. Her family reported a previous history of abnormal behavior. The consultant doctor made a tentative diagnosis based on the clinical symptoms. What would be the most appropriate investigative method to establish a conclusive diagnosis?", "options": [{"label": "A", "text": "MRI", "correct": false}, {"label": "B", "text": "Ultrasonogram", "correct": false}, {"label": "C", "text": "Sestamibi scan", "correct": true}, {"label": "D", "text": "CT scan", "correct": false}], "correct_answer": "C. Sestamibi scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ByeuH45PP3AqPvINp68W1746191802.png", "https://image.prepladder.com/content/DAf1Lf21ZX4GIIrF00a51746191811.png", "https://image.prepladder.com/content/qIW30QAl9LFCZLNCeI7t1746191818.png", "https://image.prepladder.com/content/KnWwla11jDRRyTBzXaA01746191825.png"], "explanation": "<p>Correct Answer C- &lt;span class=\"customMeta\" data-dictid=\"a1c30e30661692777198a662194f81\"&gt;Sestamibi&lt;/span&gt; scan</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Primary Hyperparathyroidism- Lab and Radiological findings</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Lab Investigations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> (SAP) levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum PTH (parathyroid hormone) assay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated PTH</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiological features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subperiosteal erosions and <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> in the <span class=\"customMeta\" data-dictid=\"27cd397275169277719513776c38c8\">phalanges</span> (usually starts in the middle <span class=\"customMeta\" data-dictid=\"e9451cd23d1692777195fe471f486e\">phalanx</span> of the index finger's <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> side<strong>) </strong>along with bone demineralisation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jones J, Chieng R, Vadera S, et al. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/subperiosteal-bone-resorption\" data-tags=\"\" height=\"352\" src=\"https://image.prepladder.com/content/ByeuH45PP3AqPvINp68W1746191802.png\" width=\"505\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>The \"salt and pepper\" appearance, or pepper pot skull</strong> (lytic lesions in the skull).</p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Niknejad M, Bell D, Gaillard F, et al.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/salt-and-pepper-sign-skull-1\" data-tags=\"\" height=\"415\" src=\"https://image.prepladder.com/content/DAf1Lf21ZX4GIIrF00a51746191811.png\" width=\"505\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Brown tumour or <span class=\"customMeta\" data-dictid=\"dc4ced4b86169277719422ad2689a5\">osteitis</span> fibrosa cystica:</strong> <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> lesions in bone from excessive <span class=\"customMeta\" data-dictid=\"fc8c28347a16927771945680bd00be\">osteoclastic</span> <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> appear as low-density, multiloculated cysts that can lead to bone expansion, accompanied by <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Frank Gaillard\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Brown_tumor\" data-tags=\"\" height=\"502\" src=\"https://image.prepladder.com/content/qIW30QAl9LFCZLNCeI7t1746191818.png\" width=\"505\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sestamibi scan (Tc-99): Localize the <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> adenoma.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Radswiki T, Elfeky M, Mellam Y, et al.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/tc-99m-sestamibi\" data-tags=\"\" height=\"269\" src=\"https://image.prepladder.com/content/KnWwla11jDRRyTBzXaA01746191825.png\" width=\"505\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presented with difficulty in activities like climbing stairs, getting up from a chair, and combing hair. Violaceous erythema of the upper eyelids was noted. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Inclusion body myositis", "correct": false}, {"label": "B", "text": "Dermatomyositis", "correct": true}, {"label": "C", "text": "Polymyositis", "correct": false}, {"label": "D", "text": "Scleroderma", "correct": false}], "correct_answer": "B. Dermatomyositis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/myRvfydYXDYucnm5tS5p1746192065.png", "https://image.prepladder.com/content/YgFBnzwLRk10mKHQVaL61746192073.png", "https://image.prepladder.com/content/vTaqsJu3Lv9WuZEU96K41746192082.png", "https://image.prepladder.com/content/oU4GC8TqxvxzuV222uDM1746192089.png", "https://image.prepladder.com/content/NHN47PiG57fvpxo7ggeB1746192096.png", "https://image.prepladder.com/content/5YzKKlNV9roqcA4EkvWi1746192104.png"], "explanation": "<p>Correct Answer B- Dermatomyositis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Dermatomyositis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dermatomyositis </strong>is a chronic, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"417c81834e169277719328d50305b6\">myositis</span> seen in adults around 50-60 years of age.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n<ul>\n<li>It presents as <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">symmetrical</span> muscle weakness (proximal &gt; distal)</li>\n<li><strong>Gottron’s papules</strong> (erythematous <span class=\"customMeta\" data-dictid=\"a37fd1603c1692777198f87a4a51dc\">scaly</span> papules over knuckles) are <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> of the disease.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dermatomyositis2.jpg\" data-tags=\"\" height=\"330\" src=\"https://image.prepladder.com/content/myRvfydYXDYucnm5tS5p1746192065.png\" width=\"608\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Gottron’s sign</strong>: Symmetric, confluent, <span class=\"customMeta\" data-dictid=\"57d8f3ea831692777202e8adc0cee9\">violaceous</span> <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> (CMVE) on the back of fingers, on the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> surfaces of joints of the elbows, knees, or ankles</li>\n<li>CMVE is seen over other sites too, and is named accordingly.</li>\n</ul>\n<p> </p>\n<ul>\n<li><strong>Heliotrope rash: </strong>CMVE over the <span class=\"customMeta\" data-dictid=\"5b1b31d3e41692777195670afc94ca\">periorbital</span> skin</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Dermatomyositis\" data-tags=\"\" height=\"210\" src=\"https://image.prepladder.com/content/YgFBnzwLRk10mKHQVaL61746192073.png\" width=\"490\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>V-Sign:</strong> CMVE over the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> aspect of the neck</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Didona, Dario &amp; Fania, Luca &amp; Didona, Biagio &amp; Eming, Rüdiger &amp; Hertl, Michael &amp; Di Zenzo, Giovanni.\" data-hash=\"\" data-license=\" CC BY\" data-source=\"https://www.researchgate.net/figure/Paraneoplastic-dermatomyositis-V-sign-Erythematous-maculopapular-rash-of-the-V-area_fig5_340099670\" data-tags=\"\" height=\"308\" src=\"https://image.prepladder.com/content/vTaqsJu3Lv9WuZEU96K41746192082.png\" width=\"396\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Shawl sign: </strong>Involvement of upper back</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Krishna Adhikari Prashant Pant Sanjeev Bhandari Sandip Paudel Buddhi Prasad Paudyal Lucky Sharma Keshav Raj Sigdel Rojina Subedi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/A-Figures-showing-V-sign-B-Shawl-sign-and-C-Holster-sign-respectively_fig2_375774466\" data-tags=\"\" height=\"332\" src=\"https://image.prepladder.com/content/oU4GC8TqxvxzuV222uDM1746192089.png\" width=\"391\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Holster sign:</strong> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">Rash</span> over the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> aspect of the thigh</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Porter, Emma &amp; Byrne, Berbie &amp; Sarfaraz, Sumreen &amp; Leonard, Niamh &amp; Field, Sinead\" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Symmetrical-ill-defined-erythema-of-the-lateral-thighs-consistent-with-Holster-sign_fig2_369461085\" data-tags=\"\" height=\"295\" src=\"https://image.prepladder.com/content/NHN47PiG57fvpxo7ggeB1746192096.png\" width=\"430\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Mechanic’s hand:</strong> Hyperkeratosis and fissuring on the edges of the fingers</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hanlin Yin Bei Liu Liangjing Lu\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/Clinical-manifestations-of-the-patients-A-C-mechanics-hands-D-aligned_fig1_357079256\" data-tags=\"\" height=\"506\" src=\"https://image.prepladder.com/content/5YzKKlNV9roqcA4EkvWi1746192104.png\" width=\"423\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male patient presents with ptosis and muscle weakness which reportedly worsens in the evening and improves in the morning. This is relieved by neostigmine. What is the likely diagnosis?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": true}, {"label": "B", "text": "Huntington chorea", "correct": false}, {"label": "C", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "D", "text": "External ophthalmoplegia", "correct": false}], "correct_answer": "A. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- &lt;span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\"&gt;Myasthenia&lt;/span&gt; gravis </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features and Diagnosis of <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">Myasthenia</span> Gravis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diplopia, ptosis, dysarthria, dysphagia</li>\n<li>Weakness in oculomotor, pharyngeal, limb, neck extensors</li>\n<li>Fluctuation and fatigue worse with activity, improved by rest</li>\n<li>Fatiguability increases as the day passes (diurnal variation)</li>\n<li>Initial symptoms frequently <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> (diplopia/ptosis)</li>\n<li>Facial weakness produces \"snarling\" expression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eye movements and ptosis</li>\n<li>Assessment of <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> in neck and extremities</li>\n<li>Weakness following repetitive muscle activation</li>\n<li>Normal deep <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> reflexes</li>\n<li>No <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> abnormalities</li>\n<li>Symptoms relieved by Anticholinesterases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti-AChR antibodies (positive in ~85% generalized MG)</li>\n<li>Anti-MuSK antibodies (in ~40% of AChR-negative cases)</li>\n<li>Repetitive nerve stimulation</li>\n<li>Single-fiber EMG</li>\n<li>CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> of chest (to evaluate thymus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Edrophonium (Tensilon) test: 2mg + 8mg IV</li>\n<li>Ice pack test for ptosis</li>\n<li>Fatigue testing (repeated muscle activation)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Study of death in all aspects is known as:", "options": [{"label": "A", "text": "Thanatology", "correct": true}, {"label": "B", "text": "Forensic anthropology", "correct": false}, {"label": "C", "text": "Toxicology", "correct": false}, {"label": "D", "text": "Molecular death", "correct": false}], "correct_answer": "A. Thanatology", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Thanatolog\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman came with complaints of hearing loss and pulsatile tinnitus. On examination, it is found that the patient has conductive hearing loss and the Rinne test results are negative. Additionally, a reddish mass is observed located behind the tympanic membrane. What is the likely diagnosis?", "options": [{"label": "A", "text": "Acute otitis media", "correct": false}, {"label": "B", "text": "Chronic otitis media", "correct": false}, {"label": "C", "text": "Glomus tumour", "correct": true}, {"label": "D", "text": "Serous otitis media", "correct": false}], "correct_answer": "C. Glomus tumour", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OiQycjRlOQwU67flWFxY1746423573.png", "https://image.prepladder.com/content/zpo7ZIJCZDsT1qLJbLuY1746423573.png", "https://image.prepladder.com/content/E5Ge6j6JKnyNzmj20JDH1746423573.png", "https://image.prepladder.com/content/bAYJMRPeBi05vNKPwaKR1746423573.png", "https://image.prepladder.com/content/1CFesPSUnfb5L3AR8oNi1746423573.png", "https://image.prepladder.com/content/I6abHj3LLf7Gdn5hWBNA1746423573.png", "https://image.prepladder.com/content/33xN8vCWohP6CbAxi1Tx1746423573.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Glomus tumor (Paraganglioma)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumors originating from the <span class=\"customMeta\" data-dictid=\"064aee539616927771943ff21f49fa\">paraganglia</span> are known as paragangliomas, with <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tumors being a specific type of paraganglioma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumour type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benign (most common <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> tumor of middle ear)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paraganglionic cells or <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> bodies .</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Commonly seen in middle-aged individuals (40-50 years), with a higher <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> in females</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Glomus tympanicum:</strong> Arise from the <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> of the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> (tympanic plexus).</li>\n<li><strong>Glomus jugulare: </strong>Arises from the <span class=\"customMeta\" data-dictid=\"48872daf681692777186072f36702a\">dome</span> of the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb (sympathetic <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> covering the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> vein).<strong> </strong></li>\n</ol>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"228\" src=\"https://image.prepladder.com/content/OiQycjRlOQwU67flWFxY1746423573.png\" width=\"324\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spread </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inferiorly: </strong>To the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> foramen</li>\n<li><strong>Anteriorly: </strong>Invading into the <span class=\"customMeta\" data-dictid=\"c3f198d2a31692777193e32f2c868c\">nasopharynx</span> (blockage of <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube)</li>\n<li><strong>Posteriorly: </strong>Invading the mastoid</li>\n<li><strong>Superiorly: </strong>To the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> and middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> (IX-XII <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsy)</li>\n<li><strong>Laterally: </strong>To the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (present as a <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> <span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\">polyp</span> of the external <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal).</li>\n<li><strong>Medially:</strong> Invading the <span class=\"customMeta\" data-dictid=\"7732c8e49d169277719171da17de32\">labyrinth</span> and <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> <span class=\"customMeta\" data-dictid=\"70469583201692777196a8f1c66bfc\">pyramid</span> (dizziness and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy).</li>\n</ul>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"243\" src=\"https://image.prepladder.com/content/zpo7ZIJCZDsT1qLJbLuY1746423573.png\" width=\"279\"/></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"186\" src=\"https://image.prepladder.com/content/E5Ge6j6JKnyNzmj20JDH1746423573.png\" width=\"274\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hearing loss (gradually progressive conductive hearing loss)</li>\n<li>Pulsatile <span class=\"customMeta\" data-dictid=\"1e668dc8ba1692777200622a8a97f3\">tinnitus</span> (heartbeat like sounds): It is <span class=\"customMeta\" data-dictid=\"8a823442c116927771993039b6a37d\">synchronous</span> with pulse and can be temporarily stopped by <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> pressure.</li>\n<li>Bleeding from ear (profuse <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in case of polyp)</li>\n<li>Dizziness or <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> may appear.</li>\n<li>Symptoms like headache, sweating, palpitation, hypertension, anxiety due to <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> (catecholamine release)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> (locally invasive)</li>\n<li>HPE reveals<strong> Zell Ballen pattern,</strong> where <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> chief cells and <span class=\"customMeta\" data-dictid=\"d02faf3d3e16927771998a3442add3\">sustentacular</span> supporting cells <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> clusters (Zell Ballen) encircled by extensive <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> sinusoids.</li>\n<li>Preoperative <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> of the tumour is not performed due to the risk of profuse <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from its highly <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> thin-walled blood sinusoids and potential injury to the high <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb or <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elsharawy, Mohamed &amp; Alsaif, Hind &amp; Elsaid, Ayman &amp; Kredees, Ali. \" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Well-defined-nests-of-cuboidal-cells-zellballen-are-separated-by-highly-vascularized_fig5_259272100\" data-tags=\"\" height=\"262\" src=\"https://image.prepladder.com/content/bAYJMRPeBi05vNKPwaKR1746423573.png\" width=\"338\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Otoscopy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Red <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> through intact <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and bulging <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <strong>(glomus tympanicum).</strong></li>\n<li><strong>“Rising sun\" appearance</strong> due to the tumor originating from the floor of middle ear<strong> (glomus jugulare).</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Michael Hawke MD, Masafumi Ohki, Shigeru Kikuchi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Glomus_Jugulare_Tumor.jpg https://www.researchgate.net/figure/a-A-red-mass-was-observed-under-the-anterior-quadrant-of-the-tympanic-membrane-b_fig1_334371255\" data-tags=\"\" height=\"170\" src=\"https://image.prepladder.com/content/1CFesPSUnfb5L3AR8oNi1746423573.png\" width=\"462\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CECT (IOC)</strong> shows <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the carotico-jugular spine on the diseased side, known as <strong>Phelp’s sign.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jones J, Walizai T, Sharma R\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/jugular-paraganglioma\" data-tags=\"\" height=\"274\" src=\"https://image.prepladder.com/content/I6abHj3LLf7Gdn5hWBNA1746423573.png\" width=\"274\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>MRI scan revealed microhemorrhages within the tumor which appear as white and gray dots on MRI, creating a<strong> \"salt and pepper</strong>\" appearance.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"258\" src=\"https://image.prepladder.com/content/33xN8vCWohP6CbAxi1Tx1746423573.png\" width=\"258\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Angiography is used to identify the arteries supplying the tumor.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the amount of milk given to a term baby in the first 24 hours after delivery?", "options": [{"label": "A", "text": "40 ml/kg", "correct": false}, {"label": "B", "text": "50 ml/kg", "correct": false}, {"label": "C", "text": "60 ml/kg", "correct": true}, {"label": "D", "text": "80 ml/kg", "correct": false}], "correct_answer": "C. 60 ml/kg", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - 60ml/kg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly diabetic female patient is presented, as shown in the image. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Aspergillosis", "correct": false}, {"label": "B", "text": "Mucormycosis", "correct": true}, {"label": "C", "text": "Foreign body", "correct": false}, {"label": "D", "text": "Rhinosporidiosis", "correct": false}], "correct_answer": "B. Mucormycosis", "question_images": ["https://image.prepladder.com/content/Qyerd4zcEi6S846Vg7Tp1746423912.png"], "explanation_images": ["https://image.prepladder.com/content/fIc4uKCFSpsSvCVcQ6V11746424037.png", "https://image.prepladder.com/content/d8r7w5CGZs3qa9r9KAdF1746424037.png", "https://image.prepladder.com/content/ORMnaqg20c0yfcR8Avae1746424037.png", "https://image.prepladder.com/content/jxv5CtKQmCYSy3UEPrxd1746424037.png", "https://image.prepladder.com/content/XUKnfaJuvXCkjA99fLou1746424037.png", "https://image.prepladder.com/content/XmLEDWAmhvmaOn4DSoV51746424037.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:730px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mucormycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is an <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> disease caused by zygomycetes (phycomycetes) - Rhizopus, <span class=\"customMeta\" data-dictid=\"2cd8f411371692777193c9fa32b32c\">Mucor</span> and Absidia. <strong>Rhizopus Arrhizus </strong>is the most common pathogen</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Timleo\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Rhizopus\" data-tags=\"\" height=\"247\" src=\"https://image.prepladder.com/content/fIc4uKCFSpsSvCVcQ6V11746424037.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Rhizopus</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" CDC/Dr. Lucille K. Georg \" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Absidia\" data-tags=\"\" height=\"171\" src=\"https://image.prepladder.com/content/d8r7w5CGZs3qa9r9KAdF1746424037.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Absidia</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" Alison Burkett, M.D., Sawanan Saitornuang, B.S., Sixto M. Leal, Jr., M.D., Ph.D.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/microbiologyzygomycetes.html\" data-tags=\"\" height=\"173\" src=\"https://image.prepladder.com/content/ORMnaqg20c0yfcR8Avae1746424037.png\" width=\"305\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Mucor</strong> (Lactophenol cotton blue stained)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Begins in the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, where spores germinate and <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> mycelia → invade adjacent tissues, leading to local destruction.</p>\n<p>Fungi invade blood vessels, causing <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> and <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> in affected areas, which contributes to its high mortality rate (Angio-invasiveness)</p>\n<p><strong>Common Sites</strong></p>\n<ul>\n<li><strong>Rhinocerebral Form</strong>: Involves the nose, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> sinuses, and orbit; frequently seen in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</li>\n<li><strong>Pulmonary Infections</strong>: When the lungs are the primary site, the <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> can invade lung arteries, leading to serious complications.</li>\n<li>Others: Cutaneous mucormycosis, GI mucormycosis, Disseminated mucormycosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Rhinocerebral Zygomycosis</strong>:\n\t\t\t\t<ul>\n<li>Facial swelling, <strong>nasal discharge</strong> (often <strong>black</strong>), fever, and <strong>mucosal necrosis</strong>.</li>\n<li>Rapid <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> can lead to severe complications, including visual loss and neurological symptoms.</li>\n</ul>\n</li>\n<li><strong>Pulmonary Zygomycosis</strong>:\n\t\t\t\t<ul>\n<li>Symptoms may include cough, fever, and <strong>hemoptysis</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histological Examination</strong>:</p>\n<p>Diagnosis is confirmed by identifying broad, non-septate (or sparsely septate) hyphae.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"259\" src=\"https://image.prepladder.com/content/jxv5CtKQmCYSy3UEPrxd1746424037.png\" width=\"296\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Culture: </strong></p>\n<ul>\n<li>After <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> for 3-4 days on Sabouraud <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> at 30-37°C, the colonies are grey-white with a thick cottony, fluffy surface.</li>\n<li>Under the microscope, nonseptate, broad hyphae with aerial sporangiophores which end in a <span class=\"customMeta\" data-dictid=\"7234e0b4e11692777199d188770525\">sporangium</span> (a <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> containing spores are seen.)</li>\n</ul>\n<p><strong>a. </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/XUKnfaJuvXCkjA99fLou1746424037.png\" width=\"222\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> <strong>b</strong>.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"191\" src=\"https://image.prepladder.com/content/XmLEDWAmhvmaOn4DSoV51746424037.png\" width=\"247\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>a. Sabouraud's <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">dextrose</span> <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> (SDA) medium showing Rhizopus growth </strong></p>\n<p><strong>b.Microscopy of LPCB stained preparation demonstrating <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">morphology</span> of Rhizopus spp. (non-septate hyphae, sporangiophore, <span class=\"customMeta\" data-dictid=\"7234e0b4e11692777199d188770525\">sporangium</span> and spores)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intravenous amphotericin B combined, where appropriate, with <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> is the recommended treatment.</li>\n<li>Medical control of diabetes is required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a neonate presenting with frothing from the mouth and respiratory distress, with the X-ray provided below?", "options": [{"label": "A", "text": "Transient tachypnea of newborn", "correct": false}, {"label": "B", "text": "Congenital diaphragmatic hernia", "correct": false}, {"label": "C", "text": "Esophageal atresia with tracheo-esophageal fistula", "correct": true}, {"label": "D", "text": "Respiratory distress syndrome", "correct": false}], "correct_answer": "C. Esophageal atresia with tracheo-esophageal fistula", "question_images": ["https://image.prepladder.com/notes/80gW3kL6wPf8FKPA8jqY1747394166.png"], "explanation_images": ["https://image.prepladder.com/content/D2DaGB8Aju58utlJE3dd1746424473.png", "https://image.prepladder.com/notes/42fxzK1IT2o4SgYnNeQN1747394314.png", "https://image.prepladder.com/content/juoWgqu8Uqao8u60TLOp1746424505.png", "https://image.prepladder.com/content/aWeDNbkxmu08NZVhMg5G1746424518.png"], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\"&gt;Esophageal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\"&gt;atresia&lt;/span&gt; with tracheo-esophageal fistula</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tracheoesophageal fistula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Embryology:</strong> Disruption during embryonic development of the <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">trachea</span> and oesophagus.</li>\n<li><strong>Genetic Factors:</strong> Associated with syndromes like <strong>Feingold syndrome, CHARGE syndrome, and anophthalmia-esophageal-genital syndrome.</strong></li>\n<li><strong>Unknown Etiology:</strong> Factors such as advanced <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> age, ethnicity, obesity, low socioeconomic status, and smoking may be involved.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types of TEF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Type A: </strong>Isolated oesophagal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> without <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">tracheoesophageal</span> fistula</li>\n<li><strong>Type B:</strong> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> with <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">tracheoesophageal</span> fistula</li>\n<li><strong>Type C:</strong> <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">Proximal</span> oesophagal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">tracheoesophageal</span> fistula</li>\n<li><strong>Type D:</strong> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> with both <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">tracheoesophageal</span> fistulas</li>\n<li><strong>Type E: </strong>Isolated <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">tracheoesophageal</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> without associated oesophagal atresia</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"396\" src=\"https://image.prepladder.com/content/D2DaGB8Aju58utlJE3dd1746424473.png\" width=\"396\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Classic Symptoms:</strong> Frothing and bubbling at the mouth and nose, coughing, cyanosis, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> exacerbated by feeding.</li>\n<li><strong>Aspiration Pneumonia:</strong> More severe with <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fistula.</li>\n<li><strong>H-Type Fistula:</strong> Chronic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> issues, bronchospasm, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> in isolated cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Esophagogram</strong></li>\n<li><strong>Chest X-ray </strong>shows a<strong> gas-filled or gasless <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> and a coiled tube in the upper oesophagus. </strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Tracheoesophageal fistula\" data-author=\"NA\" data-hash=\"12843\" data-license=\"NA\" data-source=\"https://meduniver.com/Medical/pediatria/anomalii_pichevoda_u_rebenka.html\" data-tags=\"May2025\" height=\"657\" src=\"https://image.prepladder.com/notes/42fxzK1IT2o4SgYnNeQN1747394314.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Immediate Care:</strong> Maintain <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> patency, prevent aspiration, and use antibiotics.</li>\n<li><strong>Surgical Repair:</strong> Standard involves <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> of TEF and primary end-to-end anastomosis.</li>\n<li><strong>Alternative Approaches:</strong> Delayed primary closure, <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> ligation, <span class=\"customMeta\" data-dictid=\"544c039e7e1692777188f951bd6895\">gastrostomy</span> tube placement, or using gastric, jejunal, or <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> segments if the gap &gt;3-4 cm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Respiratory Complications:</strong> Risk of <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> pneumonia.</li>\n<li><strong>Esophageal Complications:</strong> <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">Feeding</span> difficulties, failure to thrive.</li>\n<li><strong>Associated Anomalies:</strong> Often part of<strong> VACTERL association</strong> (vertebral, anal, cardiac, tracheal, esophageal, renal, limb).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Improved Outcomes:</strong> Better survival rates due to advancements in care.</li>\n<li><strong>Long-Term Complications:</strong> Potential issues include <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> difficulties, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> strictures, and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> problems.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following symptoms does a patient with Reinke's edema classically present with?", "options": [{"label": "A", "text": "Diplophonia", "correct": true}, {"label": "B", "text": "Dysphonia", "correct": false}, {"label": "C", "text": "Dysphagia of liquids more than solids", "correct": false}, {"label": "D", "text": "Dysphagia of solids more than liquids", "correct": false}], "correct_answer": "A. Diplophonia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pK9cMfI5DJqOih5zzITU1746424637.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What kind of family would the surveyor categorize the household as, considering it consists of a 35-year-old man, his 6-week pregnant wife, a 3-year old child, and the temporary presence of the man's brother and his wife during their winter vacation?", "options": [{"label": "A", "text": "Joint family", "correct": false}, {"label": "B", "text": "Nuclear family", "correct": true}, {"label": "C", "text": "Extended family", "correct": false}, {"label": "D", "text": "Third generation family", "correct": false}], "correct_answer": "B. Nuclear family", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the fluid of choice for shock in a child with severe acute malnutrition?", "options": [{"label": "A", "text": "Normal saline", "correct": false}, {"label": "B", "text": "Ringer lactate", "correct": false}, {"label": "C", "text": "10% dextrose", "correct": false}, {"label": "D", "text": "Ringer's lactate with 5% dextrose", "correct": true}], "correct_answer": "D. Ringer's lactate with 5% dextrose", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Ringer's &lt;span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\"&gt;lactate&lt;/span&gt; with 5% dextrose</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of Severe <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Malnutrition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Initial Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Monitoring</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Treat/Prevent Hypoglycemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt;54 mg/dL (3 mmol/L)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asymptomatic:</p>\n<ul>\n<li>50 mL of 10% glucose/sucrose orally/NG</li>\n<li>Follow with first feed</li>\n<li>F-75 starter diet every 2 hours</li>\n</ul>\n<p>Symptomatic:</p>\n<ul>\n<li>10% <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">dextrose</span> IV 5 mL/kg</li>\n<li>Follow with 50 mL 10% <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> via NG tube</li>\n<li>Start antibiotics immediately</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> every 30 minutes until stable</li>\n<li>Level of consciousness</li>\n<li>Vital signs every 2 hours</li>\n<li>Feed <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> volume</li>\n<li>Signs of deterioration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2. Treat/Prevent Hypothermia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Temperature &lt;35.5°C (rectal) or &lt;35°C (axillary)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate interventions:</p>\n<ul>\n<li>Warm clothing with head cover</li>\n<li>Skin-to-skin contact with mother</li>\n<li>Warm room (25-30°C)</li>\n<li>Warm feeds</li>\n<li>Overhead warmer/heat convector</li>\n</ul>\n<p>Avoid:</p>\n<ul>\n<li>Rapid rewarming</li>\n<li>Direct heat sources</li>\n<li>Prolonged exposure</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temperature every 30 minutes until &gt;36.5°C</li>\n<li>Then every 2 hours until &gt;37.5°C</li>\n<li>Watch for overheating</li>\n<li>Monitor blood glucose</li>\n<li>Check for infection signs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3. Treat/Prevent Dehydration</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical signs:</p>\n<ul>\n<li>Thirst</li>\n<li>Sunken eyes</li>\n<li>Reduced skin turgor</li>\n<li>Weak pulses</li>\n<li>Cold extremities</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ReSoMal administration:</p>\n<ul>\n<li>5-10 mL/kg/hour for first 12 hours</li>\n<li>Maximum 12 hours for rehydration</li>\n<li>Replace ongoing losses</li>\n</ul>\n<p>If shock present:</p>\n<ul>\n<li>Ringer's <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> with 5% dextrose</li>\n<li>15 mL/kg over first hour</li>\n<li>Reassess and repeat if needed</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Every 30 minutes for first 2 hours:</p>\n<ul>\n<li>Pulse rate</li>\n<li>Respiratory rate</li>\n<li>Urine output</li>\n<li>Stool frequency</li>\n</ul>\n<ul>\n<li>Signs of overhydration</li>\n<li>Mental status</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4. Correct <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">Electrolyte</span> Imbalance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common abnormalities:</p>\n<ul>\n<li>Hypokalemia</li>\n<li>Hypomagnesemia</li>\n<li>Excess total body sodium</li>\n<li>Metabolic acidosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium supplementation:</p>\n<ul>\n<li>3-4 mEq/kg/day</li>\n<li>Continue for 2 weeks</li>\n</ul>\n<p>Magnesium:</p>\n<ul>\n<li>Day 1: 0.3 mL/kg IM (max 2 mL)</li>\n<li>Then 0.8-1.2 mEq/kg/day oral</li>\n</ul>\n<p>Restrict sodium intake</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Daily electrolytes</li>\n</ul>\n<ul>\n<li>ECG if severe hypokalemia</li>\n<li>Clinical signs of deficiency</li>\n<li>Urine output</li>\n<li>Mental status changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5. Treat/Prevent Infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Screen for:</p>\n<ul>\n<li>Sepsis</li>\n<li>Pneumonia</li>\n<li>UTI</li>\n<li>TB</li>\n<li>HIV</li>\n<li>Malaria in <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> areas</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First-line antibiotics:</p>\n<ul>\n<li>Ampicillin 50 mg/kg 6 hourly</li>\n<li>Gentamicin 7.5 mg/kg daily</li>\n</ul>\n<p>If no improvement in 48h:</p>\n<ul>\n<li>Cefotaxime 100-150 mg/kg/day</li>\n<li>or Ceftriaxone 50-75 mg/kg/day</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temperature</li>\n<li>Respiratory rate</li>\n<li>Heart rate</li>\n<li>Clinical response</li>\n<li>Culture results</li>\n<li>Inflammatory markers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6. <span class=\"customMeta\" data-dictid=\"e3ae50eb0b1692777192c2315d2da8\">Micronutrient</span> Supplementation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common deficiencies:</p>\n<ul>\n<li>Vitamin A</li>\n<li>Zinc</li>\n<li>Iron</li>\n<li>Folic acid</li>\n<li>Copper</li>\n<li>Other vitamins/minerals</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitamin A (Day 1):</p>\n<ul>\n<li>6-12 months: 100,000 IU</li>\n<li>&gt;12 months: 200,000 IU</li>\n</ul>\n<p>Daily supplements:</p>\n<ul>\n<li>Folic acid 1mg/day</li>\n<li>Zinc 2mg/kg/day</li>\n<li>Copper 0.2-0.3 mg/kg/day</li>\n<li>Iron 3mg/kg/day (after stabilization)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical signs of deficiency</li>\n<li>Response to therapy</li>\n<li>Weight gain</li>\n<li>Appetite improvement</li>\n<li>Complications</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7. Initiate Feeding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assessment:</p>\n<ul>\n<li>Appetite</li>\n<li>Ability to feed</li>\n<li>Complications</li>\n<li>Metabolic status</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Initial feeding:</p>\n<ul>\n<li>F-75 formula (75 kcal/100 mL)</li>\n<li>Start 80 kcal/kg/day</li>\n<li>Increase to 100 kcal/kg/day</li>\n<li>2-hourly feeds initially</li>\n</ul>\n<p>Volume per feed:</p>\n<p>11 mL/kg/feed initially</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Feed tolerance</li>\n<li>Volume consumed</li>\n<li>Weight changes</li>\n<li>Edema</li>\n<li>Vomiting/diarrhea</li>\n<li>Refeeding syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8. Catch-up Growth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Indicators for transition:</p>\n<ul>\n<li>Return of appetite</li>\n<li>Reduced/resolved edema</li>\n<li>Metabolic stability</li>\n<li>Infection control</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transition to F-100:</p>\n<ul>\n<li>Increase to 150-200 kcal/kg/day</li>\n<li>Protein 4-6 g/kg/day</li>\n<li>6 feeds per day</li>\n<li>Gradual volume increase</li>\n</ul>\n<p>Target weight gain: &gt;10 g/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Daily weight</li>\n<li>Height weekly</li>\n<li>MUAC weekly</li>\n<li>Appetite</li>\n<li>Clinical status</li>\n<li>Feed intake</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9. <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> Stimulation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assess:</p>\n<ul>\n<li>Developmental status</li>\n<li>Interaction level</li>\n<li>Physical capabilities</li>\n<li>Emotional state</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Daily activities:</p>\n<ul>\n<li>Structured play 15-30 min</li>\n<li>Physical activity as tolerated</li>\n<li>Emotional support</li>\n<li>Mother-child bonding</li>\n<li>Age-appropriate stimulation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Development progress</li>\n<li>Activity level</li>\n<li>Social interaction</li>\n<li>Emotional response</li>\n<li>Motor skills</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10. Prepare for Follow-up</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Discharge criteria:</p>\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> x 2 weeks</li>\n<li>Weight-for-height &gt; -2 SD</li>\n<li>Good appetite</li>\n<li>Clinically well</li>\n<li>Completed immunizations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Discharge planning:</p>\n<ul>\n<li>Family education</li>\n<li>Follow-up schedule</li>\n<li>Community health worker linkage</li>\n<li>Emergency care plan</li>\n<li>Nutrition counseling</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Post-discharge:</p>\n<ul>\n<li>Weekly follow-up initially</li>\n<li>Monthly weight checks</li>\n<li>Growth monitoring</li>\n<li>Development assessment</li>\n<li>Immunization status</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which government program aims to provide health checkups and services for children aged 0-18, including a focus on those not attending school?", "options": [{"label": "A", "text": "Rashtriya Bal Swasthya Karyakaram", "correct": true}, {"label": "B", "text": "Janani Suraksha Yojna", "correct": false}, {"label": "C", "text": "Navjaat Shishu Suraksha Karyakaram", "correct": false}, {"label": "D", "text": "Mid day meal program", "correct": false}], "correct_answer": "A. Rashtriya Bal Swasthya Karyakaram", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a correct match for ABCD according to pediatric advanced life support?", "options": [{"label": "A", "text": "Airway", "correct": false}, {"label": "B", "text": "Breathing", "correct": false}, {"label": "C", "text": "Circulation", "correct": false}, {"label": "D", "text": "Dehydration", "correct": true}], "correct_answer": "D. Dehydration", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Deh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a 5-year-old girl presented to the clinic with symptoms of fever, cough, red eyes, running nose, and rash, as depicted in the image of the child's appearance?", "options": [{"label": "A", "text": "Mumps", "correct": false}, {"label": "B", "text": "Measles", "correct": true}, {"label": "C", "text": "Chickenpox", "correct": false}, {"label": "D", "text": "Erythema infectiosum", "correct": false}], "correct_answer": "B. Measles", "question_images": ["https://image.prepladder.com/content/kLfUcQc6TVbB0WBUDXyt1746426084.png"], "explanation_images": ["https://image.prepladder.com/content/ekcBvwUbtiqwrsgI2Ngt1746426167.png"], "explanation": "<p>Correct Answer B - Measles</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Measles</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Measles (rubeola) is a highly <span class=\"customMeta\" data-dictid=\"6f6ef8bf7c1692777184dfdf8cf45d\">communicable</span> childhood <span class=\"customMeta\" data-dictid=\"4f279b047716927771872685599ba9\">exanthematous</span> illness caused by the <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> virus, an <strong>RNA virus</strong> from the <strong>Paramyxoviridae family.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contact with <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> aerosols (through the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or conjunctiva)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary viremia</strong> occurs, resulting in infection of the <span class=\"customMeta\" data-dictid=\"77c058b3b21692777197f5fd539d12\">reticuloendothelial</span> system, followed by<strong> secondary viremia,</strong> which results in <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8-12 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Period of infectivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>From 3 days before to 4 days after the <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> onset</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common in preschool children</li>\n<li><strong>Prodromal phase: </strong>Fever (before rash), rhinorrhea, conjunctival <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and a dry hacking cough.</li>\n<li><strong>Koplik spots</strong>, <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> for measles, appear on the <strong>2nd or 3rd day of illness </strong>as grey-white, sand-like lesions with surrounding <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> on the <strong>buccal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> opposite the lower second molars.</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The erythematous <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> appears on the 4th day, starting behind the ears, along the hairline, and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cheeks, then <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> to the rest of the body over the next 2-3 days.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Koplik%27s_spots#/media/File:Koplik_spots,_measles_6111_lores.jpg\" data-tags=\"\" height=\"444\" src=\"https://image.prepladder.com/content/ekcBvwUbtiqwrsgI2Ngt1746426167.png\" width=\"493\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptomatic and conservative (antipyretics, maintenance of hygiene, ensuring adequate fluid and <span class=\"customMeta\" data-dictid=\"39156a37b21692777183372a301aa8\">caloric</span> intake, and humidification).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with the findings shown in the image below. What is the true statement regarding this condition?", "options": [{"label": "A", "text": "Kwashiorkor due to protein malnutrition", "correct": true}, {"label": "B", "text": "Kwashiorkor due to calorie malnutrition", "correct": false}, {"label": "C", "text": "Marasmus due to protein malnutrition", "correct": false}, {"label": "D", "text": "Marasmus due to calorie malnutrition", "correct": false}], "correct_answer": "A. Kwashiorkor due to protein malnutrition", "question_images": ["https://image.prepladder.com/notes/v4Fo1U6rzF2W816m27GX1747394502.png"], "explanation_images": ["https://image.prepladder.com/content/bWSNzkqT5f54ANr13qri1746426492.png"], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"824be8f29f16927771914124353d6b\"&gt;Kwashiorkor&lt;/span&gt; due to protein malnutrition</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3 style=\"text-align:center\"><strong>Kwashiorkor</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3 style=\"text-align:center\"><strong>Marasmus</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pitting Edema:</strong> Characterized by swelling, often starting in the legs and feet, leaving a persistent <span class=\"customMeta\" data-dictid=\"cdb5523e491692777190f8bc3775ff\">indentation</span> when pressed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe Wasting:</strong> The child appears extremely thin, with prominent bones and little body fat.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sugar Baby Appearance:</strong> The child may look deceptively healthy due to oedema, despite being malnourished.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monkey Facies:</strong> A sunken appearance of the cheeks due to loss of fat, giving an aged look.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscle Wasting:</strong> Despite the swollen appearance, muscle loss is present, leading to weakness and hypotonia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Baggy Pants Appearance:</strong> Loose, sagging skin around the <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> caused by significant muscle and fat loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mental and Neurological Symptoms:</strong> The child is apathetic, irritable, and may have <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> difficulties.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alertness: </strong>Children with <span class=\"customMeta\" data-dictid=\"122de6274d169277719141ab2c8004\">marasmus</span> remain mentally alert.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hair Changes:</strong> Hair may lose colour, become thin, and show <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> bands of colour (\"flag sign\").</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Absence of Edema:</strong> Unlike kwashiorkor, <span class=\"customMeta\" data-dictid=\"122de6274d169277719141ab2c8004\">marasmus</span> does not involve <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or oedema.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin Changes:</strong> Includes hyperpigmentation, peeling skin (\"flaky paint\" appearance), and colour changes, particularly in the buttocks, perineum, and thighs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypoglycemia Risk:</strong> The liver's <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> capacity to produce <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> increases the risk of low blood sugar.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastrointestinal Issues:</strong> Anorexia, vomiting, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension. <strong>Anaemia is</strong> present due to nutritional deficiencies.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypothermia Risk:</strong> The child may struggle to maintain <span class=\"customMeta\" data-dictid=\"4a7581c8b01692777183819f38c633\">body temperature</span> due to energy depletion.</p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child is brought for evaluation of short stature. His height is comparable with his parent’s height and his bone age corresponds to his chronological age. What is the diagnosis?", "options": [{"label": "A", "text": "Familial short stature", "correct": true}, {"label": "B", "text": "Constitutional delay", "correct": false}, {"label": "C", "text": "Undernutrition", "correct": false}, {"label": "D", "text": "Growth hormone deficiency", "correct": false}], "correct_answer": "A. Familial short stature", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\"&gt;Familial&lt;/span&gt; short statu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the interpretation of the given pedigree chart?", "options": [{"label": "A", "text": "Autosomal dominant", "correct": true}, {"label": "B", "text": "Autosomal recessive", "correct": false}, {"label": "C", "text": "X-linked recessive", "correct": false}, {"label": "D", "text": "X-linked dominant", "correct": false}], "correct_answer": "A. Autosomal dominant", "question_images": ["https://image.prepladder.com/notes/aOrYY3usL82CTWfobGGv1747378869.png"], "explanation_images": ["https://image.prepladder.com/content/s1wfDl3FLMTNHxECWfag1746426560.png", "https://image.prepladder.com/content/IZhuK6ihsTnDjEByX0Pq1746426571.png", "https://image.prepladder.com/content/Jpi9i8XZoCSMByBIU4n51746426585.png", "https://image.prepladder.com/content/BLSdyeUdodDwEwcBQ3zA1746426596.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In order to investigate the dietary habits of the diverse population residing in the urban region of Delhi, a research study is being conducted. Which of the following methods can be utilized to acquire a representative sample for the study?", "options": [{"label": "A", "text": "Cluster random sampling", "correct": false}, {"label": "B", "text": "Stratified random sampling", "correct": true}, {"label": "C", "text": "Simple random sampling", "correct": false}, {"label": "D", "text": "Systematic random sampling", "correct": false}], "correct_answer": "B. Stratified random sampling", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ In a diverse population, such as the one in urban Delhi, stratified random sampling is an effective method to ensure that different subgroups (or strata) of the population are represented in the sample.</li><li>↳ stratified random sampling</li><li>↳ In this case, the population can be divided into subgroups based on factors like socioeconomic status, age, dietary preferences, or geographic location within the urban region.</li><li>↳ After dividing the population into strata, random samples are then taken from each group, ensuring that the sample is representative of the entire population.</li><li>↳ Cluster random sampling (Option A): is incorrect because cluster sampling is used when the population is divided into clusters, often geographically, and entire clusters are randomly selected. While this can be used in large-scale studies, it doesn't specifically ensure representation of the diverse subgroups within the population as well as stratified sampling.</li><li>↳ Cluster random sampling (Option A):</li><li>↳ cluster sampling</li><li>↳ Simple random sampling (Option C): is incorrect because simple random sampling involves selecting individuals from the entire population randomly without considering any subgroups. While it may still give a sample, it may not adequately represent the diverse dietary habits of the population in urban Delhi.</li><li>↳ Simple random sampling (Option C):</li><li>↳ simple random sampling</li><li>↳ Systematic random sampling (Option D): is incorrect because systematic random sampling involves selecting every nth individual from a list or a sequence of individuals. While it's easier to implement, it doesn't ensure that different groups within the population are represented as effectively as stratified sampling.</li><li>↳ Systematic random sampling (Option D):</li><li>↳ systematic random sampling</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Giving class in a village for wound care after a dog bite by enacting it is which mode of health communication?", "options": [{"label": "A", "text": "Lecture", "correct": false}, {"label": "B", "text": "Group discussion", "correct": false}, {"label": "C", "text": "Flashcards", "correct": false}, {"label": "D", "text": "Demonstration", "correct": true}], "correct_answer": "D. Demonstration", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gonadal growth corresponds with _____.", "options": [{"label": "A", "text": "Brain", "correct": false}, {"label": "B", "text": "Skeletal system", "correct": true}, {"label": "C", "text": "Lymphoid growth", "correct": false}, {"label": "D", "text": "Dental growth", "correct": false}], "correct_answer": "B. Skeletal system", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pwEIKbMwlSYVI5TMhwfd1746426776.png"], "explanation": "<p>Correct Answer B - Sk\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:115px\">\n<p><strong>Brain growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>The brain enlarges rapidly during the latter months of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> life and early months of <span class=\"customMeta\" data-dictid=\"ba016f80c31692777196b151e95b8f\">postnatal</span> life. At birth, the head size is about 65-70% of the expected head size in adults. It reaches 90% of the adult head size in two years. Full adult size is reached by age 6.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:115px\">\n<p><strong>Growth of gonads </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gonadal growth is <span class=\"customMeta\" data-dictid=\"ea2c7a14ba1692777186a074b34ee8\">dormant</span> during childhood and becomes conspicuous during puberty.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:115px\">\n<p><strong>Growth of body fat and muscle mass </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Body tissues can be divided into fat and fat-free (lean) components. The <span class=\"customMeta\" data-dictid=\"5cc60344e3169277719143971ee179\">lean body mass</span> includes muscle tissue, internal organs, and skeleton. The growth in <span class=\"customMeta\" data-dictid=\"5cc60344e3169277719143971ee179\">lean body mass</span> is primarily due to increased skeletal and muscle mass. <span class=\"customMeta\" data-dictid=\"5cc60344e3169277719143971ee179\">Lean body mass</span> correlates closely with stature.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:115px\">\n<p><strong>Skeletal growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skeletal growth is a continuous process occurring throughout childhood and adolescence. It is steady until the pubertal growth spurt when it accelerates and subsequently slows considerably. The <span class=\"customMeta\" data-dictid=\"70f596ae8f16927771983211d9e56f\">skeleton</span> matures once the <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> or growth plates at the end of long bones <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> to the <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> or diaphysis. This occurs by about 18 years in girls and 20-22 years in boys.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:67px; vertical-align:top; width:115px\">\n<p><strong>Lymphoid growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The growth of <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> tissue is most notable during the mid-childhood. During this period, the <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> tissue is overgrown, and its mass may appear larger than that of a fully <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> adult. It reaches 200% of adult size during childhood.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a patient who presents with a headache and thick nasal discharge, and upon examination, shows hypertrophy of the inferior turbinate with a mulberry appearance?", "options": [{"label": "A", "text": "Atrophic rhinitis", "correct": false}, {"label": "B", "text": "Common cold", "correct": false}, {"label": "C", "text": "Hypertrophic rhinitis", "correct": true}, {"label": "D", "text": "Nasal polyp", "correct": false}], "correct_answer": "C. Hypertrophic rhinitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old pregnant woman who has the thalassemia trait visits the clinic for genetic counselling. Her husband is also confirmed to have the thalassemia trait. Considering their genetic background, what is the likelihood of their next offspring having thalassemia?", "options": [{"label": "A", "text": "100%", "correct": false}, {"label": "B", "text": "50%", "correct": false}, {"label": "C", "text": "75%", "correct": false}, {"label": "D", "text": "25%", "correct": true}], "correct_answer": "D. 25%", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Punnett Square Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>β</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>β⁰</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>β</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">β/β</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">β/β⁰</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>β⁰</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">β/β⁰</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">β⁰/β⁰</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the neonatal resuscitation protocol, below what heart rate are chest compressions initiated?", "options": [{"label": "A", "text": "70", "correct": false}, {"label": "B", "text": "60", "correct": true}, {"label": "C", "text": "80", "correct": false}, {"label": "D", "text": "100", "correct": false}], "correct_answer": "B. 60", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - 60</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>NRP <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">Neonatal</span> Chest Compressions Guidelines</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Heart rate below 60/min despite 30 seconds of PPV</li>\n<li>Continue until heart rate is 60/min or more</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Two-thumb technique is preferred</li>\n<li>Thumbs depress lower third of sternum</li>\n<li>Hands encircle <span class=\"customMeta\" data-dictid=\"bd42520ade1692777200832d4ca9bb\">torso</span> with fingers supporting back</li>\n<li>Avoid using xiphisternum</li>\n<li>Thumbs remain in contact during <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> and release</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Depth &amp; Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Compress chest three times</li>\n<li>One breath for ventilation</li>\n<li>Use 3:1 ratio (compression:ventilation)</li>\n<li>Complete cycle in 2 minutes</li>\n<li>Check <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> or <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> pulse periodically</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Check heart rate after 60 seconds of CC</li>\n<li>HR below 60: Continue CC with PPV and medications</li>\n<li>HR 60 or above: Stop CC, continue PPV until HR &gt;100 and <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> breathing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Important Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Must always accompany with BMV (bag-mask ventilation)</li>\n<li>Only oxygenated blood should be circulated</li>\n<li>Ventilate between compressions</li>\n<li>Positive breath should follow every third CC</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Broken ribs</li>\n<li>Liver laceration</li>\n<li>Pneumothorax</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following correctly represents the effect of the mutation causing sickle cell anaemia?", "options": [{"label": "A", "text": "Glutamate by valine at the 6th position", "correct": true}, {"label": "B", "text": "Valine by glutamate at the 6th position", "correct": false}, {"label": "C", "text": "Glutamate by valine at the 5th position", "correct": false}, {"label": "D", "text": "Valine by glutamate at the 5th position", "correct": false}], "correct_answer": "A. Glutamate by valine at the 6th position", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a sensitive and specific marker of intestinal inflammation?", "options": [{"label": "A", "text": "Procalcitonin", "correct": false}, {"label": "B", "text": "Fecal lactoferrin", "correct": true}, {"label": "C", "text": "Tissue transglutaminase IgA", "correct": false}, {"label": "D", "text": "High-sensitivity C-reactive protein", "correct": false}], "correct_answer": "B. Fecal lactoferrin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with CSF otorrhea?", "options": [{"label": "A", "text": "Battle sign", "correct": true}, {"label": "B", "text": "Traumatic rupture of the tympanic membrane", "correct": false}, {"label": "C", "text": "Penetrating injury to the eye", "correct": false}, {"label": "D", "text": "Fracture of the roof of the nose", "correct": false}], "correct_answer": "A. Battle sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gKr76NaKZNEXXhXxwBzx1746427098.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Temporal bone fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cribriform plate(most common)</strong></li>\n<li>Roof of <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> air cells</li>\n<li>Frontal sinus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sphenoid sinus(following trauma)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CSF reaches the middle ear, escaping through the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube into the nose(CSF otorhinorrhea)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child was brought to the clinic by her mother with reduced hearing for the past 2-3 months. The otoscopy finding is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hemorrhagic Myringitis bullosa", "correct": true}, {"label": "B", "text": "Serous otitis media", "correct": false}, {"label": "C", "text": "Acute otitis media", "correct": false}, {"label": "D", "text": "Myringitis granulosa", "correct": false}], "correct_answer": "A. Hemorrhagic Myringitis bullosa", "question_images": ["https://image.prepladder.com/content/kpK5qAR3ICYKRi5ZlsiP1746427178.png"], "explanation_images": ["https://image.prepladder.com/content/AMy2kiBnT86UFh7DgC2d1746427212.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old female patient presented to the outpatient department with migratory arthritis, and examination revealed a pan-systolic murmur. An echocardiography was performed, which was suggestive of mitral regurgitation. A biopsy specimen was obtained, and the image is provided below. What is the most likely lesion shown in the histopathology slide?", "options": [{"label": "A", "text": "Aschoff’s bodies", "correct": true}, {"label": "B", "text": "Epithelioid granuloma", "correct": false}, {"label": "C", "text": "Granulomatous vasculitis", "correct": false}, {"label": "D", "text": "Granuloma inguinale", "correct": false}], "correct_answer": "A. Aschoff’s bodies", "question_images": ["https://image.prepladder.com/content/tse0XXTVKVU6AETQvBLf1746427209.png"], "explanation_images": ["https://image.prepladder.com/content/o6sRIQHSwcZO5bMD4mB81746427271.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately reflects the truth about health propaganda?", "options": [{"label": "A", "text": "It is actively acquired", "correct": false}, {"label": "B", "text": "It appeals to emotions", "correct": true}, {"label": "C", "text": "It is behaviour centred", "correct": false}, {"label": "D", "text": "It aids in developing a reflective behaviour", "correct": false}], "correct_answer": "B. It appeals to emotions", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about inverted papilloma?", "options": [{"label": "A", "text": "Malignant and invasive", "correct": false}, {"label": "B", "text": "Benign and non-invasive", "correct": false}, {"label": "C", "text": "Benign and invasive", "correct": true}, {"label": "D", "text": "Malignant and non-invasive", "correct": false}], "correct_answer": "C. Benign and invasive", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lIr10JQssWbpqmqbGgrt1746427558.png", "https://image.prepladder.com/content/kGrZKLDidxMN5nXJH78N1746427558.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-year-old was brought to the emergency department with difficulty swallowing for the last few hours. The X-ray is given below. Which is the next best step to manage this patient? [", "options": [{"label": "A", "text": "Bronchoscopy", "correct": false}, {"label": "B", "text": "Esophagoscopy", "correct": true}, {"label": "C", "text": "Tracheostomy", "correct": false}, {"label": "D", "text": "Heimlich's manoeuvre", "correct": false}], "correct_answer": "B. Esophagoscopy", "question_images": ["https://image.prepladder.com/content/3TVJvdAiF8bmD7F8Dq801746427632.png"], "explanation_images": ["https://image.prepladder.com/content/G7PW6pfL6Oa9QQR5scAY1746427665.png", "https://image.prepladder.com/content/Qk8MJveBy8QeKoMkzGga1746427665.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Emergency</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (inability to handle oral secretions)</li>\n<li>Disk batteries</li>\n<li>Sharp-pointed objects</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Immediate <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> removal </strong></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Urgent </strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Blunt objects</li>\n<li>Incomplete obstruction</li>\n<li>Multiple magnets (or single <span class=\"customMeta\" data-dictid=\"883e21a28016927771915738a46f85\">magnet</span> plus another ferromagnetic object within <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> reach)</li>\n<li>Coins</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Endoscopic removal within 12 to 24 hours<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Non Urgent</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Objects in stomach &gt;2.5cm diameter</li>\n<li>Disc battery in the stomach for up to 48 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> if asymptomatic</li>\n<li>Blunt objects that fail to pass the stomach in 3-4 weeks</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">Observation<strong> </strong></td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the number of the deliveries performed by Type-A PHC in a month?", "options": [{"label": "A", "text": "Less than 20", "correct": true}, {"label": "B", "text": "20 or above", "correct": false}, {"label": "C", "text": "Less than 30", "correct": false}, {"label": "D", "text": "30 or above", "correct": false}], "correct_answer": "A. Less than 20", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At which of the following centers are the records of eligible couples maintained?", "options": [{"label": "A", "text": "PHC", "correct": false}, {"label": "B", "text": "CHC", "correct": false}, {"label": "C", "text": "Sub-centre", "correct": true}, {"label": "D", "text": "District hospital", "correct": false}], "correct_answer": "C. Sub-centre", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which diagnosis is most likely for a patient experiencing painful vesicles in the external auditory meatus and over the tympanic membrane, along with facial nerve palsy? Furthermore, which specific site is affected in this case?", "options": [{"label": "A", "text": "Ramsay Hunt syndrome and basal ganglion", "correct": false}, {"label": "B", "text": "Ramsay Hunt syndrome and geniculate ganglion", "correct": true}, {"label": "C", "text": "Melkersson syndrome and trigeminal ganglion", "correct": false}, {"label": "D", "text": "Melkersson syndrome and otic ganglion", "correct": false}], "correct_answer": "B. Ramsay Hunt syndrome and geniculate ganglion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sOJphZNNZxI9bZUEj1Am1746427965.png", "https://image.prepladder.com/notes/tdWmrJM6Q4N1QwGxb97W1747390798.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "You are administering vitamin A supplements to an 8-month-old infant for two consecutive days. What is the recommended dose?", "options": [{"label": "A", "text": "25,000 IU", "correct": false}, {"label": "B", "text": "50,000 IU", "correct": false}, {"label": "C", "text": "100,000 IU", "correct": true}, {"label": "D", "text": "200,000 IU", "correct": false}], "correct_answer": "C. 100,000 IU", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What vitamin deficiency leads to xerophthalmia, a condition characterized by dryness of the eyes?", "options": [{"label": "A", "text": "Vitamin A", "correct": true}, {"label": "B", "text": "Vitamin B", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": false}, {"label": "D", "text": "Vitamin D", "correct": false}], "correct_answer": "A. Vitamin A", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man dies due to a myocardial infarction. Which stains can be used to see the infarct in the heart while conducting an autopsy?", "options": [{"label": "A", "text": "Oil Red O", "correct": false}, {"label": "B", "text": "Triphenyl tetrazolium chloride", "correct": true}, {"label": "C", "text": "Sudan black B", "correct": false}, {"label": "D", "text": "Masson's trichrome", "correct": false}], "correct_answer": "B. Triphenyl tetrazolium chloride", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Dvdsf4zP3WvwiCqoJYcs1746428131.png", "https://image.prepladder.com/content/GbWUbIIs4g8fxEc1qIYq1746428142.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The duration for which copper T 380 A remains effective is referred to as its shelf life.", "options": [{"label": "A", "text": "3 years", "correct": false}, {"label": "B", "text": "5 years", "correct": false}, {"label": "C", "text": "7 years", "correct": false}, {"label": "D", "text": "10 years", "correct": true}], "correct_answer": "D. 10 years", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following situations is confidentiality upheld?", "options": [{"label": "A", "text": "Group discussion", "correct": false}, {"label": "B", "text": "Counselling", "correct": true}, {"label": "C", "text": "Panel discussion", "correct": false}, {"label": "D", "text": "Seminar", "correct": false}], "correct_answer": "B. Counselling", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young person with recurrent seasonal conjunctivitis presents with itchiness and eye-watering. What is the most likely cell involved in the immediate phase of this condition?", "options": [{"label": "A", "text": "Eosinophils", "correct": false}, {"label": "B", "text": "Mast cells", "correct": true}, {"label": "C", "text": "Neutrophils", "correct": false}, {"label": "D", "text": "Lymphocytes", "correct": false}], "correct_answer": "B. Mast cells", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type I <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reaction phases and its features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seconds to minutes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mast cell/basophil degranulation</strong>: <span class=\"customMeta\" data-dictid=\"a54166a5961692777189c5557f61f3\">IgE</span> <span class=\"customMeta\" data-dictid=\"2cf4952c63169277718543a0883583\">cross-linking</span> leads to the release of <span class=\"customMeta\" data-dictid=\"b5d4ddbfe71692777189a12acd5502\">histamine</span> and other mediators.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-12 hours, peaks at 24-48 hours, lasting up to days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inflammatory cell recruitment</strong>: Cytokines/chemokines attract eosinophils, neutrophils, and macrophages, causing sustained inflammation. <strong>(Options A &amp; C ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who is a teacher by profession presents to the clinic with hoarseness of voice. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Vocal polyp", "correct": false}, {"label": "B", "text": "Vocal cyst", "correct": false}, {"label": "C", "text": "Vocal nodule", "correct": true}, {"label": "D", "text": "Reinke's oedema", "correct": false}], "correct_answer": "C. Vocal nodule", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/EtEJSmwy0vihnfyy8hFY1747390951.png"], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vocal <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">Nodule</span> (Singer or screamer's nodule)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vocal Polyp</strong></p>\n<p><strong>(Option A)</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic vocal abuse (teachers, actors, vendors or pop singers.)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden Vocal abuse like shouting (Men in the age group of 30-50 years).</li>\n<li>Heavy smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laterality </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral or symmetrical</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location </strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Free edge of vocal cord at the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> 1/3rd and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> 2/3rd. This</p>\n<p>is the area of maximum <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> of the vocal cord.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Same as vocal nodules.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sessile , Reddish in the early stage and white in the chronic stage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smooth and pedunculated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hoarseness, <span class=\"customMeta\" data-dictid=\"70f48cb1981692777202b78ba53214\">vocal fatigue</span> and neck pain on prolonged phonation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hoarseness of voice and <span class=\"customMeta\" data-dictid=\"28f07d3bee1692777186c271b5856e\">diplophonia</span> (double voice due to different vibrating frequencies of two vocal cords)</li>\n<li>Large polyps- dyspnea, stridor, choking.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initially, voice rest.</li>\n<li>If it fails -</li>\n<li>microscopic <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> without injuring the vocal ligament</li>\n<li>Speech therapy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Microscopic excision</li>\n<li>Speech therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old school-going girl came for a health checkup. Her Hb is 9 g/dL. Which of the following government programs is likely to provide significant benefit to her health?", "options": [{"label": "A", "text": "Rashtriya bal swasthya karyakram", "correct": true}, {"label": "B", "text": "Janani suraksha Yojana", "correct": false}, {"label": "C", "text": "Pradhan Mantri Matru Vandana Yojana", "correct": false}, {"label": "D", "text": "Navjat Shishu Karyakram Yojana", "correct": false}], "correct_answer": "A. Rashtriya bal swasthya karyakram", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is implicated in the pathogenesis of rheumatoid arthritis?", "options": [{"label": "A", "text": "IgE-mediated", "correct": false}, {"label": "B", "text": "Defective cellular and humoral immunity", "correct": false}, {"label": "C", "text": "Autoimmunity", "correct": true}, {"label": "D", "text": "Chronic microbial infections", "correct": false}], "correct_answer": "C. Autoimmunity", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hiUq2EMKgSUclJoBclEu1746428487.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Male to female ratio - 1:3.</li>\n<li>Peaks between 25 and 55 years.</li>\n<li>Remains constant between 55 and 75.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Strongly associated with the <strong>HLA-DRβ1 gene.</strong></li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"a5379e182d1692777184224652dcb1\">concordance</span> in <span class=\"customMeta\" data-dictid=\"e7afab7b981692777192aca13178fa\">monozygotic</span> twins.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triggers and suppressors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cigarette smoking and infections can trigger RA in genetically predisposed individuals by <span class=\"customMeta\" data-dictid=\"4881d0c99216927771849df336b09a\">citrullination</span> of proteins.</li>\n<li>RA may remit during pregnancy and can first appear <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> due to <span class=\"customMeta\" data-dictid=\"55241e8b7916927771896c864d30ea\">immune suppression</span> and hormonal changes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"617\" src=\"https://image.prepladder.com/content/hiUq2EMKgSUclJoBclEu1746428487.png\" width=\"819\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A doctor is consulted by a woman who is 8 weeks pregnant and employed in an industry. As per the ESI act, what is the length of maternity leave she is entitled to?", "options": [{"label": "A", "text": "4 months", "correct": false}, {"label": "B", "text": "28 weeks, starting from 4 weeks after delivery", "correct": true}, {"label": "C", "text": "26 weeks, starting from 8 weeks before delivery", "correct": false}, {"label": "D", "text": "9 months", "correct": false}], "correct_answer": "B. 28 weeks, starting from 4 weeks after delivery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman takes aspirin for a headache, later presented with wheezing and breathlessness. Along with these two symptoms, what other clinical findings are likely to be found in this condition?", "options": [{"label": "A", "text": "Eosinophilia", "correct": false}, {"label": "B", "text": "Nasal polyp", "correct": true}, {"label": "C", "text": "Extrinsic asthma", "correct": false}, {"label": "D", "text": "Drug interaction", "correct": false}], "correct_answer": "B. Nasal polyp", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about laryngeal cancer stage T1bNOMO?", "options": [{"label": "A", "text": "Both vocal cords involved and fixed", "correct": false}, {"label": "B", "text": "Both vocal cords involved, and no metastasis", "correct": true}, {"label": "C", "text": "One vocal cord involved and metastasis", "correct": false}, {"label": "D", "text": "One vocal cord involved, and mobile", "correct": false}], "correct_answer": "B. Both vocal cords involved, and no metastasis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Tumor is limited to one subsite of <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> with normal vocal cord mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> of more than one adjacent subsites of <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> or <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> or region outside the <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> (e.g. <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> of base of tongue, vallecula, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of <span class=\"customMeta\" data-dictid=\"7cdb5ed73b16927771966f6c4800de\">pyriform</span> sinus) without <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of the larynx.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor is limited to the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> with vocal cord <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space and/or minor <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> invasion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T4a</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades through the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and/or invades tissues beyond the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (e.g. trachea, soft tissues of neck including deep <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscle of tongue, <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> or esophagus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T4b</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> space, encases <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or invades <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Tumor limited to vocal cord(s) (may involve <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> commissures) with normal mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T1a</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor is limited to one vocal cord.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T1b</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor involves both vocal cords.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor extends to <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> and/or subglottis, and/or with impaired vocal cord mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor is limited to the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> with vocal cord <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> and/or invades paraglottic space and/or minor <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> erosion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T4a</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades through <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and/or invades tissues beyond the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (e.g. trachea, soft tissues of neck including deep <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscles of the tongue, <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles, thyroid, or esophagus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T4b</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> space, encases the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or invades <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Tumor is limited to the subglottis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor extends to the vocal cord(s) with normal or impaired mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor limited to <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> with vocal cord fixation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> or <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and/or invades tissues beyond the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (e.g. trachea, soft tissues of neck including deep <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscle of tongue, <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> or esophagus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> space, encases the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or invades <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, 3 cm or less in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, more than 3 cm but not more than 6 cm in greatest dimension, or multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension, or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in the greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> more than 3 cm but not more than 6 cm in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Na</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in a <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> more than 6 cm in the greatest dimension</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No Distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the least probable cause of mucormycosis?", "options": [{"label": "A", "text": "Neutropenia", "correct": false}, {"label": "B", "text": "Broad spectrum antibiotics", "correct": true}, {"label": "C", "text": "Uncontrolled diabetes without DKA", "correct": false}, {"label": "D", "text": "Prolonged use of steroid", "correct": false}], "correct_answer": "B. Broad spectrum antibiotics", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Asbestos exposure may be associated with which of the following malignancies?", "options": [{"label": "A", "text": "Mesothelioma", "correct": true}, {"label": "B", "text": "Acute myeloid leukemia", "correct": false}, {"label": "C", "text": "Hepatic angiosarcoma", "correct": false}, {"label": "D", "text": "Skin carcinoma", "correct": false}], "correct_answer": "A. Mesothelioma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wMDe8J0fj3Yo98YPViQK1746428706.png", "https://image.prepladder.com/content/JfO6j0ubk7mfODPjSqpg1746428714.png", "https://image.prepladder.com/content/V3KNqvlbMYz7zQj9reGa1746428727.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mesothelioma</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A rare cancer arising from mesothelial cells that most commonly affects the pleura.</li>\n<li>It can also affect the peritoneum, <span class=\"customMeta\" data-dictid=\"56ab21797f16927771954b343891ef\">pericardium</span> and <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asbestos: <span class=\"customMeta\" data-dictid=\"9f56633f181692777192f07ed38b1a\">Mesothelioma</span> is the most specific asbestos-associated cancer</li>\n<li>It is not associated with smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Advanced pleural <span class=\"customMeta\" data-dictid=\"9f56633f181692777192f07ed38b1a\">mesothelioma</span> can cause extensive pleural <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and thickening, making the affected side rigid and immobile.</li>\n<li>Later stages fix the <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> in place due to pleural thickening and fibrosis.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift is not a characteristic feature of mesothelioma.</li>\n<li>M/C <span class=\"customMeta\" data-dictid=\"2878159c181692777185d495ce6244\">cytogenetic</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in mesothelioma: <strong>Homozygous <span class=\"customMeta\" data-dictid=\"cf1e8ec6121692777185eba2630061\">deletion</span> of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 9p</strong>, leading to <strong>loss</strong> of tumour <span class=\"customMeta\" data-dictid=\"92427347f51692777199a762a91d21\">suppressor</span> gene - <strong>CDKN2A.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Progressive dyspnea, chest pain, weight loss, chronic cough, hemoptysis.</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"baa424d2de16927771836afd73785b\">breath sounds</span> and <span class=\"customMeta\" data-dictid=\"e452a3bf5716927771867e7ea9b4da\">dullness</span> to <span class=\"customMeta\" data-dictid=\"4818bebdf31692777195cc835c12d4\">percussion</span> (due to pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> or thickening).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT scan:</strong> <strong>Pleural thickening, effusion, or frozen hemithorax</strong> (not causing a <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift in the presence of effusion)</li>\n<li>Confirmed by <strong>biopsy:</strong>\n<ul>\n<li><strong>Epithelioid mesothelioma</strong> shows tubules, nests, or <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> structures with uniform round to <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> and <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm.</li>\n<li><strong>Sarcomatoid mesothelioma</strong> consists of spindle-shaped cells resembling fibrosarcoma.</li>\n<li><strong>Biphasic mesothelioma</strong> displays a mixture of both patterns.</li>\n</ul>\n</li>\n<li><strong>Specific</strong> <strong>markers</strong> for mesothelioma:\n\t\t\t\t<ul>\n<li>Calretinin</li>\n<li>Epithelial <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> antigen</li>\n<li>Cytokeratin</li>\n<li>Mesothelin</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor (median survival of 9-21 months).</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Yale Rosen\" data-hash=\"\" data-license=\"CC BY SA 2.0\" data-source=\"https://www.flickr.com/photos/pulmonary_pathology/3954797985/in/photostream/\" data-tags=\"\" height=\"488\" src=\"https://image.prepladder.com/content/wMDe8J0fj3Yo98YPViQK1746428706.png\" width=\"312\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Mesothelioma- Gross</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Malignant_epithelioid_mesothelioma_2-2_-_high_mag.jpg#/media/File:Malignant_epithelioid_mesothelioma_-_high_mag.jpg\" data-tags=\"\" height=\"552\" src=\"https://image.prepladder.com/content/JfO6j0ubk7mfODPjSqpg1746428714.png\" width=\"370\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p style=\"text-align: center;\"><strong>Mesothelioma- H &amp; E stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Malignant_epithelioid_mesothelioma_2-2_-_high_mag.jpg#/media/File:Malignant_epithelioid_mesothelioma_-_calretinin_-_intermed_mag.jpg\" data-tags=\"\" height=\"205\" src=\"https://image.prepladder.com/content/V3KNqvlbMYz7zQj9reGa1746428727.png\" width=\"329\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Mesothelioma- Calretinin stain</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6JlOJ2I16ioZpspjypuA1749402408.mp3", "video": ""}, {"text": "An 8-year-old boy presents with progressive muscle weakness and walking difficulties. On examination, pseudohypertrophy of the calf muscles was noted. Which of the following is true regarding this condition?", "options": [{"label": "A", "text": "Abnormal collagen", "correct": false}, {"label": "B", "text": "Absent dystrophin", "correct": true}, {"label": "C", "text": "Expansions of CAG triplet repeats", "correct": false}, {"label": "D", "text": "Defective fibrillin", "correct": false}], "correct_answer": "B. Absent dystrophin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Duchenne <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> <span class=\"customMeta\" data-dictid=\"04568e3d19169277718672d9da94fd\">Dystrophy</span> (DMD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frameshift mutations</strong> lead to a disrupted reading frame</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dystrophin Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dystrophin deficient</li>\n<li><strong>Truncated and unstable (&lt; 3% of normal) </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe, early onset, rapid progression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X-linked recessive.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age of onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early childhood (Before 5 years)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a feature of hemolytic anaemia?", "options": [{"label": "A", "text": "Increased haptoglobin", "correct": false}, {"label": "B", "text": "Neutropenia", "correct": false}, {"label": "C", "text": "Reticulocytopenia", "correct": false}, {"label": "D", "text": "Decreased haptoglobin", "correct": true}], "correct_answer": "D. Decreased haptoglobin", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ATt4v0tUvFNxpaTGuekM1747379235.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the function of utricle and saccule?", "options": [{"label": "A", "text": "Hearing high-frequency sounds", "correct": false}, {"label": "B", "text": "Linear acceleration and deceleration", "correct": true}, {"label": "C", "text": "Angular acceleration", "correct": false}, {"label": "D", "text": "Hearing low-frequency sounds", "correct": false}], "correct_answer": "B. Linear acceleration and deceleration", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zQhJJYmMc0rGpjoRXe9t1746428929.png", "https://image.prepladder.com/content/1df78KJpvGtTFhJNbFLv1746428929.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parts of the Inner Ear</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The inner ear, or labyrinth, is essential for hearing and balance and is located within the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone. It consists of the <span class=\"customMeta\" data-dictid=\"8f50a352d71692777183234f97f2dd\">bony labyrinth</span> and the membranous labyrinth.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"469\" src=\"https://image.prepladder.com/content/zQhJJYmMc0rGpjoRXe9t1746428929.png\" width=\"467\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bony Labyrinth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A rigid structure filled with <span class=\"customMeta\" data-dictid=\"7a6af637471692777195f6d6f14afd\">perilymph</span> (a sodium-rich fluid), it has three main parts:</p>\n<ol>\n<li><strong>Vestibule:</strong> Central part connecting to the <span class=\"customMeta\" data-dictid=\"6eb2dc23ea16927771848e85bcecb2\">cochlea</span> and semicircular canals.\n\n\t\t\t\t<ul>\n<li>Bony Recesses in the <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> contains the <span class=\"customMeta\" data-dictid=\"8612f222fd16927772018800e69a12\">utricle</span> and <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> (part of the membranous labyrinth).\n\t\t\t\t\t<ul>\n<li><strong>Spherical Recess: </strong>Contains the saccule, a membranous <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> involved in detecting <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> and deceleration.</li>\n<li>Elliptical Recess: Contains the utricle, which works with the <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> to aid in balance and <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> orientation. <strong> </strong></li>\n</ul>\n</li>\n<li>Oval Window: Located on the vestibule’s <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall, it connects to the middle ear.</li>\n<li>Openings of the Semicircular Canals: The three semicircular canals (lateral, posterior, and superior) have five openings into the vestibule, enabling <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of head rotations.</li>\n<li>Opening of the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">Vestibular</span> Aqueduct: Positioned below the elliptical recess, it allows the passage of the endolymphatic duct, which carries <span class=\"customMeta\" data-dictid=\"5f331cddb3169277718749f0c2a1d9\">endolymph</span> within the membranous labyrinth.</li>\n</ul>\n</li>\n<li><strong>Semicircular Canals:</strong> Three canals (lateral, posterior, and superior) positioned at right angles to detect rotational head movement. Each has an <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> containing the <span class=\"customMeta\" data-dictid=\"855c7f67b916927771851af573bb2a\">crista</span> ampullaris for <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> function.</li>\n<li><strong>Cochlea:</strong> A <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> structure essential for hearing, divided into three chambers (scala vestibuli, <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> tympani, and <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> media). The <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> vestibuli and tympani contain <span class=\"customMeta\" data-dictid=\"7a6af637471692777195f6d6f14afd\">perilymph</span> and communicate via the helicotrema, while the <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> media houses the organ of Corti, which converts sound vibrations into electrical signals.</li>\n</ol>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"356\" src=\"https://image.prepladder.com/content/1df78KJpvGtTFhJNbFLv1746428929.png\" width=\"356\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Membranous Labyrinth</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A delicate system within the bony labyrinth, filled with potassium-rich endolymph, it includes:</p>\n<ol>\n<li><strong>Cochlear <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> (Scala Media):</strong> Inside the cochlea, it separates the <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> vestibuli and <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> tympani and contains the <span class=\"customMeta\" data-dictid=\"29bb9bd7941692777194f232aa822a\">organ of Corti</span> for hearing.</li>\n<li><strong>Utricle and Saccule:</strong> Membranous sacs in the <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> responsible for detecting <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> and balance. They are connected via the <span class=\"customMeta\" data-dictid=\"637ee8854016927772017070137245\">utriculosaccular</span> duct.</li>\n<li><strong>Semicircular Ducts:</strong> Membranous ducts within the bony semicircular canals, contributing to balance.</li>\n<li><strong>Endolymphatic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> and Sac:</strong> Extending from the <span class=\"customMeta\" data-dictid=\"8612f222fd16927772018800e69a12\">utricle</span> and saccule, the <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> ends in the endolymphatic sac, important in <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> treatments for conditions like Ménière's disease.</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male patient presents with altered sensation in the extremities, difficulty with coordination, and speech problems. On examination, it is noted that the pupillary light reaction is absent, but the accommodation reaction is present. Which condition is most likely responsible for this presentation?", "options": [{"label": "A", "text": "Neurosyphilis", "correct": true}, {"label": "B", "text": "Horner's syndrome", "correct": false}, {"label": "C", "text": "Papilledema", "correct": false}, {"label": "D", "text": "Optic Neuritis", "correct": false}], "correct_answer": "A. Neurosyphilis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/62TQBD1isJ12KSZOnAJX1746429220.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Tamm-Horsfall protein is a major component of which of the following?", "options": [{"label": "A", "text": "Mural thrombi", "correct": false}, {"label": "B", "text": "Curschmann spirals", "correct": false}, {"label": "C", "text": "Renal casts", "correct": true}, {"label": "D", "text": "Bence-Jones proteins", "correct": false}], "correct_answer": "C. Renal casts", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug is commonly used for refraction in a child with accommodative squint?", "options": [{"label": "A", "text": "1% Atropine", "correct": true}, {"label": "B", "text": "Cyclopentolate", "correct": false}, {"label": "C", "text": "Tropicamide", "correct": false}, {"label": "D", "text": "Homatropine", "correct": false}], "correct_answer": "A. 1% Atropine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - 1% A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following medications is typically prescribed as the initial treatment for tuberculosis during the first 2 months?", "options": [{"label": "A", "text": "Streptomycin", "correct": false}, {"label": "B", "text": "Ethambutol", "correct": true}, {"label": "C", "text": "Linezolide", "correct": false}, {"label": "D", "text": "Levofloxacin", "correct": false}], "correct_answer": "B. Ethambutol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the process that occurs in an oxidation pond?", "options": [{"label": "A", "text": "Always aerobic", "correct": false}, {"label": "B", "text": "Always anaerobic", "correct": false}, {"label": "C", "text": "Aerobic during day, anaerobic during night", "correct": true}, {"label": "D", "text": "Anaerobic during day, aerobic during night", "correct": false}], "correct_answer": "C. Aerobic during day, anaerobic during night", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a part of the urban health care delivery system?", "options": [{"label": "A", "text": "PHC", "correct": false}, {"label": "B", "text": "CHC", "correct": false}, {"label": "C", "text": "Swasthya Chowki", "correct": false}, {"label": "D", "text": "Subcenter", "correct": true}], "correct_answer": "D. Subcenter", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The given inclusion bodies are characteristic of which of the following organisms?", "options": [{"label": "A", "text": "Human papillomavirus", "correct": false}, {"label": "B", "text": "Cytomegalovirus", "correct": true}, {"label": "C", "text": "Epstein-Barr virus", "correct": false}, {"label": "D", "text": "Herpes simplex virus", "correct": false}], "correct_answer": "B. Cytomegalovirus", "question_images": ["https://image.prepladder.com/notes/w7qN96L2lW2f5frytUw81747379435.png"], "explanation_images": ["https://image.prepladder.com/notes/3Lc1tp4WHlc9mOjSz72M1747379854.png", "https://image.prepladder.com/content/WkyyvQPNsWDfdJUQzoVp1746429508.png", "https://image.prepladder.com/content/1VEjRi02dBzlXamNE6a01746429521.png", "https://image.prepladder.com/content/eDkUi4BZeDAWK66xjlG91746429536.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CMV infection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modes of transmission</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oral route, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> &amp; body secretions (most common)</li>\n<li>Vertical transmission</li>\n<li>Sexual transmission</li>\n<li>Organ transplantation</li>\n<li>Blood transfusion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral smear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Owl’s eye appearance of <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">inclusion</span> bodies</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Owl’s eye appearance of inclusion bodies\" data-author=\"Manon Auger, Fadi Brimo, Yonca Kanber, Pierre Olivier Fiset, Sophie Camilleri-Broet\" data-hash=\"12807\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Cytomegalovirus-infected-cells-have-characteristic-nuclear-and-cytoplasmic-inclusions_fig2_327309083\" data-tags=\"May2025\" height=\"213\" src=\"https://image.prepladder.com/notes/3Lc1tp4WHlc9mOjSz72M1747379854.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Virus isolation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is done by</p>\n<ul>\n<li>Human <span class=\"customMeta\" data-dictid=\"3095c5f0fc1692777202eda8060779\">fibroblast</span> cell line culture</li>\n<li>Shell <span class=\"customMeta\" data-dictid=\"cd235a18081692777202343e31b264\">vial</span> culture</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antigen detected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PP65</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibody detection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is done by ELISA, and the antibodies detected are</p>\n<ul>\n<li>CMV IgM antibodies.</li>\n<li>CMV IgG antibodies.</li>\n<li>Against PP150 and PP65.</li>\n<li>Against the PP52.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PCR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used in detecting CMV DNA.</li>\n<li>Quantitative <span class=\"customMeta\" data-dictid=\"6483f3ef3116927771935d328a8ab2\">nucleic acid</span> testing (<strong>QNAT) by PCR is the most sensitive and specific testing.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ganciclovir</strong> (drug of choice)</li>\n<li><strong>Foscarnet</strong> (in Ganciclovir resistance)</li>\n<li>CMV immunoglobulins and Ganciclovir are given to <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> transplant patients.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the yoke muscles for Levodepression?", "options": [{"label": "A", "text": "LSO and RIR", "correct": false}, {"label": "B", "text": "RSO and LIR", "correct": true}, {"label": "C", "text": "RIO and LIR", "correct": false}, {"label": "D", "text": "LIO and RIR", "correct": false}], "correct_answer": "B. RSO and LIR", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/gpmkwAKMQ3WPFwNagliL1747393150.png", "https://image.prepladder.com/notes/lLOZoyGFfJgoIRpDgWDW1747393165.png"], "explanation": "<p>Correct Answer B - RSO and LIR\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement accurately describes the single exposure point source epidemic?", "options": [{"label": "A", "text": "Has more than one incubation period", "correct": false}, {"label": "B", "text": "Has multiple peaks", "correct": false}, {"label": "C", "text": "Explosive in nature", "correct": true}, {"label": "D", "text": "Slow rise and fall", "correct": false}], "correct_answer": "C. Explosive in nature", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sickness absenteeism of workers in the industry is used to evaluate", "options": [{"label": "A", "text": "Health of the worker", "correct": true}, {"label": "B", "text": "Health of the family", "correct": false}, {"label": "C", "text": "Industrial environment", "correct": false}, {"label": "D", "text": "Community health", "correct": false}], "correct_answer": "A. Health of the worker", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male comes with complaints of hip pain. An X-ray of the hip shows lytic lesions and elevated serum calcium levels. Bone marrow plasma cells are 42%, and the cells seen are given in the image below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Multiple myeloma", "correct": true}, {"label": "B", "text": "CLL", "correct": false}, {"label": "C", "text": "ALL", "correct": false}, {"label": "D", "text": "CML", "correct": false}], "correct_answer": "A. Multiple myeloma", "question_images": ["https://image.prepladder.com/content/9Vc5rl4xIhe4QAzKHUn01746429663.png"], "explanation_images": ["https://image.prepladder.com/content/4RC2sfX0XclRDv29VECz1746429715.png", "https://image.prepladder.com/content/7a7eUF6FTl9GeFhVvkmo1746429727.png", "https://image.prepladder.com/content/3DyLpCxcbIyGvAbtU5X21746429739.png", "https://image.prepladder.com/content/ZTE8IJosfAZZNemlfZic1746429749.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5pgj6iasXWELuuFPtEFA1749402535.mp3", "video": ""}, {"text": "A 60-year-old patient presents with chronic dacryocystitis. She complains of recurrent tearing, discharge, and mild swelling in the inner corner of the eye. The clinical findings and history are consistent with chronic dacryocystitis. What should be the treatment of choice for this patient?", "options": [{"label": "A", "text": "Lacrimal sac massage", "correct": false}, {"label": "B", "text": "Dacryocystorhinostomy", "correct": true}, {"label": "C", "text": "Syringing", "correct": false}, {"label": "D", "text": "Probing", "correct": false}], "correct_answer": "B. Dacryocystorhinostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/eBZKA5HBr5dfvd3BxdFs1746429860.png", "https://image.prepladder.com/content/QMPviM4dGt1w1adlyqPK1746429876.png"], "explanation": "<p>Correct Answer B - Dacryocystorhinostomy</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Acute Dacryocystitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Chronic Dacryocystitis</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Aetiology</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> of chronic dacryocystitis</li>\n<li>Spread from neighbouring infected structures (e.g., sinuses, bones, <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> abscess)</li>\n<li><strong>Causative organisms: </strong>Streptococcus haemolyticus, Pneumococcus, Staphylococcus</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Stasis and mild infection of long duration</li>\n<li>Common in women aged 40-60</li>\n<li><strong>Causes:</strong> <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> factors (narrow bony canal), <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> diseases, foreign bodies, infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Clinical Features/ Sequelae</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ol>\n<li><strong>Stage of cellulitis: </strong>Painful <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> at the <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> sac, epiphora, fever, redness, and oedema.</li>\n<li><strong>Lacrimal abscess: </strong>Pus-filled sac, <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> swelling, may <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> forming an abscess.</li>\n<li><strong>Fistula formation: </strong>Untreated <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> leads to <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> discharge, forming a fistula.</li>\n</ol>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ol>\n<li><strong>Stage of chronic catarrhal dacryocystitis: </strong>Watering eye, mild redness, NLD block</li>\n<li><strong>Lacrimal mucocele: </strong>Swelling below inner canthus, <span class=\"customMeta\" data-dictid=\"14f3af3bf516927771939c1efb8726\">mucoid</span> fluid regurgitation.</li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> dacryocystitis: </strong>Purulent <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> (d/t infection), <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> conjunctivitis.</li>\n<li><strong>Chronic fibrotic sac: </strong>Thickened mucosa, persistent epiphora, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> folds.</li>\n</ol>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Chaiti Aranke Waman Chavan\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Acute-dacryocystitis-with-pre-septal-cellulitis-with-fistula_fig1_381056510\" data-tags=\"\" height=\"327\" src=\"https://image.prepladder.com/content/eBZKA5HBr5dfvd3BxdFs1746429860.png\" width=\"403\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Alexis Mathieu 1,*,Stéphanie Baillif 2,3ORCID,Marie-Noelle Delyfer 1,4ORCID,Éric Longueville 1,Valentine Coste-Verdier 1,Jacques Lagier 2,Abdulrhman Alrabiah 2 andArnaud Martel 2,3ORCID\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://www.mdpi.com/2077-0383/13/17/5129\" data-tags=\"\" height=\"358\" src=\"https://image.prepladder.com/content/QMPviM4dGt1w1adlyqPK1746429876.png\" width=\"334\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Conjunctivitis, corneal ulcer, lid abscess, <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> cellulitis, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> cellulitis, rarely <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombosis.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Conjunctivitis, <span class=\"customMeta\" data-dictid=\"410b701d9916927771861ac447b041\">ectropion</span> of lower lid, risk of corneal ulcers.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Cellulitis:</strong> Systemic antibiotics, anti-inflammatory drugs, hot fomentation.</li>\n<li><strong>Lacrimal abscess:</strong> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">Drainage</span> with incision, antibiotics, possible DCT or DCR later.</li>\n<li><strong>External fistula: </strong>Fistulectomy with DCT or DCR after controlling infection.</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Conservative: </strong>Probing and syringing (early stages).</li>\n<li><strong>Dacryocystorhinostomy (DCR):</strong> Preferred surgery to re-establish <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> drainage.</li>\n<li><strong>Dacryocystectomy (DCT):</strong> Indicated if DCR is contraindicated or in cases of fibrosis, infection, or old age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Immediately post-delivery, the uterus corresponds to _____weeks of gestational age. Options:", "options": [{"label": "A", "text": "20", "correct": true}, {"label": "B", "text": "16", "correct": false}, {"label": "C", "text": "12", "correct": false}, {"label": "D", "text": "30", "correct": false}], "correct_answer": "A. 20", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:577px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Weight of uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Uterus <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immediately after delivery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1000gm </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Just below the <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> (corresponds to 20 weeks of gestational age)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 week after delivery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>500gm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Midway between the <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> and <span class=\"customMeta\" data-dictid=\"48b6a0a5fb1692777199da12372b14\">symphysis</span> pubis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 weeks after delivery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>300gm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> (becomes <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> organ)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 weeks after delivery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100gm<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involutes completely</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6-8 weeks after delivery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>60gm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Returns to normal (pre-pregnant) size</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following picture shows a lymph node biopsy of a 30-year-old male with cervical lymphadenopathy. The diagnosis is:", "options": [{"label": "A", "text": "Acute myeloid leukemia (AML)", "correct": false}, {"label": "B", "text": "Hodgkin disease", "correct": true}, {"label": "C", "text": "Human papillomavirus (HPV)", "correct": false}, {"label": "D", "text": "Chronic lymphocytic leukemia (CLL)", "correct": false}], "correct_answer": "B. Hodgkin disease", "question_images": ["https://image.prepladder.com/content/MhzsG7ZX7zVOO8GAJ5On1746429956.png"], "explanation_images": ["https://image.prepladder.com/content/s5axcuoBNkNq64mvyVYZ1746430089.png", "https://image.prepladder.com/content/q4rq6GbiJQy34qRoLwhm1746430100.png", "https://image.prepladder.com/content/816sNER83l4XSaWIIxX01746430109.png", "https://image.prepladder.com/content/EJtDGcbPBuzWydvIzAG61746430120.png", "https://image.prepladder.com/content/8rB0GX8QxjzSZNBdxk6Z1746430134.png", "https://image.prepladder.com/content/0gHtW685QQmuZtjP11eB1746430144.png", "https://image.prepladder.com/content/Mrm9U2OwQsr3TsjkZYes1746430154.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Histopathological variants of Hodgkin’s Lymphoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Mononuclear cells</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Emanuela Vaccher,Annunziata Gloghini,Caterina Volpi Antonino Carbone\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Hodgkin-lymphoma-HL-in-individuals-infected-by-HIV-Hodgkin-and-Reed-Sternberg-HRS_fig3_363317499\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/s5axcuoBNkNq64mvyVYZ1746430089.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Single <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> with a large, inclusion-like nucleolus</strong> with abundant cytoplasm.</li>\n<li>Seen in Mixed Cellularity Hodgkin Lymphoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Popcorn cells</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron \" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Nodular_lymphocyte_predominant_Hodgkin_lymphoma#/media/File:Popcorn_cell_in_nodular_lymphocyte_predominant_Hodgkin_lymphoma_-_very_high_mag_cropped.jpg\" data-tags=\"\" height=\"291\" src=\"https://image.prepladder.com/content/q4rq6GbiJQy34qRoLwhm1746430100.png\" width=\"395\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cells with <strong>multiple infolded nuclear membranes, small nucleoli, fine chromatin,</strong> and abundant pale cytoplasm.</li>\n<li>Seen in <span class=\"customMeta\" data-dictid=\"bfa856c77716927771939978c5afd0\">Nodular</span> <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> - Predominant Hodgkin lymphoma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Reed-sternberg cell</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ed Uthman, MD\" data-hash=\"\" data-license=\"CC-BY-SA 2.0\" data-source=\"https://www.instagram.com/p/CncKr1cMheC/\" data-tags=\"\" height=\"262\" src=\"https://image.prepladder.com/content/816sNER83l4XSaWIIxX01746430109.png\" width=\"397\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is characterised by <strong>two nuclear lobes, large inclusion-like nucleoli</strong>, and abundant <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> and is typically surrounded by lymphocytes, macrophages, and an eosinophil.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4. Lacunar cells</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Humpath\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Nodular_lymphocyte_predominant_Hodgkin_lymphoma_2014_4.png\" data-tags=\"\" height=\"269\" src=\"https://image.prepladder.com/content/EJtDGcbPBuzWydvIzAG61746430120.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Typically found in the <span class=\"customMeta\" data-dictid=\"bfa856c77716927771939978c5afd0\">nodular</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> subtype.</li>\n<li><strong>Nuclei are more delicate, folded, or multilobate. </strong></li>\n<li>Abundant pale <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> often gets disrupted during sectioning, creating an appearance where the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> sits in an empty space (lacuna).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Subtype of Hodgkin lymphoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reed-Sternberg Cell Variant</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nodular Sclerosis (NSHL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lacunar Cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mixed Cellularity (MCHL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnostic Reed-Sternberg Cells and Mononuclear Variants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocyte-Rich (LRHL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnostic Reed-Sternberg Cells and Mononuclear Variants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocyte Depletion (LDHL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnostic Reed-Sternberg Cells and Variants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nodular Lymphocyte-Predominant (NLPHL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphohistiocytic (L&amp;H) Cells</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uaT8KEPSXVXo4zSI0FS51749402692.mp3", "video": ""}, {"text": "A patient presents to the OPD with the given visual field effect. What is the probable site of the lesion based on the image displayed?", "options": [{"label": "A", "text": "3", "correct": true}, {"label": "B", "text": "1", "correct": false}, {"label": "C", "text": "4", "correct": false}, {"label": "D", "text": "6", "correct": false}], "correct_answer": "A. 3", "question_images": ["https://image.prepladder.com/content/DIX6GkV0BjGaHgGrhx9q1746429968.png", "https://image.prepladder.com/notes/s6JznnbxVSkq6jLPXu5p1747393356.png"], "explanation_images": ["https://image.prepladder.com/content/4r0YsDCmvS2lKkrULXZI1746430013.png", "https://image.prepladder.com/content/PCcWxdiSL76hsVQK8fFh1746430080.png", "https://image.prepladder.com/content/0sLsFJGoYXc2RaZ6cCqd1746430088.png", "https://image.prepladder.com/notes/6WgxMapC3W4lUtpB9q8n1747393583.png", "https://image.prepladder.com/content/zcxkVnDtzZ40Xy2S7pFT1746430111.png", "https://image.prepladder.com/content/bGGvacH6h1f6NZEqZwOA1746430121.png", "https://image.prepladder.com/content/C1cPdl5LQnFfqCU1eGMi1746430315.png", "https://image.prepladder.com/content/4VIWLEqI9YG5FnDlron91746430299.png"], "explanation": "<p>Correct Answer A - 3</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Visual Pathway Lesions and Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Site of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fibers Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Field Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Nerve</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> + <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/PCcWxdiSL76hsVQK8fFh1746430080.png\" width=\"313\"/></p>\n<p style=\"text-align:center\"><strong>Anopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Chiasma</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"308\" src=\"https://image.prepladder.com/content/0sLsFJGoYXc2RaZ6cCqd1746430088.png\" width=\"313\"/></p>\n<p style=\"text-align:center\"><strong>Bitemporal Hemianopia</strong></p>\n<p style=\"text-align:center\"><strong>(Heteronymous Hemianopia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Optic Tract (Option C ruled out)</strong></li>\n<li><strong>Lateral Geniculate Body (LGB Lesion)</strong></li>\n<li><strong>Optic Radiation</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"Homonymous hemianopia\" data-author=\"\" data-hash=\"12838\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"170\" src=\"https://image.prepladder.com/notes/6WgxMapC3W4lUtpB9q8n1747393583.png\" width=\"300\"/></p>\n<p style=\"text-align:center\"><strong>Right <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">Homonymous</span> Hemianopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Visual Cortex without the involvement of tip</strong></p>\n<p><strong>(Post. Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers except <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> representation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"319\" src=\"https://image.prepladder.com/content/zcxkVnDtzZ40Xy2S7pFT1746430111.png\" width=\"313\"/></p>\n<p style=\"text-align:center\"><strong>Homonymous <span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\">Hemianopia</span> with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">Macular</span> Sparing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tip of Visual Cortex</strong></p>\n<p><strong>(Middle Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Macular Representation of Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> and <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"319\" src=\"https://image.prepladder.com/content/bGGvacH6h1f6NZEqZwOA1746430121.png\" width=\"313\"/></p>\n<p style=\"text-align:center\"><strong>Macular <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">Homonymous</span> Hemianopia</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Inferior <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> Radiations (Meyer’s Loop)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Superior <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> Radiations (Baum’s Loop)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Temporal <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parietal lobe</strong> <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Affected Visual Field</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superior quadrants of the <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> visual field</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inferior quadrants of the <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> visual field</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Visual Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">homonymous</span> quadrantanopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inferior <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">homonymous</span> quadrantanopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Associated Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Memory loss</li>\n<li>Hearing loss</li>\n<li>Auditory hallucinations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contralateral hemiplegia</li>\n<li>Hemianesthesia</li>\n<li>Optokinetic nystagmus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"299\" src=\"https://image.prepladder.com/content/C1cPdl5LQnFfqCU1eGMi1746430315.png\" width=\"299\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"177\" src=\"https://image.prepladder.com/content/4VIWLEqI9YG5FnDlron91746430299.png\" width=\"277\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female presents with frequent headaches. The investigation reveals raised intracranial pressure and the presence of a dural-based tumour. Which of the following histological findings correlates with the diagnosis?", "options": [{"label": "A", "text": "Fried-egg appearance", "correct": false}, {"label": "B", "text": "Flexner-Wintersteiner rosettes", "correct": false}, {"label": "C", "text": "Psammoma bodies with whorling of tumor cells", "correct": true}, {"label": "D", "text": "Homer-Wright rosettes", "correct": false}], "correct_answer": "C. Psammoma bodies with whorling of tumor cells", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/76i0YioH8Q5eAlmqb09A1747380216.png", "https://image.prepladder.com/content/rVa3RfwwL4ADFfCZ4cKB1746430486.png", "https://image.prepladder.com/content/Qv8D9zaqUDXXC3TIkysC1746430496.png", "https://image.prepladder.com/content/5UYoMD9a37FHKakRJNIW1746430507.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following cells plays a key role in phagocytosis and chronic inflammation in the liver?", "options": [{"label": "A", "text": "Hepatocytes", "correct": false}, {"label": "B", "text": "Ito cells", "correct": false}, {"label": "C", "text": "Sinusoidal endothelial cells", "correct": false}, {"label": "D", "text": "Kupffer cells", "correct": true}], "correct_answer": "D. Kupffer cells", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/gPMx8Dt23O5SVTiLCsch1747380398.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image below displays the findings of a fundoscopy. What is the probable diagnosis?", "options": [{"label": "A", "text": "CRAO", "correct": true}, {"label": "B", "text": "CRVO", "correct": false}, {"label": "C", "text": "Diabetic retinopathy", "correct": false}, {"label": "D", "text": "Cystoid macular edema", "correct": false}], "correct_answer": "A. CRAO", "question_images": ["https://image.prepladder.com/content/EN8rPN9Mx4UlEHye5Jlo1746430571.png"], "explanation_images": ["https://image.prepladder.com/content/JN6tXucghsNHfitXDWJi1746430635.png", "https://image.prepladder.com/content/EXY1UboEOGq2bCO8nPhB1746430664.png", "https://image.prepladder.com/content/00gO7ihnj7W9I5AxroRl1746433577.png"], "explanation": "<p>Correct Answer A - CRAO\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked in the image given below.", "options": [{"label": "A", "text": "External capsule", "correct": false}, {"label": "B", "text": "Internal Capsule", "correct": true}, {"label": "C", "text": "Caudate nucleu", "correct": false}, {"label": "D", "text": "Putamen", "correct": false}], "correct_answer": "B. Internal Capsule", "question_images": ["https://image.prepladder.com/notes/QrKSUsy7uRfTshEhaoil1747383478.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the rib that is shown in the X-ray.", "options": [{"label": "A", "text": "3rd rib anterior part", "correct": false}, {"label": "B", "text": "3rd rib posterior part", "correct": true}, {"label": "C", "text": "4th rib anterior part", "correct": false}, {"label": "D", "text": "1st rib anterior part", "correct": false}], "correct_answer": "B. 3rd rib posterior part", "question_images": ["https://image.prepladder.com/notes/YFMDWck97NfVqsoZBYec1747383599.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with elevated liver enzymes presented to the OPD with the following eye finding on gonioscopy. It is associated with?", "options": [{"label": "A", "text": "Copper", "correct": true}, {"label": "B", "text": "Zinc", "correct": false}, {"label": "C", "text": "Selenium", "correct": false}, {"label": "D", "text": "Iron", "correct": false}], "correct_answer": "A. Copper", "question_images": ["https://image.prepladder.com/content/Sl4VxSbLGGMPqUDkPirt1746430953.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to you with pain and redness in the right eye following an injury during welding. On examination, the image as seen below is observed. Which of the following is the appropriate next step in managing this patient?", "options": [{"label": "A", "text": "Steroids and antibiotics", "correct": false}, {"label": "B", "text": "Surgical exploration", "correct": false}, {"label": "C", "text": "Keratoplasty", "correct": false}, {"label": "D", "text": "Removal by 26G needle", "correct": true}], "correct_answer": "D. Removal by 26G needle", "question_images": ["https://image.prepladder.com/notes/9fTfwXE3BalDKWfLKLmL1747393919.png"], "explanation_images": [], "explanation": "<p>Correct Answer D - Removal by 26G\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable medical condition for a 70-year-old individual who has relied on presbyopia glasses but can now comfortably read the newspaper without them?", "options": [{"label": "A", "text": "Index myopia", "correct": true}, {"label": "B", "text": "Index hypermetropia", "correct": false}, {"label": "C", "text": "Presbyopia", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Index myopia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Index myopia:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Myopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Axial Myopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increase in the <span class=\"customMeta\" data-dictid=\"c12a40cc401692777181852b507764\">anteroposterior</span> length of the <span class=\"customMeta\" data-dictid=\"53c6bebcbb169277718777b3fe0e5c\">eyeball</span> (most common form).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Curvatural Myopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of the cornea, lens, or both.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Positional Myopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior placement of the <span class=\"customMeta\" data-dictid=\"35b1a3c6191692777185a1e2376fc0\">crystalline</span> lens in the eye.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Index Myopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Increase in the <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> index of the <span class=\"customMeta\" data-dictid=\"35b1a3c6191692777185a1e2376fc0\">crystalline</span> lens, often due to nuclear sclerosis.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Myopia due to Excessive Accommodation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> of accommodation, leading to excessive <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> power.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Asthenopic symptoms</li>\n<li>Half-shutting of eyes for better clarity</li>\n<li>Prominent eyeball.</li>\n<li>Prominent, large, and somewhat sluggishly reacting pupils.</li>\n<li>Slightly deeper <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chamber.</li>\n<li>Normal fundus; rarely a <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> myopic <span class=\"customMeta\" data-dictid=\"0539eefe3f169277718547881d187d\">crescent</span> may be seen.</li>\n</ul>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prescription of appropriate <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> lenses</li>\n<li>Surgical Treatment</li>\n</ul>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a three-year-old boy, his parents have noticed a progressive decline in coordination over the last six months. During a physical examination, a growth resembling a cauliflower is observed in the left eye, along with leukocoria and the absence of a red reflex. Microscopic analysis of the sample reveals the presence of Flexner-Wintersteiner rosettes. Which gene is associated with this condition?", "options": [{"label": "A", "text": "Rb gene", "correct": true}, {"label": "B", "text": "ATP 7B gene", "correct": false}, {"label": "C", "text": "Rhodopsin gene", "correct": false}, {"label": "D", "text": "FBN 1 gene", "correct": false}], "correct_answer": "A. Rb gene", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/djeLevJ17QUjKt6rWlaR1746431736.png"], "explanation": "<p>Correct Answer A - Rb gene</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>Flexner-Wintersteiner rosettes (highly specific)-</strong><strong> </strong>These are composed of an ‘empty’ <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> surrounded by columnar cells</li>\n<li><strong>Homer-Wright rosettes</strong> - These are pseudo-rosettes and consist of cells surrounding a central <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> made up of their processes</li>\n<li>Undifferentiated tumor cells</li>\n<li>Areas of <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and calcification</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Leukocoria (60%)</li>\n<li>Strabismus (20%)</li>\n<li>Painful red eye (7%)</li>\n<li>Poor vision (5%)</li>\n<li>Asymptomatic (3%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fundus Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>White, elevated mass in the retina</li>\n<li>Can be endophytic, exophytic, or mixed growth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CT scan:</strong> <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">Calcification</span> in 90% of cases</li>\n<li><strong>MRI:</strong> Better for evaluating <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve and <span class=\"customMeta\" data-dictid=\"7d57c304c01692777187da125d18d8\">extraocular</span> extension</li>\n<li><strong>Ultrasound:</strong> Useful for initial screening</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>RB1 gene </strong>mutation on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 13q14</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for a 3-year-old child with amblyopia in the right eye?", "options": [{"label": "A", "text": "Observation", "correct": false}, {"label": "B", "text": "Spectacles or refraction with a near addition", "correct": false}, {"label": "C", "text": "Occlusion Therapy", "correct": true}, {"label": "D", "text": "Radial keratotomy", "correct": false}], "correct_answer": "C. Occlusion Therapy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\"&gt;Occlusion&lt;/span&gt; Th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle serves as the yoke muscle for the right lateral rectus?", "options": [{"label": "A", "text": "Right superior oblique", "correct": false}, {"label": "B", "text": "Left medial rectus", "correct": true}, {"label": "C", "text": "Left lateral rectus", "correct": false}, {"label": "D", "text": "Right medial rectus", "correct": false}], "correct_answer": "B. Left medial rectus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BgiPbc3sAqfahQo8k3871746432089.png", "https://image.prepladder.com/content/VszAkGbn6XLvBfAupsvD1746432101.png"], "explanation": "<p>Correct Answer B - Left &lt;span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\"&gt;medial&lt;/span&gt; rectu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What substance is responsible for the development of a diabetic cataract in a 68-year-old female patient, which has been present for 3 months?", "options": [{"label": "A", "text": "Glucose", "correct": false}, {"label": "B", "text": "Fructose", "correct": false}, {"label": "C", "text": "Lactose + Glucose", "correct": false}, {"label": "D", "text": "Sorbitol", "correct": true}], "correct_answer": "D. Sorbitol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What kind of laser can be utilized to treat posterior capsular opacification, which is observed during an examination of a patient who has reported decreased visual acuity following cataract surgery?", "options": [{"label": "A", "text": "Femto laser", "correct": false}, {"label": "B", "text": "Nd YAG laser", "correct": true}, {"label": "C", "text": "Argon fluoride", "correct": false}, {"label": "D", "text": "Argon", "correct": false}], "correct_answer": "B. Nd YAG laser", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bP2T5IwM453wOxQ0ZTec1746432535.png", "https://image.prepladder.com/content/nIFnvJGWrwKJKVij00sS1746432535.png", "https://image.prepladder.com/content/GDlJy0PepY5DxVkMjz5R1746432535.png"], "explanation": "<p>Correct Answer B - Nd YAG laser</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>M/C <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> following <span class=\"customMeta\" data-dictid=\"ab0f3917ce1692777187309ec78709\">extracapsular</span> lens extraction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Posterior <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">Capsule</span> <span class=\"customMeta\" data-dictid=\"990cbfd3111692777194c6967ee125\">Opacification</span> (PCO)</strong>: Common <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of after cataract.</li>\n<li>Dense Membranous After Cataract: Thick <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> formation.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Raj, Shetal &amp; Vasavada, Abhay &amp; Johar, Kaid &amp; Vasavada, Vaishali &amp; Vasavada, Viraj.\" data-hash=\"\" data-license=\"CC BY 2.5\" data-source=\"An eye with posterior capsule opacification before (A) and after Nd:... | Download Scientific Diagram (researchgate.net)\" data-tags=\"\" height=\"312\" src=\"https://image.prepladder.com/content/bP2T5IwM453wOxQ0ZTec1746432535.png\" width=\"371\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Soemmering's Ring:</strong> Thick ring behind the iris, enclosed between <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> layers.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Peck, Travis &amp; Aggarwal, Shruti &amp; Johnson, Sandra. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"Slit lamp photograph of the right eye showing an incomplete ring of... | Download Scientific Diagram (researchgate.net)\" data-tags=\"\" height=\"392\" src=\"https://image.prepladder.com/content/nIFnvJGWrwKJKVij00sS1746432535.png\" width=\"537\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Elschnig's Pearls:</strong> Clustered, <span class=\"customMeta\" data-dictid=\"869a7f073716927772017c4d29804a\">vacuolated</span> <span class=\"customMeta\" data-dictid=\"550fa75ff216927771992c0987c58e\">subcapsular</span> epithelial cells along the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> capsule.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"C.Y. Lewis\" data-hash=\"\" data-license=\"CC BY-NC-ND 3.0\" data-source=\"Atlas Entry - Aftercataract (Elschnig's pearls) (eyerounds.org)\" data-tags=\"\" height=\"349\" src=\"https://image.prepladder.com/content/GDlJy0PepY5DxVkMjz5R1746432535.png\" width=\"387\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>ND YAG laser <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> capsulotomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman at 32 weeks, presented with severe abdominal pain, bleeding per vagina, and loss of fetal movements. On examination, her uterus is tender. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Abruptio placenta", "correct": true}, {"label": "B", "text": "Placenta previa", "correct": false}, {"label": "C", "text": "Polyhydraminos", "correct": false}, {"label": "D", "text": "Preterm labor", "correct": false}], "correct_answer": "A. Abruptio placenta", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is an outlet forceps?", "options": [{"label": "A", "text": "Piper forceps", "correct": false}, {"label": "B", "text": "Wrigley forceps", "correct": true}, {"label": "C", "text": "Das forceps", "correct": false}, {"label": "D", "text": "Kielland forceps", "correct": false}], "correct_answer": "B. Wrigley forceps", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mKV5vR5HRu9gPfZvm0F01746436027.png", "https://image.prepladder.com/content/bpxT2DXKsFfzu7uR0JJh1746436027.png", "https://image.prepladder.com/content/Swx9FHhu98u8GBMsehZF1746436027.png", "https://image.prepladder.com/content/arU29yKEhJvUxJyR5j8w1746436027.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a hyper-estrogenic condition?", "options": [{"label": "A", "text": "Low BMI", "correct": true}, {"label": "B", "text": "Ovarian cancer", "correct": false}, {"label": "C", "text": "Endometriosis", "correct": false}, {"label": "D", "text": "Tamoxifen usage", "correct": false}], "correct_answer": "A. Low BMI", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female undergoes a methylene blue 3 swab test and the middle swab is stained with blue. What is the likely diagnosis?", "options": [{"label": "A", "text": "Uterovaginal fistula", "correct": false}, {"label": "B", "text": "Vesicovaginal fistula", "correct": true}, {"label": "C", "text": "Vesicouterine fistula", "correct": false}, {"label": "D", "text": "Ureterovaginal fistula", "correct": false}], "correct_answer": "B. Vesicovaginal fistula", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xIBF1eXwSAUJkbneY7Dt1746436278.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following hormones are secreted by sertoli cells and Leydig cells respectively?", "options": [{"label": "A", "text": "DHA and testosterone", "correct": false}, {"label": "B", "text": "Testosterone and inhibin", "correct": false}, {"label": "C", "text": "Testosterone and DHA", "correct": false}, {"label": "D", "text": "Inhibin and testosterone", "correct": true}], "correct_answer": "D. Inhibin and testosterone", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman requests for medical termination of pregnancy (MTP). The doctor decides to perform a suction evacuation. Till when can this be performed?", "options": [{"label": "A", "text": "12 weeks of gestation", "correct": true}, {"label": "B", "text": "18 weeks of gestation", "correct": false}, {"label": "C", "text": "20 weeks of gestation", "correct": false}, {"label": "D", "text": "24 weeks of gestation", "correct": false}], "correct_answer": "A. 12 weeks of gestation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/p5fDnuDQtl8nhKoaKvlp1746436497.png", "https://image.prepladder.com/content/wxjGSDqwf5JPONiNwlEz1746436497.png", "https://image.prepladder.com/content/bykXasMp8aP1z09a2HU61746436497.png", "https://image.prepladder.com/content/uX07J89Cpfp1fQOGOAYC1746436497.png", "https://image.prepladder.com/content/fNGy3S4BvRdQMee9ZgZs1746436497.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:487px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gestational Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Abortive method</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 7 weeks</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medical Abortion (99% success rate if done before 7 weeks)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 9 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 10 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medical Abortion</li>\n<li><strong>Suction evacuation</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Up to 12 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Suction evacuation</strong></li>\n<li>Dilatation and Curettage (D&amp;C)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>12-20 weeks (Option B &amp; C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dilatation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>20-24 weeks (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dilatation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E) </strong></li>\n<li><strong>Prostaglandin Induction.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;24 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hysterotomy</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Trimester</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Regimen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1st</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mifepristone 200 mg orally, followed by Misoprostol 800 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> vaginally after 24 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best method with a high success rate.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2nd</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mifepristone 200 mg orally, followed by Misoprostol 400 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> every 3 hours for up to 5 doses</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hygroscopic dilators (e.g., laminaria) may be used before administration for <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> ripening.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Misoprostol 400 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> every 3 hours for up to 5 doses</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used when Mifepristone is not available.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dinoprostone 20 mg <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> every 4 hours.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less commonly used.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-dose <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> Oxytocin in saline.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Longer <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">induction</span> duration is rarely used.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Trimester</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Procedure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1st</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Manual Vacuum Aspiration (MVA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MVA is an <span class=\"customMeta\" data-dictid=\"a9f32a257d1692777194caf3b4cf78\">outpatient</span> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> abortion procedure used up to 12 weeks of gestation.</li>\n<li>The procedure involves dilating the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> and inserting a <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> attached to a manual vacuum <span class=\"customMeta\" data-dictid=\"559fa730881692777182e593effebf\">aspirator</span> or a 60-mL syringe.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> is used to remove retained tissue from the uterus.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"f3c62587931692777181dabdaa512d\">approximate</span> pressure is around - 610 mmHg.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"310\" src=\"https://image.prepladder.com/content/p5fDnuDQtl8nhKoaKvlp1746436497.png\" width=\"265\"/></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Electric Vacuum Aspiration (EVA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>EVA is similar to MVA.</li>\n<li>Instead of a manual syringe, it uses an electric pump to generate <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> to remove retained products of conception.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dilation and Curettage (D&amp;C)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>D&amp;C is performed up to 12 weeks of <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> by dilating the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> and using instruments like curettes and <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> cannula.</li>\n<li>MVA and EVA are preferred over sharp D&amp;C for being safer and more efficient.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"225\" src=\"https://image.prepladder.com/content/wxjGSDqwf5JPONiNwlEz1746436497.png\" width=\"264\"/></p>\n<p style=\"text-align: center;\"><strong>Karman’s cannula</strong></p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"citizen\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hegar_dilators\" data-tags=\"\" height=\"188\" src=\"https://image.prepladder.com/content/bykXasMp8aP1z09a2HU61746436497.png\" width=\"264\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Hegar’s dilator</strong></p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"SnowBink\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Uterine_Curette_01.jpg#/media/File:Uterine_Curette_02.jpg\" data-tags=\"\" height=\"292\" src=\"https://image.prepladder.com/content/uX07J89Cpfp1fQOGOAYC1746436497.png\" width=\"86\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Uterine curette</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2nd</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dilation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>D&amp;E is a 2nd-trimester abortion method involving <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> using osmotic dilators. Ovum <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> are then used to remove the pregnancy tissue.</li>\n<li>Draining <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid before removing the <span class=\"customMeta\" data-dictid=\"421fecf0e21692777202704942ac48\">fetus</span> is crucial to minimize the risk of <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> during the procedure.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"259\" src=\"https://image.prepladder.com/content/fNGy3S4BvRdQMee9ZgZs1746436497.png\" width=\"264\"/></p>\n<p style=\"text-align: center;\"><strong>Ovum forceps</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hysterotomy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"6b602c38bf16927771898ad1392b00\">hysterotomy</span> is a <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedure where the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> is <span class=\"customMeta\" data-dictid=\"13e924e3cb169277719021021fc6d2\">incised</span> to remove the fetus.</li>\n<li>Reserved for 2nd-trimester abortions where other methods are not feasible or have failed.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please determine the segment of the liver that is highlighted in red in the provided image.", "options": [{"label": "A", "text": "V", "correct": true}, {"label": "B", "text": "IVa", "correct": false}, {"label": "C", "text": "VII", "correct": false}, {"label": "D", "text": "III", "correct": false}], "correct_answer": "A. V", "question_images": ["https://image.prepladder.com/notes/4WJ4ywlvAr7fn74b53ds1747383689.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the radiotherapy treatment given to a cancer patient that involves administering a dose of 1.8 to 2 Gy once daily for 5 days per week over a period of 6 to 8 weeks?", "options": [{"label": "A", "text": "Regular Fractionated radiotherapy", "correct": true}, {"label": "B", "text": "Hyper fractionated radiotherapy", "correct": false}, {"label": "C", "text": "Accelerated fractionation radiotherapy", "correct": false}, {"label": "D", "text": "Brachytherapy", "correct": false}], "correct_answer": "A. Regular Fractionated radiotherapy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wV44ebMhXTomUlYh8Kbi1746437048.png", "https://image.prepladder.com/content/g1k7BnuL9wyaNtF7nyrV1746437048.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spatially Fractionated Radiation Therapy (SFRT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delivers <span class=\"customMeta\" data-dictid=\"bbe1b94c491692777188fe4f85b1ce\">heterogeneous</span> doses to spare normal tissue, effective in bulky tumors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperfractionation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More frequent, smaller doses to enhance local control.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Accelerated Fractionation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shortens overall treatment time, maintaining or enhancing efficacy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the section of the intestine shown in the barium study provided.", "options": [{"label": "A", "text": "Ileum", "correct": false}, {"label": "B", "text": "Transverse colon", "correct": false}, {"label": "C", "text": "Jejunum", "correct": true}, {"label": "D", "text": "Splenic flexure", "correct": false}], "correct_answer": "C. Jejunum", "question_images": ["https://image.prepladder.com/notes/hdM8MWsBfgLDdwneq8g71747383845.png"], "explanation_images": ["https://image.prepladder.com/content/I7GDDD6b140DzBlaqjfZ1746437254.png", "https://image.prepladder.com/content/xfVqu0mmhFd4Njva7Z5p1746437254.png", "https://image.prepladder.com/content/RzKcKLpkuRPtTlqMRVZo1746437254.png", "https://image.prepladder.com/content/G9oXlSpWU1TcuZi6rM2W1746437254.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:727px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Radiological Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal Abdomen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Single bubble in the stomach</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A single air bubble seen in the left upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> corresponds to the <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> of the stomach. A large single bubble is seen in cases of pyloric atresia, GOO.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jeremy Jones\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/normal-abdominal-x-ray-1\" data-tags=\"\" height=\"228\" src=\"https://image.prepladder.com/content/I7GDDD6b140DzBlaqjfZ1746437254.png\" width=\"169\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pyloric Atresia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>\"Single bubble\" sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A single distended stomach with no air in the small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> or beyond, caused by <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> at the pylorus.</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Samir,\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:GOO_AXR.jpg\" data-tags=\"\" height=\"295\" src=\"https://image.prepladder.com/content/xfVqu0mmhFd4Njva7Z5p1746437254.png\" width=\"235\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duodenal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">Atresia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>\"Double bubble\" sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distended stomach and <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> duodenum; no <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> gas due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> at the duodenum.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Pediatric Radiology Olgahospital Klinikum Stuttgart\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:DuodAtres.png\" data-tags=\"\" height=\"328\" src=\"https://image.prepladder.com/content/RzKcKLpkuRPtTlqMRVZo1746437254.png\" width=\"261\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Jejunal Atresia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>\"Triple bubble\" sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Three distended loops of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> (stomach, duodenum, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> jejunum) with no <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> gas.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hisham Alwakkaa\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/jejunal-atresia-2#image-33384261\" data-tags=\"\" height=\"443\" src=\"https://image.prepladder.com/content/G9oXlSpWU1TcuZi6rM2W1746437254.png\" width=\"265\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ileal Atresia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple air-fluid levels</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilated small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops with air-fluid levels and no gas in the large intestine, more <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> than jejunal atresia.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman, who is 5 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?", "options": [{"label": "A", "text": "Postpartum depression", "correct": false}, {"label": "B", "text": "Postpartum blues", "correct": true}, {"label": "C", "text": "Postpartum psychosis", "correct": false}, {"label": "D", "text": "Postpartum anxiety", "correct": false}], "correct_answer": "B. Postpartum blues", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disorder </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Postpartum Blues (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Postpartum Depression (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Postpartum <span class=\"customMeta\" data-dictid=\"1cb2d1482916927771964c2890313e\">Psychosis</span> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4-5 days after delivery</strong>, lasts a few days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gradual onset over <strong>4-6 months following delivery or abortion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sudden, typically <strong>within 4-6 weeks after delivery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transient, lasts for a few days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can persist beyond <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> period</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can persist beyond <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> period</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Depression</li>\n<li>Anxiety</li>\n<li><strong>Tearfulness</strong></li>\n<li><strong>Insomnia</strong></li>\n<li>Negative feelings</li>\n<li><strong>Mood swings</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Loss of energy and appetite</li>\n<li>Insomnia</li>\n<li>Social withdrawal</li>\n<li>Irritability</li>\n<li><strong>Suicidal attitude </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fear</li>\n<li>Restlessness</li>\n<li><strong>Hallucinations</strong></li>\n<li><strong>Delusions </strong></li>\n<li>Disorientation</li>\n<li><strong>Suicidal and <span class=\"customMeta\" data-dictid=\"4c815174781692777190e1b4a5d704\">infantile</span> impulses</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reassurance</li>\n<li>psychological support</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CBT</li>\n<li>SSRIs, <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> Patch later.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urgent psychiatric consultation, hospitalization.</li>\n</ul>\n<ul>\n<li>Chlorpromazine, <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> estradiol, lithium, <span class=\"customMeta\" data-dictid=\"f999d172b91692777186778c4e5593\">ECT</span> (if necessary)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good with treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High risk of recurrence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Breastfeeding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally safe</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Safe with SSRIs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contraindicated with some medications (Lithium)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primigravida woman gives birth to a baby with the following defect. Identify the anomaly.", "options": [{"label": "A", "text": "Meningoencephalocele", "correct": false}, {"label": "B", "text": "Craniorachischisis", "correct": true}, {"label": "C", "text": "Myelomeningocele", "correct": false}, {"label": "D", "text": "Rachischisis", "correct": false}], "correct_answer": "B. Craniorachischisis", "question_images": ["https://image.prepladder.com/content/CKZbhv9ucz1RdHvKvCkd1746437720.png"], "explanation_images": ["https://image.prepladder.com/content/FUcj4FjPvSW8SKPsUtkM1746437749.png", "https://image.prepladder.com/content/L2DeHX2QjIyGppsK2gBG1746437749.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition shown below?", "options": [{"label": "A", "text": "Condyloma lata", "correct": false}, {"label": "B", "text": "Molluscum contagiosum", "correct": false}, {"label": "C", "text": "Condyloma accuminata", "correct": true}, {"label": "D", "text": "None of above", "correct": false}], "correct_answer": "C. Condyloma accuminata", "question_images": ["https://image.prepladder.com/notes/4qBso1Vw8Lcckm3nJee71747392545.png"], "explanation_images": ["https://image.prepladder.com/content/QP7xSa1FT88jF8BoBIqQ1746437834.png", "https://image.prepladder.com/content/EMaEX1MoILq4dcWTwvTg1746437834.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female patient presents to the emergency department with chills and rigors. She has acute pain in the right flank region. The imaging is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cholecystitis", "correct": false}, {"label": "B", "text": "Emphysematous pyelonephritis", "correct": true}, {"label": "C", "text": "Small bowel obstruction", "correct": false}, {"label": "D", "text": "Volvulus", "correct": false}], "correct_answer": "B. Emphysematous pyelonephritis", "question_images": ["https://image.prepladder.com/notes/t8014f4HddjraWWP9tWe1747383985.png"], "explanation_images": ["https://image.prepladder.com/content/yccrUiBSAXey4nHOjhtt1746437621.png", "https://image.prepladder.com/content/n2aU1nAfSNGCSVBWUkeE1746437621.png", "https://image.prepladder.com/content/3UBNAmKDHfWoW3AOBnTa1746437621.png", "https://image.prepladder.com/content/sixQhNzh0gATlSEezrYg1746437664.png", "https://image.prepladder.com/content/TOVSApeKPSnUNaFWV92f1746437680.png", "https://image.prepladder.com/content/3Ev1ZRkzoYbYmyBkf77e1746437684.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4><strong>Acute <span class=\"customMeta\" data-dictid=\"7d244db63c1692777196490682ecc8\">Pyelonephritis</span> </strong></h4>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4><strong>Xanthogranulomatous Pyelonephritis</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4><strong>Emphysematous Pyelonephritis</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound (USG):</strong> This may show <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> enlargement, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> echogenicity, and dilated collecting systems.</p>\n<p> </p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kao, Jeff &amp; Wu, Ching-Jiunn.\" data-hash=\"\" data-license=\"CC BY-NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Diffuse-acute-pyelonephritis-in-a-31-year-old-woman-A-Longitudinal-ultrasound-of-the_fig1_244858312\" data-tags=\"\" height=\"202\" src=\"https://image.prepladder.com/content/yccrUiBSAXey4nHOjhtt1746437621.png\" width=\"219\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound (USG):</strong> Shows an enlarged <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with <strong>echogenic staghorn <span class=\"customMeta\" data-dictid=\"eae898f16d1692777183cc3469a664\">calculi</span> and <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> masses</strong> replacing <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> parenchyma.</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ciccarese, Federica &amp; Brandi, Nicolò &amp; Corcioni, Beniamino &amp; Golfieri, Rita &amp; Gaudiano, Caterina.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Radiographic-and-ultrasonographic-US-appearance-of-xanthogranulomatous-Pyelonephritis_fig1_347212248\" data-tags=\"\" height=\"184\" src=\"https://image.prepladder.com/content/n2aU1nAfSNGCSVBWUkeE1746437621.png\" width=\"219\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plain <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> X-ray:</strong> Detects gas in the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> region in about 70% of cases.</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Montelongo-Rodríguez, Fred &amp; Robles-Torres, José &amp; García-Saucedo, Jesús &amp; Ruíz-Galindo, Efraín &amp; Pacheco-Molina, Carlos &amp; Gómez-Guerra, Lauro.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Abdominal-x-ray-shows-gas-distributed-in-the-topography-of-the-right-kidney-arrows_fig1_354626047\" data-tags=\"\" height=\"239\" src=\"https://image.prepladder.com/content/3UBNAmKDHfWoW3AOBnTa1746437621.png\" width=\"219\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contrast-enhanced CT:</strong> Most sensitive, showing wedge-shaped <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> areas, <span class=\"customMeta\" data-dictid=\"83b138c27e16927771993110e65f52\">striated</span> nephrograms, and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> wall thickening.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Irfan Moinuddin, Erika Bracamonte, Bijin Thajudeen, Amy Sussman, Machaiah Madhrira, James Costello\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2015/250530\" data-tags=\"\" height=\"192\" src=\"https://image.prepladder.com/content/sixQhNzh0gATlSEezrYg1746437664.png\" width=\"342\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Scan</strong> reveals a non-functioning kidney, <strong>staghorn calculus, expanded calyces, and <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> changes</strong>. A characteristic bear <span class=\"customMeta\" data-dictid=\"27e3bff9a21692777194ab2ee09585\">paw</span> sign is noted.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Xu, Zhunan &amp; Cai, Tong &amp; Zhang, Xuebao &amp; Wu, Jitao &amp; Liu, Chu. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Bear-paw-sign-multiple-rounded-low-density-areas-with-enhancing-rings-arranged-in-a_fig1_355754695\" data-tags=\"\" height=\"342\" src=\"https://image.prepladder.com/content/TOVSApeKPSnUNaFWV92f1746437680.png\" width=\"342\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT:</strong> Gold standard, reveals gas within the kidney, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> enlargement, <span class=\"customMeta\" data-dictid=\"419338f1b71692777195411fd0bfcd\">perinephric</span> stranding and abscesses. Helps classify into Type 1 (gas without fluid) or Type 2 (gas with fluid).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dutta, Deep &amp; Ks, Shivaprasad &amp; Kumar, Manoj &amp; Biswas, Dibakar &amp; Ghosh, Sujoy &amp; Mukhopadhyay, Pradip &amp; MUKHOPADHYAY, SATINATH &amp; Chowdhury, Subhankar.\" data-hash=\"\" data-license=\"CC BY-NC SA 3.0\" data-source=\"https://www.researchgate.net/figure/CT-abdomen-showing-enlargement-distortion-of-architecture-and-loss-of-corticomedullary_fig2_258704358\" data-tags=\"\" height=\"354\" src=\"https://image.prepladder.com/content/3Ev1ZRkzoYbYmyBkf77e1746437684.png\" width=\"342\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute infection of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> involving the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> and collecting system is usually caused by <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> bacteria.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is a chronic <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> response to <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> infection - that leads to the destruction of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> and its replacement by lipid-laden foamy macrophages.</li>\n<li>Destruction spreads from the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pelvis→medulla→ cortex.</li>\n<li>Usually, staghorn <span class=\"customMeta\" data-dictid=\"7c0090409b16927771839521583331\">calculus</span> is present in the pelvis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> infection with gas accumulation in and around the kidney, primarily in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman presented with complaints of passing grape-like vesicles vaginally. A USG scan was done and is shown below. Which of the following hormone levels need to be checked in this patient? hCG-Human Chorionic Gonadotropin", "options": [{"label": "A", "text": "GnRh", "correct": false}, {"label": "B", "text": "FSH", "correct": false}, {"label": "C", "text": "LH", "correct": false}, {"label": "D", "text": "hCG", "correct": true}], "correct_answer": "D. hCG", "question_images": ["https://image.prepladder.com/content/7xxUUvGipw2EYUetdvfJ1746437893.png"], "explanation_images": ["https://image.prepladder.com/content/69lPWqNBiTu3m8Hojj6c1746437954.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young primigravida at 32 weeks gestation was admitted since her BP was 150/90 mmHg and urine dipstick was 2+ on antenatal checkup. On examination, she has pedal edema. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Placenta previa", "correct": false}, {"label": "B", "text": "Placenta abruptio", "correct": false}, {"label": "C", "text": "Spontaneous abortion", "correct": false}, {"label": "D", "text": "Preeclampsia", "correct": true}], "correct_answer": "D. Preeclampsia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hamman sign is seen in", "options": [{"label": "A", "text": "Pneumoperitoneum", "correct": false}, {"label": "B", "text": "Pneumopericardium", "correct": false}, {"label": "C", "text": "Pneumomediastinum", "correct": true}, {"label": "D", "text": "Hydropneumothorax", "correct": false}], "correct_answer": "C. Pneumomediastinum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PHdvzNje3Y9wQTt5xfPb1746438089.png", "https://image.prepladder.com/content/GCkOAp3WxfT1JdFF9qvG1746438089.png", "https://image.prepladder.com/content/Iwc4qcadQJuWtUio4eSr1746438089.png", "https://image.prepladder.com/content/gJZATV3220ED560CVdkM1746438298.png", "https://image.prepladder.com/content/bqsGSgKRvo7NTmuse7m91746438343.png", "https://image.prepladder.com/content/mUIUXlfZsMTguNUvPtOH1746438357.png", "https://image.prepladder.com/content/zlFVIY81NLoTfx4X9YJO1746438383.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A girl presented with complaints of irregular periods, acne, and increased facial hair growth.USG revealed multiple ovarian follicles. Which of the following would be increased in this patient?", "options": [{"label": "A", "text": "Sex hormone binding globulin levels", "correct": false}, {"label": "B", "text": "Serum testosterone", "correct": true}, {"label": "C", "text": "FSH levels", "correct": false}, {"label": "D", "text": "FSH/LH ratio", "correct": false}], "correct_answer": "B. Serum testosterone", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7fhoSmlVXSQYwXjD16431746438603.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male was referred to the urology OPD for evaluation of infertility. Karyotyping analysis revealed an XXY karyotype. Which of the following statements is not true about the condition?", "options": [{"label": "A", "text": "Levels of follicle-stimulating hormone are reduced", "correct": true}, {"label": "B", "text": "Azoospermia can be seen", "correct": false}, {"label": "C", "text": "Plasma estradiol levels are elevated", "correct": false}, {"label": "D", "text": "Testes size is reduced", "correct": false}], "correct_answer": "A. Levels of follicle-stimulating hormone are reduced", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 35-year-old pregnant woman at 32 weeks of gestation, which of the following conditions is oxytocin contraindicated for?", "options": [{"label": "A", "text": "Placenta covering internal os", "correct": true}, {"label": "B", "text": "Induction of labor in post-term pregnancy", "correct": false}, {"label": "C", "text": "Augmentation of labor in case of slow progress", "correct": false}, {"label": "D", "text": "Preterm labor with cervical dilation of 3 cm", "correct": false}], "correct_answer": "A. Placenta covering internal os", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Whole-body CT scan protocol for a trauma patient includes all, except", "options": [{"label": "A", "text": "CT Head", "correct": false}, {"label": "B", "text": "CT Cervical spine", "correct": false}, {"label": "C", "text": "CT Limbs", "correct": true}, {"label": "D", "text": "CT Abdomen", "correct": false}], "correct_answer": "C. CT Limbs", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the dose of Misoprostol in medical abortion?", "options": [{"label": "A", "text": "800 micrograms", "correct": true}, {"label": "B", "text": "25 micrograms", "correct": false}, {"label": "C", "text": "200 micrograms", "correct": false}, {"label": "D", "text": "400 micrograms", "correct": false}], "correct_answer": "A. 800 micrograms", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:684px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Trimester</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Regimen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1st</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mifepristone 200 mg orally, followed by <strong>Misoprostol 800 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> </strong>vaginally after 24 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medical abortion; Miscarriage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Best method with a high success rate.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2nd</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mifepristone 200 mg orally, followed by <span class=\"customMeta\" data-dictid=\"818841e1731692777192343c40aa73\">Misoprostol</span> 400 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> every 3 hours for up to 5 doses</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MTP</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hygroscopic dilators (e.g., laminaria) may be used before administration for <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> ripening.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Misoprostol 400 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> every 3 hours for up to 5 doses</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MTP</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used when <span class=\"customMeta\" data-dictid=\"f9a7fe348e16927771921ce2ada3b2\">Mifepristone</span> is not available.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dinoprostone 20 mg <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> every 4 hours.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MTP</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less commonly used.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-dose <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">Oxytocin</span> in saline.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MTP</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Longer <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">induction</span> duration is rarely used.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following statements is correct in pregnancy?", "options": [{"label": "A", "text": "GFR decrease", "correct": false}, {"label": "B", "text": "Platelet increase", "correct": false}, {"label": "C", "text": "Serum creatinine decrease", "correct": true}, {"label": "D", "text": "Both B &amp;amp; C", "correct": false}], "correct_answer": "C. Serum creatinine decrease", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "McCall’s culdoplasty is done in which of the following?", "options": [{"label": "A", "text": "Enterocele repair", "correct": true}, {"label": "B", "text": "Rectocele repair", "correct": false}, {"label": "C", "text": "Urethrocele repair", "correct": false}, {"label": "D", "text": "Vault prolapse surgery", "correct": false}], "correct_answer": "A. Enterocele repair", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Galactokinesis is governed by:", "options": [{"label": "A", "text": "Prolactin", "correct": false}, {"label": "B", "text": "Estrogen", "correct": false}, {"label": "C", "text": "Oxytocin", "correct": true}, {"label": "D", "text": "Progesterone", "correct": false}], "correct_answer": "C. Oxytocin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EPjt0yR5ucs5cLuYQfEs1746439249.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sperm count on a seminormal is 16 million/ml, with 40% motility and &amp;lt;1% of sperm with normal morphology. What is the term for this condition?", "options": [{"label": "A", "text": "Oligospermia", "correct": false}, {"label": "B", "text": "Normospermia", "correct": false}, {"label": "C", "text": "Asthenospermia", "correct": false}, {"label": "D", "text": "Teratospermia", "correct": true}], "correct_answer": "D. Teratospermia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:487px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Normal (Normozoospermia)</strong></p>\n<p><strong>(WHO 2021 Guidelines)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Volume</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 1.4 ml</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>pH</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7.2-8.0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Concentration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>At least 16 million/ ml</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Total count</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>39 million/ejaculate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Total Motility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>42% or more</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Progressive motility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>30% or more</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphology (most important)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4% or more </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pus cells (WBC)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-2 million/ml</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Viability</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>54% or more</p>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Williams Gynecology, 4th Edition, Page 443</li><li>↳ Shaw’s textbook of Gynaecology, 17th Edition, Page 207</li><li>↳ Comparison of the WHO reference manual for semen analysis as per the 5th &amp; 6th edition</li><li>↳ https://www.sciencedirect.com/science/article/abs/pii/S1521693412001216#</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 31-year-old female presented with a history of vaginal delivery 2 days ago and complained of pain and sensory loss in the anterolateral aspect of the thigh. Which of the following nerves is involved?", "options": [{"label": "A", "text": "Sciatic nerve", "correct": false}, {"label": "B", "text": "Obturator nerve", "correct": false}, {"label": "C", "text": "Ilioinguinal nerve", "correct": false}, {"label": "D", "text": "Lateral cutaneous nerve of thigh", "correct": true}], "correct_answer": "D. Lateral cutaneous nerve of thigh", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presented for the evaluation of infertility. He has been having recurrent hospitalization for infections, since 2 years of age. What is the most likely diagnosis ?", "options": [{"label": "A", "text": "Celiac disease", "correct": false}, {"label": "B", "text": "Cystic fibrosis", "correct": false}, {"label": "C", "text": "Primary ciliary dyskinesia", "correct": true}, {"label": "D", "text": "COPD", "correct": false}], "correct_answer": "C. Primary ciliary dyskinesia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female presented with a history of profuse vaginal discharge. The discharge has a fishy odour. Microscopy revealed the cell shown in the image. What is the probable diagnosis?", "options": [{"label": "A", "text": "Herpes", "correct": false}, {"label": "B", "text": "Candida albicans", "correct": false}, {"label": "C", "text": "Trichomonas vaginalis", "correct": false}, {"label": "D", "text": "Bacterial vaginosis", "correct": true}], "correct_answer": "D. Bacterial vaginosis", "question_images": ["https://image.prepladder.com/notes/fkwdRx1orPHpL3dszM6y1747392861.png"], "explanation_images": ["https://image.prepladder.com/content/yRY254Q4V0WOO7REZMMd1746440234.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following can not be used for emergency contraception?", "options": [{"label": "A", "text": "LNG 1.5 mg single dose", "correct": false}, {"label": "B", "text": "Centchroman 60 mg, twice in 24 hours", "correct": false}, {"label": "C", "text": "LNG 0.75 mg single dose in 72 hours", "correct": true}, {"label": "D", "text": "Ulipristal acetate 30 mg single dose", "correct": false}], "correct_answer": "C. LNG 0.75 mg single dose in 72 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a direct cause of maternal death?", "options": [{"label": "A", "text": "Anemia", "correct": false}, {"label": "B", "text": "Malaria", "correct": false}, {"label": "C", "text": "Heart disease", "correct": false}, {"label": "D", "text": "Eclampsia", "correct": true}], "correct_answer": "D. Eclampsia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The screening method for GDM recommended in India is done between:", "options": [{"label": "A", "text": "24-28 weeks of gestation", "correct": true}, {"label": "B", "text": "32-34 weeks of gestation", "correct": false}, {"label": "C", "text": "28-32 weeks of gestation", "correct": false}, {"label": "D", "text": "34-38 weeks of gestation", "correct": false}], "correct_answer": "A. 24-28 weeks of gestation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:334px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>mg/dL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>mmol/litre</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fasting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤ 92</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5.1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1 hour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤ 180</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10.1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2 hours</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤ 153</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8.5</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which trimester is the quadruple test performed?", "options": [{"label": "A", "text": "2nd trimester", "correct": true}, {"label": "B", "text": "3rd trimester", "correct": false}, {"label": "C", "text": "1st trimester", "correct": false}, {"label": "D", "text": "All trimesters", "correct": false}], "correct_answer": "A. 2nd trimester", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:651px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>First trimester</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Second trimester</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Timing </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>11 - 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>15 - 22 weeks</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Screening test</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dual Test:</strong>\n<ul>\n<li>PAPP-A (Pregnancy Associated <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> Protein-A)</li>\n<li>Beta-hCG</li>\n</ul>\n</li>\n<li>Can be combined with <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> measurement of - Nuchal translucency (NT) and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bone If NT is ≥ 3 mm in the first trimester</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Triple Test:</strong>\n<ul>\n<li>Maternal <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">Alpha</span> Fetoprotein (MSAFP)</li>\n<li>Unconjugated <span class=\"customMeta\" data-dictid=\"8951ad7a1d1692777187a1ba0b8899\">estriol</span> (uE3)</li>\n<li>Beta hCG</li>\n</ul>\n</li>\n</ul>\n<p>OR</p>\n<ul>\n<li><strong>Quadruple Test:</strong>\n<ul>\n<li>Maternal <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">Serum</span> <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">Alpha</span> Fetoprotein (MSAFP)</li>\n<li>Unconjugated <span class=\"customMeta\" data-dictid=\"8951ad7a1d1692777187a1ba0b8899\">estriol</span> (uE3)</li>\n<li>Beta hCG</li>\n<li>Dimeric inhibin-A</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient with postpartum hemorrhage has been given ergometrine and oxytocin. The bleeding still continues. Which prostaglandin derivative can be given in this situation?", "options": [{"label": "A", "text": "Dinoprostone", "correct": false}, {"label": "B", "text": "Misoprostol", "correct": false}, {"label": "C", "text": "Latanoprost", "correct": false}, {"label": "D", "text": "Carboprost", "correct": true}], "correct_answer": "D. Carboprost", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs cannot be given in bacterial vaginosis?", "options": [{"label": "A", "text": "Clindamycin", "correct": false}, {"label": "B", "text": "Erythromycin", "correct": true}, {"label": "C", "text": "Metronidazole", "correct": false}, {"label": "D", "text": "Tinidazole", "correct": false}], "correct_answer": "B. Erythromycin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/N0aM28eBKRoaHeItLEoD1746443690.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presented with difficulty in activities like climbing stairs, getting up from a chair, and combing hair. Violaceous erythema of the upper eyelids was noted. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Inclusion body myositis", "correct": false}, {"label": "B", "text": "Dermatomyositis", "correct": true}, {"label": "C", "text": "Polymyositis", "correct": false}, {"label": "D", "text": "Scleroderma", "correct": false}], "correct_answer": "B. Dermatomyositis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kBn2sGMSwr1ORdWuJL1x1746445159.png", "https://image.prepladder.com/content/AhHEOdBvSyGEN5KYGiQT1746445228.png", "https://image.prepladder.com/content/s4jW0wsVjZBzbjYOaGFW1746445236.png", "https://image.prepladder.com/content/TxunHiuGqTp8xIYNu7yR1746445248.png", "https://image.prepladder.com/content/QY7PenSS4FuFEVV6EyWi1746445256.png", "https://image.prepladder.com/content/US5N0kTbKBWHA7hTSPF61746445263.png"], "explanation": "<p>Correct Answer B - Dermatomyositis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dermatomyositis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dermatomyositis </strong>is a chronic, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"417c81834e169277719328d50305b6\">myositis</span> seen in adults around 50-60 years of age.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n<ul>\n<li>It presents as <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">symmetrical</span> muscle weakness (proximal &gt; distal)</li>\n<li><strong>Gottron’s papules</strong> (erythematous <span class=\"customMeta\" data-dictid=\"a37fd1603c1692777198f87a4a51dc\">scaly</span> papules over knuckles) are <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> of the disease.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"330\" src=\"https://image.prepladder.com/content/kBn2sGMSwr1ORdWuJL1x1746445159.png\" width=\"608\"/></p>\n<ul>\n<li><strong>Gottron’s sign</strong>: Symmetric, confluent, <span class=\"customMeta\" data-dictid=\"57d8f3ea831692777202e8adc0cee9\">violaceous</span> <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> (CMVE) on the back of fingers, on the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> surfaces of joints of the elbows, knees, or ankles</li>\n</ul>\n<ul>\n<li>CMVE is seen over other sites too, and is named accordingly.\n\t\t\t\t<ul>\n<li><strong>Heliotrope rash: </strong>CMVE over the <span class=\"customMeta\" data-dictid=\"5b1b31d3e41692777195670afc94ca\">periorbital</span> skin</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"210\" src=\"https://image.prepladder.com/content/AhHEOdBvSyGEN5KYGiQT1746445228.png\" width=\"490\"/></p>\n<ul>\n<li>\n<ul>\n<li><strong>V-Sign:</strong> CMVE over the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> aspect of the neck</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"308\" src=\"https://image.prepladder.com/content/s4jW0wsVjZBzbjYOaGFW1746445236.png\" width=\"396\"/></p>\n<ul>\n<li>\n<ul>\n<li><strong>Shawl sign: </strong>Involvement of upper back</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"332\" src=\"https://image.prepladder.com/content/TxunHiuGqTp8xIYNu7yR1746445248.png\" width=\"391\"/></p>\n<ul>\n<li>\n<ul>\n<li><strong>Holster sign:</strong> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">Rash</span> over the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> aspect of the thigh</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"295\" src=\"https://image.prepladder.com/content/QY7PenSS4FuFEVV6EyWi1746445256.png\" width=\"430\"/></p>\n<ul>\n<li>\n<ul>\n<li><strong>Mechanic’s hand:</strong> <span class=\"customMeta\" data-dictid=\"fc203fa4cb1692777189d4212b9366\">Hyperkeratosis</span> and fissuring on the edges of the fingers</li>\n</ul>\n</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"506\" src=\"https://image.prepladder.com/content/US5N0kTbKBWHA7hTSPF61746445263.png\" width=\"423\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male patient presents with ptosis and muscle weakness which reportedly worsens in the evening and improves in the morning. This is relieved by neostigmine. What is the likely diagnosis?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": true}, {"label": "B", "text": "Huntington chorea", "correct": false}, {"label": "C", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "D", "text": "External ophthalmoplegia", "correct": false}], "correct_answer": "A. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\"&gt;Myasthenia&lt;/span&gt; gravis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features and Diagnosis of <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">Myasthenia</span> Gravis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diplopia, ptosis, dysarthria, dysphagia</li>\n<li>Weakness in oculomotor, pharyngeal, limb, neck extensors</li>\n<li>Fluctuation and fatigue worse with activity, improved by rest</li>\n<li>Fatiguability increases as the day passes (diurnal variation)</li>\n<li>Initial symptoms frequently <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> (diplopia/ptosis)</li>\n<li>Facial weakness produces \"snarling\" expression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eye movements and ptosis</li>\n<li>Assessment of <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> in neck and extremities</li>\n<li>Weakness following repetitive muscle activation</li>\n<li>Normal deep <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> reflexes</li>\n<li>No <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> abnormalities</li>\n<li>Symptoms relieved by Anticholinesterases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti-AChR antibodies (positive in ~85% generalized MG)</li>\n<li>Anti-MuSK antibodies (in ~40% of AChR-negative cases)</li>\n<li>Repetitive nerve stimulation</li>\n<li>Single-fiber EMG</li>\n<li>CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> of chest (to evaluate thymus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Edrophonium (Tensilon) test: 2mg + 8mg IV</li>\n<li>Ice pack test for ptosis</li>\n<li>Fatigue testing (repeated muscle activation)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Bell's palsy involves:", "options": [{"label": "A", "text": "Ipsilateral upper and lower halves of the face", "correct": true}, {"label": "B", "text": "Contralateral upper and lower halves of the face", "correct": false}, {"label": "C", "text": "Ipsilateral lower half of the face", "correct": false}, {"label": "D", "text": "Contralateral lower half of the face", "correct": false}], "correct_answer": "A. Ipsilateral upper and lower halves of the face", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ml933jIv0AqfHBxdAJm51746445675.png"], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\"&gt;Ipsilateral&lt;/span&gt; upper and lower halves of the face</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bell’s Palsy</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"Bellspalsy - Bell's palsy - Wikipedia\" data-tags=\"\" height=\"451\" src=\"https://image.prepladder.com/content/Ml933jIv0AqfHBxdAJm51746445675.png\" width=\"305\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inflammation of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve</li>\n<li>HSV-1 reactivation- Common cause</li>\n<li>VZV <span class=\"customMeta\" data-dictid=\"eee52fe3cc16927771970c8dffdfd2\">reactivation</span> in Ramsay Hunt</li>\n<li>Edema within <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> canal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute onset (24-72 hours)</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis</li>\n<li>Loss of taste <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> 2/3 tongue</li>\n<li>Hyperacusis (stapedius paralysis)</li>\n<li>Decreased tear production</li>\n<li>Bell's phenomenon present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical diagnosis primary</li>\n<li>EMG/NCS if no improvement</li>\n<li>MRI if <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> features</li>\n<li>CSF analysis if indicated</li>\n<li>Lyme titers in <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> areas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment &amp; Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prednisone 60-80mg × 5 days</li>\n<li>Valacyclovir 1000mg TID × 5-7 days</li>\n<li>Eye protection crucial</li>\n<li>80% recovery rate</li>\n<li>Axonal <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> = worse prognosis</li>\n<li>Incomplete <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> in 1st week = best prognosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs reduce mortality in a patient with heart failure?", "options": [{"label": "A", "text": "Metoprolol", "correct": true}, {"label": "B", "text": "Furosemide", "correct": false}, {"label": "C", "text": "Prazosin", "correct": false}, {"label": "D", "text": "Torsemide", "correct": false}], "correct_answer": "A. Metoprolol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Metoprolol</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>First-line drugs used in the treatment of Chronic <span class=\"customMeta\" data-dictid=\"d120a30dab1692777184bdcc21c20d\">CHF</span> (mortality-reducing)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ARBs/ACE-inhibitors/ARNI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Either of these can be started as<strong> initial therapy.</strong></li>\n<li>ACE-inhibitors: Captopril, Enalapril</li>\n<li>ARBs: Telmisartan, Olmesartan</li>\n<li>ARNI: <strong>ARB+Neprilysin <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> - Valsartan-Sacubitril (most preferred 1st line drug)</strong></li>\n<li>ADR: <strong>Cough, angioedema</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Beta-blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardioselective (2nd gen): <strong>Metoprolol, Bisoprolol</strong></li>\n<li>3rd gen: <strong>Carvedilol</strong> (both α- &amp; β- <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> action) - Best <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> for heart failure</li>\n<li>ADR: Bradycardia, Hypotension</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>SGLT-2 Inhibitors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dapagliflozin, Empagliflozin</li>\n<li>ADR: <strong>UTI, Forunier gangrene, <span class=\"customMeta\" data-dictid=\"dafe10db1216927771874c034ff821\">Euglycemic</span> DKA</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aldosterone antagonists</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Spironolactone </strong></li>\n<li>ADR: <strong>Gynaecomastia</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 309 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "For what population size is an urban Primary Health Centre (PHC) typically intended?", "options": [{"label": "A", "text": "1 per 50,000", "correct": true}, {"label": "B", "text": "1 per 100,000", "correct": false}, {"label": "C", "text": "1 per 250,000", "correct": false}, {"label": "D", "text": "1 per 200,000", "correct": false}], "correct_answer": "A. 1 per 50,000", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 1 per 50,000</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of primary health centre</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Plain population</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hilly &amp; tribal population</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Rural PHC</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1 per 30,000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1 per 20,000</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Urban PHC</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1 per 50,000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Multispeciality UPHC/Polyclinic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1 per 2-3 lakh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a technology-based surveillance system for tuberculosis (TB) in India?", "options": [{"label": "A", "text": "Nikshay", "correct": true}, {"label": "B", "text": "Nischay", "correct": false}, {"label": "C", "text": "Dots99", "correct": false}, {"label": "D", "text": "DOTS", "correct": false}], "correct_answer": "A. Nikshay", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Niksh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A gym owner observes that individuals who drink iced tea during their workouts tend to lose more weight. What is the nature of this relationship?", "options": [{"label": "A", "text": "Spurious", "correct": false}, {"label": "B", "text": "Relative", "correct": false}, {"label": "C", "text": "Direct", "correct": false}, {"label": "D", "text": "Indirect", "correct": true}], "correct_answer": "D. Indirect", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Indirect</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spurious (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An association that appears to be present but is actually due to chance or an error in data.<br/>\n<br/>\n\t\t\tIf the gym owner's observation was spurious, it would mean that the association between iced tea consumption and weight loss is completely false and exists due to some error in observation or data collection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indirect (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An association in which a third variable (known as the <span class=\"customMeta\" data-dictid=\"fe39bb8df416927771849b06e48169\">confounding</span> variable) causes both the predictor and the outcome.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Direct (Causal) (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An association where the predictor directly influences the outcome.</p>\n<p> </p>\n<p>If the relationship between iced tea consumption and weight loss were direct, it would mean that drinking iced tea itself leads to weight loss. However, it is unlikely that drinking iced tea alone would have a direct effect on weight loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>a. One-to-One causal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A direct causal link between a single predictor and a single outcome.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>b. Multifactorial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An association involving multiple factors contributing to the outcome.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A study was conducted in 3 states to measure the mean blood pressure in each community. Health workers were assigned to visit each house in the 3 communities. The mean blood pressure of each community was then compared. What is the study design called?", "options": [{"label": "A", "text": "Case-control", "correct": false}, {"label": "B", "text": "Cross-sectional", "correct": true}, {"label": "C", "text": "Cohort", "correct": false}, {"label": "D", "text": "Ecological study", "correct": false}], "correct_answer": "B. Cross-sectional", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Wasting in a child is assessed by which of the following measures?", "options": [{"label": "A", "text": "Weight-for-height", "correct": true}, {"label": "B", "text": "Weight-for-age", "correct": false}, {"label": "C", "text": "Height-for-weight", "correct": false}, {"label": "D", "text": "Height-for-age", "correct": false}], "correct_answer": "A. Weight-for-height", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A- Weight-for-heigh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the context of a new onset of a morbid disease, how does the change in incidence affect the prevalence of the disease?", "options": [{"label": "A", "text": "Prevalence is not related to incidence", "correct": false}, {"label": "B", "text": "Incidence will increase, and prevalence will decrease", "correct": false}, {"label": "C", "text": "Incidence and prevalence will increase", "correct": true}, {"label": "D", "text": "Prevalence will increase with a decrease in the incidence", "correct": false}], "correct_answer": "C. Incidence and prevalence will increase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C- &lt;span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\"&gt;Incidence&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\"&gt;prevalence&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the vector responsible for transmitting Orientia tsutsugamushi?", "options": [{"label": "A", "text": "Mite", "correct": true}, {"label": "B", "text": "Tick", "correct": false}, {"label": "C", "text": "Louse", "correct": false}, {"label": "D", "text": "Flea", "correct": false}], "correct_answer": "A. Mite", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A- M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What concentration of fluoride is typically associated with causing crippling fluorosis?", "options": [{"label": "A", "text": "&amp;gt; 10 mg/L", "correct": true}, {"label": "B", "text": "&amp;gt; 6 mg/L", "correct": false}, {"label": "C", "text": "&amp;gt; 3 mg/L", "correct": false}, {"label": "D", "text": "&amp;gt; 1.5 mg/L", "correct": false}], "correct_answer": "A. &gt; 10 mg/L", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A- &amp;gt; 10 mg/L</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fluoride (mg/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Less than 0.5</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Dental cavities</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>0.5–1.0</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Protection against <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> cavities. Good for bone and teeth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>1.5–3.0</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Dental fluorosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>3.0–10</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Skeletal fluorosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>10 or more</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Crippling skeletal <span class=\"customMeta\" data-dictid=\"bcf8138ea016927772034f9286529e\">fluorosis</span> and severe osteosclerosis</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drinking Water Quality Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Recommended Value</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Microbiological Aspects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Coliform Bacteria (E. coli)</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>0 coliforms per 100ml of <span class=\"customMeta\" data-dictid=\"e0b9b6647b1692777196072340adcd\">potable</span> water</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chemical Properties</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Chlorides</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Maximum: 600 mg/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Hardness</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>100-300 mg/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Total Dissolved Solids (TDS)</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Less than 600 mg/L (good), permissible up to 1000 mg/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Lead</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>0.01 mg/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Fluoride</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>0.5-0.8 mg/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Nitrate</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>&lt; 50 mg/L</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Physical Properties</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Turbidity</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Up to 5 NTU (Nephelometric Turbidity Unit)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Color</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Up to 15 TCU (True Color Unit) or 5 Hazen units</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What were the goals for Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) by 2023?", "options": [{"label": "A", "text": "70/30", "correct": true}, {"label": "B", "text": "30/70", "correct": false}, {"label": "C", "text": "100/30", "correct": false}, {"label": "D", "text": "30/100", "correct": false}], "correct_answer": "A. 70/30", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tt2O1ASwwNmQIl04h0xH1747138342.png", "https://image.prepladder.com/content/WmOwUxcC0p9pNpbOMkzC1747138366.png"], "explanation": "<p>Correct Option A- 70/3\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The Anemia Mukt Bharat program aims to address anemia across India through targeted interventions. Which statement accurately describes its administration of Iron and Folic Acid (IFA) supplementation?", "options": [{"label": "A", "text": "IFA is provided during the 2nd trimester of pregnancy and continues during lactation for up to 6 months", "correct": true}, {"label": "B", "text": "IFA supplementation is administered solely during pregnancy", "correct": false}, {"label": "C", "text": "A 100-day course of IFA supplementation is sufficient", "correct": false}, {"label": "D", "text": "Administering IFA during the 1st trimester is adequate.", "correct": false}], "correct_answer": "A. IFA is provided during the 2nd trimester of pregnancy and continues during lactation for up to 6 months", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0hsTMjdZ18xkxcd2LURh1747377936.png"], "explanation": "<p>Correct Option A- IFA is provided during the 2nd &lt;span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\"&gt;trimester&lt;/span&gt; of pregnancy and continues during &lt;span class=\"customMeta\" data-dictid=\"4abd8094e51692777191b1eb073735\"&gt;lactation&lt;/span&gt; for up to 6 month\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a population with a total of 4050 births, there are 50 stillbirths, 50 neonatal deaths within the first 7 days, and 150 deaths between 8 and 28 days of life. What is the Neonatal Mortality Rate (NMR) for this population?", "options": [{"label": "A", "text": "12.5", "correct": false}, {"label": "B", "text": "50", "correct": true}, {"label": "C", "text": "49.4", "correct": false}, {"label": "D", "text": "62.5", "correct": false}], "correct_answer": "B. 50", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B- 5\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the WHO definition of blindness?", "options": [{"label": "A", "text": "6/60", "correct": false}, {"label": "B", "text": "3/60", "correct": true}, {"label": "C", "text": "6/18", "correct": false}, {"label": "D", "text": "1/60", "correct": false}], "correct_answer": "B. 3/60", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B- 3/6\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate relative risk for the given situation: Exposed to malaria Not exposed to malaria Vaccinated 6 94 Non-vaccinated 12 88", "options": [{"label": "A", "text": "0.5", "correct": true}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "1.5", "correct": false}, {"label": "D", "text": "1.7", "correct": false}], "correct_answer": "A. 0.5", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Mpynv8YyS4gq2Y7bXgMD1747377986.png"], "explanation": "<p>Correct Option A- 0.5\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the typical Glomerular Filtration Rate (GFR) in a healthy adult?", "options": [{"label": "A", "text": "125 ml/min", "correct": true}, {"label": "B", "text": "200 ml/min", "correct": false}, {"label": "C", "text": "100 ml/min", "correct": false}, {"label": "D", "text": "150 ml/min", "correct": false}], "correct_answer": "A. 125 ml/min", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How does the muscle spindle detect muscle length during muscle contraction?", "options": [{"label": "A", "text": "Stretch receptor on the tendon", "correct": false}, {"label": "B", "text": "Stretch receptor in the muscle belly", "correct": true}, {"label": "C", "text": "Golgi tendon organ", "correct": false}, {"label": "D", "text": "Mechanoreceptor in the joint capsule", "correct": false}], "correct_answer": "B. Stretch receptor in the muscle belly", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which substance inhibits the iron transporter on the basal side of the enterocyte?", "options": [{"label": "A", "text": "Hepcidin", "correct": true}, {"label": "B", "text": "Ferritin", "correct": false}, {"label": "C", "text": "Transferrin", "correct": false}, {"label": "D", "text": "Ferroportin", "correct": false}], "correct_answer": "A. Hepcidin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/B5FqfvX0h8SkcyPTPgUG1747377699.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is brought to the Emergency Room following a road traffic accident (RTA) with thoracic and abdominal injuries. The patient is found to be in hypovolemic shock. What is the most probable cause of the decreased cardiac output in this case?", "options": [{"label": "A", "text": "Decrease in preload", "correct": true}, {"label": "B", "text": "Decrease in contractility of the heart", "correct": false}, {"label": "C", "text": "Increase in preload", "correct": false}, {"label": "D", "text": "Increase in afterload", "correct": false}], "correct_answer": "A. Decrease in preload", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:683px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Types of shock</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Pathophysiology</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Cardiac output</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cardiogenic</p>\n<p><strong>(Option B)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inadequate pumping of the heart due to myocardial function.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute myocardial infarction</li>\n<li>Heart failure</li>\n<li>Cardiac arrhythmias</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypovolemic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased amount of fluid in the <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> system</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute hemorrhage</li>\n<li>Burn</li>\n<li>Metabolic: <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> ketoacidosis</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> or vomiting.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distributive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sudden increase in the <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> capacity due to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> marked vasodilation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neurogenic shock</li>\n<li>Anaphylactic shock</li>\n<li>Septic shock</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obstructive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obstruction to the <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> of blood from the ventricle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardiac tamponade</li>\n<li>Constrictive pericarditis</li>\n<li>Cardiac tumor</li>\n<li>Tension pneumothorax</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following best explains the role of a second messenger in cellular signaling?", "options": [{"label": "A", "text": "Act on extracellular receptors", "correct": false}, {"label": "B", "text": "Modulate extracellular hormone response", "correct": false}, {"label": "C", "text": "Modulate intracellular hormone response", "correct": true}, {"label": "D", "text": "Directly interacts with the cell's DNA", "correct": false}], "correct_answer": "C. Modulate intracellular hormone response", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Activation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Enzymes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Second Messengers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cellular Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adenylyl Cyclase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GPCR-Gs binding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adenylyl Cyclase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>cAMP</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protein phosphorylation, e.g., <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormones, <span class=\"customMeta\" data-dictid=\"3f4575b0a516927771805f688177c0\">adrenocortical</span> steroids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phospholipase C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GPCR binding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Phospholipase C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IP3, DAG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calcium mobilization, smooth muscle contraction, protein phosphorylation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What renal function is represented by the formula UV/P?", "options": [{"label": "A", "text": "Filtration", "correct": false}, {"label": "B", "text": "Tubular Secretion", "correct": false}, {"label": "C", "text": "Tubular Reabsorption", "correct": false}, {"label": "D", "text": "Clearance", "correct": true}], "correct_answer": "D. Clearance", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Inulin Clearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Used to measure <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">Glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">Filtration</span> Rate (GFR) as it is freely filtered but not reabsorbed or secreted.</li>\n<li>Not ideal for routine use due to <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> administration.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Creatinine Clearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Estimates GFR using creatinine, which is primarily filtered by the glomeruli.</li>\n<li>Slightly inaccurate due to <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> secretion, but practical for clinical settings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PAH Clearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Estimates <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> Flow (RPF).</li>\n<li>PAH is cleared through both <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> and <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> secretion.</li>\n<li>Correction for PAH <span class=\"customMeta\" data-dictid=\"00456bf7d8169277718782edf9fa2c\">extraction</span> ratio improves accuracy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fracture shown in the image?", "options": [{"label": "A", "text": "Radial head fracture", "correct": true}, {"label": "B", "text": "Elbow fracture", "correct": false}, {"label": "C", "text": "Medial epicondyle fracture", "correct": false}, {"label": "D", "text": "Lateral epicondyle fracture", "correct": false}], "correct_answer": "A. Radial head fracture", "question_images": ["https://image.prepladder.com/content/1tcsf297DlM2LGTraAT81747375920.png"], "explanation_images": ["https://image.prepladder.com/content/GWAK45DR9i3o9apjeKAw1747375930.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head, the upper part of the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> that articulates with the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> and <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> at the elbow joint.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most commonly caused by a fall onto an outstretched hand (FOOSH)</li>\n<li>Direct trauma or a blow to the elbow</li>\n<li>MVA (Motor Vehicle Accidents) or sports injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Types of Fractures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type I: Non-displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (usually treated conservatively)</li>\n<li>Type II: Displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with a single fragment (may require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention)</li>\n<li>Type III: <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">Comminuted</span> (multiple fragments, often requiring <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> or replacement)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> aspect of the elbow</li>\n<li>Swelling and bruising around the elbow joint</li>\n<li>Limited range of motion, with <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> and extension</li>\n<li>Difficulty <span class=\"customMeta\" data-dictid=\"d3daf86e63169277719936e262ff26\">supination</span> and pronation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tenderness, swelling, and limited motion.</li>\n<li>X-rays: Used to classify the type and <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the fracture.</li>\n<li>CT scan: Used for more complex fractures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment Options</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conservative management: For non-displaced (Type I) fractures.</li>\n<li>Surgical management: For displaced (Type II) or <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> (Type III) fractures- <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head fixation, replacement (arthroplasty), or excision.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Loss of elbow range of motion</li>\n<li>Chronic pain</li>\n<li>Elbow instability</li>\n<li>Post-traumatic arthritis</li>\n<li>Stiffness or <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of the joint</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fracture?", "options": [{"label": "A", "text": "Lateral epicondyle fracture", "correct": true}, {"label": "B", "text": "Medial epicondyle fracture", "correct": false}, {"label": "C", "text": "Supra condyle fracture", "correct": false}, {"label": "D", "text": "Infra condyle fracture", "correct": false}], "correct_answer": "A. Lateral epicondyle fracture", "question_images": ["https://image.prepladder.com/content/Covzo8P3OSR1ISXX0LIj1747376016.png", "https://image.prepladder.com/content/Yi4X7aVjEmPhQm3R8PwQ1747376026.png"], "explanation_images": ["https://image.prepladder.com/content/uxWAe3o2m3KKSVrbhxR71747376041.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:618px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> involving the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"ca4c4e935616927771849e13b0396f\">condyle</span> of the humerus. It is typically seen in children.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most commonly by direct trauma to the elbow (Fall on the outstretched hand or a direct blow).</li>\n<li>Torsional forces during activity or sports.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Types of Fractures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type I: Non-displaced fractures (usually treated conservatively).</li>\n<li>Type II: Displaced fractures (may require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention).</li>\n<li>Type III: Comminuted fractures with significant <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> (often require surgery).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> around the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> aspect of the elbow.</li>\n<li>Limited range of motion, especially during extension and rotation.</li>\n<li>Deformity or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> positioning of the <span class=\"customMeta\" data-dictid=\"3fead70a341692777187431ed9d5e0\">elbow joint</span> (in more severe cases).</li>\n<li>Tenderness over the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> condyle.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical examination: History of trauma, swelling, and deformity.</li>\n<li>X-rays: To assess <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> type and displacement. <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> and <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> views are commonly taken.</li>\n<li>CT scan: Can help evaluate complex fractures or assess joint involvement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment Options</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Non-displaced fractures (Type I): Conservative management with rest, ice, and a <span class=\"customMeta\" data-dictid=\"5e2a7b127c1692777198f4895cc7c0\">sling</span> or cast for immobilization.</li>\n<li>Displaced fractures (Type II): Require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> fixation, such as the use of pins or screws.</li>\n<li>Comminuted fractures (Type III): Open reduction and internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (ORIF).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elbow <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> or loss of range of motion.</li>\n<li>Malunion or improper healing, leading to <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> deformity.</li>\n<li>Post-traumatic <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> due to joint surface involvement.</li>\n<li>Nerve injury (Radial nerve) due to <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given organism?", "options": [{"label": "A", "text": "Microsporum Gypseum", "correct": false}, {"label": "B", "text": "Microsporum audouinii", "correct": false}, {"label": "C", "text": "Epidermophyton Floccosum", "correct": true}, {"label": "D", "text": "Trichophyton", "correct": false}], "correct_answer": "C. Epidermophyton Floccosum", "question_images": ["https://image.prepladder.com/content/qCJdE4dtr4lERfAataxJ1747375164.png"], "explanation_images": ["https://image.prepladder.com/content/n4bF6fq2WK3uU0tdxMzN1747375234.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Genus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Key Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microsporum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predominantly macroconidia; spindle-shaped, <span class=\"customMeta\" data-dictid=\"688c032c5f169277719340e2e620d1\">multicellular</span> structures; <strong>infects hair and skin.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trichophyton</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More abundant microconidia in clusters; macroconidia are thin, and elongated; include species like <em>T. rubrum</em> which is common in humans. <strong>Infects hair, nails and skin.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidermophyton</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lacks microconidia; club-shaped, <span class=\"customMeta\" data-dictid=\"688c032c5f169277719340e2e620d1\">multicellular</span> macroconidia; infects <strong>skin and nails but not hair.</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Trichophyton</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Microsporum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Epidermophyton</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Site of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hair, nail, and skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hair and skin only</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin and nail only</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Colony</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Powdery pigmented</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cotton-like pigmented</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Powdery greenish yellow</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Spores</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>a. Microconidia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abundant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Relatively scanty</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>b. Macroconidia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pencil or cylindrical-shaped</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spindle-shaped</p>\n<p><strong>(Option A &amp; B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Club or pear-shaped</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Habitat Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anthropophilic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily found in humans; causes mild, chronic lesions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T. rubrum, E. floccosum, M. audouinii</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zoophilic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Natural parasites of animals; cause severe <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> but are treatable.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T. verrucosum, M. canis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Geophilic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found in soil; less <span class=\"customMeta\" data-dictid=\"aab99c76cb16927771946daf9e4dbf\">pathogenic</span> to humans.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M. gypseum, T. ajelloi</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The diagnosis in a patient who is unable to do internal and external rotation of the hip is?", "options": [{"label": "A", "text": "Femur head fracture", "correct": false}, {"label": "B", "text": "Acetabular fractures", "correct": false}, {"label": "C", "text": "Dislocation of hip", "correct": true}, {"label": "D", "text": "Pelvis fracture", "correct": false}], "correct_answer": "C. Dislocation of hip", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/flVqeVIFc0WcMyn5K9ms1747376131.png", "https://image.prepladder.com/content/MziPIWLljrrD1MWgBgHm1747376140.png", "https://image.prepladder.com/content/j0nL8EvTInMpOGQmJv201747376152.png", "https://image.prepladder.com/content/ORCyLQSiqx62xAQ0YZBE1747376156.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:670px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong><br/>\n\t\t\tCaused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>Femoral head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Femoral head displaced from the acetabulum.</li>\n<li>The thigh is internally rotated, the <span class=\"customMeta\" data-dictid=\"0404f7b31816927771912f2b470952\">lesser trochanter</span> is not seen, and Shenton’s line is broken.</li>\n<li>May require a CT scan for associated fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/flVqeVIFc0WcMyn5K9ms1747376131.png\" width=\"500\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/MziPIWLljrrD1MWgBgHm1747376140.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub\" data-tags=\"\" height=\"910\" src=\"https://image.prepladder.com/content/j0nL8EvTInMpOGQmJv201747376152.png\" width=\"622\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"\" height=\"609\" src=\"https://image.prepladder.com/content/ORCyLQSiqx62xAQ0YZBE1747376156.png\" width=\"622\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Relative bradycardia is seen in", "options": [{"label": "A", "text": "Dengue", "correct": false}, {"label": "B", "text": "Brucella", "correct": true}, {"label": "C", "text": "Bordetella", "correct": false}, {"label": "D", "text": "Leptospirosis", "correct": false}], "correct_answer": "B. Brucella", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Biochemical Properties</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Growth &amp; Susceptibility</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small, non-motile, aerobic, Gram-negative coccobacilli</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Catalase positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Do not grow well on standard laboratory media</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-capsulated and non-spore forming</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oxidase positive (except<em> B. neotomae</em> and <em>B. ovis)</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Destroyed by heat at 60°C in 10 minutes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often exhibit a <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> appearance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urease positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Killed by 1% <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> in 15 minutes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Utilize oxygen but do not typically <span class=\"customMeta\" data-dictid=\"9af2ec7d1c16927772021e06a81cb5\">ferment</span> carbohydrates</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Killed by pasteurization</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Standard <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">Agglutination</span> Test (SAT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tube <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">agglutination</span> test using <span class=\"customMeta\" data-dictid=\"b02f35d9471692777198bf98bee1f7\">serial</span> dilutions of patient's <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> and killed B. <span class=\"customMeta\" data-dictid=\"08b6873cdf16927771808060833cc5\">abortus</span> antigen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Significant titer: 160 or more.</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"9f660984cd1692777183b93d848da3\">brucellosis</span> titer: 640 or more within 3-4 weeks.</li>\n<li>Prozone phenomenon common.</li>\n<li>False positives with cholera, tularemia, <span class=\"customMeta\" data-dictid=\"b98ea6f7ff1692777202949d7a5b46\">yersinia</span> infection, or immunization</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Complement Fixation Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects IgG antibodies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Valuable in chronic cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>ELISA (Enzyme-Linked Immunosorbent Assay)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distinguishes between IgM and IgG antibodies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Useful for differentiating <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> from chronic infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rapid Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes rapid <span class=\"customMeta\" data-dictid=\"1dd1a9a2f21692777186672cf2ab93\">dipstick</span> tests and Rose Bengal card test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Quick results.</li>\n<li>Can be used for initial screening</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small, non-motile, aerobic, Gram-negative coccobacilli, Non-capsulated, non-spore forming, Bipolar staining</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical Properties</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Catalase positive, Oxidase positive (except B. neotomae and B. ovis), Urease positive, Utilize oxygen, do not <span class=\"customMeta\" data-dictid=\"9af2ec7d1c16927772021e06a81cb5\">ferment</span> carbohydrates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth &amp; Susceptibility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Do not grow well on standard media. Destroyed by heat at 60°C in 10 min, Killed by 1% <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> in 15 min, Killed by pasteurization.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zoonotic Nature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects goats, sheep, cattle, buffaloes, pigs. Human infection through contact or consumption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermittent fever, loss of appetite, nausea, <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> and <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> pains, fatigue, sweating, relative bradycardia, joint pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trypticase <span class=\"customMeta\" data-dictid=\"9264daf7031692777198ba5b8d6e8e\">soy</span> <span class=\"customMeta\" data-dictid=\"46988d61a21692777183ac440c691a\">broth</span> or <span class=\"customMeta\" data-dictid=\"1ce278e02d1692777183655ea881dc\">brucella</span> broth. Biphasic <span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\">blood culture</span> (Castaneda method). Large <span class=\"customMeta\" data-dictid=\"b9b690b70c16927771833aae799b33\">blood volume</span> (5 ml). Incubation: 37°C, 5-10% CO2, 6-8 weeks. 30-50% positive cases. Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> cultureshave a higher yield.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serological Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SAT: Significant <span class=\"customMeta\" data-dictid=\"07e6f3a1921692777200051f692a60\">titer</span> 160+, Acute 640+, Complement Fixation: IgG detection, ELISA: Distinguishes IgM &amp; IgG. Rapid Tests: Dipstick, Rose Bengal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adults: Doxycycline 45 days, Streptomycin 2 weeks, Children: Cotrimoxazole + Rifampicin/Gentamycin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaccination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No human vaccine, Occupational risk: Attenuated live vaccine, Animals: B. <span class=\"customMeta\" data-dictid=\"08b6873cdf16927771808060833cc5\">abortus</span> strain 19 vaccine.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Zellweger syndrome is associated with which cellular organelle?", "options": [{"label": "A", "text": "Peroxisomes", "correct": true}, {"label": "B", "text": "Nucleosomes", "correct": false}, {"label": "C", "text": "Lysosomes", "correct": false}, {"label": "D", "text": "Ribosomes", "correct": false}], "correct_answer": "A. Peroxisomes", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:751px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Zellweger Spectrum Disorder </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rare autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder with <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"c0d194cb5b16927771957905b7aad6\">peroxisome</span> <span class=\"customMeta\" data-dictid=\"2a7dfbac301692777183497b04697a\">biogenesis</span> affecting <strong>VLCFA metabolism.</strong></li>\n<li>Includes Zellweger syndrome, <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> adrenoleukodystrophy, <span class=\"customMeta\" data-dictid=\"4c815174781692777190e1b4a5d704\">infantile</span> Refsum disease, and <span class=\"customMeta\" data-dictid=\"fb6c267e9b1692777197157d5a3207\">rhizomelic</span> <span class=\"customMeta\" data-dictid=\"f5b22e0e2c1692777184a00af86fe9\">chondrodysplasia</span> punctata.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Caused by mutations in <strong>PEX genes <span class=\"customMeta\" data-dictid=\"b989cb3b0d1692777187dd7965b4d3\">encoding</span> peroxins,</strong> primarily <strong>PEX1/PEX6</strong></li>\n<li>Functional peroxisomal disturbances:\n\t\t\t\t<ol>\n<li>Zellweger spectrum: Generalized peroxisomal dysfunction.</li>\n<li>Adrenoleukodystrophy: Mutations in ABCD1, impacting VLCFA transport.</li>\n<li>Rhizomelic <span class=\"customMeta\" data-dictid=\"f5b22e0e2c1692777184a00af86fe9\">chondrodysplasia</span> punctata: Multiple <span class=\"customMeta\" data-dictid=\"11d4157da4169277718762144a4fe7\">enzymatic</span> defects.</li>\n</ol>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peroxisomes: Membrane-bound organelles with &gt;50 enzymes for <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid metabolism, abundant in liver/kidney.</li>\n<li>Mutated PEX genes disrupt <span class=\"customMeta\" data-dictid=\"c0d194cb5b16927771957905b7aad6\">peroxisome</span> formation, leading to VLCFA accumulation, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> biosynthesis, and neuronal damage.</li>\n<li>Major abnormalities:\n\t\t\t\t<ul>\n<li>Brain: Demyelination, neuronal injury.</li>\n<li>Liver: Fibrosis.</li>\n<li>Kidney: Cortical cysts.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multisystem involvement with severity depending on age of onset:</p>\n<ul>\n<li>Neonatal-Infantile: Hypotonia, <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> issues, seizures, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> dysmorphism, <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> and hearing abnormalities, hepatomegaly.</li>\n<li>Childhood: Developmental delay, FTT, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> dysfunction, <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, neuroregression.</li>\n<li>Adolescent-Adult: Neuroregression, ataxia, neuropathy, <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, leukodystrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial: Clinical features + elevated VLCFA on <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> screening.</li>\n<li>Biochemical tests: Elevated VLCFA, <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> acid intermediates, and phytanic/pristanic acid; <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> plasmalogens.</li>\n<li>Genetic testing: Confirms PEX mutations.</li>\n<li>Prenatal diagnosis and <span class=\"customMeta\" data-dictid=\"8a7bcc05181692777188abbdcdf808\">genetic counseling</span> recommended.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>No cure; supportive care focuses on improving quality of life.</li>\n</ul>\n<p> </p>\n<p><strong>Therapies</strong>:</p>\n<ol>\n<li><strong>Docosahexaenoic acid</strong></li>\n<li><strong>Lorenzo oil:</strong> Reduces VLCFA but doesn't halt disease progression.</li>\n<li><strong>Cholic acid</strong>: Approved for <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> dysfunction.</li>\n</ol>\n<p> </p>\n<p><strong>Supportive Measures:</strong></p>\n<ul>\n<li>Hearing aids for hearing loss.</li>\n<li>Ophthalmologic care for vision issues.</li>\n<li>Antiepileptics for seizures.</li>\n<li>Vitamin supplementation: Fat-soluble vitamins (A, D, E, K).</li>\n<li>Cortisone for <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency.</li>\n<li>Gastrostomy for <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> difficulties.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure pointed in the anatomical snuff box.", "options": [{"label": "A", "text": "Adductor pollicis", "correct": false}, {"label": "B", "text": "Extensor pollicis brevis", "correct": true}, {"label": "C", "text": "Flexor pollicis longus", "correct": false}, {"label": "D", "text": "Cephalic vein", "correct": false}], "correct_answer": "B. Extensor pollicis brevis", "question_images": ["https://image.prepladder.com/content/ap6NQET1ctTRYOAhQX1k1747376212.png"], "explanation_images": ["https://image.prepladder.com/content/aOXaeN0AbmJeDuggGiaC1747376221.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a history of watery diarrhea and vomiting. The pathogen exhibited darting motility. Which is the best selective media for the involved pathogen?", "options": [{"label": "A", "text": "Nutrient media", "correct": false}, {"label": "B", "text": "TCBS", "correct": true}, {"label": "C", "text": "Cetrimide agar", "correct": false}, {"label": "D", "text": "Potassium Tellurite Agar", "correct": false}], "correct_answer": "B. TCBS", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/F8E9klY2naY8ss96Gco21747375243.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which blood is transfused in a patient with a Bombay blood group?", "options": [{"label": "A", "text": "A", "correct": false}, {"label": "B", "text": "B", "correct": false}, {"label": "C", "text": "AB", "correct": false}, {"label": "D", "text": "O negative", "correct": true}], "correct_answer": "D. O negative", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the composition of lactulose?", "options": [{"label": "A", "text": "Glucose + Galactose", "correct": false}, {"label": "B", "text": "Glucose + Fructose", "correct": false}, {"label": "C", "text": "Galactose + Fructose", "correct": true}, {"label": "D", "text": "Fructose + Ribulose", "correct": false}], "correct_answer": "C. Galactose + Fructose", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disaccharide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sugars present</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Linkage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Maltose (Basic thumb rule)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> residues - <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> + glucose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>alpha(1,4)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Isomaltose (Six atoms)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> residues - <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> + glucose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>a(1,6)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trehalose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> residues - <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> + glucose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>a(1,1)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sucrose </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucose + <span class=\"customMeta\" data-dictid=\"d5bac53d50169277720363f48a6b3a\">fructose</span> <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>a(1,2)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lactose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Galactose + <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>beta(1,4)</strong></p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid whitesmoke; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Disaccharide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid whitesmoke; border-left:none; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Common name</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Sucrose</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Table sugar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Lactose</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Milk sugar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Maltose</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Malt sugar</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following microorganisms is likely responsible for causing bilateral infiltrates in an HIV-positive patient?", "options": [{"label": "A", "text": "Cryptococcus", "correct": false}, {"label": "B", "text": "Histoplasmosis", "correct": false}, {"label": "C", "text": "Pneumocystis Jirovecii", "correct": true}, {"label": "D", "text": "Aspergillus", "correct": false}], "correct_answer": "C. Pneumocystis Jirovecii", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nqIQT349uJT7BKKqHJEL1747375330.png", "https://image.prepladder.com/content/Ql5V8lRz0ZH0b97jSwbq1747375349.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pneumocystis jirovecii</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Trophozoite - thin-walled, irregularly shaped, 1-5 µm in size</li>\n<li>Precyst - an <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">intermediate</span> stage of the sexual phase, 5-8 µm in size</li>\n<li>Cyst - thick-walled, spherical, containing up to 8 <span class=\"customMeta\" data-dictid=\"d8d91f0402169277719039e737dcb8\">intracystic</span> bodies and up to 8 µm in size</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HIV: CD4 &lt; 200</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"141d29cc7f16927771890a8e0860e6\">immunodeficiency</span> states</li>\n<li>Transplant recipients</li>\n<li>Hematological malignancies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transmitted by <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> droplets and is <strong>asymptomatic</strong> in <strong>immunocompetent</strong> individuals. In <strong>immunocompromised</strong> patients, life-threatening <strong>pneumonia</strong> develops.</p>\n<p><strong>PCP</strong> - <strong>Pneumocystis Carinii pneumonia</strong></p>\n<ul>\n<li>Dyspnoea</li>\n<li>Dry cough</li>\n<li>Fever</li>\n<li>Weight loss</li>\n<li>B/L <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> causing <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> infiltrates</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>GMS</strong> / <strong>Giemsa</strong> stain- mc used</li>\n<li>Giemsa, <span class=\"customMeta\" data-dictid=\"87f88d49311692777200eb848ea567\">toluidine</span> blue, <span class=\"customMeta\" data-dictid=\"cb3712727816927771925665b0b1e0\">methenamine</span> silver, and calcofluor white stains can demonstrate trophozoites - <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> wall is black with a <strong>methenamine silver stain</strong>.</li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Pulminary Pathology\" data-hash=\"\" data-license=\"CC BY SA 2.0\" data-source=\"https://en.wikipedia.org/wiki/Pneumocystis_pneumonia\" data-tags=\"\" height=\"356\" src=\"https://image.prepladder.com/content/nqIQT349uJT7BKKqHJEL1747375330.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"User InvictaHOG\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Pneumocystosis\" data-tags=\"\" height=\"305\" src=\"https://image.prepladder.com/content/Ql5V8lRz0ZH0b97jSwbq1747375349.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Crushed Ping Pong ball</strong> (also called Helmet/Hat or Cup and Saucer appearance).</p>\n<ul>\n<li><strong>The β-d-glucan test</strong> has proven to be quite useful for rapid diagnosis of Pneumocystis <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> with a high degree of sensitivity and specificity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The cornerstone for both prevention and treatment is <strong>trimethoprim-sulfamethoxazole.</strong></li>\n<li>Alternative therapies have been used in AIDS patients; they include pentamidine, trimethoprim-dapsone, clindamycin-primaquine, atovaquone, and trimetrexate.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A couple brings their 4-year-old child to the outpatient department (OPD) due to self-mutilating behavior and poor growth. Which of the following associated enzyme deficiencies could explain these symptoms?", "options": [{"label": "A", "text": "HGPRT deficiency", "correct": true}, {"label": "B", "text": "Homogentisic Aciduria", "correct": false}, {"label": "C", "text": "Phenylalanine Hydroxylase deficiency", "correct": false}, {"label": "D", "text": "Adenosine deaminase deficiency", "correct": false}], "correct_answer": "A. HGPRT deficiency", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lesch-Nyhan Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metabolic: Severe<strong> gout, <span class=\"customMeta\" data-dictid=\"ed72793e89169277719946435952a9\">sodium urate</span> crystal deposition</strong> causing j<strong>oint <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage</strong>.</li>\n<li>Neurological:\n\t\t\t\t<ul>\n<li><strong>Poor muscle control.</strong></li>\n<li><strong>Involuntary movements</strong> (resembling Huntington's disease).</li>\n<li><strong>Facial grimacing,</strong> repetitive limb movements.</li>\n</ul>\n</li>\n<li>Behavioral: <strong>Self-mutilation</strong> (lip and finger biting, starting ~2nd year).</li>\n<li>Other: <strong>Moderate developmental delays</strong>, potential <strong>megaloblastic anemia</strong> (from poor vitamin B12 utilization).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metabolic: <strong>Allopurinol </strong>for gout; <strong>lithotripsy </strong>for <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> stones.</li>\n<li>Neurological: <strong>Symptomatic treatment </strong>with drugs like <strong>carbidopa/levodopa, diazepam, phenobarbital, or haloperidol.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-month-old baby presents with severe hepatomegaly, cataracts in both eyes, lethargy, and hypotonia. Based on these symptoms, which enzyme deficiency is most likely involved?", "options": [{"label": "A", "text": "Galactokinase", "correct": false}, {"label": "B", "text": "Hepatic Kinase", "correct": false}, {"label": "C", "text": "Hepatic Glucose-6-Phosphatase", "correct": false}, {"label": "D", "text": "Galactose-1-Phosphate Uridyl Transferase", "correct": true}], "correct_answer": "D. Galactose-1-Phosphate Uridyl Transferase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Galactosemia </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Galactose-1-phosphate uridylyltransferase (GALT) - <strong>Classical type</strong></li>\n<li><strong>Galactokinase- <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> disease with only oil drop cataract. (Option A ruled out)</strong></li>\n<li>Epimerase- SNHL + symptoms of classical type</li>\n</ul>\n<p>(Low galactose-based diet can be given which is contraindicated in the classical type)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Accumulation of galactose-1-phosphate <strong>(toxic causing jaundice, and liver damage)</strong></li>\n<li>Inability to metabolize <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> from milk</li>\n<li>Damage to liver, kidney, and brain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hepatic: Jaundice, hepatomegaly</li>\n<li>GI: Vomiting, diarrhea, failure to thrive</li>\n<li>CNS: Seizures, intellectual disability</li>\n<li>Eyes: Oil drop cataracts</li>\n<li>Increased risk of E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> sepsis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reducing substance in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (positive)( Positive Benedict test but negative <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> test)</li>\n<li>Direct <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> (GALT) assay</li>\n<li>Genetic testing <strong>(Perinatal diagnosis is possible)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lactose-free diet</li>\n<li>Breast Milk contraindicated</li>\n<li>Soy-based or elemental formulas</li>\n<li>Calcium supplementation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the process of converting unconjugated substances into conjugated forms called?", "options": [{"label": "A", "text": "Glycation", "correct": false}, {"label": "B", "text": "Glucuronidation", "correct": true}, {"label": "C", "text": "Glycosylation", "correct": false}, {"label": "D", "text": "Oxidation", "correct": false}], "correct_answer": "B. Glucuronidation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:653px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Synthetic Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Glucuronidation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjugation with <span class=\"customMeta\" data-dictid=\"18167012bd16927771884c32cedf99\">glucuronic acid</span> via UDP-glucuronosyl transferases (UGTs).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chloramphenicol, aspirin, paracetamol, morphine, bilirubin, <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> hormones, thyroxine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acetylation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjugation with <span class=\"customMeta\" data-dictid=\"6ade0969281692777180216b0c3d76\">acetyl</span> CoA, mediated by N-acetyl transferases.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Isoniazid, sulfonamides, hydralazine, dapsone, clonazepam.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Methylation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Methylation of amines and phenols by <span class=\"customMeta\" data-dictid=\"bc09155adc169277719248f9543785\">methyl</span> transferases using <span class=\"customMeta\" data-dictid=\"373f4a37af16927771920ee58f2edf\">methionine</span> or <span class=\"customMeta\" data-dictid=\"dabfa103741692777185dac756c49b\">cysteine</span> as donors.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adrenaline, histamine, methyldopa, captopril, mercaptopurine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sulfation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjugation of phenols and steroids with <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">sulfate</span> by sulfotransferases (SULTs).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chloramphenicol, methyldopa, <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> steroids.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Glycine Conjugation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjugation with <span class=\"customMeta\" data-dictid=\"6df8c5de5016927771881dc6865f2e\">glycine</span> for drugs with <span class=\"customMeta\" data-dictid=\"077c7b455c1692777183ed9de98e47\">carboxylic acid</span> groups.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Salicylates, <span class=\"customMeta\" data-dictid=\"c10496dcc416927771937d7280d782\">nicotinic</span> acid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Glutathione Conjugation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjugation of <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> intermediates with <span class=\"customMeta\" data-dictid=\"f945849e691692777188ad7ce5b5e2\">glutathione</span> via glutathione-S-transferases.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paracetamol (reactive intermediates), quinones, epoxides.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ribonucleoside Synthesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjugation for <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of <span class=\"customMeta\" data-dictid=\"c03d9c910716927771961a9a2609b5\">purine</span> and <span class=\"customMeta\" data-dictid=\"cb474d9869169277719611d301e616\">pyrimidine</span> antimetabolites.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cancer chemotherapeutic agents.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of strenuous exercise forgot to eat a meal and later consumed alcohol at a party. Which of the following metabolic processes is inhibited by alcohol consumption?", "options": [{"label": "A", "text": "Gluconeogenesis", "correct": true}, {"label": "B", "text": "Glycogenolysis", "correct": false}, {"label": "C", "text": "HMP shunt", "correct": false}, {"label": "D", "text": "Ketone body formation", "correct": false}], "correct_answer": "A. Gluconeogenesis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred management for a pediatric patient with symptomatic adenoid hypertrophy causing chronic nasal obstruction and sleep apnea?", "options": [{"label": "A", "text": "Adenoidectomy", "correct": true}, {"label": "B", "text": "Adenoidectomy with grommet insertion", "correct": false}, {"label": "C", "text": "Antibiotic therapy", "correct": false}, {"label": "D", "text": "Watchful waiting", "correct": false}], "correct_answer": "A. Adenoidectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">Adenoid</span> Hypertrophy:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Management: (For Mild Cases initially)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breathing exercises</li>\n<li>Decongestant <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> drops</li>\n<li>Antihistamines for any <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> allergies</li>\n<li>Topical <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Steroids may reduce <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> size and improve related symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Intervention: (Adenoidectomy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Traditional Methods: Blind <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> adenoidectomy</strong> remains common, but it has disadvantages, including unpredictable <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and poor access to the <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> adenoid. Hence, <strong>Endoscopic management</strong> is currently preferred.</li>\n<li><strong>Direct Vision Techniques:</strong>\n<ul>\n<li><strong>Suction Diathermy</strong></li>\n<li><strong>Endoscopic Coblation/Microdebridement involves using <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> to visualise and</strong> allows for precise removal of obstructive <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> tissue, addressing the underlying issue directly.</li>\n<li><strong>KTP Laser:</strong> Associated with a higher risk of <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> stenosis, while the gold laser has not shown this risk.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most commonly used test for newborn hearing screening?", "options": [{"label": "A", "text": "Otoacoustic Emissions (OAE)", "correct": true}, {"label": "B", "text": "Brainstem Evoked Response Audiometry (BERA)", "correct": false}, {"label": "C", "text": "Pure Tone Audiometry (PTA)", "correct": false}, {"label": "D", "text": "Tympanometry", "correct": false}], "correct_answer": "A. Otoacoustic Emissions (OAE)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female working as a senior executive leading a sedentary lifestyle presents to the OPD with palmoplantar pigmentation. X-ray spine shows calcification of intervertebral discs. On adding Benedict’s reagent to the urine sample, it gives a greenish-brown precipitate and comes positive. What is the most likely enzyme deficiency in this patient?", "options": [{"label": "A", "text": "Phenylalanine hydroxylase", "correct": false}, {"label": "B", "text": "Tyrosine hydroxylase", "correct": false}, {"label": "C", "text": "Homogentisic acid oxidase", "correct": true}, {"label": "D", "text": "PHPP dioxygenase", "correct": false}], "correct_answer": "C. Homogentisic acid oxidase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:771px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Alkaptonuria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare <strong>autosomal recessive</strong> genetic disorder caused by a <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of <strong>homogentisate 1,2 <span class=\"customMeta\" data-dictid=\"fd6641649b16927771869679be8da7\">dioxygenase</span> (HGD)</strong>, an <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> in the<strong> tyrosine <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> pathway.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism and Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defective tyrosine <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> → <span class=\"customMeta\" data-dictid=\"d442747c48169277718942db69fa7e\">homogentisic acid</span> (HGA) accumulation → ochronotic <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> deposition → <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> disease (ochronosis).</p>\n<p> </p>\n<ul>\n<li>Deficiency: HGD fails to convert HGA to maleylacetoacetate.</li>\n<li>Consequences:\n\t\t\t\t<ul>\n<li>HGA oxidizes into melanin-like polymers → <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue deposition (ochronosis).</li>\n<li>Affects joints, heart valves, kidneys, and vessels.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Triad: Homogentisic aciduria, ochronosis, ochronotic osteoarthropathy.</strong></li>\n<li><strong>Pediatric signs: Dark <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (oxidized HGA).</strong></li>\n<li><strong>Musculoskeletal</strong>: <strong>Arthritis </strong>(spine, hips, knees), kyphoscoliosis, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> stenosis.</li>\n<li><strong>Cardiac</strong>: A<strong>ortic stenosis, <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disease, <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease.</strong></li>\n<li><strong>Renal/Metabolic:</strong> <strong>Stones </strong>(renal, gallbladder, prostate).</li>\n<li><strong>Neurological</strong>: Peripheral neuropathy, stroke.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Clinical scoring: AKU Severity Score Index</strong> (AKUSSI).</li>\n<li><strong>Diagnostic tests:</strong>\n<ul>\n<li><strong>Gold standard: <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> HGA quantification via gas chromatography-mass spectrometry.</strong></li>\n<li>Genetic testing for HGD mutations.</li>\n<li>Imaging (CT/MRI): Joint involvement, valvular calcification.</li>\n<li>Echocardiography: Valvular abnormalities.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Symptomatic</strong>: Pain control, physiotherapy, joint surgery.</li>\n<li><strong>Diet</strong>: Low-protein diet (limited efficacy).</li>\n<li>Medications:\n\t\t\t\t<ul>\n<li><strong>Vitamin C</strong>: Reduces HGA <span class=\"customMeta\" data-dictid=\"224ea8a9e41692777194e81be113d8\">oxidation</span> but not <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> excretion.</li>\n<li><strong>Nitisinone</strong>: Inhibits tyrosine metabolism, reduces HGA &gt;95%. <strong>Side effects: tyrosinemia, leukopenia, thrombocytopenia.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis and Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Prognosis</strong>: Normal life expectancy; <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> quality of life (pain, sleep issues, disability).</li>\n<li><strong>Complications</strong>:\n\t\t\t\t<ul>\n<li>Stones (renal, gallbladder, salivary).</li>\n<li>Tendon/ligament ruptures.</li>\n<li>Osteopenia, fractures.</li>\n<li>Aortic calcification/stenosis.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following disorders is characterized by the presence of a cherry red spot on the retina?", "options": [{"label": "A", "text": "Tay-Sachs disease", "correct": true}, {"label": "B", "text": "Fabry's disease", "correct": false}, {"label": "C", "text": "Gaucher's disease", "correct": false}, {"label": "D", "text": "Von Gierke's disease", "correct": false}], "correct_answer": "A. Tay-Sachs disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tay-Sachs Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Autosomal recessive</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deficiency of <strong>hexosaminidase A enzyme</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Accumulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GM2 <span class=\"customMeta\" data-dictid=\"284061bc521692777188fc821ddb5c\">ganglioside</span> in <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells and neurons</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial symptoms include loss of head control, inability to sit, exaggerated <span class=\"customMeta\" data-dictid=\"49a672054e169277719974b3f062e9\">startle</span> response to sound, and a disproportionately large head.</li>\n<li>Progressive features include<strong> spasticity, deafness, and blindness.</strong></li>\n<li>Not associated with organomegaly.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fundus Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cherry-red spot is caused by GM2 <span class=\"customMeta\" data-dictid=\"284061bc521692777188fc821ddb5c\">ganglioside</span> accumulation in the <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells of the retina, creating a contrast with the normal red fovea.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the most common location of Nasopharyngeal carcinoma:", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": true}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "B. 2", "question_images": ["https://image.prepladder.com/content/rCecS6HsSutc1DyPaOIE1747372740.png"], "explanation_images": ["https://image.prepladder.com/content/CLQniT0CD4PQRmPSFHst1747372841.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>• A deep <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">recess</span> located in the <strong>nasopharynx</strong>, behind the <strong>torus tubarius</strong> (the <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> opening of the Eustachian tube)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>• <strong>Posterolateral wall of the nasopharynx</strong></p>\n<p>• Just <strong>behind the Eustachian tube opening</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Clinical Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>• Common site for <strong>nasopharyngeal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (NPC)</strong> origin</p>\n<p>• Close to the <strong>pharyngeal opening of the Eustachian tube</strong>, so tumors here may cause <strong>ear symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Related Structures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>• Close to the <strong>Eustachian tube</strong>, <strong>tensor and <span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\">levator</span> veli palatini muscles</strong>, and <strong>retropharyngeal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Symptoms if Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>• <strong>Unilateral ear <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> or hearing loss</strong> (due to Eustachian tube obstruction)</p>\n<p>• <strong>Nasal obstruction</strong>, <strong>epistaxis</strong> (nosebleeds)</p>\n<p>• <strong>Neck mass</strong> (from <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> spread)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred initial management for a patient presenting with cerebrospinal fluid (CSF) rhinorrhea?", "options": [{"label": "A", "text": "Functional Endoscopic Sinus Surgery (FESS)", "correct": false}, {"label": "B", "text": "Administration of steroids", "correct": false}, {"label": "C", "text": "Bed rest with head elevation and avoidance of straining activities", "correct": true}, {"label": "D", "text": "Immediate surgical repair without initial medical management", "correct": false}], "correct_answer": "C. Bed rest with head elevation and avoidance of straining activities", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which structure is most commonly involved in the compression of the anterior ethmoid nerve, leading to Sluder's neuralgia?", "options": [{"label": "A", "text": "Superior turbinate", "correct": false}, {"label": "B", "text": "Middle turbinate", "correct": true}, {"label": "C", "text": "Inferior turbinate", "correct": false}, {"label": "D", "text": "Nasal septum", "correct": false}], "correct_answer": "B. Middle turbinate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following topical local anesthetics is commonly used in cataract surgery?", "options": [{"label": "A", "text": "Proparacaine 0.5%", "correct": true}, {"label": "B", "text": "Bupivacaine 0.5%", "correct": false}, {"label": "C", "text": "Halothane", "correct": false}, {"label": "D", "text": "Nitrous Oxide", "correct": false}], "correct_answer": "A. Proparacaine 0.5%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer presents with a painful snakebite wound on his right foot. There are two fang marks with swelling and bleeding at the bite site. What is the first step in management?", "options": [{"label": "A", "text": "Polyvalent ASV", "correct": false}, {"label": "B", "text": "Sling or splint leading to immobilization", "correct": true}, {"label": "C", "text": "Venom suction", "correct": false}, {"label": "D", "text": "See the snake brought by a relative", "correct": false}], "correct_answer": "B. Sling or splint leading to immobilization", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications/Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>First Aid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<ul>\n<li>Do not allow the victim to walk (Carry)</li>\n<li>Avoid tourniquets, except in specific cases(No)</li>\n<li>Reassure patient</li>\n<li>Immobilize bitten limb <strong>(Option B)</strong></li>\n<li>Transport to the hospital quickly</li>\n<li>Tell the doctor about any <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Tourniquets only for severe elapid/sea snake bites with &gt;0.5h but &lt;2-3h transport time</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<ul>\n<li>Check for signs of envenomation</li>\n<li>Monitor vital signs</li>\n<li>Perform 20-minute <span class=\"customMeta\" data-dictid=\"60d609888b169277720258496ef45a\">whole blood</span> <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> time</li>\n<li>Check <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> profile, CPK, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Incoagulable blood indicates <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"3e641db3d416927771871043236d4b\">envenomation</span> by Viperidae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Antivenom Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<ul>\n<li><strong>Mild: </strong>50 ml</li>\n<li><strong>Moderate: </strong>50-100 ml</li>\n<li><strong>Severe:</strong> 150-200 ml</li>\n</ul>\n<p>Effective against the 4 most important <span class=\"customMeta\" data-dictid=\"6ab7a16d751692777201645703100e\">venomous</span> snakes in India, namely, Cobra, Common Krait, Russell's <span class=\"customMeta\" data-dictid=\"efbb05601b1692777202641ca3e610\">viper</span> and saw-scaled viper.</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Haemostatic abnormalities</li>\n<li>Neurotoxicity</li>\n<li>Cardiovascular dysfunction</li>\n<li>Impaired consciousness</li>\n<li>Rhabdomyolysis</li>\n<li>Extensive local swelling</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Antivenom Administration </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<ul>\n<li>Dilute in 5 ml/kg body weight of <span class=\"customMeta\" data-dictid=\"28f696d61216927771904dbe51b33b\">isotonic</span> saline/5% Dextrose</li>\n<li>Infuse over 1-2 hours</li>\n<li>Monitor for <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reactions</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Repeat if severe signs persist after 1-2 hours or if <span class=\"customMeta\" data-dictid=\"254d99e23d1692777184c9e13d0b18\">coagulability</span> is not restored within 6 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Supportive Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<ul>\n<li>Tetanus prophylaxis</li>\n<li>Antibiotics (if severe local reaction)</li>\n<li>Manage <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> paralysis</li>\n<li>Fresh frozen plasma/cryoprecipitates for severe bleeding</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Avoid heparin, corticosteroids, and EDTA.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common drug used in day care surgery/TIVA?", "options": [{"label": "A", "text": "Sodium thiopentone", "correct": false}, {"label": "B", "text": "Propofol", "correct": true}, {"label": "C", "text": "Halothane", "correct": false}, {"label": "D", "text": "Ketamine", "correct": false}], "correct_answer": "B. Propofol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the use of the Mallampatti classification?", "options": [{"label": "A", "text": "Endotracheal intubation", "correct": true}, {"label": "B", "text": "To evaluate the risk of surgery", "correct": false}, {"label": "C", "text": "To evaluate the pros and cons of surgery", "correct": false}, {"label": "D", "text": "To evaluate the fitness of the patient", "correct": false}], "correct_answer": "A. Endotracheal intubation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d70GQzzz38Q1XGSwoupW1747208424.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Blood during autopsy is preserved in?", "options": [{"label": "A", "text": "NaF", "correct": true}, {"label": "B", "text": "NaCl", "correct": false}, {"label": "C", "text": "Formalin", "correct": false}, {"label": "D", "text": "Rectified spirit", "correct": false}], "correct_answer": "A. NaF", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Specimen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Importance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary specimen; collect from femoral, iliac, or axillary veins to avoid contamination.</p>\n<p><strong>Preservative: </strong>Lithium <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">heparin</span> or EDTA tube, Sodium fluoride/oxalate <strong>(Option A)</strong>, if alcohol is suspected</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Useful for detecting parent compounds and metabolites of poisons.</p>\n<p><strong>Preservative: </strong>No preservative, sodium <span class=\"customMeta\" data-dictid=\"7cdfdfcdc616927772026ac0b8d995\">fluoride</span> is added, if alcohol is</p>\n<p>Suspected</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastric Contents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps identify ingested poisons and their concentrations through <span class=\"customMeta\" data-dictid=\"58a09a3d07169277720271320338d4\">vomitus</span> and stomach contents analysis.</p>\n<p><strong>Preservative:</strong> Saturated <span class=\"customMeta\" data-dictid=\"77e95b17ce1692777198780a5d0843\">salt solution</span> if there is no chance of acid poison.<strong>(Option B)</strong></p>\n<p>Rectified spirit if poisoned by acid <strong>(Option C)</strong></p>\n<p>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Analyzes <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> and concentration of drugs; critical when blood/urine concentrations are low. Bile can detect specific substances like <span class=\"customMeta\" data-dictid=\"c6cef1cc8616927771849eace61464\">chlorpromazine</span> and morphine.</p>\n<p><strong>Preservative:</strong> Saturated <span class=\"customMeta\" data-dictid=\"77e95b17ce1692777198780a5d0843\">salt solution</span> if there is no chance of acid poison.</p>\n<p>Rectified spirit if poisoned by acid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hair and Nails</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"6e8ada09fa1692777189bfbace851a\">heavy metal</span> poisoning; metals accumulate in keratin. Neutron <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> analysis identifies specific metals and exposure patterns.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scene Residues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides clues about the <span class=\"customMeta\" data-dictid=\"b437be3f051692777196d06a1fa93d\">poison</span> through materials found at the scene, such as tablets or empty containers.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of trauma presents with hearing loss. A High-Resolution Computed Tomography (HRCT) scan was performed. Which of the following structures is not typically visualized on HRCT?", "options": [{"label": "A", "text": "Cochlea", "correct": false}, {"label": "B", "text": "Vestibule", "correct": false}, {"label": "C", "text": "Semicircular canal", "correct": false}, {"label": "D", "text": "Organ of Corti", "correct": true}], "correct_answer": "D. Organ of Corti", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the best drug to reduce LDL cholesterol levels?", "options": [{"label": "A", "text": "Niacin", "correct": false}, {"label": "B", "text": "Fibrates", "correct": false}, {"label": "C", "text": "Statins", "correct": true}, {"label": "D", "text": "Resins", "correct": false}], "correct_answer": "C. Statins", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>LDL-C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Total TG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HDL</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Statins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Decreases (maximum)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Mild reduction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Increase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Resin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Decreases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">increases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">No effect</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fibrates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Decreases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Maximum reduction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Increases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Niacin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Decreases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Reduced (almost 50%)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Maximum increase</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During measurement of a rifled barrel weapon, the caliber depends on?", "options": [{"label": "A", "text": "Distance between two opposite lands", "correct": true}, {"label": "B", "text": "Distance between two opposite grooves", "correct": false}, {"label": "C", "text": "Number of lead pellets", "correct": false}, {"label": "D", "text": "Mass and velocity", "correct": false}], "correct_answer": "A. Distance between two opposite lands", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uJGPALt5v7poTpWYT2w31747374695.png", "https://image.prepladder.com/content/hK5mifXd8E6Nc3REMFHn1747374704.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male patient with a history of hyperlipidemia was started on statins for elevated triglyceride levels. Despite the statin therapy, his triglycerides remain persistently elevated at over 600 mg/dL. Which of the following medications should be administered next to help manage the triglyceride levels?", "options": [{"label": "A", "text": "Fibrates", "correct": true}, {"label": "B", "text": "Niacin", "correct": false}, {"label": "C", "text": "Statins", "correct": false}, {"label": "D", "text": "Resins", "correct": false}], "correct_answer": "A. Fibrates", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the forensic examination of semen from a rape victim, the identification of distinctive yellow needle-like crystals raises attention. What is the specific test employed to ascertain the presence of sperm?", "options": [{"label": "A", "text": "Barberio test", "correct": true}, {"label": "B", "text": "Acid phosphatase test", "correct": false}, {"label": "C", "text": "Papanicolaou smear", "correct": false}, {"label": "D", "text": "Florence test", "correct": false}], "correct_answer": "A. Barberio test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WCAAAd8AXIg8M48y7hRb1747374782.png", "https://image.prepladder.com/content/ybs833qjhbVP4Imq9Hwf1747374789.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Test Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Substance Detected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Result</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Reagent Used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Mnemonic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Barberio Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Spermine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Yellow needle-shaped crystals of Spermine Picrate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Picric acid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Barbar picks your hair with a needle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Detects Spermine from the prostate; confirms the presence of seminal fluid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Florence Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Choline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Dark brown rhombic crystals of <span class=\"customMeta\" data-dictid=\"ad6984dc581692777184936c84dd97\">Choline</span> iodide</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>KI (Potassium Iodide)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Florence has 'C', C for Choline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>It detects <span class=\"customMeta\" data-dictid=\"ad6984dc581692777184936c84dd97\">choline</span> from the <span class=\"customMeta\" data-dictid=\"c78e813e3a1692777198261357cb13\">seminal vesicle</span> and is used to identify seminal fluid.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female who had a history of chronic sun exposure presented to the OPD clinic with brownish pigmentation as shown in the image. Which of the following is the diagnosis? '", "options": [{"label": "A", "text": "Melasma", "correct": true}, {"label": "B", "text": "Freckles", "correct": false}, {"label": "C", "text": "Melanoma", "correct": false}, {"label": "D", "text": "Basal cell carcinoma", "correct": false}], "correct_answer": "A. Melasma", "question_images": ["https://image.prepladder.com/content/sX9reu8nMoirxeAfju4k1747379159.png"], "explanation_images": ["https://image.prepladder.com/content/iUVsBoVYNcQ4oQmitSJq1747379338.png", "https://image.prepladder.com/content/gQ1uRhIjZMSXjdBfwFoD1747379370.png", "https://image.prepladder.com/content/xvRCOKIRrkMqJonESH2b1747379433.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a police investigation, some bones are uncovered from the crime scene. Which of the following tests would aid in differentiating between human and canine bones, during the forensic analysis?", "options": [{"label": "A", "text": "Precipitin test", "correct": true}, {"label": "B", "text": "Acid-phosphatase", "correct": false}, {"label": "C", "text": "LDH", "correct": false}, {"label": "D", "text": "Teichmann test", "correct": false}], "correct_answer": "A. Precipitin test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gFNaRXm1UZ663vMeJmm21747374880.png", "https://image.prepladder.com/content/7p99mXgegSEqyLmvsuGz1747374893.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Takayama Test</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Vanessa Stewart, Paul Deacon, Nathalie Zahra, Mari Uchimoto, Kevin Farrugia\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://rke.abertay.ac.uk/ws/portalfiles/portal/15029667/Farrugia_TheEffectOfMarkEnhancementTechniquesOnThePresumptiveAndConfirmatoryTests_Author_2018.pdf\" data-tags=\"\" height=\"248\" src=\"https://image.prepladder.com/content/gFNaRXm1UZ663vMeJmm21747374880.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> by forming red, feathery crystals of <span class=\"customMeta\" data-dictid=\"dcccae21671692777196dc33208a39\">pyridine</span> ferroprotoporphyrin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Teichmann Test </strong><strong>(Option D ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://elearning.raghunathpurcollege.ac.in/files/CE08FC0816227718690.pdf\" data-tags=\"\" height=\"373\" src=\"https://image.prepladder.com/content/7p99mXgegSEqyLmvsuGz1747374893.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Converts <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> to hemin, creating brownish-yellow <span class=\"customMeta\" data-dictid=\"0115afa2131692777197b45ae0d136\">rhomboid</span> crystals, confirming blood presence.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Precipitin Test </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identifies species origin through antibody-antigen reactions, using antisera specific to human blood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HemaTrace Test </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses <span class=\"customMeta\" data-dictid=\"b2b82438d6169277719287eb450079\">monoclonal</span> antibodies to detect human hemoglobin, showing a visible pink band for confirmation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presents to the OPD with complaints of recurrent lesions on lips as shown below, which is associated with fever. Which of the following is the characteristic feature seen in Tzanck smear?", "options": [{"label": "A", "text": "Handerson patterson bodies", "correct": false}, {"label": "B", "text": "Multinucleated giant cells", "correct": true}, {"label": "C", "text": "Owl eye appearance", "correct": false}, {"label": "D", "text": "Acantholytic cells", "correct": false}], "correct_answer": "B. Multinucleated giant cells", "question_images": ["https://image.prepladder.com/content/JkOrLCMIOmHFkVrCvTT81747209108.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:467px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>First line</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Acyclovir (topical/oral)</li>\n<li>Hydrocolloid dressing</li>\n<li>Topical penciclovir</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Second line</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Long-term <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> acyclovir</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Third line</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>IV acyclovir</li>\n<li>Penciclovir</li>\n<li>Foscarnet</li>\n<li>IV cidofovir</li>\n<li>Topical imiquimod</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate treatment for a patient presenting with diarrhea and a flask-shaped ulcer on a colonoscopy?", "options": [{"label": "A", "text": "Metronidazole", "correct": true}, {"label": "B", "text": "Ciprofloxacin", "correct": false}, {"label": "C", "text": "Vancomycin", "correct": false}, {"label": "D", "text": "Ampicillin", "correct": false}], "correct_answer": "A. Metronidazole", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:1px solid #333438; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tissue Amebicidal Drugs </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p> </p>\n<p><strong>Metronidazole</strong></p>\n<p> </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<ol>\n<li><strong>DOC for all forms of amebiasis</strong></li>\n<li>Treats <span class=\"customMeta\" data-dictid=\"6000beebf41692777181fb008e4936\">amebic colitis</span> and liver abscess</li>\n<li><strong>Penetrates well into body tissues and fluids, </strong>including <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> secretions, seminal fluid, saliva, breast milk, and <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid.</li>\n</ol>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<ol>\n<li>Effective against Entamoeba histolytica trophozoites but less effective against cysts.</li>\n<li><strong>Inhibits protein <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> in Entamoeba</strong></li>\n<li>Treats giardiasis, trichomoniasis, and <span class=\"customMeta\" data-dictid=\"4880fc99551692777181e25a64560f\">anaerobic</span> infections</li>\n<li>Used in combination therapy for H. pylori infection</li>\n</ol>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Tinidazole</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p><strong>Amebic <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> and liver abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>Also used to treat <strong>Trichomoniasis.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Ornidazole</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p><strong>Acute amoebic dysentery</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Secnidazole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Emetine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>Acute amoebic <span class=\"customMeta\" data-dictid=\"83b2863439169277718675fa3b9b00\">dysentery</span> or <strong>amoebic liver <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> in patients not tolerating metronidazole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<ul>\n<li>Directly acting amoebicide that kills trophozoites but has no effect on cysts.</li>\n<li><strong>Side effects include <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> and cardiotoxicity.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Chloroquine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p><strong>Amoebic liver abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>Kills the liver stage of <em>Entamoeba histolytica</em></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Luminal Amebicidal Drugs </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p style=\"text-align:center\"><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p style=\"text-align:center\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p style=\"text-align:center\"><strong>Additional points &amp; S/E</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p><strong>Paromomycin</strong></p>\n<p><strong>(DOC)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>An Aminoglycoside</p>\n<p><strong>Luminal agent for amebiasis.</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>An <strong>alternative drug for Giardiasis</strong>, especially in the first <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> of pregnancy where <span class=\"customMeta\" data-dictid=\"452c41e7811692777192cd0d89fdc7\">metronidazole</span> is C/I.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Diloxanide furoate</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p><strong>Mild intestinal amebiasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>Furoate is the active <span class=\"customMeta\" data-dictid=\"708d2a81e4169277719263f5f17227\">moiety</span> that kills <em>Entamoeba</em></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Quiniodochlor</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p>Rarely used due to dangerous <strong>side effects such as SMON</strong> (Subacute myelo-optico-neuropathy)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none\">\n<p><strong>Iodoquinol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none\">\n<p><strong>Contains <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> and can cause <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> abnormalities</strong> and allergy</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:1px solid #333438; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Luminal Amebicidal Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:1px solid #333438; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tissue Amebicidal Drugs</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<ul>\n<li>Paromomycin</li>\n<li>Diloxanide furoate</li>\n<li>Quiniodochlor</li>\n<li>Iodoquinol</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<ul>\n<li>Metronidazole or its congeners (Tinidazole, Ornidazole)</li>\n<li>Emetine</li>\n<li>Chloroquine</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A truck driver reports multiple painful genital ulcers on his scrotum following unprotected sexual intercourse, accompanied by painful lymph nodes. What is the most likely cause?", "options": [{"label": "A", "text": "Chancre", "correct": false}, {"label": "B", "text": "Chancroid", "correct": true}, {"label": "C", "text": "Donovanosis", "correct": false}, {"label": "D", "text": "Herpes", "correct": false}], "correct_answer": "B. Chancroid", "question_images": ["https://image.prepladder.com/content/zq8N4dl8ThNej4ezQhsX1747379570.png"], "explanation_images": ["https://image.prepladder.com/content/dLp6pfVq0n4lcnRjLKMt1747379603.png", "https://image.prepladder.com/content/UmsZ73RESN8Zp0K7MMlU1747379614.png", "https://image.prepladder.com/content/fqqrHGBcmhKCutObN6WV1747379662.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ulcer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lymph Node</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Syphilis - <span class=\"customMeta\" data-dictid=\"9831f4be811692777200e41d827a02\">treponema</span> Pallidum</strong></p>\n<p><strong>(Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> called a <strong>chancre</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-tender and rubbery in consistency.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Donovanosis- Klebsiella granulomatis</strong></p>\n<p><strong>(Option C) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless, beefy red ulcers known as <strong>granulomas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pseudo-bubo </strong>(enlarged and tender but occurs due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and not infection)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Vanessa Ngan\" data-hash=\"\" data-license=\"NA\" data-source=\"https://dermnetnz.org/topics/granuloma-inguinale\" data-tags=\"\" height=\"390\" src=\"https://image.prepladder.com/content/dLp6pfVq0n4lcnRjLKMt1747379603.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Herpes Simplex</strong></p>\n<p><strong>(Option D) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grouped vesicles or shallow erosions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple, enlarged and inflamed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Landon Jones, MD; and Richard M. Cantor, MD, FAAP, FACEP\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.acepnow.com/article/in-neonates-with-herpes-how-often-does-mom-have-genital-herpes/\" data-tags=\"\" height=\"289\" src=\"https://image.prepladder.com/content/UmsZ73RESN8Zp0K7MMlU1747379614.png\" width=\"426\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphogranuloma Venerum</p>\n<p>(Chlamydia)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Solitary and painless.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Swollen, inflamed, and <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes containing <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> material.</li>\n<li>Palpable <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> or <span class=\"customMeta\" data-dictid=\"27efa994461692777203a9c1696153\">furrow</span> that may be felt in the inguinal region due to the <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> and <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes. <strong>(Groove of Greenlat)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NAHerbert L. Fred, MD and Hendrik A. van Dijk \" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/Lymphogranuloma_venereum#/media/File:Lymphogranuloma_venerum_-_lymph_nodes.jpg\" data-tags=\"\" height=\"343\" src=\"https://image.prepladder.com/content/fqqrHGBcmhKCutObN6WV1747379662.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic patient was on medication and forgot to take his meals before going to the gym. He fainted while exercising, and their blood sugar level was found to be 60 mg/dL. Which of the following antidiabetic drugs can cause hypoglycemia when used in monotherapy?", "options": [{"label": "A", "text": "Sulfonylureas", "correct": true}, {"label": "B", "text": "Metformin", "correct": false}, {"label": "C", "text": "Acarbose", "correct": false}, {"label": "D", "text": "Pioglitazone", "correct": false}], "correct_answer": "A. Sulfonylureas", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sulfonylureas</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Site of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pancreatic β cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type 2 Diabetes Mellitus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sulfonylureas ⟶ Bind to Receptors on Pancreatic β Cells ⟶ Closure of <strong>ATP-sensitive K<sup>+</sup> Channels </strong>⟶ Membrane <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> ⟶ Opening of Voltage-Gated Ca².+ Channels ⟶ Ca²<sup>+</sup> Influx ⟶ Exocytosis of <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> Granules ⟶ Increased <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> Secretion ⟶ Lower Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> Levels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1st Generation</p>\n<ul>\n<li>Tolbutamide</li>\n<li>Chlorpropamide</li>\n</ul>\n<p>2nd Generation</p>\n<ul>\n<li>Glibenclamide</li>\n<li>Glipizide</li>\n<li>Gliclazide</li>\n</ul>\n<ul>\n<li>Glimepiride</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Two handkerchiefs with blood stains are found at a crime scene. What is the most appropriate procedure for handling these items?", "options": [{"label": "A", "text": "Place them in same plastic bag and seal it for preservation", "correct": false}, {"label": "B", "text": "Rinse the bloodstains with water to prevent contamination", "correct": false}, {"label": "C", "text": "Preserve in an envelope/paper bag", "correct": true}, {"label": "D", "text": "Place them in different plastic bags and seal it for preservation", "correct": false}], "correct_answer": "C. Preserve in an envelope/paper bag", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with a sore throat starts developing skin lesions as in the image below. Which of the following is the diagnosis?", "options": [{"label": "A", "text": "Guttate psoriasis", "correct": true}, {"label": "B", "text": "Pustular psoriasis", "correct": false}, {"label": "C", "text": "Erythrodermic", "correct": false}, {"label": "D", "text": "Inverse psoriasis", "correct": false}], "correct_answer": "A. Guttate psoriasis", "question_images": ["https://image.prepladder.com/content/kqaaEAYxkZl47hKd57uj1747209680.png"], "explanation_images": ["https://image.prepladder.com/content/un5m6sjCs4kwClBO2Xrd1747379721.png", "https://image.prepladder.com/content/NXCfe1ffjgP0z0x4HPzC1747379849.png", "https://image.prepladder.com/content/9bjXyBJjJvMWzhGEKAbs1747380014.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent gastrointestinal surgery and had her jejunum resected. Which of the following drugs should be added to her treatment?", "options": [{"label": "A", "text": "Liraglutide", "correct": false}, {"label": "B", "text": "Teduglutide", "correct": true}, {"label": "C", "text": "Exenatide", "correct": false}, {"label": "D", "text": "Semaglutide", "correct": false}], "correct_answer": "B. Teduglutide", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Teduglutide</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peptide hormone (GLP-2 <span class=\"customMeta\" data-dictid=\"22e0051a181692777181872183edb2\">analogue</span> )</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Teduglutide ⟶ Binds to <strong>GLP-2 Receptors</strong> on Intestinal epithelial cells ⟶ Activation of Guanylate Cyclase ⟶ Increased production of cGMP ⟶ Activation of Protein Kinase G⟶ Regulation of Tight Junctions and Epithelial transporters ⟶ Enhanced intestinal <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of fluid and nutrients ⟶ Improved <span class=\"customMeta\" data-dictid=\"b5f500def916927771888b49285ac6\">glycemic</span> control.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment of <strong>short <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> syndrome (SBS) </strong>in adult patients who are dependent on <span class=\"customMeta\" data-dictid=\"f4eacdbe7b1692777194d7caa2017d\">parenteral</span> support.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Benefits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"01be542e8e16927771861e861ab536\">dependence</span> on <span class=\"customMeta\" data-dictid=\"f4eacdbe7b1692777194d7caa2017d\">parenteral</span> nutrition</li>\n<li>Improves intestinal <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> and transit time</li>\n<li>Increases nutrient <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> and fluid balance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea and Vomiting</li>\n<li>Headache</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gastrointestinal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or perforation</li>\n<li>Gastrointestinal cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Special Points</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Requires <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> injection</li>\n<li>Dosing and adjustment should be based on individual patient responses.</li>\n<li>Regular monitoring of nutritional status and <span class=\"customMeta\" data-dictid=\"98d46770fc1692777202253fb59fe9\">fluid balance</span> is essential.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following procedures has been banned by the Supreme Court of India due to its association with sexual assault cases involving doctors?", "options": [{"label": "A", "text": "Foley’s catheter insertion", "correct": false}, {"label": "B", "text": "Colposcopy", "correct": false}, {"label": "C", "text": "PV speculum insertion", "correct": false}, {"label": "D", "text": "Two-finger test", "correct": true}], "correct_answer": "D. Two-finger test", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Request for Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Any police officer can request it within 24 hours.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Consent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Must obtain consent from the woman</li>\n<li>Examination supervised by a female RMP.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Initial Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Ask the victim to remove clothing.</li>\n<li>Examine and collect evidence from clothes.</li>\n<li>Look for foreign objects (hairs, seminal stains)</li>\n<li>Search for physical injuries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Detection of Micro Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Apply toluidine-blue contrast to the anogenital area.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Swabs Collection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>4 swabs:\n\t\t\t\t<ul>\n<li>Smear: Prepare a <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> for <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> examination.</li>\n<li>Sperm: Use <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> for <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> testing.</li>\n<li>DNA Profiling</li>\n<li>Chemical Tests: Acid phosphatase, <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> phosphokinase, <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> dehydrogenase.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examination Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Examine in <span class=\"customMeta\" data-dictid=\"0f4e6b47941692777191c7f9edb1eb\">lithotomy</span> position under good lighting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hymen Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Use Glaister-Keene rods or hymenoscope</li>\n<li>Look for <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> (usually <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> at 5-7 o'clock position).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Vaginal Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Use a <span class=\"customMeta\" data-dictid=\"7d681686dc1692777198955a8ffd20\">speculum</span> for <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> examination.<strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cervical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Use a <span class=\"customMeta\" data-dictid=\"f1d1c017431692777184b3c22afce2\">colposcope</span> for <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> examination. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Post-Examination Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Treat STDs, injuries, or potential pregnancy.</li>\n<li>Provide psychological support.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the mechanism of action of Local anesthetics?", "options": [{"label": "A", "text": "Blocks Na + channels", "correct": true}, {"label": "B", "text": "Stimulate Ca + Channels", "correct": false}, {"label": "C", "text": "Block Cl - Channels", "correct": false}, {"label": "D", "text": "Stimulate K + channels", "correct": false}], "correct_answer": "A. Blocks Na + channels", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary mechanism of action of methotrexate?", "options": [{"label": "A", "text": "Inhibits DNA synthesis by blocking thymidylate synthase", "correct": false}, {"label": "B", "text": "Inhibits dihydrofolate reductase, leading to decreased DNA synthesis", "correct": true}, {"label": "C", "text": "Inhibits RNA synthesis by blocking RNA polymerase", "correct": false}, {"label": "D", "text": "Interferes with microtubule formation during cell division", "correct": false}], "correct_answer": "B. Inhibits dihydrofolate reductase, leading to decreased DNA synthesis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of Ethosuximide?", "options": [{"label": "A", "text": "Enhances GABAergic inhibition", "correct": false}, {"label": "B", "text": "Inhibits calcium channels in thalamic neurons", "correct": true}, {"label": "C", "text": "Blocks sodium channels", "correct": false}, {"label": "D", "text": "Increases serotonin levels", "correct": false}], "correct_answer": "B. Inhibits calcium channels in thalamic neurons", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ethosuximide</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primarily blocks T type of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only used in absence seizures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is not hepatotoxic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> suppression</li>\n<li>SLE - like symptoms</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient with a history of bronchial asthma has developed an acute attack of migraine. Which drug should be avoided?", "options": [{"label": "A", "text": "Sumatriptan", "correct": false}, {"label": "B", "text": "Propranolol", "correct": true}, {"label": "C", "text": "Ergotamine", "correct": false}, {"label": "D", "text": "Lasmiditan", "correct": false}], "correct_answer": "B. Propranolol", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old girl presents with generalized muscle weakness and protrusion of the eyelids (ptosis) that worsens as the day progresses. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myasthenia Gravis", "correct": true}, {"label": "B", "text": "Fibromyalgia", "correct": false}, {"label": "C", "text": "Myotonic Dystrophy", "correct": false}, {"label": "D", "text": "Guillain-Barré Syndrome", "correct": false}], "correct_answer": "A. Myasthenia Gravis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:580px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Affected Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ocular muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mimics central eye movement disorders.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cogan's lid <span class=\"customMeta\" data-dictid=\"4f7448b3e51692777201ff5cafde0d\">twitch</span> sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> rises briefly after looking down for some time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shoulder <span class=\"customMeta\" data-dictid=\"a1d37a92d41692777188e12a817797\">girdle</span> muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Difficulty in overhead activities like combing hair.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Weakness may cause <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> risks.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the investigation of choice for detecting enteric fever in the first week?", "options": [{"label": "A", "text": "Blood culture", "correct": true}, {"label": "B", "text": "Urine culture", "correct": false}, {"label": "C", "text": "Stool culture", "correct": false}, {"label": "D", "text": "Antibody detection", "correct": false}], "correct_answer": "A. Blood culture", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:609px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Duration of Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Specimen Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>% Positivity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1st week</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood culture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>90%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2nd week</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood culture</p>\n<p>Faeces culture</p>\n<p>Widal test</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>75%</p>\n<p>50%</p>\n<p>Low Titre</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3rd week</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Widal test</p>\n<p>Blood culture</p>\n<p>Faeces culture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>80-100%</p>\n<p>60%</p>\n<p>80%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4th week</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urine Culture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>25-40%</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Typhoid</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Salmonella enterica serotypes Typhi and Paratyphi A, B, and C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fecal-oral route via contaminated food/water, known as the \"4 Fs\" (flies, fingers, feces, and fomites)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation Period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6-30 days (typically 10-14 days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gradually increasing fever (38-40°C)</li>\n<li>Fatigue and malaise</li>\n<li>Headache</li>\n<li>Abdominal pain</li>\n<li>Anorexia</li>\n<li>Variable <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> habits (constipation/diarrhea)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood culture (gold standard)</li>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> culture (most sensitive)</li>\n<li>Widal test (antibody test, less reliable)</li>\n<li>PCR and molecular testing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Azithromycin (areas with high <span class=\"customMeta\" data-dictid=\"1f83ae1e461692777184d9acc4db71\">ciprofloxacin</span> resistance)</li>\n<li>Ciprofloxacin (areas with low resistance)</li>\n<li>Ceftriaxone (severe cases)</li>\n<li>Supportive care (fluids, antipyretics)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intestinal <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> (1.3% of cases)</li>\n<li>Gastrointestinal bleeding</li>\n<li>Delirium (25% of cases)</li>\n<li>Hepatitis</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"628dbda70016927771848651ec4130\">carrier state</span> (1-4% of cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hand hygiene</li>\n<li>Safe food and water practices</li>\n<li>Vaccination (ViPS, Ty21a, or TCV vaccines)</li>\n<li>Improved <span class=\"customMeta\" data-dictid=\"18aafee1a71692777198cdc688e8aa\">sanitation</span> infrastructure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the diagnostic test for carcinoid tumors?", "options": [{"label": "A", "text": "24-hour urinary catecholamines", "correct": false}, {"label": "B", "text": "Serum calcitonin levels", "correct": false}, {"label": "C", "text": "Serum chromogranin A", "correct": false}, {"label": "D", "text": "Urinary 5-hydroxyindoleacetic acid", "correct": true}], "correct_answer": "D. Urinary 5-hydroxyindoleacetic acid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diagnostic Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5-HIAA <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</li>\n<li>24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> collection</li>\n<li>Measures <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> metabolites</li>\n<li>Can be challenging if patient is consuming serotonin-rich foods (e.g., salmon, eggs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Somatostatin Scintigraphy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Also known as OctreoScan</li>\n<li>Can confirm presence of <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> receptors</li>\n<li>Helps in tumor localization</li>\n<li>Used to predict response to <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> <span class=\"customMeta\" data-dictid=\"22e0051a181692777181872183edb2\">analogue</span> therapy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>68Ga-DOTATATE PET Scan</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>More sensitive <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> technique</li>\n<li>Uses <span class=\"customMeta\" data-dictid=\"f391426a781692777197a16039bb5e\">radioactive</span> gallium-68</li>\n<li>Helps predict response to treatment</li>\n<li>Particularly useful for NET imaging</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chromogranin A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood test biomarker</li>\n<li>Elevated in metastatic disease</li>\n<li>Should be interpreted with caution in patients with <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> dysfunction, patients taking PPIs</li>\n<li>Not <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> alone, but helpful in monitoring</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flushing episodes (2-5 mins)</li>\n<li>Diarrhea</li>\n<li>Wheezing</li>\n<li>Heart <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> problems</li>\n<li>Abdominal pain</li>\n<li>Telangiectasia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Carcinoid syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carcinoid syndrome is caused by hormone <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> (mainly <strong>serotonin</strong>) from <strong>neuroendocrine tumors (NETs). </strong></li>\n<li>Commonly arises from NETs in the <strong>small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> or appendix</strong>.</li>\n<li>The syndrome typically occurs when the tumor has metastasized to the liver or retroperitoneum, allowing the hormones to enter <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> circulation.</li>\n<li><strong>Histamine and tachykinins</strong> (e.g., substance P) may also contribute to the syndrome.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flushing: Sudden onset of an intense red or purplish color, especially on the upper body, neck, and face, often with a sensation of warmth.</li>\n<li>Diarrhea: Frequent watery stools, often over 10 times/day, significantly impacting daily life.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Less Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wheezing or asthma-like symptoms</li>\n<li>Impaired cognitive function in advanced cases</li>\n<li>Pellagra-like skin lesions due to <span class=\"customMeta\" data-dictid=\"acad87464816927771937783e41318\">niacin</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (from <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> being used to produce <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> instead of niacin).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Somatostatin analogues</strong>: <strong>Mainstay </strong>treatment that <strong>mimics somatostatin,</strong> which inhibits hormone <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> (e.g., serotonin).\n\t\t\t\t<ul>\n<li>Most NETs (around 90%) have <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> receptors and respond to these analogues.</li>\n</ul>\n</li>\n<li><strong>Telotristat ethyl</strong>: Blocks <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> production; used as <strong>adjunctive therapy </strong>for patients who don't fully respond to <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> analogues.</li>\n<li>Surgery: Considered for <strong>localized tumors </strong>but often not possible in patients with metastatic disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male with a 20-year history of chronic alcohol consumption, averaging 500 ml daily, presents to the clinic with complaints of sensations of insects crawling on his skin, agitation, and irritation. He reports that his last drink was 3 days ago. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Alcohol intoxication", "correct": false}, {"label": "B", "text": "Delirium tremens", "correct": true}, {"label": "C", "text": "Tolerance", "correct": false}, {"label": "D", "text": "Reaction due to alcohol", "correct": false}], "correct_answer": "B. Delirium tremens", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage of Alcohol Withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Onset After Last Drink</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild Withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild anxiety, tremulousness, nausea, headache, palpitations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-8 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benzodiazepines (lorazepam, chlordiazepoxide, diazepam). Carbamazepine (800 mg daily).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate (Alcoholic Hallucinosis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visual, auditory, or <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> hallucinations, intact orientation, normal vital signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8-12 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benzodiazepines (lorazepam, chlordiazepoxide, diazepam).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe (Withdrawal Seizures)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> seizures, usually brief and <span class=\"customMeta\" data-dictid=\"7fe60173fc1692777198c84099eccc\">self-limited</span> (rum fits)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-24 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benzodiazepines (Treatment of choice).</p>\n<p>Anticonvulsants not more beneficial.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Life-Threatening (Delirium Tremens)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe agitation, confusion, disorientation, visual hallucinations, <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> hyperactivity, profound sweating, tremors, insomnia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 72 hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher doses of Benzodiazepines (<strong>50-100 mg <span class=\"customMeta\" data-dictid=\"1bd4ee18101692777184c7413e5728\">chlordiazepoxide</span> every 4 hours or <span class=\"customMeta\" data-dictid=\"4398b2978c16927771915937fed503\">lorazepam</span> IV). </strong>Supportive care (high-calorie diet, multivitamins).</p>\n<p>Haloperidol for severe <span class=\"customMeta\" data-dictid=\"2e9cc77ee216927771801bf1296c9c\">agitation</span> (caution with <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> threshold).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protracted Withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms may last 2-6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acamprosate is recommended for symptom relief, and cognitive and behavioural approaches are recommended.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the medical term for a person who fears seeing tall buildings and looking down from heights?", "options": [{"label": "A", "text": "Agoraphobia", "correct": false}, {"label": "B", "text": "Acrophobia", "correct": true}, {"label": "C", "text": "Claustrophobia", "correct": false}, {"label": "D", "text": "Nomophobia", "correct": false}], "correct_answer": "B. Acrophobia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 46-year-old male presents to the outpatient department with a history of lower back pain and painful urination. Upon investigation, he is found to have normocytic normochromic anemia and hypercalcemia. Serum protein electrophoresis reveals an M-spike in the gamma region. Which of the following tests is most appropriate to confirm the diagnosis of multiple myeloma?", "options": [{"label": "A", "text": "Liver function test", "correct": false}, {"label": "B", "text": "Bence Jones protein in urine", "correct": true}, {"label": "C", "text": "Urine albumin-to-creatinine ratio (UACR) test", "correct": false}, {"label": "D", "text": "Heat and acetic acid test", "correct": false}], "correct_answer": "B. Bence Jones protein in urine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother presented her daughter with complaints that she has started behaving weirdly about her food habits for the last few months. She eats a lot of burgers in one go, and then she vomits it out. Her BMI is 27. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Anorexia nervosa", "correct": false}, {"label": "B", "text": "Binge eating disorder", "correct": false}, {"label": "C", "text": "Bulimia nervosa", "correct": true}, {"label": "D", "text": "OCD", "correct": false}], "correct_answer": "C. Bulimia nervosa", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/R6UBhakkjxQBQvUSQwc91747215605.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Bulimia Nervosa (eating disorder)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age of Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Late <span class=\"customMeta\" data-dictid=\"98d9739e5f1692777180d7de404750\">adolescence</span> and young adulthood (8-21 years).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Binge Eating Episodes: </strong>Recurring episodes of <span class=\"customMeta\" data-dictid=\"45c64c16b516927771832de6bd0523\">binge</span> eating, occurring at least weekly for the last 3 months.</li>\n<li><strong>Compensatory Behaviors: </strong>Purging behaviours (self-induced vomiting, <span class=\"customMeta\" data-dictid=\"452c3c115d169277719186b3353c18\">laxative</span> abuse, diuretics), excessive exercise, fasting.</li>\n<li><strong>BMI: </strong>Often normal or slightly <span class=\"customMeta\" data-dictid=\"e01b899fb61692777194fb4270ce6f\">overweight</span> (compared to <span class=\"customMeta\" data-dictid=\"8deb4a7e2b1692777181c91be40ed9\">anorexia</span> nervosa).</li>\n<li><strong>Gender prevalence: </strong>More common in females than males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Appear due to repeated purging.</p>\n<ul>\n<li>Parotitis or (parotid <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> (may see increased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> amylase)</li>\n<li>Enamel <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> (from vomiting)</li>\n<li>Dental caries</li>\n<li>Mallory-Weiss syndrome (esophageal tears).</li>\n<li><strong>Russell's Sign (callus on knuckles: </strong>Due to self-induced vomiting, the knuckles get injured by the teeth.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kyukyusha\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Russell%27s_sign#/media/File:Russell's_Sign.png\" data-tags=\"\" height=\"442\" src=\"https://image.prepladder.com/content/R6UBhakkjxQBQvUSQwc91747215605.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cognitive Behavioral Therapy (CBT):</strong></p>\n<ul>\n<li>First-line treatment focuses on modifying distorted thoughts and behaviours related to eating and body image.</li>\n</ul>\n<p><strong>Nutritional Rehabilitation:</strong></p>\n<ul>\n<li>Aimed at restoring healthy eating patterns and addressing nutritional deficiencies.</li>\n</ul>\n<p><strong>Antidepressants </strong></p>\n<ul>\n<li><strong>Fluoxetine: </strong>Most effective medication for reducing binge-eating episodes and associated symptoms.</li>\n<li><strong>Topiramate: </strong>This can be effective in suppressing <span class=\"customMeta\" data-dictid=\"45c64c16b516927771832de6bd0523\">binge</span> eating but not as commonly used as fluoxetine.</li>\n<li><strong>Bupropion: </strong>Contraindicated due to an increased risk of seizures, especially in patients with eating disorders.</li>\n</ul>\n<p><strong>Evidence indicates that CBT and medications (particularly fluoxetine) are the most effective combination.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young woman presents with recurrent headaches, easy bruising, and episodes of visual blurring. Her platelet count is elevated, while her red blood cell (RBC) and white blood cell (WBC) counts are normal. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Essential Thrombocytosis", "correct": true}, {"label": "B", "text": "Polycythemia Vera", "correct": false}, {"label": "C", "text": "Chronic Myeloid Leukemia (CML)", "correct": false}, {"label": "D", "text": "Acute Myeloid Leukemia (AML)", "correct": false}], "correct_answer": "A. Essential Thrombocytosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Essential Thrombocytosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clonal <span class=\"customMeta\" data-dictid=\"8dd789d7d1169277719303d4744837\">myeloproliferative</span> disorder</li>\n<li>Characterized by increased <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> production</li>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"a9e4aca9db16927771925f99eb40c9\">megakaryocyte</span> proliferation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>JAK2 V617F <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> (50-60% of cases)</li>\n<li>CALR mutations (type 1 and 2)</li>\n<li>MPL mutations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Platelet count &gt;450,000/μL</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> megakaryocytes</li>\n<li>Normal RBC and WBC Count</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often asymptomatic</li>\n<li>Thrombotic events (arterial &gt; venous)</li>\n<li>Erythromelalgia</li>\n<li>Ocular migraines &amp; visual disturbances</li>\n<li>TIAs</li>\n<li>Spontaneous <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> &amp; easy bruising</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Platelet count &gt;450,000/μL</li>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> showing <span class=\"customMeta\" data-dictid=\"a9e4aca9db16927771925f99eb40c9\">megakaryocyte</span> proliferation</li>\n<li>Not meeting WHO criteria for other <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">myeloid</span> neoplasms</li>\n<li>Presence of JAK2, CALR, or MPL mutation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thrombosis (major cause of morbidity)</li>\n<li>Hemorrhage (especially with counts &gt;1 million/μL)</li>\n<li>Progression to myelofibrosis</li>\n<li>Small risk of leukemic transformation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low-dose <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> for <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> prevention</li>\n<li>Hydroxyurea for high-risk patients</li>\n<li>Anagrelide for cytoreduction</li>\n<li>Plateletpheresis for severe cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old female patient who has been on anti-diabetic therapy for the last 10 years, has experienced three episodes of vaginal candidiasis infections in the past two months. Which hypoglycemic agent should be avoided in this patient?", "options": [{"label": "A", "text": "Acarbose", "correct": false}, {"label": "B", "text": "Metformin", "correct": false}, {"label": "C", "text": "Gliflozins", "correct": true}, {"label": "D", "text": "Linagliptin", "correct": false}], "correct_answer": "C. Gliflozins", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with a unilateral throbbing headache that worsens with exposure to bright light. She occasionally skips breakfast. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hunger headache", "correct": false}, {"label": "B", "text": "Migraine", "correct": true}, {"label": "C", "text": "Tension headache", "correct": false}, {"label": "D", "text": "Cluster headache", "correct": false}], "correct_answer": "B. Migraine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features of Migraine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Premonitory (Prodromal) Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neck discomfort</li>\n<li>Cognitive <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> (brain “fog”)</li>\n<li>Mood changes</li>\n<li>Fatigue</li>\n<li>Yawning/sleepiness</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"01cdc9604816927772010d5f2b7e82\">urination</span> and thirst</li>\n<li>Food cravings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aura</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neurologic disturbances (e.g., visual disturbances like scintillating scotoma)</li>\n<li>Due to Cerebral vasoconstriction. Therefore prevention is by Vasodilators.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Headache Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain</li>\n<li>Nausea/vomiting</li>\n<li>Sensory sensitivities:\n\t\t\t\t<ul>\n<li>Photophobia (sensitivity to light)</li>\n<li>Phonophobia (sensitivity to sound)</li>\n<li>Osmophobia (sensitivity to smells)</li>\n<li>Allodynia (pain from non-painful stimuli)</li>\n<li>Vertigo</li>\n</ul>\n</li>\n<li>Due to cerebral vasodilation. So treatment is Vasoconstrictors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Postdrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tiredness</li>\n<li>Weariness</li>\n<li>Impaired concentration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Simplified Diagnostic Criteria for <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">Migraine</span> by International Headache Society:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Criteria:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Repeated attacks of headache lasting 4–72h in patients with a normal physical examination, no other reasonable cause for the headache, and:</p>\n<p> </p>\n<p><strong>At least 2 of the following features:</strong></p>\n<ul>\n<li><strong>Unilateral pain</strong></li>\n<li><strong>Throbbing pain</strong></li>\n<li>Aggravation by movement</li>\n<li>Moderate or severe intensity</li>\n</ul>\n<p> </p>\n<p><strong>Plus at least 1 of the following features: </strong></p>\n<ul>\n<li>Nausea/vomiting</li>\n<li><strong>Photophobia </strong>and phonophobia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman with obstructive lung disease is currently using salmeterol and tiotropium but continues to experience breathlessness and frequent exacerbations. Given her current situation, which of the following treatments would be most appropriate?", "options": [{"label": "A", "text": "Nebulization with LAMA-LABA", "correct": false}, {"label": "B", "text": "Long-Term Oxygen Therapy (LTOT)", "correct": true}, {"label": "C", "text": "Positive Pressure Ventilation (PPV)", "correct": false}, {"label": "D", "text": "Pneumococcal Vaccine", "correct": false}], "correct_answer": "B. Long-Term Oxygen Therapy (LTOT)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lumbar puncture was performed on a patient in a sitting position, and the patient is now experiencing a very severe headache. Which of the following is NOT a recommended management strategy for a post-lumbar puncture headache?", "options": [{"label": "A", "text": "Lie in a supine position", "correct": false}, {"label": "B", "text": "Administer intravenous caffeine", "correct": false}, {"label": "C", "text": "Restrict water intake", "correct": true}, {"label": "D", "text": "Perform a low-volume blood patch", "correct": false}], "correct_answer": "C. Restrict water intake", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient presents with colicky abdominal pain, joint pain, and palpable purpura. Urinalysis shows only red blood cells with no other significant findings. Which of the following is the likely diagnosis?", "options": [{"label": "A", "text": "IgA vasculitis", "correct": true}, {"label": "B", "text": "Granulomatosis with polyangiitis", "correct": false}, {"label": "C", "text": "Microscopic polyangiitis", "correct": false}, {"label": "D", "text": "Behçet's disease", "correct": false}], "correct_answer": "A. IgA vasculitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman presents with intermenstrual bleeding following the insertion of an intrauterine device (IUD). She reports no other complications. What is the most appropriate initial management step?", "options": [{"label": "A", "text": "Remove the IUD", "correct": false}, {"label": "B", "text": "Reassure the patient and observe", "correct": true}, {"label": "C", "text": "Perform a pelvic ultrasound", "correct": false}, {"label": "D", "text": "Prescribe hormonal therapy", "correct": false}], "correct_answer": "B. Reassure the patient and observe", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/A65zQxhSSJY8rZiK5rOa1747383521.png"], "explanation": "\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:28px; vertical-align:top; width:624px\">\n<p style=\"text-align:center\"><strong>SIDE EFFECTS OF IUCD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:312px\">\n<p style=\"text-align:center\"><strong>IMMEDIATE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:312px\">\n<p style=\"text-align:center\"><strong>REMOTE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:312px\">\n<ul>\n<li>Cramp-like pain</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:312px\">\n<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> bleeding<strong>(most common)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:312px\">\n<ul>\n<li>Syncopal attack</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:312px\">\n<ul>\n<li>Pain <strong>(2nd most common)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:28px; vertical-align:top; width:312px\">\n<ul>\n<li>Partial or complete perforation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:28px; vertical-align:top; width:312px\">\n<ul>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease (PID)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:28px; vertical-align:top; width:312px\">\n<ul>\n<li>Spontaneous expulsion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:28px; vertical-align:top; width:312px\">\n<ul>\n<li>Perforation of the uterus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient visits a haematologist with symptoms of weakness and fatigue. Laboratory tests show low haemoglobin, a low reticulocyte count, and normal WBC and platelet counts. The bone marrow analysis reveals a selective reduction in erythroid precursors. What is the likely diagnosis?", "options": [{"label": "A", "text": "Aplastic anemia", "correct": false}, {"label": "B", "text": "Pure red cell aplasia", "correct": true}, {"label": "C", "text": "Iron deficiency anaemia", "correct": false}, {"label": "D", "text": "Pernicious anemia", "correct": false}], "correct_answer": "B. Pure red cell aplasia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with Vitamin A deficiency?", "options": [{"label": "A", "text": "Pinguecula", "correct": false}, {"label": "B", "text": "Bitot’s spots", "correct": true}, {"label": "C", "text": "Pterygium", "correct": false}, {"label": "D", "text": "Stocker’s line", "correct": false}], "correct_answer": "B. Bitot’s spots", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>XN</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Night blindness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X1A: Conjunctival xerosis.</li>\n<li>X1B: Bitot spots. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Corneal xerosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X3A: Corneal ulceration, less than one-third.</li>\n<li>X3B: Corneal ulceration, more than one-third.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>XS</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Corneal scar.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>XF</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Xerophthalmic fundus.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following parameters decreases acute inflammation?", "options": [{"label": "A", "text": "CRP", "correct": false}, {"label": "B", "text": "Hepcidin", "correct": false}, {"label": "C", "text": "Fibrinogen", "correct": false}, {"label": "D", "text": "Albumin", "correct": true}], "correct_answer": "D. Albumin", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Inflammation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Inflammation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pathogen, injured tissues</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> due to non-degradable pathogens, persistent foreign bodies, or <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> reactions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cells infiltrated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neutrophils/Polymorphonuclear cells (PMN).</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Exception:</strong> Typhoid (<strong>Relative Lymphocytosis</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphocytes, macrophages, </strong><strong>and</strong><strong> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>Exception: </strong>Chronic</p>\n<p>Pseudomonas (it shows the <span class=\"customMeta\" data-dictid=\"47d4b14d841692777195ec9f299139\">persistence</span> of <strong>Neutrophils</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary mediators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasoactive amines, eicosanoids</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IFN-y and other cytokines, growth factors, <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> oxygen species, <span class=\"customMeta\" data-dictid=\"310799d8981692777189d3a272674d\">hydrolytic</span> enzymes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delayed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Few days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to many months or years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Outcomes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resolution, <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation, chronic inflammation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tissue destruction, fibrosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve innervates the lateral rectus muscle?", "options": [{"label": "A", "text": "Sixth nerve", "correct": true}, {"label": "B", "text": "Seventh nerve", "correct": false}, {"label": "C", "text": "Third nerve", "correct": false}, {"label": "D", "text": "Fourth nerve", "correct": false}], "correct_answer": "A. Sixth nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic nerve (CN II)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Purely sensory</li>\n<li>Senses the incoming light and image displayed on retina</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oculomotor nerve (CN III)</strong><strong> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Innervates majority of the <span class=\"customMeta\" data-dictid=\"7d57c304c01692777187da125d18d8\">extraocular</span> muscles</li>\n<li>Motor <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the superior <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> muscle, <span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\">levator</span> <span class=\"customMeta\" data-dictid=\"4f6407581c1692777194e86eb9904c\">palpebrae</span> superioris muscle, <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> muscle, and the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> muscle.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trochlear nerve (CN IV) </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Motor <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the superior <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trigeminal Nerve (CN V) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ophthalmic branch of the <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> nerve provides <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the eye</li>\n<li>Afferent part of corneal and <span class=\"customMeta\" data-dictid=\"7b8d2e6b3a1692777191cfff333306\">lacrimation</span> reflex</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abducens Nerve (CN VI) </strong><strong>(Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Motor <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the<strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Facial Nerve (CN VII)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Motor <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> of the orbicularis <span class=\"customMeta\" data-dictid=\"7860833ed41692777194b7b9b531f7\">oculi</span> muscle</li>\n<li>Efferent part of corneal and <span class=\"customMeta\" data-dictid=\"7b8d2e6b3a1692777191cfff333306\">lacrimation</span> reflex</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sympathetic Nervous System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> nerves: Innervates the pupillary <span class=\"customMeta\" data-dictid=\"34cb72fd361692777186bfa0354926\">dilator</span> muscles causing mydriasis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parasympathetic nervous system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Short <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> nerves:<strong> </strong>Innervates the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> pupillae muscles causing miosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Oil drop cataract is seen in?", "options": [{"label": "A", "text": "Galactosemia", "correct": true}, {"label": "B", "text": "Wilson's disease", "correct": false}, {"label": "C", "text": "Gaucher's disease", "correct": false}, {"label": "D", "text": "Tay-Sachs disease", "correct": false}], "correct_answer": "A. Galactosemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/itVEefSVifrG1DThunHU1747378530.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Galactosemia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inborn error of <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> metabolism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Galactose-1-phosphate uridyltransferase (GPUT)</li>\n<li>Galactokinase (GK)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">cataract</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Bilateral </strong></li>\n<li><strong>“Oil droplet” (Option A)</strong></li>\n<li><strong>Central lens </strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Anagha Medsinge, Ken K Nischal\" data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/Oil-droplet-cataract-in-galactosemia_fig5_271331844\" data-tags=\"\" height=\"420\" src=\"https://image.prepladder.com/content/itVEefSVifrG1DThunHU1747378530.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>May be reversed </strong></li>\n<li>May be prevented if milk and milk products are eliminated at an early stage</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the device.", "options": [{"label": "A", "text": "Mirena", "correct": false}, {"label": "B", "text": "Lippes Loop", "correct": true}, {"label": "C", "text": "Copper T", "correct": false}, {"label": "D", "text": "Progestasert", "correct": false}], "correct_answer": "B. Lippes Loop", "question_images": ["https://image.prepladder.com/content/ccw8mn5QGlJRzkmjkC7s1747217326.png"], "explanation_images": ["https://image.prepladder.com/content/ilIs7E13Xagev1m3wo731747383818.png", "https://image.prepladder.com/content/1vC8vsMwj9P8alSRISTS1747383762.png", "https://image.prepladder.com/content/Cw2xXGDlpBuwCkQhlA6l1747383826.png", "https://image.prepladder.com/content/CzWLDGnb0EHZSrP6SplF1747383566.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lippe’s Loop</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Features of Lippes Loop:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Non-medicated</strong> device</li>\n<li>Has a <strong>high failure rate</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mechanism of Action:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Foreign body reaction</li>\n<li>Cellular/Biochemical changes in endometrium/uterine fluids</li>\n<li>Impair <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> of gamete</li>\n<li>Reduce chances of fertilization, rather than implantation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with elevated calcium and normal alkaline phosphatase undergoes a skull X-ray. What is the likely diagnosis?", "options": [{"label": "A", "text": "Grave’s disease", "correct": false}, {"label": "B", "text": "Paget’s disease", "correct": false}, {"label": "C", "text": "Multiple myeloma", "correct": true}, {"label": "D", "text": "CML", "correct": false}], "correct_answer": "C. Multiple myeloma", "question_images": ["https://image.prepladder.com/content/Am65HH5VavrM34ejYNCC1747217816.png"], "explanation_images": ["https://image.prepladder.com/content/45gvr83TrPCjHDv0KMOg1747217858.png", "https://image.prepladder.com/content/7WVvYMBH0vnjWFJos3bc1747217858.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Monoclonal Immunoglobulins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Free Light Chains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>IgG: Most common (55% of patients).</li>\n<li>IgA: Seen in 25% of cases.</li>\n<li>IgM, IgD, IgE: Less common.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often produced in excess, these are called <strong>Bence Jones proteins</strong>.</li>\n<li>It can cause <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> (renal disease).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Criteria for Multiple myeloma:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>≥10% clonal <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells (or)<strong> </strong>a biopsy-proven bony or <span class=\"customMeta\" data-dictid=\"0ba1f7edfa1692777187ae6f51e603\">extramedullary</span> plasmacytoma</li>\n</ul>\n<p><strong> + (PLUS)</strong></p>\n<ul>\n<li>Evidence of one or more <span class=\"customMeta\" data-dictid=\"652999e42416927771936e1f3246e3\">multiple myeloma</span> defining events (MDE): (CRAB features)\n\t\t\t\t<ul>\n<li>Hyper<strong>C</strong>alcemia <strong>(S.Ca2+ &gt;11g/dl)</strong><strong> </strong></li>\n<li><strong>R</strong>enal failure <strong>(S. Creatinine &gt;2mg/dl) </strong></li>\n<li><strong>A</strong>naemia <strong>(Hb &lt;10gm)</strong><strong> </strong></li>\n<li>Lytic <strong>B</strong>one lesions are attributable to the <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cell disorder.</li>\n</ul>\n</li>\n</ul>\n<p><strong> (OR)</strong></p>\n<ul>\n<li>One or more biomarkers of <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (SLIM criteria)\n\t\t\t\t<ul>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> clonal plasmacytosis<strong> </strong><strong>≥60%</strong> (<strong>S</strong>ixty per cent)</li>\n<li>Serum involved/uninvolved free <strong>Li</strong>ght chain (FLC) ratio<strong> </strong><strong>≥ 100</strong> (provided involved FLC is ≥100 mg/L)</li>\n<li><strong>&gt;1</strong> <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on<strong> M</strong>RI.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman presents with intermenstrual spotting during the first month after IUCD insertion. She has no other complications. What is the most appropriate next step?", "options": [{"label": "A", "text": "Iron supplements and reassurance", "correct": false}, {"label": "B", "text": "Remove the IUCD", "correct": false}, {"label": "C", "text": "Observation and reassurance", "correct": true}, {"label": "D", "text": "Oral antibiotics", "correct": false}], "correct_answer": "C. Observation and reassurance", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the type of cataract seen following a blunt trauma?", "options": [{"label": "A", "text": "Rosette cataract", "correct": true}, {"label": "B", "text": "Christmas tree cataract", "correct": false}, {"label": "C", "text": "Snowflake cataract", "correct": false}, {"label": "D", "text": "Sunflower cataract", "correct": false}], "correct_answer": "A. Rosette cataract", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hVll1cdRXTJTU6YfqyoQ1747217913.png", "https://image.prepladder.com/content/IZB5DddJwmTRvdn6Jzci1747217929.png", "https://image.prepladder.com/content/pVwJeev49ubiv9SyH5J51747217941.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman, 10 years after mastectomy, notices gradual swelling and heaviness in her right upper limb without pain. On examination, bluish nodules on the skin with no infections are noted. What is the most likely cause of her symptoms?", "options": [{"label": "A", "text": "Lymphangiosarcoma", "correct": true}, {"label": "B", "text": "Thoracic outlet syndrome", "correct": false}, {"label": "C", "text": "Chronic venous insufficiency", "correct": false}, {"label": "D", "text": "Recurrent breast cancer", "correct": false}], "correct_answer": "A. Lymphangiosarcoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Explanations </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphedema </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling is caused by the accumulation of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> fluid in the arm or <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> due to the removal of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.(After MRM and axillary dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wound infection/Flap necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Postoperative infections where blackening of <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> line is seen (flap necrosis), if necrosed site note removed, leads to wound infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Post-Mastectomy Pain Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic pain in the chest or upper arm due to nerve damage or <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nerve Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Long<strong> </strong>thoracic nerve- injury leads to winging of the scapula</li>\n<li>Thoracodorsal nerve</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphangiosarcoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Stewart-Treves syndrome</strong> - Cancerous growth in the <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> vessels, often associated with long-standing lymphedema.</li>\n<li>After an average of 10.5 years following MRM and radiotherapy, the patient develops angiosarcoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve defect causes lagophthalmos?", "options": [{"label": "A", "text": "7th nerve", "correct": true}, {"label": "B", "text": "6th nerve", "correct": false}, {"label": "C", "text": "4th nerve", "correct": false}, {"label": "D", "text": "5th nerve", "correct": false}], "correct_answer": "A. 7th nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common cause of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy</li>\n<li>Characterized by idiopathic, <strong>LMN <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis</strong> of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> onset</li>\n<li><strong>Most commonly the Labyrinthine segment</strong> of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve is involved.</li>\n<li><strong>Males and females are equally affected.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic: Most common cause</strong></li>\n<li>Viral Infection: <strong>HSV</strong> &gt;&gt; Herpes zoster</li>\n<li>Vascular Ischemia</li>\n<li>Hereditary: Positive family history in 6-8%</li>\n<li>Autoimmune</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in diabetics (due to angiopathy) and pregnant women (due to fluid retention).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden onset of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> with inability to close the eye (Bell's phenomenon)<strong> (Option A)</strong>, <span class=\"customMeta\" data-dictid=\"0bead1317716927771827dc3e80706\">asymmetry</span> of the face, epiphora, drooping mouth, and dribbling of saliva.</li>\n<li>Associated symptoms may include ear pain, noise <span class=\"customMeta\" data-dictid=\"7794e5fd7a1692777190ee626ede62\">intolerance</span> (stapedial paralysis), or loss of taste (chorda tympani involvement).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is made by excluding other causes of <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>General: Reassurance, pain relief, eye protection and physiotherapy</li>\n<li>Medical: <strong>Prednisolone</strong> 60 mg per day for 5 days then <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by 10 mg per day (for a total treatment time of 10 days) and 50 mg per day (in two divided doses) for 10 days, <strong>Acyclovir</strong></li>\n<li>Surgical: Nerve decompression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>85%-90% of patients fully recover </strong></li>\n<li>Incomplete resolution are mainly seen in recurrent/late recovery cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common complication of ERCP?", "options": [{"label": "A", "text": "Duodenal perforation", "correct": false}, {"label": "B", "text": "Cholangitis", "correct": false}, {"label": "C", "text": "Hemorrhage", "correct": false}, {"label": "D", "text": "Pancreatitis", "correct": true}], "correct_answer": "D. Pancreatitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How does the World Health Organization (WHO) define blindness?", "options": [{"label": "A", "text": "VA &amp;lt; 3/60", "correct": true}, {"label": "B", "text": "VA &amp;lt; 6/60", "correct": false}, {"label": "C", "text": "VA &amp;gt; 3/60", "correct": false}, {"label": "D", "text": "VA &amp;gt; 6/60", "correct": false}], "correct_answer": "A. VA &lt; 3/60", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>NPCB Classification of Visual Impairment</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The National Programme for Control of <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">Blindness</span> (NPCB) in India defines <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">blindness</span> as \"visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of &lt;3/60 in a better eye with best possible correction\" and central <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> &lt;10 degrees. The NPCB further categorizes visual <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> as:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Visual Acuity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Visual Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 6/18 in the better eye with available correction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Low Vision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 6/18 to 6/60</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Economic Blindness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 6/60 to 3/60</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Social Blindness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 3/60 to 1/60</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Manifest Blindness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 1/60 to the perception of light</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Absolute Blindness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>No perception of light</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>WHO Classification of Visual Impairment</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The World Health Organization (WHO) defines <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">blindness</span> as \"visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 3/60 (Snellen) or its equivalent\".<strong>(Option A)</strong></p>\n<p>The International Classification of Disease 11 (2018) classifies vision <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> into distance and near-presenting vision impairment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Visual Acuity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mild Distance Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 6/12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Moderate Distance Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 6/18</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Severe Distance Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 6/60</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Blindness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 3/60<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Near Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Presenting near vision <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than N6 or M0.8 at 40 cm with existing correction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with irregular periods, acne, excessive hair growth, and increased serum insulin and testosterone levels. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Polycystic Ovary Syndrome (PCOS)", "correct": true}, {"label": "B", "text": "Endometriosis", "correct": false}, {"label": "C", "text": "Ovarian tumor", "correct": false}, {"label": "D", "text": "Hypothyroidism", "correct": false}], "correct_answer": "A. Polycystic Ovary Syndrome (PCOS)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents to the emergency department with severe abdominal pain radiating to the back. Laboratory investigations reveal elevated serum amylase and lipase levels. Which of the following should be avoided in the management of the given condition?", "options": [{"label": "A", "text": "Nil per oral", "correct": false}, {"label": "B", "text": "Administration of 5% dextrose", "correct": true}, {"label": "C", "text": "Parenteral nutrition", "correct": false}, {"label": "D", "text": "Early initiation of oral feedings", "correct": false}], "correct_answer": "B. Administration of 5% dextrose", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An alcoholic patient presents with lower back pain and fever. During history-taking, he mentions experiencing similar episodes in the past with amylase levels being elevated. Which type of necrosis is likely to be present?", "options": [{"label": "A", "text": "Fibrinoid necrosis", "correct": false}, {"label": "B", "text": "Fat necrosis", "correct": true}, {"label": "C", "text": "Coagulative necrosis", "correct": false}, {"label": "D", "text": "Liquefactive necrosis", "correct": false}], "correct_answer": "B. Fat necrosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s9YmqDgjxHoHO9w1w1m71747218089.png", "https://image.prepladder.com/content/Ii5UFRMUw9Z0VuaFSDYb1747218089.png", "https://image.prepladder.com/content/hmovgxBbqqvDBBMYZuMY1747218089.png", "https://image.prepladder.com/content/L0rHZuWcIhSVRWkFhmlz1747218089.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Organ involved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coagulative necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ischaemia in the Heart, Liver, Kidney and dry gangrene.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liquefactive necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypoxic death of cells in CNS, Wet gangrene, Abscess.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caseous necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TB infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrinoid necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immune reaction involving blood vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fat necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute pancreatitis, Breast.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where is the Bartholin gland located?", "options": [{"label": "A", "text": "Anterior 1/3rd of labia majora", "correct": false}, {"label": "B", "text": "Posterior 1/3rd of labia majora", "correct": true}, {"label": "C", "text": "Lateral 1/3rd of labia majora", "correct": false}, {"label": "D", "text": "Medial 1/3rd of labia majora", "correct": false}], "correct_answer": "B. Posterior 1/3rd of labia majora", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/glfHTPd1jHVxIaBZKTnS1747384008.png", "https://image.prepladder.com/content/WeRnLd9jlFxbIp09OMhH1747384002.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with sudden painful decrease in vision and a fixed, vertically oval pupil. What is the likely diagnosis?", "options": [{"label": "A", "text": "Macular degeneration", "correct": false}, {"label": "B", "text": "Optic neuritis", "correct": false}, {"label": "C", "text": "Acute congestive glaucoma", "correct": true}, {"label": "D", "text": "Acute anterior uveitis", "correct": false}], "correct_answer": "C. Acute congestive glaucoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FyS1sE5rVge70jkqaluq1747218462.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old nulligravida presents with no cystocele and no rectocele but has a third-degree uterine prolapse. What is the most appropriate management for her condition?", "options": [{"label": "A", "text": "LeFort colpocleisis", "correct": false}, {"label": "B", "text": "Fothergill operation (Manchester procedure)", "correct": false}, {"label": "C", "text": "Shirodkar vaginal approach", "correct": false}, {"label": "D", "text": "Abdominal sling surgery", "correct": true}], "correct_answer": "D. Abdominal sling surgery", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category of patient</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment of <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">Uterine</span> Prolapse</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nulliparous or <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> prolapse</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Abdominal <span class=\"customMeta\" data-dictid=\"5e2a7b127c1692777198f4895cc7c0\">sling</span> operations:</strong></p>\n<ul>\n<li>Abdominal wall cervicopexy</li>\n<li>Shirodkar’s <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"5e2a7b127c1692777198f4895cc7c0\">sling</span> operation</li>\n<li>Khanna’s <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"5e2a7b127c1692777198f4895cc7c0\">sling</span> operation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pregnancy &amp; <span class=\"customMeta\" data-dictid=\"ba016f80c31692777196b151e95b8f\">postnatal</span> period</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ring <span class=\"customMeta\" data-dictid=\"e3571980751692777195feb15eb7d3\">pessary</span> (up to 16 weeks POG)</li>\n<li>Pelvic floor exercises</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;40 Years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fothergill’s repair (Manchester operation)</li>\n<li>Shirodkar’s procedure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;40 Years - with completed family</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vaginal <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> &amp; <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> floor repair</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;60 Years - unit for surgery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Le-fort’s repair</li>\n<li>Colpocleisis</li>\n</ul>\n<p>These are done if the patient doesn’t want to retain sexual function</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>First degree</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> descends downward, but the external os (opening of the cervix) remains inside the vagina.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Second degree</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> body remains inside the <span class=\"customMeta\" data-dictid=\"8537d8358c169277720162f2f6971b\">vagina</span> while the external os protrudes outside the <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> introitus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Third degree (Procidentia)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The cervix, <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> body, and <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> descend to lie outside the introitus.</p>\n<p>The complete <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> protrudes outside the vagina.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old pregnant woman presents with a history of decreased fetal movements and respiratory distress in her newborn. On examination, the neonate appeared cyanotic, with increased breathing work. Auscultation reveals bowel sounds in the left hemithorax. A chest x-ray is given in the image. Which of the following congenital anomalies is most likely responsible for these findings?", "options": [{"label": "A", "text": "Congenital diaphragmatic hernia", "correct": true}, {"label": "B", "text": "Tetralogy of Fallot", "correct": false}, {"label": "C", "text": "Transposition of the Great Vessels", "correct": false}, {"label": "D", "text": "Tracheoesophageal fistula", "correct": false}], "correct_answer": "A. Congenital diaphragmatic hernia", "question_images": ["https://image.prepladder.com/content/iNMQsnmNIxoT1ozg8ALl1747218524.png"], "explanation_images": ["https://image.prepladder.com/content/yrqBaj0tPzHF5TNX5AFY1747218569.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Bochdalek Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Morgagni Hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Left-sided</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Right-sided</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Posterolateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Anteromedial</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Herniated Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Small intestine, stomach</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Transverse colon, sometimes liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Scaphoid abdomen, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress, <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Mostly Asymptomatic and Incidental</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Pulmonary hypoplasia</li>\n<li>Pulmonary hypertension</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Less severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Polyhydramnios, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> LHR, and liver position</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Rarely detected prenatally; usually diagnosed later</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Variable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Generally Better prognosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the correct definition of postpartum pyrexia?", "options": [{"label": "A", "text": "After 24 hours, temperature &amp;gt; 100.4 degrees Fahrenheit", "correct": true}, {"label": "B", "text": "After 6 hours, temperature &amp;gt; 100.4 degrees Fahrenheit", "correct": false}, {"label": "C", "text": "After 3 hours, temperature &amp;gt; 100.4 degrees Fahrenheit", "correct": false}, {"label": "D", "text": "After 12 hours, temperature &amp;gt; 100.4 degrees Fahrenheit", "correct": false}], "correct_answer": "A. After 24 hours, temperature &gt; 100.4 degrees Fahrenheit", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During an endoscopy, a man is found to have the squamocolumnar junction located more proximally than normal. Which of the following conditions is most likely responsible for this finding?", "options": [{"label": "A", "text": "Achalasia cardia", "correct": false}, {"label": "B", "text": "Sliding hernia", "correct": true}, {"label": "C", "text": "Rolling hernia", "correct": false}, {"label": "D", "text": "Gastroesophageal reflux disease", "correct": false}], "correct_answer": "B. Sliding hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GJbYd4M5Sf9V0Tk6MlCM1747218733.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I/Sliding Hiatus Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common type.</p>\n<p><strong>The <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> and part of the stomach slide up through the diaphragm.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II/Paraesophageal Hiatus Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Part of the stomach pushes through the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> next to the oesophagus. The <span class=\"customMeta\" data-dictid=\"9f47bfb9a616927771887db45c89c7\">gastroesophageal</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> remains in place.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III/Mixed Hiatus Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Combines features of both sliding and <span class=\"customMeta\" data-dictid=\"dfb43383f5169277719429a15f12a6\">paraesophageal</span> hernias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves <span class=\"customMeta\" data-dictid=\"93943f6ee2169277720298325fd255\">viscera</span> other than the stomach in the hernial sac, like the colon.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the cause of sudden painless loss of vision?", "options": [{"label": "A", "text": "Chemical injuries to the eyeball", "correct": false}, {"label": "B", "text": "Acute congestive glaucoma", "correct": false}, {"label": "C", "text": "Acute iridocyclitis", "correct": false}, {"label": "D", "text": "Central serous retinopathy", "correct": true}], "correct_answer": "D. Central serous retinopathy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kVoIBHFFjV7lQSJelzvY1747218691.png", "https://image.prepladder.com/content/5DoGknUNTqjha52OUnYp1747218700.png", "https://image.prepladder.com/content/tGFLRAFweBNAWLqYDEyP1747218710.png", "https://image.prepladder.com/content/6GGj0gioUar4CWcsmKuU1747218723.png", "https://image.prepladder.com/content/JT7uYAcCLEg9UMfixslW1747218740.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which appendicular carcinoma is most commonly associated with pseudomyxoma peritonei?", "options": [{"label": "A", "text": "Mucinous cystadenoma", "correct": true}, {"label": "B", "text": "Adenocarcinoma", "correct": false}, {"label": "C", "text": "Carcinoid tumour", "correct": false}, {"label": "D", "text": "Serous cystadenoma", "correct": false}], "correct_answer": "A. Mucinous cystadenoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the given pedigree chart indicate?", "options": [{"label": "A", "text": "Autosomal Dominant (AD)", "correct": false}, {"label": "B", "text": "Autosomal Recessive (AR)", "correct": false}, {"label": "C", "text": "Mitochondrial Disorder", "correct": true}, {"label": "D", "text": "X-linked Recessive (XLR)", "correct": false}], "correct_answer": "C. Mitochondrial Disorder", "question_images": ["https://image.prepladder.com/content/0CXQ1bvy8VuVEyZkg8nt1747218542.png"], "explanation_images": ["https://image.prepladder.com/content/5skDdAfDuGiJO0p3NtP31747218814.png", "https://image.prepladder.com/content/FXra7bgMPskDCfNl5v6D1747218814.png", "https://image.prepladder.com/content/JA3BK0fWs5QsKTXhVqLG1747218814.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the best post-coital contraceptive method?", "options": [{"label": "A", "text": "Levonorgestrel (LNG)", "correct": true}, {"label": "B", "text": "Estrogen", "correct": false}, {"label": "C", "text": "Norethisterone", "correct": false}, {"label": "D", "text": "Ulipristal acetate", "correct": false}], "correct_answer": "A. Levonorgestrel (LNG)", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the treatment of choice in a pregnant woman with an anal wart, as shown in the image given below?", "options": [{"label": "A", "text": "Trichloroacetic acid application", "correct": false}, {"label": "B", "text": "Excision", "correct": false}, {"label": "C", "text": "Cryotherapy with liquid nitrogen", "correct": true}, {"label": "D", "text": "Oral acyclovir", "correct": false}], "correct_answer": "C. Cryotherapy with liquid nitrogen", "question_images": ["https://image.prepladder.com/content/vBJJF370vjqxHFVadFL11747384878.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given instrument", "options": [{"label": "A", "text": "Universal retractor", "correct": false}, {"label": "B", "text": "Doyen’s speculum", "correct": false}, {"label": "C", "text": "Mouth clamp", "correct": false}, {"label": "D", "text": "Eye speculum", "correct": true}], "correct_answer": "D. Eye speculum", "question_images": ["https://image.prepladder.com/content/n4HLRrFc9Ey0TGqthw7H1747378712.png"], "explanation_images": ["https://image.prepladder.com/content/rdFEQ2vmafXK3UNveIeQ1747378715.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For how long is exclusive breastfeeding recommended?", "options": [{"label": "A", "text": "3 months", "correct": false}, {"label": "B", "text": "6 months", "correct": true}, {"label": "C", "text": "9 months", "correct": false}, {"label": "D", "text": "12 months", "correct": false}], "correct_answer": "B. 6 months", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following layers is associated with the beaten bronze appearance?", "options": [{"label": "A", "text": "Endothelial Layer", "correct": true}, {"label": "B", "text": "Stroma", "correct": false}, {"label": "C", "text": "Sub-Epithelial Layer", "correct": false}, {"label": "D", "text": "Epithelial Layer", "correct": false}], "correct_answer": "A. Endothelial Layer", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/p94ZKjUyPE4bpQFRqQRy1747219196.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the contraindications for the use of ventouse (vacuum extraction) during delivery?", "options": [{"label": "A", "text": "Decreased bear down efforts", "correct": false}, {"label": "B", "text": "Heart disease", "correct": false}, {"label": "C", "text": "Preterm", "correct": true}, {"label": "D", "text": "Dilatation &amp;gt; 8 cm", "correct": false}], "correct_answer": "C. Preterm", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QLCYsWhJ6nFN7QLqXRpu1747384047.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In cases of suspected ectopic pregnancy, which hormone is typically measured?", "options": [{"label": "A", "text": "Estrogen", "correct": false}, {"label": "B", "text": "Progesterone", "correct": false}, {"label": "C", "text": "Beta hCG", "correct": true}, {"label": "D", "text": "LH", "correct": false}], "correct_answer": "C. Beta hCG", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with conjugated hyperbilirubinemia?", "options": [{"label": "A", "text": "Crigler Najar -1 syndrome", "correct": false}, {"label": "B", "text": "Crigler Najar -2 syndrome", "correct": false}, {"label": "C", "text": "Gilbert syndrome", "correct": false}, {"label": "D", "text": "Dubin-Johnson syndrome", "correct": true}], "correct_answer": "D. Dubin-Johnson syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Syndromes of Unconjugated hyperbilirubinemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severity of Unconjugated hyperbilirubinemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crigler-Najjar syndrome type 1</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of UGT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crigler-Najjar syndrome <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> </strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Partial <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of UGT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to moderate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gilbert syndrome</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very mild <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of UGT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild, asymptomatic</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Syndromes of Conjugated hyperbilirubinemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disorder </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Defect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gross Feature of liver </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dubin Johnson syndrome </strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect in <strong>canalicular MRP2 protein.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pigmented liver (due to <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> metabolite).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rotor syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defective ATP-dependent <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> excretion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-pigmented liver.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 17-week pregnant woman presents with hypertension, with blood pressure measurements of 140/94 mmHg initially and 144/90 mmHg four hours later. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Gestational Hypertension", "correct": false}, {"label": "B", "text": "Chronic Hypertension", "correct": true}, {"label": "C", "text": "Acute on Chronic Hypertension", "correct": false}, {"label": "D", "text": "Pre-eclampsia", "correct": false}], "correct_answer": "B. Chronic Hypertension", "question_images": [], "explanation_images": [], "explanation": "\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hypertension in Obstetrics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gestational</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>BP&gt;140/90 (5th Korotkoff sound to record diastolic BP)</li>\n<li>After 20 weeks -&gt;2 occasions - 6 hours apart</li>\n<li>Previously <span class=\"customMeta\" data-dictid=\"dcf83226dd1692777193d04dce5f19\">normotensive</span> women</li>\n<li>Also called <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> hypertension</li>\n</ul>\n<ul>\n<li>After delivery within 12 weeks BP is normal again</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Preeclampsia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proteinuria ≥300 mg/24 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> or 1 + or more by dipstick</li>\n<li>Urine protein: Creatinine ratio &gt;0.3 = Proteinuria</li>\n<li>Early onset: &lt;34 weeks of pregnancy</li>\n<li>Late onset: &gt;34 weeks of pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eclampsia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Convulsion (generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> convulsions) + Hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pre-existing <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> presenting in early pregnancy</p>\n<ul>\n<li>Essential hypertension</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis</li>\n<li>Pheochromocytoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman, who is gravida 1, para 1, presents with intermenstrual bleeding for the past 1.5 months. What is the initial investigation of choice?", "options": [{"label": "A", "text": "Ultrasound of the abdomen", "correct": false}, {"label": "B", "text": "Transvaginal ultrasound (TVS)", "correct": false}, {"label": "C", "text": "Urine pregnancy test", "correct": true}, {"label": "D", "text": "Endometrial biopsy", "correct": false}], "correct_answer": "C. Urine pregnancy test", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most effective enzyme in Acute inflammation?", "options": [{"label": "A", "text": "NADPH oxidase", "correct": true}, {"label": "B", "text": "Defensin", "correct": false}, {"label": "C", "text": "Catalase", "correct": false}, {"label": "D", "text": "MPO", "correct": false}], "correct_answer": "A. NADPH oxidase", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Inflammation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Inflammation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pathogen, injured tissues</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> due to non-degradable pathogens, persistent foreign bodies, or <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> reactions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cells infiltrated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neutrophils/Polymorphonuclear cells (PMN).</strong></p>\n<p>Exception: Typhoid (<strong>Relative Lymphocytosis</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphocytes, macrophages, </strong><strong>and</strong><strong> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells</strong></p>\n<p>Exception: Chronic</p>\n<p>Pseudomonas (it shows the <span class=\"customMeta\" data-dictid=\"47d4b14d841692777195ec9f299139\">persistence</span> of <strong>Neutrophils</strong><strong>)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary mediators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasoactive amines, eicosanoids</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IFN-y and other cytokines, growth factors, <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> oxygen species, <span class=\"customMeta\" data-dictid=\"310799d8981692777189d3a272674d\">hydrolytic</span> enzymes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delayed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Few days.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to many months or years.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Outcomes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resolution, <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation, chronic inflammation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tissue destruction, fibrosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the earliest marker to rise in a case of myocardial infarction (MI)?", "options": [{"label": "A", "text": "CKMB (Creatine Kinase-MB)", "correct": false}, {"label": "B", "text": "Troponin", "correct": false}, {"label": "C", "text": "LDH", "correct": false}, {"label": "D", "text": "Heart fatty acid binding protein", "correct": true}], "correct_answer": "D. Heart fatty acid binding protein", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiac Markers</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac Troponin</strong></p>\n<p><strong>(Troponin T and I) </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Preferred biochemical markers</strong> due to their sensitivity and specificity.</li>\n<li><strong>Troponin levels:</strong>\n<ul>\n<li>Increase within 3-6 hours.</li>\n<li>Peak at around 36 hours.</li>\n<li>Remains elevated for<strong> </strong>7-10 days after STEMI.</li>\n</ul>\n</li>\n<li>Troponin should be measured at presentation and repeated at 1-3 hours (high-sensitivity assays) or 3-6 hours (conventional assays).</li>\n<li>Cardiac <span class=\"customMeta\" data-dictid=\"69d29372dc169277720014447abea8\">troponin</span> levels remain elevated for several days after an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (AMI), making them unreliable for detecting reinfarction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Creatine Phosphokinase (CK) and CK-MB</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CK rises within 4-8 hours.</li>\n<li>Peaks by 24 hours.</li>\n<li>Returns to normal within 48-72 hours.</li>\n<li>CK-MB elevated:\n\t\t\t\t<ul>\n<li>Cardiac surgery</li>\n<li>Myocarditis</li>\n<li>Electrical cardioversion</li>\n</ul>\n</li>\n<li>CK-MB levels normalise within 48 to 72 hours, so a subsequent rise can confirm reinfarction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lactate Dehydrogenase (LDH) </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increase in the blood 6 to 12 hours after ACS.</li>\n<li>Peak within 24 to 72 hours.</li>\n<li>Normalise within 8 to 14 days.</li>\n<li>LDH is no longer used to diagnose myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> because it is not specific to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> myocytes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart-type <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">Fatty</span> Acid-Binding Protein (H-FABP)</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is the <strong>earliest marker to rise</strong> in a case of myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (MI).</li>\n<li>It has higher sensitivity than <span class=\"customMeta\" data-dictid=\"69d29372dc169277720014447abea8\">troponin</span> and CK-MB for detecting AMI within 4 hours of symptom onset, but its <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> is lower.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiac Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Time to rise</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>H-FABP(Heart <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid binding protein)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 1 hour</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Troponin T and I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-4 hrs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CK-MB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-4 hrs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>LDH1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>24 hrs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male patient who underwent gastrointestinal surgery one month ago, presents with a palpable abdominal bulge at the surgical site. Physical examination reveals a reducible 12 cm incisional hernia. What is the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Schedule for laparoscopic mesh repair", "correct": true}, {"label": "B", "text": "Prescribe an abdominal belt for daily use", "correct": false}, {"label": "C", "text": "Advise observation and reassessment in six months", "correct": false}, {"label": "D", "text": "Laparoscopic closure without mesh", "correct": false}], "correct_answer": "A. Schedule for laparoscopic mesh repair", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zHuGpeIVK6jBBIbzlajK1747219716.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mesh Placement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Inlay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within the fascial <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> itself</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesh is sutured to the edges of the fascial defect.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It can be used for large defects where primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> isn't possible.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates</strong> due to <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> separation from fascial edges under <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Onlay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>On top of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath/external <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> aponeurosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcutaneous tissue is dissected off; the fascial <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> is closed primarily, and the <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed on top and secured</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically easier and less invasive.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher risk of <strong>seroma formation</strong>, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> infection, and skin necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Retromuscular</strong></p>\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Behind the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle but <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> is opened, the <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed in the created space, and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> is closed over it</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates</strong>, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> well incorporated into tissues</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More complex procedure, <strong>risk of injury to <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> bundles.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Preperitoneal</strong></p>\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peritoneum is separated from <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed in this space, <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> is closed over it.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> incorporation, <strong>lower risk of adhesions.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically challenging, risk of peritoneal tears.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with a strawberry skull, mental retardation, and the given karyotype suggests which diagnosis?", "options": [{"label": "A", "text": "Patau syndrome", "correct": false}, {"label": "B", "text": "Edward syndrome", "correct": true}, {"label": "C", "text": "Prader-Willi syndrome", "correct": false}, {"label": "D", "text": "Angelman syndrome", "correct": false}], "correct_answer": "B. Edward syndrome", "question_images": ["https://image.prepladder.com/content/weDu53gtkjQl94AqarMr1747219850.png"], "explanation_images": ["https://image.prepladder.com/content/lqfwMa7fqB9BAqDUKeug1747219893.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents for her annual checkup with no specific complaints. As part of preventive screening, which cancer screening test should be prioritized based on the most common malignancy affecting females?", "options": [{"label": "A", "text": "Mammogram", "correct": true}, {"label": "B", "text": "Pap smear", "correct": false}, {"label": "C", "text": "Transvaginal ultrasound", "correct": false}, {"label": "D", "text": "Colonoscopy", "correct": false}], "correct_answer": "A. Mammogram", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old G2P1 presents in active labor at 39 weeks gestation. On examination, the fetus is in occiput posterior (OP) position with reassuring fetal heart tones. She had a previous uncomplicated vaginal delivery. What is the most appropriate initial management?", "options": [{"label": "A", "text": "Proceed with normal vaginal delivery", "correct": true}, {"label": "B", "text": "Immediate cesarean section", "correct": false}, {"label": "C", "text": "External cephalic version", "correct": false}, {"label": "D", "text": "Forceps rotation", "correct": false}], "correct_answer": "A. Proceed with normal vaginal delivery", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Part</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Engaging diameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of labor</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>VERTEX</p>\n<p>(Flexed)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occipito-anterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suboccipito-bregmatic (9.5 cm)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vaginal delivery (head born by extension)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occipito-posterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sub-occipitofrontal (10 cm) or <span class=\"customMeta\" data-dictid=\"507427481b1692777194acb737e1ff\">Occipitofrontal</span> (11.5 cm)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterior 3/8\" <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> → OA → Vaginal delivery</li>\n<li>Anterior 1/8\" <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> → OT → manual <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> - <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> ext, LSCS in case of DTA</li>\n<li>Posterior 1/8\" <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> → DOP → Face to <span class=\"customMeta\" data-dictid=\"09cc11ccda1692777196f75bd122ee\">pubis</span> delivery</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BROW</p>\n<p>(deflexed)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mento-vertical (14cm)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No mechanism → LSCS</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>FACE</p>\n<p>(extended)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mento-anterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sub-mento-bregmatic (9.5 cm)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vaginal delivery (head delivers by flexion)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mento-posterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sterno-bregmatic (17.5 cm)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterior 3/8\" <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> → MA → Vaginal delivery</li>\n<li>Anterior 1/8\" <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> → MT → LSCS</li>\n<li>Posterior 1/8\" <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> → MP → LSCS</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate is diagnosed with gastroschisis. What is the most appropriate management strategy for this condition?", "options": [{"label": "A", "text": "Surgical wall repair", "correct": true}, {"label": "B", "text": "Wait and watch", "correct": false}, {"label": "C", "text": "Slowly putting it inside", "correct": false}, {"label": "D", "text": "Surgical excision", "correct": false}], "correct_answer": "A. Surgical wall repair", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wVaJWkwrfh92tLMbOzwW1747220030.png", "https://image.prepladder.com/content/vv7UpnpyCIXf4uDPB1l41747220036.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Omphalocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gastroschisis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> where <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> contents protrude through the <strong>base of the umbilicus</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> is when <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> contents protrude through a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> typically located to the<strong> right of the umbilicus.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Covering</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"18b73c28601692777188f2aae28838\">herniated</span> organs are covered by two layers: <strong>Amnion (outer) and <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> (inner)</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> covers the exposed organs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Chromosomal abnormalities: </strong>Associated with Trisomy 13, 18, and 21.</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> malformations affect multiple systems in the following order: <strong>cardiovascular&gt; Muscular&gt; gastrointestinal&gt; genitourinary. </strong>(Mnemonic: \"CM GIGU\")</li>\n<li><strong>Beckwith-Wiedemann Syndrome: </strong>Can include hemihypertrophy, macroglossia, visceromegaly, omphalocele, and increased risk of hepatoblastoma.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fewer chromosomal abnormalities compared to omphalocele.</li>\n<li>Higher risk of intestinal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> and dysfunction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally poor due to associated <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> malformations, which are the most common cause of death.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally better than <span class=\"customMeta\" data-dictid=\"fc7e9c02921692777194319bbee508\">omphalocele</span> due to fewer associated <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> closure</strong> is preferred for small to medium-sized defects.</li>\n<li><strong>Larger defects</strong> may require:</li>\n<li><strong>Prosthetic patch closure</strong> (e.g., <strong>Gore-Tex</strong>),</li>\n<li><strong>Porcine small intestinal submucosa</strong>-derived biomaterials (e.g., <strong>Surgisis</strong>),</li>\n<li><strong>Skin <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> closure</strong>, or</li>\n<li><strong>Placement of a silo</strong> for <strong>sequential reduction</strong> and <strong>staged closure</strong>.</li>\n<li>For <strong>giant omphaloceles</strong>, <strong>topical application of <span class=\"customMeta\" data-dictid=\"0507a1a3f51692777187ca51264f84\">escharotic</span> agents</strong> like <strong>povidone-iodine (Betadine)</strong> <span class=\"customMeta\" data-dictid=\"25ee86538e1692777194ef5ba9e4f1\">ointment</span> or <strong>silver nitrate</strong> is used to thicken and <span class=\"customMeta\" data-dictid=\"51b54455da1692777187ef9039ace9\">epithelialize</span> the sac.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary closure</strong> is typically done under <strong>general anesthesia</strong> and often requires admission to the <strong>NICU</strong> for <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> ventilation.</li>\n<li>Alternatively, a <strong>preformed silo</strong> can be placed at the bedside for gradual reduction, sometimes avoiding the need for general <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> altogether.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"423\" src=\"https://image.prepladder.com/content/wVaJWkwrfh92tLMbOzwW1747220030.png\" width=\"423\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"265\" src=\"https://image.prepladder.com/content/vv7UpnpyCIXf4uDPB1l41747220036.png\" width=\"439\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the image:", "options": [{"label": "A", "text": "Omphalocele", "correct": true}, {"label": "B", "text": "Urachal cyst", "correct": false}, {"label": "C", "text": "Umbilical hernia", "correct": false}, {"label": "D", "text": "Umbilical adenoma", "correct": false}], "correct_answer": "A. Omphalocele", "question_images": ["https://image.prepladder.com/content/UxAsgYTcHkokFVUfelhz1748277545.png"], "explanation_images": ["https://image.prepladder.com/content/wK1LWP7okOkqikk2ZicC1748277600.png", "https://image.prepladder.com/content/bepPEMBFAa9Rqp3nyv6m1748277823.png", "https://image.prepladder.com/content/2yQDwIOGNsg5WrqSMnhK1748277869.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old female presents with cervical lymphadenopathy. A biopsy has revealed granulomatous necrotising inflammation. Which of the following options is correct?", "options": [{"label": "A", "text": "Metastatic calcification with normal serum calcium level", "correct": false}, {"label": "B", "text": "Dystrophic calcification with normal serum calcium level", "correct": true}, {"label": "C", "text": "Metastatic calcification with increased serum calcium level", "correct": false}, {"label": "D", "text": "Dystrophic calcification with increased serum calcium level", "correct": false}], "correct_answer": "B. Dystrophic calcification with normal serum calcium level", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fwv3WBla2wnXgFXeJ3px1747220212.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition in the image:", "options": [{"label": "A", "text": "Bulbar urethral stricture", "correct": true}, {"label": "B", "text": "Membranous urethral injury", "correct": false}, {"label": "C", "text": "Urethral tear", "correct": false}, {"label": "D", "text": "Prostate hyperplasia", "correct": false}], "correct_answer": "A. Bulbar urethral stricture", "question_images": ["https://image.prepladder.com/content/tMYKlL4bs8fFJ5JnA7nY1747220356.png"], "explanation_images": ["https://image.prepladder.com/content/nQda5NIGXUZSAO8yrgm91747385090.png", "https://image.prepladder.com/content/Z3hrq0ndEarNQ1AaAxqJ1747220407.png", "https://image.prepladder.com/content/SRllfG8HJJdGvvgZkIxc1747220449.png", "https://image.prepladder.com/content/1WNVCjsw1fvpGPV3I5P21747220457.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior Urethral Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior Urethral Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (most common)</li>\n<li>Penile urethra</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"394\" src=\"https://image.prepladder.com/content/SRllfG8HJJdGvvgZkIxc1747220449.png\" width=\"394\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (bulbomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> most common)</li>\n<li>Prostatic urethra</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"463\" src=\"https://image.prepladder.com/content/1WNVCjsw1fvpGPV3I5P21747220457.png\" width=\"463\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Straddle injuries</li>\n<li>Direct trauma</li>\n<li>Iatrogenic injuries (catheterization, cystoscopy)</li>\n<li>Penetrating trauma (stab/gunshot wounds)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pelvic fractures (often due to motor vehicle accidents)</strong></li>\n<li>Blunt trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hematuria (blood in urine)</li>\n<li>Penile/perineal bruising <strong>(butterfly-shaped hematoma)</strong></li>\n<li>Perineal pain</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> or difficulty voiding</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> or <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> due to hematoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Blood at the meatus</strong></li>\n<li><strong>Inability to void</strong></li>\n<li><strong>High-riding <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> on rectal exam</strong></li>\n<li><strong>Perineal or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> pain</strong></li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> associated with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU)</strong>: <strong>Gold standard,</strong> shows the extent and location of the injury.</li>\n<li>Voiding Cystourethrography (VCUG): Used to assess urethral <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> post-repair</li>\n<li>Ultrasound: Can detect <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or associated injuries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU): Gold standard for initial assessment</strong></li>\n<li>CT Urethrography: Useful in evaluating complex injuries</li>\n<li>Pelvic CT Scan: Important for associated <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Cystoscopy: Sometimes performed for further evaluation</li>\n<li>If injury at Prostatomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> - High lying <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> → On IVP- <strong>Pie in-sky appearance </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following conditions is pneumomediastinum commonly found?", "options": [{"label": "A", "text": "Pulsion diverticulum", "correct": false}, {"label": "B", "text": "Boerhaave syndrome", "correct": true}, {"label": "C", "text": "Mallory-Weiss syndrome", "correct": false}, {"label": "D", "text": "Pericarditis", "correct": false}], "correct_answer": "B. Boerhaave syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Boerhaave syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> caused by a sudden increase in intraesophageal pressure, typically from <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> against a closed <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> resulting in a <strong>left-sided <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> perforation</strong>, which allows <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> contents to spill into the pleural cavity, leading to a <strong>left pleural effusion</strong> and <strong>subcutaneous emphysema</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classic triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vomiting, chest pain, and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> emphysema. <strong>(Mackler’s triad)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May include fever, tachycardia, and <span class=\"customMeta\" data-dictid=\"28f03e93ee1692777200dd8ea97b29\">tachypnea</span> in the presence of sepsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hamman’s sign (crunching sound on <span class=\"customMeta\" data-dictid=\"b2f0dbabe516927771821b0ec5ba85\">auscultation</span> due to <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> emphysema).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pneumothorax/<strong>Pneumomediastinum</strong>, mediastinitis, and sepsis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following organs is a primary lymphoid organ?", "options": [{"label": "A", "text": "Lymph node", "correct": false}, {"label": "B", "text": "Spleen", "correct": false}, {"label": "C", "text": "Thymus", "correct": true}, {"label": "D", "text": "MALT", "correct": false}], "correct_answer": "C. Thymus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2nYy0KTCGnpT3roU3x401747220937.png", "https://image.prepladder.com/content/SX0WqdIAmfe036449lmu1747377123.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Primary <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">Lymphoid</span> Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Secondary <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">Lymphoid</span> Organs</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone Marrow:</strong></p>\n<ul>\n<li>Origin of all blood cells from <span class=\"customMeta\" data-dictid=\"25a049eb321692777195ee5ad55371\">pluripotent</span> <span class=\"customMeta\" data-dictid=\"d2e0ab499c169277718886ab5a46bf\">hematopoietic</span> stem cells (a process called hematopoiesis).</li>\n<li>Hematopoiesis shifts to <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> from the liver after <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> life, eventually confined to <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> bones after puberty.</li>\n<li>Progenitor T and B cells develop in bone marrow; B cells <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> here, while T cell progenitors migrate to the thymus.</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymph Nodes:</strong> <strong>(Option A ruled out)</strong></p>\n<ul>\n<li>Filter antigens and <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> T and B cells.</li>\n<li>Structured into <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> (B cell area), <span class=\"customMeta\" data-dictid=\"f0cd1f6d6616927771948c9a83865f\">paracortex</span> (T cell area), and <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> (rich in <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spleen:</strong> <strong>(Option B ruled out)</strong></p>\n<ul>\n<li>Largest secondary <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> organ, involved in filtering blood-borne antigens.</li>\n<li>Contains white <span class=\"customMeta\" data-dictid=\"5b7b8d266716927771968316ee113b\">pulp</span> (T and B cells) and red <span class=\"customMeta\" data-dictid=\"5b7b8d266716927771968316ee113b\">pulp</span> (site of RBC destruction).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thymus:</strong><strong> </strong><strong>(Option C)</strong></p>\n<ul>\n<li>Site of T cell <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> and maturation.</li>\n<li>Developed from the third/fourth <span class=\"customMeta\" data-dictid=\"8ffc8a6b6416927771956d80dd7241\">pharyngeal pouch</span> in embryonic life.</li>\n<li>Active during childhood, decreases in size after puberty.</li>\n<li>Thymic hormones (e.g., thymulin, thymopoietin) help attract and <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> T cells.</li>\n<li>Central tolerance occurs here, removing self-reactive T cells to prevent autoimmunity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucosa-associated <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">Lymphoid</span> Tissue (MALT): </strong><strong>(Option D ruled out)</strong></p>\n<ul>\n<li>Located in mucosal sites (intestine, respiratory, <span class=\"customMeta\" data-dictid=\"2942e9d19616927772014161ee8f70\">urogenital</span> tracts) to protect against pathogens.</li>\n<li>Includes loose clusters of <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> cells and organised structures (e.g., tonsils, Peyer’s patches in intestines).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man experiences initial paralysis in both legs, which then progresses to affect both upper limbs as well. Over time, he shows slight improvement in upper limbs but no improvement in his lower trunk and both legs. Based on this description, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Diplegia", "correct": true}, {"label": "B", "text": "Quadriplegia", "correct": false}, {"label": "C", "text": "Paraplegia", "correct": false}, {"label": "D", "text": "Monoplegia", "correct": false}], "correct_answer": "A. Diplegia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient develops a severe infection and necrosis in the scrotal region after 5 days of catheterization. Based on the clinical presentation, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Fournier’s gangrene", "correct": true}, {"label": "B", "text": "Gas gangrene", "correct": false}, {"label": "C", "text": "Wet gangrene", "correct": false}, {"label": "D", "text": "Scrotal hematoma", "correct": false}], "correct_answer": "A. Fournier’s gangrene", "question_images": ["https://image.prepladder.com/content/6XTud23ZOTrsMPbYu7tU1747385439.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fournier's Gangrene</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Necrotizing infection</strong> of the soft tissues in the perineum, external genitalia, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> region, akin to <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Symptoms:</strong> Intense pain in the genitalia, progressing through</li>\n</ul>\n<p>five phases:</p>\n<ul>\n<li>\n<ul>\n<li><strong>Prodromal Phase:</strong> Fever and lethargy.</li>\n<li><strong>Early Pain Phase:</strong> Intense pain, possible edema, pruritus.</li>\n<li><strong>Progressive Phase:</strong> Increased pain, and erythema.</li>\n<li><strong>Crepitation Phase: </strong>Dusky skin with <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> crepitation.</li>\n<li><strong>Gangrene Phase:</strong> <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">Gangrene</span> with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</li>\n</ul>\n</li>\n<li>Pain may decrease as <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> progresses.</li>\n<li>Severity ranges from <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease, diabetes mellitus, malnutrition, alcoholism, <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical presentation supported by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial Treatment:</strong>\n<ul>\n<li>Fluid resuscitation.</li>\n<li>Broad-spectrum antibiotics.</li>\n<li>Surgical debridement of necrotic tissue.</li>\n</ul>\n</li>\n<li><strong>Additional Measures:</strong>\n<ul>\n<li>Urinary and faecal <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> to prevent wound contamination.</li>\n<li>Intensive monitoring for sepsis.</li>\n<li>Wound review and vacuum-assisted dressing.</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> post-infection control.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with a painless testicular mass. After orchidectomy, histopathological examination reveals the presence of Reinke's crystals within the tumor cells. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Sertoli cell tumor", "correct": false}, {"label": "B", "text": "Leydig cell tumor", "correct": true}, {"label": "C", "text": "Seminoma", "correct": false}, {"label": "D", "text": "Yolk sac tumor", "correct": false}], "correct_answer": "B. Leydig cell tumor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/IHMjI4VMwAiVqomRfnds1747222982.png", "https://image.prepladder.com/content/ej57hZFogCCVybJzbm7t1747222991.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Leydig cell tumour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sertoli cell tumor (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormonal involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It often involves androgens, estrogens, and corticosteroids.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hormonally silent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conditions associated with</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Klinefelter syndrome.</li>\n<li>Cryptorchidism.</li>\n<li>Renal cell carcinoma.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carney complex.</li>\n<li>Peutz-Jeghers syndrome.</li>\n<li>Familial <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> polyposis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10% (in adults)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gross</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Circumscribed nodules, usually &lt; 5 cm in diameter.</li>\n<li>They have a distinctive golden brown, <span class=\"customMeta\" data-dictid=\"d9ec45007b1692777189e3b26e44ca\">homogeneous</span> appearance on cut surfaces.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Firm, small nodules with a homogeneous</li>\n<li>grey-white to yellow cut surface.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The tumour cells resemble their normal counterparts.</li>\n<li>They are large and have <strong>round or polygonal cell outlines</strong>, <strong>abundant</strong> <strong>granular <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm</strong>, and a <strong>round central nucleus.</strong></li>\n<li>The <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> frequently contains <strong>lipid droplets</strong>, <strong>vacuoles</strong>, or <strong>lipofuscin</strong> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> and, most characteristically, rod-shaped <strong>Reinke crystalloids</strong> (25% of the tumors).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The tumour cells are arranged in <strong>distinctive trabeculae</strong> that tend to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> <strong>cord-like structures</strong> and <strong>tubules.</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"1. Dr. Dharam Ramnani 2. Mikael Haggstrom &amp; Nephron 3. Dr. Roshan Nasimudeen\"' data-hash=\"\" data-license='\"1. Unknown 2. CC BY SA 3.0 3. CC BY SA 4.0\"' data-source='\"1. https://www.webpathology.com/image.asp?case=38&amp;n=4 2. https://commons.wikimedia.org/wiki/File:Call-Exner_bodies.png 3. https://commons.wikimedia.org/wiki/File:Granulosa_cell_tumor_ovary.jpg\"' data-tags=\"\" height=\"398\" src=\"https://image.prepladder.com/content/IHMjI4VMwAiVqomRfnds1747222982.png\" width=\"330\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://librepathology.org/wiki/File:Sertoli_cell_tumour_high_mag.jpg\" data-tags=\"\" height=\"281\" src=\"https://image.prepladder.com/content/ej57hZFogCCVybJzbm7t1747222991.png\" width=\"417\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with calf pain while walking a certain distance. The pain is severe enough that he must stop and rest before continuing. According to Boyd's grading, which of the following grades best describes this condition?", "options": [{"label": "A", "text": "Grade 1", "correct": false}, {"label": "B", "text": "Grade 2", "correct": false}, {"label": "C", "text": "Grade 3", "correct": true}, {"label": "D", "text": "Grade 4", "correct": false}], "correct_answer": "C. Grade 3", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Grade I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Pain develops after walking a certain distance (claudication distance). The pain subsides due to increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> circulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Pain persists even while continuing to walk, but the patient can still walk with effort.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Patient must stop and rest to relieve the pain; walking becomes significantly impaired.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Patient experiences rest pain, and the pain persists even at rest, indicating severe arterial disease.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the emergency room after a road traffic accident with shock and hypotension. The extended focused assessment with sonography for trauma (eFAST) is negative, the X-ray is normal, and the ECG shows no abnormalities. The patient's SpO2 is 93%, blood pressure is 80/60 mmHg, and pulse rate is 40/min. Based on this information, what type of shock is most likely?", "options": [{"label": "A", "text": "Septic shock", "correct": false}, {"label": "B", "text": "Hemorrhagic shock", "correct": false}, {"label": "C", "text": "Cardiogenic shock", "correct": false}, {"label": "D", "text": "Neurogenic shock", "correct": true}], "correct_answer": "D. Neurogenic shock", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Co8IlOErexfVtea2GtPW1747385463.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cardiac Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Central Venous Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mean Arterial Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cardiogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Distributive(Septic, anaphylactic, neurogenic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑ or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓ or N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Obstructive (pulmonary embolism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, tension pneumothorax)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 21-year-old man presents with episodes of chest pain. Physical examination reveals a bisferiens pulse and a heaving apex. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Dilated Cardiomyopathy (DCM)", "correct": false}, {"label": "B", "text": "Hypertrophic Cardiomyopathy (HCM)", "correct": true}, {"label": "C", "text": "Mitral Stenosis", "correct": false}, {"label": "D", "text": "Aortic Stenosis", "correct": false}], "correct_answer": "B. Hypertrophic Cardiomyopathy (HCM)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/keoK0lWcZee6ZvvI0GYv1747383268.png", "https://image.prepladder.com/content/3C5uV8GUZU0hl8LT8toD1747383278.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypertrophic Cardiomyopathy (HCM)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autosomal dominant genetic disorder</li>\n<li>Mutations in beta-myosin heavy-chain, troponin, and myosin-binding protein C</li>\n<li>Inappropriate left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Physical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bisferiens (jerky arterial) pulse</strong></li>\n<li><strong>Heaving <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> </strong></li>\n<li>Mid-systolic murmur</li>\n<li>Dynamic LVOT obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Angina (chest pain)</li>\n<li>Dyspnea</li>\n<li>Syncope</li>\n<li>MC cause of sudden death</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathological Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Misaligned myocardial fibers</li>\n<li>Myocardial fibrosis</li>\n<li>Rigid left ventricle</li>\n<li>Impaired diastolic filling</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Examination Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Palpable Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Hypertrophy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An enlarged left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> can be felt during physical examination, indicating hypertrophy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Double Impulse at the Apex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> <span class=\"customMeta\" data-dictid=\"14669154fc16927772033d797d9d61\">fourth heart sound</span> suggests forceful atrial <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> against a non-compliant ventricle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mid-Systolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">Murmur</span> at the Base</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Turbulent <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> through the obstructed left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> outflow <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> produces a mid-systolic murmur.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pansystolic <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">Murmur</span> at the Apex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Indicates <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> caused by <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> motion of the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Jerky Arterial Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Characteristic of HOCM, contrasts with the <strong>slow-rising pulse seen in aortic stenosis.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pulsus bisferiens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A double pulse noticed during <span class=\"customMeta\" data-dictid=\"13941ea4ec1692777199fc8cfd1a7a\">systole</span> in the <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> pulse is called <span class=\"customMeta\" data-dictid=\"a507417e891692777196a900bd7993\">pulsus</span> bisferiens. It is associated with severe aortic disease accompanied by <span class=\"customMeta\" data-dictid=\"32a29a166b1692777182d46c390c42\">aortic regurgitation</span> and HOCM.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In patients at risk of refeeding syndrome, which of the following electrolyte imbalances is typically not associated with this condition?", "options": [{"label": "A", "text": "Hypokalemia", "correct": false}, {"label": "B", "text": "Hyperkalemia", "correct": true}, {"label": "C", "text": "Hypocalcemia", "correct": false}, {"label": "D", "text": "Hypophosphatemia", "correct": false}], "correct_answer": "B. Hyperkalemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GuKiS5fQ8zKopSMYgPIy1747223474.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>One or more of the following: (OR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Two or more of the following:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BMI &lt;16 kg/m<sup>2</sup></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BMI &lt;18.5 kg/m<sup>2</sup></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unintentional weight loss &gt;15% within the last 3-6 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unintentional weight loss &gt;10% within the last 3-6 months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Little or no nutritional <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> for more than 10 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Little or no nutritional <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> for more than 5 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low potassium, <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> or <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> levels prior to feeding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>History of alcohol abuse or on medication, including insulin, chemotherapy, antacids or diuretics.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the daily fluid requirement for a 3-day-old baby with a birth weight of 1500 grams?", "options": [{"label": "A", "text": "100-110 ml/kg/day", "correct": false}, {"label": "B", "text": "80-90 ml/kg/day", "correct": true}, {"label": "C", "text": "120-130 ml/kg/day", "correct": false}, {"label": "D", "text": "130-150 ml/kg/day", "correct": false}], "correct_answer": "B. 80-90 ml/kg/day", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Birth Weight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Day 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2-6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>7 &amp; Beyond</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;1500 gm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>80 ml/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase daily by 10-15 ml/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>150 ml/kg/day</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;1500 gm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>60 ml/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase daily by 10-15 ml/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>150 ml/kg/day</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a seat belt injury, which of the following organs is most commonly affected?", "options": [{"label": "A", "text": "Liver", "correct": false}, {"label": "B", "text": "Spleen", "correct": false}, {"label": "C", "text": "Pancreas", "correct": false}, {"label": "D", "text": "Hollow viscus", "correct": true}], "correct_answer": "D. Hollow viscus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FaPpuzt5cN6uAsCEALsD1747385569.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrives at the emergency department following severe maxillofacial trauma sustained in a road traffic accident. The airway is compromised, and immediate intervention is required. What is the most appropriate immediate management?", "options": [{"label": "A", "text": "Tracheostomy", "correct": false}, {"label": "B", "text": "Orotracheal intubation", "correct": false}, {"label": "C", "text": "Cricothyroidotomy", "correct": true}, {"label": "D", "text": "Bag mask with jaw thrust", "correct": false}], "correct_answer": "C. Cricothyroidotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what age does the transfer of one object to another hand happen?", "options": [{"label": "A", "text": "4 months", "correct": false}, {"label": "B", "text": "9 months", "correct": false}, {"label": "C", "text": "7 months", "correct": true}, {"label": "D", "text": "12 months", "correct": false}], "correct_answer": "C. 7 months", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Gross Motor Domain Milestones </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Fine Motor Domain Milestones </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Language Domain Milestones </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Social Domain Milestones </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>1 month</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Alerts to sound</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>2 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Social smile</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>3 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Neck holding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Coos (musical vowel sounds)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Recognizes mother; anticipates feeds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>4 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bidextrous reach</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Laughs loud</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>5 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Rolls over</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sits in <span class=\"customMeta\" data-dictid=\"83962896b5169277720032c8e8bd50\">tripod</span> fashion (sitting with own support)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Unidextrous reach</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Monosyllables (ba, da, pa), ah-goo sounds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Recognizes strangers, stranger anxiety</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>7 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Transfers objects between hands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>8 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sitting without support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>9 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Stands holding on (with support)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Immature pincer grasp; probes with forefinger</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bisyllables (mama, baba, dada)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Waves “bye-bye”</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>12 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Creeps well; walks but falls; stands without support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pincer grasp mature</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1-2 words with meaning</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Comes when called; plays simple ball game</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>15 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Walks alone; creeps upstairs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Imitates scribbling; tower of 2 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Jargon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>18 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Runs; explores drawers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Scribbles; tower of 3 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>8-10 word vocabulary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Copies parents in task (e.g., sweeping)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>2 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Walks up and downstairs (2 feet/step); jumps</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tower of 6 blocks; vertical and <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> stroke</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>2-3 word sentences, use pronouns “I”, “me”, “you”</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Asks for food, drink, toilet; pulls people to show toys</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>3 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Rides tricycle; <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> going upstairs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tower of 9 blocks; copies circle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Asks questions; knows full name and gender</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Shares toys; knows full name and gender</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>4 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hops on one foot; <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> going downstairs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Copies cross; bridge with blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Says song or poem; tells stories</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Plays cooperatively in a group; goes to toilet alone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>5 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Skips</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Copies triangle; gate with blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Asks meaning of words</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Helps in household tasks, dresses, and undresses</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the possible diagnosis for a newborn exhibiting weak lower limb pulses and strong upper limb pulses?", "options": [{"label": "A", "text": "TGA", "correct": false}, {"label": "B", "text": "COA", "correct": true}, {"label": "C", "text": "TOF", "correct": false}, {"label": "D", "text": "Ebstein anomaly", "correct": false}], "correct_answer": "B. COA", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/z0jagWVVEasPe9F4OOc41747384230.png", "https://image.prepladder.com/content/pqiYzM4kcHeVMXPAssr61747384242.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Coarctation of the Aorta</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Constrictions of the <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> of varying degrees at any point from the <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> to the <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> bifurcation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Differential cyanosis</li>\n<li>Heart failure in severe cases</li>\n<li>Weakness or pain/claudication (or both) in the legs after exercise</li>\n<li><strong>Radio-femoral delay: </strong>Disparity in <span class=\"customMeta\" data-dictid=\"1e3e250f171692777196358cb28804\">pulsation</span> and BP in the arms and legs</li>\n<li>Systolic or continuous murmurs are heard over the left and right sides of the chest laterally and posteriorly due to <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> blood flow.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chest x-ray:</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Bishal kc, Sachin Dhungel, Samir Gautam, Mazhar Khan, Aziz Ullah\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/chest-X-ray-showing-the-figure-3-sign-formed-by-the-aortic-nob-the-stenotic-segment_fig1_365626074\" data-tags=\"\" height=\"731\" src=\"https://image.prepladder.com/content/pqiYzM4kcHeVMXPAssr61747384242.png\" width=\"600\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li style=\"text-align:center\">The arrows indicate rib notching and the yellow line shows the site of coarctation</li>\n<li>Enlarged left <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> produces a prominent shadow in the left superior mediastinum.</li>\n<li>Notching of the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> border of the ribs from pressure <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> by enlarged <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> vessels (Common in late childhood after 1st decade of life)</li>\n<li>Descending <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> has an area of post-stenotic dilation.</li>\n</ul>\n<ul>\n<li>ECG, echocardiography, colour Doppler, CT, and MRI.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infusion of <span class=\"customMeta\" data-dictid=\"42815e46071692777196c90c46f78b\">prostaglandin</span> E1 to reopen the <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> and reestablish adequate lower-extremity blood flow.</li>\n<li>Surgical repair</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What condition is likely in a newborn presenting with dry, rough skin, a big tongue and rough hair?", "options": [{"label": "A", "text": "Congenital hypothyroidism", "correct": true}, {"label": "B", "text": "Prader-Willi syndrome", "correct": false}, {"label": "C", "text": "Edward syndrome", "correct": false}, {"label": "D", "text": "Galactosemia", "correct": false}], "correct_answer": "A. Congenital hypothyroidism", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4ase4HK5wRJDfwWtTI9N1747384336.png", "https://image.prepladder.com/content/ufHnp3KVXbYdfMx4gORD1747384357.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Congenital Hypothyroidism</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Rastogi and LaFranchi; licensee BioMed Central Ltd\" data-hash=\"\" data-license=\"CC BY 2.5\" data-source=\"https://commons.wikimedia.org/wiki/File:CDpic1.png\" data-tags=\"\" height=\"527\" src=\"https://image.prepladder.com/content/4ase4HK5wRJDfwWtTI9N1747384336.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Rastogi and LaFranchi\" data-hash=\"\" data-license=\"CC BY 2.5\" data-source=\"https://commons.wikimedia.org/wiki/File:CDpic3.png\" data-tags=\"\" height=\"765\" src=\"https://image.prepladder.com/content/ufHnp3KVXbYdfMx4gORD1747384357.png\" width=\"363\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually birth weight &amp; length is normal</li>\n<li>Wide open <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> fontanelle</li>\n<li><strong>Delayed <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> fontanelle</strong></li>\n<li><strong>Prolonged <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> jaundice- Early sign</strong> (it is due to delayed <span class=\"customMeta\" data-dictid=\"76948f718016927771924774ade7e9\">maturation</span> of <span class=\"customMeta\" data-dictid=\"ed6dc0698216927771889e8a118c4f\">glucuronide</span> conjugation)</li>\n<li><strong>Myxedematous facies:</strong> Large, protruded tongue <strong>(Macroglossia)</strong></li>\n<li>Cold intolerance</li>\n<li>Hypotonia</li>\n<li><strong>Rough skin and Rough hair</strong></li>\n<li>Constipation</li>\n<li>Abdominal distension</li>\n<li>Umbilical hernia</li>\n<li><strong>In Untreated Cases:</strong>\n<ul>\n<li>Delayed development</li>\n<li>Intellectual disability</li>\n<li>Delayed dentition</li>\n<li>Short stature</li>\n<li>Delayed puberty</li>\n<li>Delayed bone maturation</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray findings in <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> hypothyroidism:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> and <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> at birth</li>\n<li>Punctate <span class=\"customMeta\" data-dictid=\"dc486020a916927771874098596bbc\">epiphyseal</span> dysgenesis</li>\n<li>Deformity or breaking of the 12th <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> or 1st or 2nd <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> vertebrae</li>\n<li>X-ray image of skull- large <span class=\"customMeta\" data-dictid=\"271b7fd44c1692777203478adeaa35\">fontanelle</span> and wide sutures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Screening:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Universal <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> screening for <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> hypothyroidism</li>\n<li><strong>At birth, with <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> cord blood</strong></li>\n<li><strong>Heel prick: </strong>dried blood spots, sample collected<strong> beyond 48 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> </strong>or 48-72hrs</li>\n<li>Should not be done in first 1-2 days, to avoid TSH surge</li>\n<li>Most sensitive approach- check for T4 and TSH both</li>\n</ul>\n<p><strong>ASH's first strategy:</strong></p>\n<ul>\n<li>Initial TSH screening using dried blood spot</li>\n<li>If<strong> TSH&gt;20mIU/L,</strong> recheck</li>\n<li>Obtain a <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> blood sample to check T4 and TSH levels if TSH remains elevated.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Oral levothyroxine </strong>(early morning with empty stomach for older children; and for newborns, it is to be given at a fixed time).</li>\n<li>The dose is higher in the earlier age group and as the babies grow the dose reduces.</li>\n<li>Newborn- 10-15mg/kg/day</li>\n<li>Children- 2-4mg/kg/day</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely age of a child who can ride a tricycle, walk up stairs with alternate steps, but cannot hop?", "options": [{"label": "A", "text": "2.5 years", "correct": false}, {"label": "B", "text": "3.5 years", "correct": true}, {"label": "C", "text": "4.5 years", "correct": false}, {"label": "D", "text": "5.5 years", "correct": false}], "correct_answer": "B. 3.5 years", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Developmental Milestones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gross Motor Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fine Motor Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Social Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Language Milestones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 month</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alerts to sounds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Social smile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neck holding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recognises mother, anticipates feed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cooing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Laugh Loud</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rolls over</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bidextrous reach</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sits in <span class=\"customMeta\" data-dictid=\"83962896b5169277720032c8e8bd50\">tripod</span> position</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unidextrous reach</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recognize strangers, stranger anxiety</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monosyllables</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sits without support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stands with support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immature pincer grasp</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Waves bye bye</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bisyllables</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Creeps well, stands without support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mature pincer grasp</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comes when called, plays simple ball game</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 to 2 words with meaning</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Walks alone; crawls up stairs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imitates scribbling, tower of 2 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jargon speech</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs stiffly, sits on small chair, walks up stairs with 1 hand held, explores drawers and wastebaskets</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scribbles, tower of 3 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copies parents in task</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8 to 10 words vocabulary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs well, walks up and down stairs, 1 step at a time, opens doors, climbs on furniture, jumps</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tower of 6 blocks, vertical and <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> stroke</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asks for food, drink, toilet, pulls people to show toys</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 to 3 word sentences</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Goes up stairs <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> feet, Rides tricycle, stands momentarily on 1 foot</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tower of 9 blocks, copies circle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shares toys, knows full name and gender</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asks questions, tells name and gender</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hops on 1 foot; throws ball overhand, uses <span class=\"customMeta\" data-dictid=\"e712802aa11692777198fd87cbce00\">scissors</span> to cut out pictures, climbs well</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copies cross, bridge with blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Plays cooperatively in a group, goes to toilet alone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Says song or poem, tells stories</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copies triangle, gate with blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps in household tasks, dresses and undresses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asks meaning of words</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male presents with a history of low-grade fever and cough. Based on the provided Chest X-ray image, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Lung cancer", "correct": false}, {"label": "B", "text": "Miliary TB", "correct": true}, {"label": "C", "text": "ARDS", "correct": false}, {"label": "D", "text": "Aspergilloma", "correct": false}], "correct_answer": "B. Miliary TB", "question_images": ["https://image.prepladder.com/content/fOsjdMjzArUlJ5FjJjCr1747224883.png"], "explanation_images": ["https://image.prepladder.com/content/GQParDOff5QqJv57Ztjd1747380867.png", "https://image.prepladder.com/content/LGF3xk5f65nmZguAZ0Xb1747380878.png", "https://image.prepladder.com/content/dUwTn0aQetGSvHsMtbKn1747380884.png", "https://image.prepladder.com/content/uUdYiO7wxMmpwSWYv0Ex1747380920.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the muscle that is defective in the given image.", "options": [{"label": "A", "text": "Gluteus medius and Gluteus minimus", "correct": true}, {"label": "B", "text": "Gluteus maximus", "correct": false}, {"label": "C", "text": "Piriformis", "correct": false}, {"label": "D", "text": "Obturator internus", "correct": false}], "correct_answer": "A. Gluteus medius and Gluteus minimus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WRiTlGHOqjlUdovfd63O1747373283.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is not a potential cause for the radiological finding shown below?", "options": [{"label": "A", "text": "Consolidation", "correct": false}, {"label": "B", "text": "Collapse", "correct": false}, {"label": "C", "text": "Pleural effusion", "correct": false}, {"label": "D", "text": "Foreign body", "correct": true}], "correct_answer": "D. Foreign body", "question_images": ["https://image.prepladder.com/content/0N9yQ20XekpIGeopUtst1747381033.png"], "explanation_images": ["https://image.prepladder.com/content/G7F7nPaFvUUByvXja6Q81747381044.png", "https://image.prepladder.com/content/LC9qFYMWrKt5u3pL8ybL1747381052.png", "https://image.prepladder.com/content/ZVFhNAmWQ1ymPDbbVPZu1747381071.png", "https://image.prepladder.com/content/aXmTkQz6s6BwI8TGP5bS1747381081.png", "https://image.prepladder.com/content/bYgV7zsnHdRDVm95nL3K1747381091.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:739px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Whiteout hemithorax/Opacified <span class=\"customMeta\" data-dictid=\"b260e236dd169277718828436007c2\">hemithorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Blackout hemithorax/Hyperlucent <span class=\"customMeta\" data-dictid=\"b260e236dd169277718828436007c2\">hemithorax</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>This refers to when there is complete <span class=\"customMeta\" data-dictid=\"990cbfd3111692777194c6967ee125\">opacification</span> of an entire hemithorax.</li>\n<li>Clinical information and other radiological findings are important to make a definite diagnosis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>This refers to an entire hyperlucent hemithorax.</li>\n<li>It results from various <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> and <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> conditions of the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> parenchyma, airway, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> vasculature, pleural space, and chest wall.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:338px\">\n<p style=\"text-align:center\"><strong>Differential diagnoses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:401px\">\n<p style=\"text-align:center\"><strong>Differential diagnoses </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Atelectasis of the entire lung</li>\n<li>Large pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> <strong>(Option C)</strong></li>\n<li>Pneumonia of the entire lung</li>\n<li>Postpneumonectomy appearance</li>\n<li>Large pulmonary, pleural, or <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> mass in diseases like Ewing sarcoma, mesothelioma</li>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> or agenesis</li>\n<li>Consolidation<strong> (Option A)</strong></li>\n<li>Collapse <strong>(Option B)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Radiologic technique errors</li>\n<li>Emphysema (bullous emphysema)</li>\n<li>Asymmetric <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> soft tissue due to conditions like:\n\t\t\t\t<ul>\n<li>Poland syndrome</li>\n<li>Unilateral mastectomy</li>\n<li>Some professions like butchers, carpenters, etc</li>\n</ul>\n</li>\n<li>Atrophy of trapezius muscle after radical neck dissection</li>\n<li>Extrapulmonary air collection in <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> emphysema</li>\n<li>Contralateral large pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> (Pseudo hyperlucent appearance of opposite lung)</li>\n<li><strong>Bronchial obstruction</strong>\n<ul>\n<li><strong>Foreign body in children</strong></li>\n<li><strong>Bronchial <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> </strong></li>\n<li><strong>Endobronchial tumor</strong></li>\n<li><strong>Broncholith </strong></li>\n</ul>\n</li>\n<li>Bronchiolitis obliterans in Swyer-James syndrome</li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> hyperinflation</li>\n<li>Conditions affecting <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> vessels:\n\t\t\t\t<ul>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"133b86a0a516927771809ea08682e8\">agenesis</span> or hypoplasia</li>\n<li>Proximal <span class=\"customMeta\" data-dictid=\"abc81e8daf1692777190c03d7842ef\">interruption</span> of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery</li>\n<li>Massive central <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (PE) leading to oligemia</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ghosh, Nilanjan, Nabanita Das and Kaustav Nayek.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Lung-Hypoplasia-Without-Other-Congenital-Anomaly-A-Ghosh-Das/b0537ecc97ea8c72428edfbed26382538dda28be\" data-tags=\"\" height=\"263\" src=\"https://image.prepladder.com/content/G7F7nPaFvUUByvXja6Q81747381044.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"Shahi, Pratyush, Apoorv Sehgal, Ahmer Zafar, Aarushi Sudan and Vishali Moond. “Brachysyndactyly in Poland Syndrome.” Cureus 12 (2020): n. pag.\" data-source=\"https://www.semanticscholar.org/paper/Brachysyndactyly-in-Poland-Syndrome-Shahi-Sehgal/ee9bbefd60286924117208acfb7630a98df9e7d4\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/LC9qFYMWrKt5u3pL8ybL1747381052.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mathew, Denny, Daniel Nicholas Prince and Nasreen Mahomed. “Extra-skeletal Ewing Sarcoma of the chest wall in a child.” SA Journal of Radiology 23 (2019): n. pag.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Extra-skeletal-Ewing-Sarcoma-of-the-chest-wall-in-a-Mathew-Prince/812ed8936a518996dcb366c0e7b35a1782308b43\" data-tags=\"\" height=\"412\" src=\"https://image.prepladder.com/content/ZVFhNAmWQ1ymPDbbVPZu1747381071.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Silva, Denise Rossato, Sandra Jungblut Schuh and Paulo de Tarso Roth Dalcin. “Posteroanterior chest X-ray for the diagnosis of pneumothorax: methods, usage, and resolution.” (2010).\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Posteroanterior-chest-X-ray-for-the-diagnosis-of-Silva-Schuh/43977f1ebb88c6bca71a866d47a56d87c704c40a\" data-tags=\"\" height=\"567\" src=\"https://image.prepladder.com/content/aXmTkQz6s6BwI8TGP5bS1747381081.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Agarwal, Ritesh and Ashutosh Nath Aggarwal. “Bullous lung disease or bullous emphysema?” Respiratory care 51 5 (2006): 532-4 .\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Bullous-lung-disease-or-bullous-emphysema-Agarwal-Aggarwal/ef2a57a7e08a385b144b258892725b49de5d45aa\" data-tags=\"\" height=\"532\" src=\"https://image.prepladder.com/content/bYgV7zsnHdRDVm95nL3K1747381091.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the type of joint between epiphysis and diaphysis of a long bone?", "options": [{"label": "A", "text": "Symphysis", "correct": false}, {"label": "B", "text": "Synchondrosis", "correct": true}, {"label": "C", "text": "Synostosis", "correct": false}, {"label": "D", "text": "Syndesmosis", "correct": false}], "correct_answer": "B. Synchondrosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cSkBuoKqkmxUCZW45gre1747373344.png", "https://image.prepladder.com/content/ix84xJaB4CUnXAVT3o6F1747373356.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4><strong>Primary <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">Cartilaginous</span> Joints (Synchondrosis)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4><strong>Secondary <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">Cartilaginous</span> Joints (Symphysis) (Option A)</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immobile</li>\n<li>Occur where <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> centres remain separated by <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">hyaline</span> cartilage.</li>\n<li>Found in bones that <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> from more than one <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> centre.</li>\n<li>Hyaline <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> here can ossify with age, leading to <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> when growth is completed.</li>\n<li>Temporary and mainly for growth.</li>\n<li>Mostly associated with growth plates. The joint between the first rib and the <span class=\"customMeta\" data-dictid=\"7f52cf1a7f1692777191d49738d6b9\">manubrium</span> is a permanent synchondrosis.</li>\n</ul>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/cSkBuoKqkmxUCZW45gre1747373344.png\" width=\"4167\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Slightly mobile</li>\n<li>Defined by a pad or disc of <span class=\"customMeta\" data-dictid=\"50747b27421692777202260a27b878\">fibrocartilage</span> between articulating bones, e.g., <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> discs.</li>\n<li>Built to handle a variety of stresses (compression, tension, etc.).</li>\n<li>Permanent and provide limited movement.</li>\n<li>Found along the midline (e.g., <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis, <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> joints). Strong ligaments reinforce the joints and are key to stability and movement.</li>\n<li>Symphyses are built for durability and movement, but they also allow growth in areas like the <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> discs.</li>\n</ul>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/ix84xJaB4CUnXAVT3o6F1747373356.png\" width=\"4167\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presented with severe abdominal pain following alcohol intake. Make a diagnosis based on the given X-ray.", "options": [{"label": "A", "text": "Pneumoperitoneum", "correct": true}, {"label": "B", "text": "SBO", "correct": false}, {"label": "C", "text": "Esophageal perforation", "correct": false}, {"label": "D", "text": "Pneumomediastinum", "correct": false}], "correct_answer": "A. Pneumoperitoneum", "question_images": ["https://image.prepladder.com/content/j5UmsEOq2w5lxOHl6hg81747225272.png"], "explanation_images": ["https://image.prepladder.com/content/nOeMrJ28jkucgh0pjqMa1747381153.png", "https://image.prepladder.com/content/H9yNcNip3v6yM5Vf8JfQ1747381159.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Ga-68 PSMA PET scan is used to diagnose which of the following conditions?", "options": [{"label": "A", "text": "Lung cancer", "correct": false}, {"label": "B", "text": "Prostate cancer", "correct": true}, {"label": "C", "text": "Colon cancer", "correct": false}, {"label": "D", "text": "Liver cancer", "correct": false}], "correct_answer": "B. Prostate cancer", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures develop from the 6th pharyngeal arch artery on the left side?", "options": [{"label": "A", "text": "Arch of Aorta", "correct": false}, {"label": "B", "text": "Ductus arteriosus", "correct": false}, {"label": "C", "text": "Carotid arteries", "correct": false}, {"label": "D", "text": "Subclavian artery", "correct": true}], "correct_answer": "D. Subclavian artery", "question_images": ["https://image.prepladder.com/content/f2VbjCIyqJF65mXmxXgf1747374074.png"], "explanation_images": ["https://image.prepladder.com/content/6ZIxTBun4VOSlv6mpoJH1747373452.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Pharyngeal Arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Artery of Arch</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Maxillary artery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Second</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyoid artery</strong>, Stapedial artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Third</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, <strong>Internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fourth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arch of <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> </strong>(left side), Subclavian <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (right side)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sixth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ductus arteriosus (left side), <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (right side)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A surgical procedure is performed on the great saphenous vein, around 2.5 cm anterior to the medial malleolus. Which of the following structures is most likely to be injured?", "options": [{"label": "A", "text": "Saphenous nerve", "correct": true}, {"label": "B", "text": "Sural nerve", "correct": false}, {"label": "C", "text": "Deep peroneal nerve", "correct": false}, {"label": "D", "text": "Tibial nerve", "correct": false}], "correct_answer": "A. Saphenous nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following nerves supplies the muscle that is involved in the moment given below?", "options": [{"label": "A", "text": "Spinal accessory nerve", "correct": true}, {"label": "B", "text": "Long thoracic nerve", "correct": false}, {"label": "C", "text": "Spinal branch of axillary nerve", "correct": false}, {"label": "D", "text": "Radial nerve", "correct": false}], "correct_answer": "A. Spinal accessory nerve", "question_images": ["https://image.prepladder.com/content/1bLVTEFHwHdUIS6MWQc01747374011.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the given image, the physician is trying to palpate which of the following arteries?", "options": [{"label": "A", "text": "Anterior tibial artery", "correct": false}, {"label": "B", "text": "Posterior tibial artery", "correct": true}, {"label": "C", "text": "Dorsalis pedis artery", "correct": false}, {"label": "D", "text": "Lateral plantar artery", "correct": false}], "correct_answer": "B. Posterior tibial artery", "question_images": ["https://image.prepladder.com/content/qb38AZo3jP2U5cb4qEBT1747373753.png"], "explanation_images": ["https://image.prepladder.com/content/9tTTBUjyBOhyb7GWyO671747373785.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 160 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which term refers to the practice of instilling a particular point of view in people's minds and inhibiting their independent thought?", "options": [{"label": "A", "text": "Health Propaganda", "correct": true}, {"label": "B", "text": "Health Promotion", "correct": false}, {"label": "C", "text": "Health Awareness", "correct": false}, {"label": "D", "text": "Health Education", "correct": false}], "correct_answer": "A. Health Propaganda", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A- Health Propag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman develops edema, visual disturbances, and heart failure after consuming a food item. What is the most likely adulterant?", "options": [{"label": "A", "text": "Sanguinarine", "correct": true}, {"label": "B", "text": "BOAA", "correct": false}, {"label": "C", "text": "Pyrrolizidine", "correct": false}, {"label": "D", "text": "Aflatoxin", "correct": false}], "correct_answer": "A. Sanguinarine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A- Sangu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What percentage of data falls within one standard deviation of the mean in a normal distribution?", "options": [{"label": "A", "text": "68%", "correct": true}, {"label": "B", "text": "95%", "correct": false}, {"label": "C", "text": "98%", "correct": false}, {"label": "D", "text": "99%", "correct": false}], "correct_answer": "A. 68%", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kjFCgY4B6swWdF2jvJhJ1747378025.png"], "explanation": "<p>Correct Option A- 68%</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Area under the curve </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Observation covered </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mean +/- 1 SD</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">68.3% ~ 68% of observation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mean +/- 2 SD</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">95.4% ~ 95% of observation <strong> (Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mean +/- 3 SD</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">99.7% ~ 99% of observation <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mean +/- ∞SD</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">100% of observation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the growth rate if the crude birth rate is 19 and the crude death rate is 7?", "options": [{"label": "A", "text": "1.2%", "correct": true}, {"label": "B", "text": "0.7%", "correct": false}, {"label": "C", "text": "1.1%", "correct": false}, {"label": "D", "text": "1.5%", "correct": false}], "correct_answer": "A. 1.2%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A- 1.2%\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which pneumoconiosis is caused by exposure to cotton dust?", "options": [{"label": "A", "text": "Byssinosis", "correct": true}, {"label": "B", "text": "Bagassosis", "correct": false}, {"label": "C", "text": "Anthracosis", "correct": false}, {"label": "D", "text": "Silicosis", "correct": false}], "correct_answer": "A. Byssinosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A- B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a family, Mr. X is 69 years old, and his wife, Mrs. X, is 58 years old. They have a 30-year-old son, his 28-year-old wife, and a 5-year-old grandchild. Calculate the dependency ratio for this family.", "options": [{"label": "A", "text": "0.33", "correct": false}, {"label": "B", "text": "0.66", "correct": true}, {"label": "C", "text": "0.22", "correct": false}, {"label": "D", "text": "0.44", "correct": false}], "correct_answer": "B. 0.66", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VAjwBs2QwwqxhTUmdfkU1747378077.png"], "explanation": "<p>Correct Option B - 0.66\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What level of prevention is being addressed by administering an injection of benzathine penicillin to a patient with rheumatic heart disease?", "options": [{"label": "A", "text": "Primordial", "correct": false}, {"label": "B", "text": "Primary", "correct": false}, {"label": "C", "text": "Secondary", "correct": true}, {"label": "D", "text": "Tertiary", "correct": false}], "correct_answer": "C. Secondary", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C) Secondary:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Level of Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Goals </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primordial (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To prevent the establishment of risk factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lifestyle modification</li>\n<li>Health promotion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Interventions to prevent the onset of disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vaccinations</li>\n<li>Health education</li>\n<li>Family planning</li>\n<li>Use of <span class=\"customMeta\" data-dictid=\"8fad75f63f1692777192f93996c6ab\">mosquito</span> nets</li>\n<li><strong>Pre-placement examination</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> and prompt treatment of disease to prevent complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Screening tests (e.g., mammograms, PAP smears)</li>\n<li>Self-examinations</li>\n<li>Health camps with screening</li>\n<li>DOTS for TB; ART for HIV; MDT for leprosy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tertiary (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Interventions to manage and reduce complications of existing disease to prevent disability or death</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rehabilitation</li>\n<li>Physical therapy</li>\n<li>Chronic disease management programs</li>\n<li>Reconstructive surgery</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What physiological response is most likely to occur in a person exposed to high temperatures while exercising vigorously to maintain internal body temperature within a narrow range?", "options": [{"label": "A", "text": "Sweating and vasodilation in the skin", "correct": true}, {"label": "B", "text": "Shivering and vasoconstriction in the skin", "correct": false}, {"label": "C", "text": "Increased production of heat by the liver", "correct": false}, {"label": "D", "text": "Decreased heart rate (HR) and respiratory rate (RR)", "correct": false}], "correct_answer": "A. Sweating and vasodilation in the skin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mpOjBXFCqAtG15V9KTM21747377764.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended area per worker in a factory, considering that any height above a specified limit is not taken into account?", "options": [{"label": "A", "text": "100 cubic feet", "correct": false}, {"label": "B", "text": "500 cubic feet", "correct": true}, {"label": "C", "text": "300 cubic feet", "correct": false}, {"label": "D", "text": "400 cubic feet", "correct": false}], "correct_answer": "B. 500 cubic feet", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B- 500 cubic feet</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Factory Act</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An establishment employing 10 or more workers where power is used or 20 or more workers where power is not used.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Applicability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Applies to all of India and covers all factories, including <span class=\"customMeta\" data-dictid=\"231e76e11c1692777195bd586f5b59\">perennial</span> and <span class=\"customMeta\" data-dictid=\"201a6ea7721692777198c51d735506\">seasonal</span> factories.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age Restrictions</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prohibits employment of children below 14 years of age.</li>\n<li>15-18 year olds need fitness certificate for factory work from a certified surgeon</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hours of Work</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Work limited to 48 hours/week or 9 hours/day; max 60 hours/week with overtime.</li>\n<li>Adolescents: max 4.5 hours/day.</li>\n<li>Women and adolescents: work hours 6 am to 7 pm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Leave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Grants 1 day of leave per 15 days of work for adolescents</li>\n<li>1 day per 30 days of work for adults.</li>\n<li>Permits accumulation of leaves up to 40 days for adolescents and 30 days for adults.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Health &amp; Safety</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mandates a <strong>minimum of 500 cubic <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> of space per worker.</strong></li>\n<li>Requires 1 safety officer per 1000 workers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Welfare</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stipulates 1 welfare officer per 500 workers, 1 canteen per 250 workers, and 1 <span class=\"customMeta\" data-dictid=\"4751516864169277718500f84f5fb3\">crèche</span> per 30 women workers.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following components is absent in smooth muscle?", "options": [{"label": "A", "text": "Actin", "correct": false}, {"label": "B", "text": "Myosin", "correct": false}, {"label": "C", "text": "Tropomyosin", "correct": false}, {"label": "D", "text": "Troponin", "correct": true}], "correct_answer": "D. Troponin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Smooth muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Skeletal muscles</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spindle-shaped, single <span class=\"customMeta\" data-dictid=\"a6f7ad44aa1692777193665a7f5d9a\">nucleated</span> cells.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple <span class=\"customMeta\" data-dictid=\"a6f7ad44aa1692777193665a7f5d9a\">nucleated</span> cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neuromuscular <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> is not present.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proper <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> is present.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caveolae is present.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T-tubule is present.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Predominantly, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channels are present.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Predominantly, sodium channels are present.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Actin</strong> and<strong> myosin</strong> are present but not properly organised. <strong>(Options A and B)</strong></li>\n<li><strong>Tropomyosin</strong> is present and plays a role in regulating the interaction between <span class=\"customMeta\" data-dictid=\"8e023fb81e16927771802d21820404\">actin</span> and myosin.<strong> (Option C)</strong></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Actin and <span class=\"customMeta\" data-dictid=\"99c8e09d6f1692777193d7716ab6eb\">myosin</span> are properly organised.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A dense body is present.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The Z- line is present.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Calmodulin is present, and Titin is absent.</li>\n<li><strong>Troponin is absent</strong></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Troponin and Titin are present.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrives at the emergency department unconscious. An arterial blood gas (ABG) analysis reveals the following results: pH: 7.1 PCO2: 23 mmHg PO2: 98 mmHg HCO3: 16 mEq/L What do these ABG results indicate about the patient's condition?", "options": [{"label": "A", "text": "Metabolic acidosis", "correct": true}, {"label": "B", "text": "Metabolic alkalosis", "correct": false}, {"label": "C", "text": "Respiratory acidosis", "correct": false}, {"label": "D", "text": "Respiratory alkalosis", "correct": false}], "correct_answer": "A. Metabolic acidosis", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-anion gap </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>M</strong>ethanol poisoning</li>\n<li><strong>U</strong>remia: AKI, CKD</li>\n<li><strong>D</strong>iabetic ketoacidosis</li>\n<li><strong>P</strong>aracetamol poisoning</li>\n<li><strong>I</strong>ron and isoniazid</li>\n<li><strong>L</strong>actic acidosis</li>\n<li><strong>E</strong>thylene <span class=\"customMeta\" data-dictid=\"7451dcad4f1692777188609e12be1d\">glycol</span> poisoning</li>\n<li><strong>S</strong>alicylate poisoning</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>H</strong>yperchloremia</li>\n<li><strong>A</strong>ddison's disease</li>\n<li><strong>R</strong>enal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis</li>\n<li><strong>D</strong>iarrhoea and conditions causing GI loss of HCO3- (ureterosigmoidostomy or external <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> drainage)</li>\n<li><strong>A</strong>cetazolamide</li>\n<li><strong>S</strong>pironolactone and K-sparing diuretics</li>\n<li><strong>S</strong>aline <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> (rapid <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> )</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reduced <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap: </strong>Multiple <span class=\"customMeta\" data-dictid=\"aa6a0dfcb61692777193561ed10fac\">myeloma</span> and <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">nephrotic</span> syndrome</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Heart of sewage disposal plant:", "options": [{"label": "A", "text": "Primary sedimentation tank", "correct": false}, {"label": "B", "text": "Aeration tank", "correct": true}, {"label": "C", "text": "Secondary sedimentation tank", "correct": false}, {"label": "D", "text": "Sludge digestion tank", "correct": false}], "correct_answer": "B. Aeration tank", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Xi77LvZaoEYeeiiLBsk01747378132.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"ec8505f749169277718070157610a9\"&gt;Aeration&lt;/span&gt; tank\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which ion is primarily involved in the function of O2-sensitive channels in peripheral chemoreceptors?", "options": [{"label": "A", "text": "Potassium (K+)", "correct": true}, {"label": "B", "text": "Sodium (Na+)", "correct": false}, {"label": "C", "text": "Bicarbonate (HCO3-)", "correct": false}, {"label": "D", "text": "Chloride (Cl-)", "correct": false}], "correct_answer": "A. Potassium (K+)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true regarding an increase in Glomerular Filtration Rate (GFR)?", "options": [{"label": "A", "text": "Increase in the resistance of the afferent arteriole", "correct": false}, {"label": "B", "text": "Decrease in the resistance of the efferent arteriole", "correct": false}, {"label": "C", "text": "Increase in Bowman's capsule hydrostatic pressure", "correct": false}, {"label": "D", "text": "Increase in renal perfusion", "correct": true}], "correct_answer": "D. Increase in renal perfusion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Arteriole Change</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Effect on Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Effect on <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">Glomerular</span> <span class=\"customMeta\" data-dictid=\"20b745c46c1692777189374f036950\">Hydrostatic</span> Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Effect on GFR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Effect on RPF</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Afferent <span class=\"customMeta\" data-dictid=\"bf9d31e4c81692777182230292a7a3\">Arteriole</span> Constriction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases</p>\n<p><strong>(Option A)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Afferent <span class=\"customMeta\" data-dictid=\"bf9d31e4c81692777182230292a7a3\">Arteriole</span> Dilation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Efferent <span class=\"customMeta\" data-dictid=\"bf9d31e4c81692777182230292a7a3\">Arteriole</span> Constriction- Mild</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slight increase</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Efferent <span class=\"customMeta\" data-dictid=\"bf9d31e4c81692777182230292a7a3\">Arteriole</span> Constriction- Severe</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initially increases GFR then ultimately decreases.</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"8833ce72c71692777187014d5585e7\">efferent</span> <span class=\"customMeta\" data-dictid=\"bf9d31e4c81692777182230292a7a3\">arteriole</span> <span class=\"customMeta\" data-dictid=\"4880e9b3761692777185e64eba797c\">constriction</span> reduces <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and increases <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> fraction, concentrating <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> proteins in the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> capillaries and elevating <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"2e711a1abe1692777184b0bf50216b\">colloid</span> osmotic pressure.</li>\n<li>This counteracts the effect of increased <span class=\"customMeta\" data-dictid=\"20b745c46c1692777189374f036950\">hydrostatic</span> pressure, ultimately reducing GFR</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Efferent <span class=\"customMeta\" data-dictid=\"bf9d31e4c81692777182230292a7a3\">Arteriole</span> Dilation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases</p>\n<p><strong>(Option B)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which protein does calcium bind to during smooth muscle contraction?", "options": [{"label": "A", "text": "Calmodulin", "correct": true}, {"label": "B", "text": "Troponin C", "correct": false}, {"label": "C", "text": "Topoisomerase", "correct": false}, {"label": "D", "text": "Actin", "correct": false}], "correct_answer": "A. Calmodulin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/drX5A3imK1fdwQ6atvHr1747377806.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Paris green dust is commonly used to kill which of the following?", "options": [{"label": "A", "text": "Anopheles larva", "correct": true}, {"label": "B", "text": "Houseflies", "correct": false}, {"label": "C", "text": "Bedbugs", "correct": false}, {"label": "D", "text": "Cockroaches", "correct": false}], "correct_answer": "A. Anopheles larva", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Anopheles larva</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Environmental measures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chemical control</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Biological control</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yield permanent results and source reduction.</p>\n<p>E.g.</p>\n<ul>\n<li>Filling drains and ditches.</li>\n<li>Levelling of ground.</li>\n<li>Proper <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of <span class=\"customMeta\" data-dictid=\"275662f5c11692777183ab59ae573b\">breeding</span> areas.</li>\n<li>Intermittent irrigation.</li>\n<li>Changing water alkalinity.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Using larvicides</p>\n<p>E.g.</p>\n<p>1. Physical:</p>\n<ul>\n<li>MLO (Mosquito larvicidal oil): 200L/hectare</li>\n</ul>\n<p>2. Chemical:</p>\n<ul>\n<li>Paris green</li>\n<li>Temephos (Abate): 200L/hectare</li>\n</ul>\n<p>3. IGR (insect growth regulators):</p>\n<ul>\n<li>Inhibit <span class=\"customMeta\" data-dictid=\"b24b4918a916927771844114519396\">chitin</span> formation, <span class=\"customMeta\" data-dictid=\"b8b85a8a841692777192148859c5c8\">moulding</span> and adult maturation.</li>\n<li>Pyriproxyfen and Diflubenzuron</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Larvivorous Fishes:</strong></p>\n<p>1. Gambusia and Poecilia fish</p>\n<p>2. Bacillus thuringiensis (used in polluted waters)</p>\n<p>3. Toxorhynchites splendens</p>\n<p>(predator <span class=\"customMeta\" data-dictid=\"8fad75f63f1692777192f93996c6ab\">mosquito</span> for Aedes and Anopheles)</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following cannot be studied using case-control study?", "options": [{"label": "A", "text": "Effect to cause", "correct": false}, {"label": "B", "text": "Rare Disease", "correct": false}, {"label": "C", "text": "Odds ratio", "correct": false}, {"label": "D", "text": "Cause to effect", "correct": true}], "correct_answer": "D. Cause to effect", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Cause to effect</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Advantages </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disadvantages </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Less time taken.</li>\n<li>Inexpensive.</li>\n<li>Minimal ethical problems.</li>\n<li>Multiple exposure was studied.</li>\n<li>Rare diseases can be studied.</li>\n<li>Attrition bias not present</li>\n<li>Forms the <span class=\"customMeta\" data-dictid=\"cfcd8c317716927771977076433c53\">rationale</span> for prevention and control programmes based on risk factors.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Selection bias.</li>\n<li>Recall bias.</li>\n<li>Interviewer bias.</li>\n<li>Cannot measure incidence: Only provides estimation of relative risk.</li>\n<li><strong>Cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between causes and associated factors</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Air humidity and dew point temperature of the air is measured using which of the following instruments?", "options": [{"label": "A", "text": "Sling psychrometer", "correct": true}, {"label": "B", "text": "Kata thermometer", "correct": false}, {"label": "C", "text": "Barometer", "correct": false}, {"label": "D", "text": "Dial thermometer", "correct": false}], "correct_answer": "A. Sling psychrometer", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WTT5sWB7nfQXuVH02pCW1747206192.png", "https://image.prepladder.com/content/5Td6QG5LWClo5XZYipVW1747206202.png", "https://image.prepladder.com/content/X7rViq0RF65Fmh23hiWt1747206242.png", "https://image.prepladder.com/content/qMPSbOCGYGTOTTDkjClV1747206250.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5e2a7b127c1692777198f4895cc7c0\"&gt;Sling&lt;/span&gt; psychrometer</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Air <span class=\"customMeta\" data-dictid=\"941f005c7d1692777189872035c678\">humidity</span> measuring instruments</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A. Hygrometer</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hannes Grobe\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Hygrometer-thermometer_hg.jpg\" data-tags=\"\" height=\"277\" src=\"https://image.prepladder.com/content/WTT5sWB7nfQXuVH02pCW1747206192.png\" width=\"390\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B. <span class=\"customMeta\" data-dictid=\"5e2a7b127c1692777198f4895cc7c0\">Sling</span> psychrometer</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CambridgeBayWeather\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Wet-bulb_temperature#/media/File:Sling_psychrometer.JPG\" data-tags=\"\" height=\"149\" src=\"https://image.prepladder.com/content/5Td6QG5LWClo5XZYipVW1747206202.png\" width=\"344\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Wet and dry thermometers are mounted side by side</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C. Assman psychrometer</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Assmann\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://www.si.edu/object/nmah_1167487\" data-tags=\"\" height=\"202\" src=\"https://image.prepladder.com/content/X7rViq0RF65Fmh23hiWt1747206242.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Can be used even in strong sunshine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>D. Dry and wet bulb hygrometer</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"550\" src=\"https://image.prepladder.com/content/qMPSbOCGYGTOTTDkjClV1747206250.png\" width=\"466\"/></p>\n<ul>\n<li>Most widely used</li>\n<li>Same readings in both (dry and wet) bulbs indicate 100 per cent <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> with moisture</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7 year old boy is brought to the OPD. He fell on his outstretched arm while riding on his cycle. Clinical examination findings are presented in the image below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Dorsal displacement supracondylar fracture of humerus", "correct": false}, {"label": "B", "text": "Undisplaced supracondylar fracture", "correct": false}, {"label": "C", "text": "Malunion of a supracondylar fracture of humerus", "correct": true}, {"label": "D", "text": "Proximal humerus fracture", "correct": false}], "correct_answer": "C. Malunion of a supracondylar fracture of humerus", "question_images": ["https://image.prepladder.com/content/U9E3j7vR1z7LbEWnP0Lw1747376357.png"], "explanation_images": ["https://image.prepladder.com/content/nXS78u9gtcN9XWxtcjBI1747376371.png", "https://image.prepladder.com/content/RUQz6N83bEtkSfiWI1ne1747376378.png", "https://image.prepladder.com/content/PA4i6ct6OhKCPDW9xxyE1747376391.png", "https://image.prepladder.com/content/lyCFGmXDoKkuJOvzYPZC1747376406.png", "https://image.prepladder.com/content/SobJbK3Y6EYz0JdaAHx81747376428.png", "https://image.prepladder.com/content/9GoVUbWIVhFEbR53rbqd1747376443.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Supracondylar Fractures </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fall on outstretched hand (FOOSH)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Humerus fractures just above the condyles.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Displacements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> is usually displaced by</p>\n<ul>\n<li>Posterior shift (Due to Impaction)</li>\n<li>Posterior Tilt</li>\n<li>Proximal shift</li>\n<li>Medial shift/ Tilt</li>\n<li>Internal rotation</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/nXS78u9gtcN9XWxtcjBI1747376371.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Type 1:</strong> Undisplaced fracture</li>\n<li><strong>Type 2:</strong> Partially displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of only <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> cortex</li>\n<li><strong>Type 3:</strong> Completely displaced <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cortex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe elbow pain, swelling, deformity, and loss of function may occur, and neurological symptoms like weakness in wrist <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> or the <strong>\"hand of benediction\"</strong> sign may also occur if the<strong> <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve</strong> is affected.</li>\n<li>Unusual <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> of the <span class=\"customMeta\" data-dictid=\"42c351f10a1692777194fbc64fc061\">olecranon</span> in the backward tilt <strong>(S-shaped deformity)</strong></li>\n<li>The skin around the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> has a dimpled appearance <strong>(Dimple sign)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Three bony parts relationship is maintained.</li>\n<li><strong>Fat Pad or Sail sign: </strong>A <span class=\"customMeta\" data-dictid=\"4537d6e7e216927772007d067522aa\">translucent</span> shadow-like appearance representing <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fat pads.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dr Graham Lloyd-Jones\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.radiologymasterclass.co.uk/gallery/trauma/x-ray_arm_1/fractures_8\" data-tags=\"\" height=\"335\" src=\"https://image.prepladder.com/content/RUQz6N83bEtkSfiWI1ne1747376378.png\" width=\"296\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Disturbed tear drop sign:</strong> An <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> appearance of the fat pad, suggesting the presence of an injury, such as a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or joint effusion.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/PA4i6ct6OhKCPDW9xxyE1747376391.png\" width=\"500\"/></p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Mous A, Hacking C, Campos A\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/supracondylar-humeral-fracture-2\" data-tags=\"\" height=\"323\" src=\"https://image.prepladder.com/content/lyCFGmXDoKkuJOvzYPZC1747376406.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<ul>\n<li><strong>Fishtail sign: </strong>The ends of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> fragment are slightly widened and serrated, resembling a fishtail<strong>.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD, Diego Delso\" data-hash=\"\" data-license=\"CC BY-SA 3.0, CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Supracondylar_humerus_fracture#/media/File:Supracondylar09.JPG, https://en.wikipedia.org/wiki/Common_dentex#/media/File:Dent%C3%B3n_com%C3%BAn_(Dentex_dentex),_franja_marina_Teno-Rasca,_Tenerife,_Espa%C3%B1a,_2022-01-08,_DD,_DD_64.jpg\" data-tags=\"\" height=\"340\" src=\"https://image.prepladder.com/content/SobJbK3Y6EYz0JdaAHx81747376428.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Crescent sign: </strong>The normal <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> gap of the <span class=\"customMeta\" data-dictid=\"3fead70a341692777187431ed9d5e0\">elbow joint</span> is replaced by a crescent-shaped shadow from the <span class=\"customMeta\" data-dictid=\"2f2b8ee27316927771830e8372cc12\">capitulum</span> overlapping the olecranon, indicating <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> tilt of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Leonardo Lustosa\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/supracondylar-fracture-gartland-type-i-2\" data-tags=\"\" height=\"654\" src=\"https://image.prepladder.com/content/9GoVUbWIVhFEbR53rbqd1747376443.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on the type of fracture</p>\n<ul>\n<li><strong>Undisplaced fracture: </strong>Immobilisation in above-elbow <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> slab with the elbow in 90-degree flexion.</li>\n<li><strong>Displaced fractures</strong>\n<ul>\n<li>Closed reduction with <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> K-wire fixation. (for Type 2 fracture)</li>\n<li>Open reduction internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with K-wire. (for Type 3 fracture)</li>\n</ul>\n</li>\n<li><strong>In Late presentation with swelling</strong>\n<ul>\n<li>Dunlop <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (skin)</li>\n<li>Smith <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (skeletal)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Early complications</strong>\n<ul>\n<li>Vascular injury (commonly Brachial artery)</li>\n<li>Nerve injury (commonly <strong>Anterior Interosseous nerve</strong>)</li>\n</ul>\n</li>\n<li><strong>Delayed complications</strong>\n<ul>\n<li><strong>Cubitus <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or Gunstock <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Malunion) (Option C)</strong></li>\n<li>Volkmann's Ischemia and <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome.</li>\n<li>Elbow stiffness</li>\n<li>Myositis ossificans.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is related to Navjaat Shishu Suraksha Karyakram?", "options": [{"label": "A", "text": "Mother", "correct": false}, {"label": "B", "text": "Children", "correct": false}, {"label": "C", "text": "Newborn", "correct": true}, {"label": "D", "text": "Pregnant woman", "correct": false}], "correct_answer": "C. Newborn", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/R5aav05rKuMYKqgQNhuq1747206536.png"], "explanation": "<p>Correct Option C - Newborn</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:1px solid #333438; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Navjaat Shishu Suraksha Karyakram(NSSK)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<ul>\n<li>A training program launched by the Indian Government to equip doctors and nurses with essential <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> care skills, specifically addressing birth asphyxia.</li>\n<li>The ultimate goal is to reduce <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> mortality and morbidity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p><strong>Goals/Objectives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<ul>\n<li>Reduce Neonatal Mortality Rate: Decrease India's Neonatal Mortality Rate to single digits by 2030.</li>\n<li>Improve <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">Newborn</span> Care Quality: Enhance the quality of <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> care.</li>\n<li>Prevent <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">Perinatal</span> Asphyxia-Related Issues: Reduce <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">perinatal</span> asphyxia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #333438; border-left:1px solid #333438; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<p><strong>Strategies </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #333438; border-left:none; border-right:1px solid #333438; border-top:none; vertical-align:top\">\n<ul>\n<li>Capacity Building: Equip healthcare providers with necessary knowledge and skills.</li>\n<li>Essential <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">Newborn</span> Care and <span class=\"customMeta\" data-dictid=\"d343b06c7f1692777197edaea107af\">Resuscitation</span> Training.</li>\n<li>Updated Curriculum and Training Methodology</li>\n<li>Standardized Equipment and Supplies: Provide clean, functional equipment.</li>\n<li>Effective Knowledge and Skill Transfer: Improve practical application of training.</li>\n<li>Focus on \"Golden Minute\": Quick assessment and resuscitation. Promoting Clean Birth Practices: Adhere to WHO's \"six cleans\". Kangaroo Mother Care (KMC). Promotion: Encourage KMC for low birth weight babies.</li>\n<li>Timely Immunization: Ensure <span class=\"customMeta\" data-dictid=\"f23be6aa561692777201ca2e1aaa27\">vaccination</span> before discharge.</li>\n<li>Educate parents on <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> care.</li>\n<li>Effective Neonatal Transport: Establish protocols for the safe transport of sick newborns.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male presents to the OPD with complaints of pain in the left knee region. He reports that the pain is often worse at night and mentions that he has been taking Aspirin to relieve the pain. An X-ray of the knee is shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Chondroblastoma", "correct": false}, {"label": "B", "text": "Osteoid osteoma", "correct": true}, {"label": "C", "text": "Skeletal TB", "correct": false}, {"label": "D", "text": "Osteosarcoma", "correct": false}], "correct_answer": "B. Osteoid osteoma", "question_images": ["https://image.prepladder.com/content/18ObwzOS0F8hOnXLnLLF1747376535.png"], "explanation_images": ["https://image.prepladder.com/content/O8wifnI1MczLaJ4JZDOu1747376547.png", "https://image.prepladder.com/content/qQVN2ZSQUTqq3QeeQeii1747376562.png", "https://image.prepladder.com/content/Gp3bRbuPIaLHwlc8DhpC1747376594.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Osteoid Osteoma</strong></p>\n<p>A small, <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> bone tumor composed of <span class=\"customMeta\" data-dictid=\"74fb39c2cd1692777194eae8b91386\">osteoid</span> and woven bone with a surrounding <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> of <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> bone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sex: </strong>Males &gt; Females</p>\n<p><strong>Age: </strong>Young patients, but rare under 5 years and over 30.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>The <span class=\"customMeta\" data-dictid=\"604558eae21692777186613f3915a9\">diaphysis</span> </strong>of long bones, especially <strong>the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tibia, and femur.</strong></p>\n<p>It can also occur in the <strong>spine</strong>, particularly the <strong>posterior arches.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"00375928541692777193ce8621da42\">nidus</span> <strong>releases prostaglandins</strong> which cause the characteristic pain that relieves on taking NSAIDs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Characterized by <strong>pain, often worse at night (Night crises), and relieved by NSAIDs (<em>Therapeutic test</em>).</strong></p>\n<p>When near joints, it may cause <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and effusion.</p>\n<p>In the spine, it can lead to muscle spasms and scoliosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-Ray: </strong></p>\n<p>Dense <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> with a small, <strong>rounded area of osteolysis</strong>, often obscured by the surrounding sclerosis.</p>\n<p>The characteristic <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> is<strong> less than 1.5 cm in diameter</strong> with a <strong>sclerotic margin and <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> nidus. </strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/O8wifnI1MczLaJ4JZDOu1747376547.png\" width=\"500\"/></p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Adlan, Amirul &amp; Azzopardi, Christine &amp; Davies, Mark &amp; James, Steven &amp; Botchu, R\" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Right-leg-anteroposterior-radiograph-showing-osteoid-osteoma-arrow-with-marked-cortical_fig1_361999794\" data-tags=\"\" height=\"1349\" src=\"https://image.prepladder.com/content/qQVN2ZSQUTqq3QeeQeii1747376562.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Isotope bone scans (Best investigation) </strong>are positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Consists of a <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> of woven bone, osteoblastic rimming, osteoclasts, and dilated capillaries.</p>\n<p>The <strong>mature <span class=\"customMeta\" data-dictid=\"74fb39c2cd1692777194eae8b91386\">osteoid</span> forms the nidus, </strong>surrounded by <strong>dense, <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> bone and soft tissue with <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> changes.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Osteoid_osteoma_-_very_high_mag.jpg\" data-tags=\"\" height=\"335\" src=\"https://image.prepladder.com/content/Gp3bRbuPIaLHwlc8DhpC1747376594.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT-guided <span class=\"customMeta\" data-dictid=\"07f73f8986169277719716f3a62e1b\">radiofrequency</span> ablation.</strong></p>\n<p>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the nidus<strong> (gold standard)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle is attached to lesser trochanter?", "options": [{"label": "A", "text": "Piriformis", "correct": false}, {"label": "B", "text": "Psoas minor", "correct": false}, {"label": "C", "text": "Obturator internus", "correct": false}, {"label": "D", "text": "Psoas major muscle", "correct": true}], "correct_answer": "D. Psoas major muscle", "question_images": ["https://image.prepladder.com/content/YfxyJ3qYjeStlWqjX2iv1747376641.png"], "explanation_images": ["https://image.prepladder.com/content/9icfr9oj9piB0g4dLhgg1747376656.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Hip <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> Muscle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Origin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Attachment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iliopsoas (Psoas major + Iliacus)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Psoas major: Transverse processes of T12-L5 vertebrae</li>\n<li>Iliacus: <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">Iliac</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> of the pelvis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Both muscles combine and attach at the <span class=\"customMeta\" data-dictid=\"0404f7b31816927771912f2b470952\">lesser trochanter</span> of the femur</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primary hip flexor</li>\n<li>Flexion of the hip joint</li>\n<li>Assists in trunk <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (psoas)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rectus Femoris</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> spine (AIIS) and acetabulum</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tibial <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> via the patellar tendon</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion of the hip</li>\n<li>Extends the knee</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sartorius</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterior superior <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> spine (ASIS)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medial surface of the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> (Pes anserinus)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion, abduction, and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of the hip</li>\n<li>Flexion of the knee</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tensor Fasciae Latae (TFL)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterior part of the <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> crest</li>\n<li>Anterior superior <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> spine (ASIS)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Iliotibial band (ITB), which attaches to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"ca4c4e935616927771849e13b0396f\">condyle</span> of the tibia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion and <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> of the hip</li>\n<li>Medial <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> of the hip</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pectineus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pectineal line of the pubis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pectineal line of the femur</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion and <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">adduction</span> of the hip</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adductor Longus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pubic bone near the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medial <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> aspera of the femur</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion of the hip (when the hip is in extension)</li>\n<li>Adduction of the hip</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following is seen in the terrible triad of elbow, except.", "options": [{"label": "A", "text": "Elbow dislocation", "correct": false}, {"label": "B", "text": "Radial head fracture", "correct": false}, {"label": "C", "text": "Fracture of the olecranon", "correct": true}, {"label": "D", "text": "Fracture of the coronoid process of ulna", "correct": false}], "correct_answer": "C. Fracture of the olecranon", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TYfhdR2RrPdvoDbpU1UJ1747376740.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Stages of the demographic cycle with the same birth rate but variable death rate are?", "options": [{"label": "A", "text": "Stage 1 + stage 2", "correct": true}, {"label": "B", "text": "Stage 2 + stage 3", "correct": false}, {"label": "C", "text": "Stage 3 + stage 5", "correct": false}, {"label": "D", "text": "Stage 4 + stage 5", "correct": false}], "correct_answer": "A. Stage 1 + stage 2", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/r0QKMGcDmMpfZPYXv9Hz1747206812.png"], "explanation": "<p>Correct Option A - Stage 1 + stage 2</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Birth rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Death rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Population </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High stationery </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Population is stable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Early expanding </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Starts declining</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Population rapidly expands</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Late expanding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Starts declining</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Keeps declining</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Population still grows (birth &gt; death)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low stationery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stable population</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Declining</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Population declines (death &gt; birth)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with pneumonia provides a BAL sample, as shown below. What is the likely pathogen responsible, and what is the relative management?", "options": [{"label": "A", "text": "Mucormycosis, Terbinafin", "correct": false}, {"label": "B", "text": "Aspergillus, Amphotericin B", "correct": false}, {"label": "C", "text": "Pneumocystis Carinii, Cotrimoxazole", "correct": true}, {"label": "D", "text": "Candida,Itraconazole", "correct": false}], "correct_answer": "C. Pneumocystis Carinii, Cotrimoxazole", "question_images": ["https://image.prepladder.com/content/4mR2N6HjpwQfdsqWOM1Z1747375412.png"], "explanation_images": ["https://image.prepladder.com/content/1gNdfi6CplxiTfwLoapZ1747375431.png", "https://image.prepladder.com/content/VD857TSTrBXXWBMN99jZ1747375442.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pneumocystis jirovecii</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Trophozoite - thin-walled, irregularly shaped, 1-5 µm in size</li>\n<li>Precyst - an <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">intermediate</span> stage of the sexual phase, 5-8 µm in size</li>\n<li>Cyst - thick-walled, spherical, containing up to 8 <span class=\"customMeta\" data-dictid=\"d8d91f0402169277719039e737dcb8\">intracystic</span> bodies and up to 8 µm in size</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HIV: CD4 &lt; 200</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"141d29cc7f16927771890a8e0860e6\">immunodeficiency</span> states</li>\n<li>Transplant recipients</li>\n<li>Hematological malignancies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transmitted by <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> droplets and is <strong>asymptomatic</strong> in <strong>immunocompetent</strong> individuals. In <strong>immunocompromised</strong> patients, life-threatening <strong>pneumonia</strong> develops.</p>\n<p><strong>PCP</strong> - <strong>Pneumocystis Carinii pneumonia</strong></p>\n<ul>\n<li>Dyspnoea</li>\n<li>Dry cough</li>\n<li>Fever</li>\n<li>Weight loss</li>\n<li>B/L <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> causing <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> infiltrates</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>GMS</strong> / <strong>Giemsa</strong> stain- mc used</li>\n<li>Giemsa, <span class=\"customMeta\" data-dictid=\"87f88d49311692777200eb848ea567\">toluidine</span> blue, <span class=\"customMeta\" data-dictid=\"cb3712727816927771925665b0b1e0\">methenamine</span> silver, and calcofluor white stains can demonstrate trophozoites - <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> wall is black with a <strong>methenamine silver stain</strong>.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Pulminary Pathology\" data-hash=\"\" data-license=\"CC BY SA 2.0\" data-source=\"Pulminary Pathology\thttps://en.wikipedia.org/wiki/Pneumocystis_pneumonia\" data-tags=\"\" height=\"356\" src=\"https://image.prepladder.com/content/1gNdfi6CplxiTfwLoapZ1747375431.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"User InvictaHOG\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Pneumocystosis\" data-tags=\"\" height=\"305\" src=\"https://image.prepladder.com/content/VD857TSTrBXXWBMN99jZ1747375442.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Crushed Ping Pong ball</strong> (also called Helmet/Hat or Cup and Saucer appearance).</p>\n<ul>\n<li><strong>The β-d-glucan test</strong> has proven to be quite useful for rapid diagnosis of Pneumocystis <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> with a high degree of sensitivity and specificity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The cornerstone for both prevention and treatment is <strong>trimethoprim-sulfamethoxazole.</strong></li>\n<li>Alternative therapies have been used in AIDS patients; they include pentamidine, trimethoprim-dapsone, clindamycin-primaquine, atovaquone, and trimetrexate.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the mechanism of action of diphtheria toxin?", "options": [{"label": "A", "text": "ADP phosphorylation of EF-2 - Decreasing protein synthesis", "correct": true}, {"label": "B", "text": "Increasing cAMP", "correct": false}, {"label": "C", "text": "Increasing cGMP", "correct": false}, {"label": "D", "text": "Decreasing 60s ribosome", "correct": false}], "correct_answer": "A. ADP phosphorylation of EF-2 - Decreasing protein synthesis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Production and Structure</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>DT is a protein <span class=\"customMeta\" data-dictid=\"b86cccaa081692777187127cb18860\">exotoxin</span> produced by the <span class=\"customMeta\" data-dictid=\"db69884a9c16927772001871c2a495\">toxigenic</span> Corynebacterium diphtheriae.</li>\n<li>Consists of two fragments(Bipartite), A and B, with a <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">molecular weight</span> of approximately 62,000 daltons.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Role of <span class=\"customMeta\" data-dictid=\"38000b363e1692777191e63fbc7c30\">Lysogenic</span> β-phage</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>The tox gene is carried by a <span class=\"customMeta\" data-dictid=\"38000b363e1692777191e63fbc7c30\">lysogenic</span> β-phage.</li>\n<li>Only phage-infected strains produce toxin; nontoxigenic strains can become <span class=\"customMeta\" data-dictid=\"db69884a9c16927772001871c2a495\">toxigenic</span> if infected.</li>\n<li><em>Corynebacterium diphtheriae</em> remains <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> at the infection site, with only the <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> entering circulation, causing toxaemia but not bacteremia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Mechanism of Action</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Fragment B binds host cell receptors, facilitating fragment A entry into the cytoplasm.</li>\n<li>Fragment A catalyses ADP-ribosylation of EF-2, halting protein synthesis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Potency</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"4f6bb2e54b1692777191056bf2218b\">lethal</span> dose for a 250g guinea pig: is 0.0001 mg.</li>\n<li>The estimated <span class=\"customMeta\" data-dictid=\"4f6bb2e54b1692777191056bf2218b\">lethal</span> dose for humans: 130 ng/kg body weight.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Systemic Effects</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>DT spreads via blood, causing <span class=\"customMeta\" data-dictid=\"b37b57210716927771933ee216a834\">myocarditis</span> and neuritis.</li>\n<li>Myocarditis is potentially fatal.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Factors Affecting Production</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Influenced by environmental factors: <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> pH (7.8-8.0), oxygen, and iron concentration in the growth medium.</li>\n<li>High production with low iron availability (0.1 mg/l); iron addition inhibits production (0.5 mg/l).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Toxoid Formation</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Treatment with <span class=\"customMeta\" data-dictid=\"ce1a75d1d11692777203467ea3666a\">formalin</span> (0.2-0.4%), and <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> at 37°C for 4-6 weeks converts DT to toxoid.</li>\n<li>Toxoid lacks <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> but induces an immune response; used in vaccines.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:bottom\">\n<p>Immunity</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:bottom\">\n<ul>\n<li>Immunity is primarily mediated by <span class=\"customMeta\" data-dictid=\"2ff0b3039f16927771818bb2a247b0\">antitoxin</span> antibodies neutralizing DT.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Toxin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Source</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Diphtheria <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">Toxin</span> (DT)</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Corynebacterium diphtheriae</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Secreted by bacteria infected with tox-carrying β-phage.</li>\n<li>Cleaved into fragments B and A.</li>\n<li>Fragment B binds to human cell receptors.</li>\n<li>Fragment A ADP-ribosylates <span class=\"customMeta\" data-dictid=\"3e53f6980f1692777187044dd3f9e7\">elongation</span> factor 2 (EF-2), halting protein synthesis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Exotoxin A</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p>Pseudomonas aeruginosa</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Secreted by Pseudomonas aeruginosa.</li>\n<li>Inhibits protein <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> in eukaryotic cells.</li>\n<li>The mechanism involves a similar process to DT, disrupting EF-2 function.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Infection in humans occurs by ingestion of quadrinucleate cysts through contaminated food or water. Which of the following is likely the cause of this infection?", "options": [{"label": "A", "text": "Giardia lamblia", "correct": false}, {"label": "B", "text": "Entamoeba Histolytica", "correct": true}, {"label": "C", "text": "Cryptosporidium parvum", "correct": false}, {"label": "D", "text": "Cyclospora Cayetanensis", "correct": false}], "correct_answer": "B. Entamoeba Histolytica", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RRiNycjcHTOtjTnoeG3M1747375521.png", "https://image.prepladder.com/content/UlsdP1zQpiC2aE6hw63S1747375593.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the diagnostic test for monkeypox?", "options": [{"label": "A", "text": "ELISA", "correct": false}, {"label": "B", "text": "Hemagglutination assay", "correct": false}, {"label": "C", "text": "PCR", "correct": true}, {"label": "D", "text": "Hybrid Capture assay", "correct": false}], "correct_answer": "C. PCR", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MgZ2DIVRaNfVGROSGshU1747375631.png", "https://image.prepladder.com/content/gKp0zCzpr44Xp5oxyNq11747375672.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Monkeypox infections</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"94f0354eb31692777192e26866b027\">monkeypox</span> virus belongs to the<strong> Orthopoxvirus genus</strong>.</li>\n<li>Monkeypox is a rare <strong>zoonotic infection</strong> first recognized in <strong>captive monkeys</strong> in 1958.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infection likely occurs through <strong>direct contact with wild animals</strong>.</li>\n<li>The exact primary <span class=\"customMeta\" data-dictid=\"8dcd2c17c316927771973b713c858f\">reservoir</span> host remains unidentified, but species such as <strong>squirrels, rabbits</strong>, and <strong>rodents </strong>can be infected.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Monkeypox.jpg\" data-tags=\"\" height=\"337\" src=\"https://image.prepladder.com/content/MgZ2DIVRaNfVGROSGshU1747375631.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptoms resemble those of <span class=\"customMeta\" data-dictid=\"9c1a0ed00916927771986d03319405\">smallpox</span> but are generally milder.</li>\n<li>Fever and rash.</li>\n<li><strong>Lymphadenopathy </strong>is a prominent feature in most cases, <strong>unlike in <span class=\"customMeta\" data-dictid=\"9c1a0ed00916927771986d03319405\">smallpox</span> or chickenpox.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Respiratory distress</li>\n<li>Secondary bacterial infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaccination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The<strong> <span class=\"customMeta\" data-dictid=\"92af8db8a116927772011711df3c11\">vaccinia</span> vaccine </strong>can offer protection against <span class=\"customMeta\" data-dictid=\"94f0354eb31692777192e26866b027\">monkeypox</span> or lessen its severity.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Gathany, CDC\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Smallpox_vaccine.jpg\" data-tags=\"\" height=\"292\" src=\"https://image.prepladder.com/content/gKp0zCzpr44Xp5oxyNq11747375672.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Human-to-Human transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transmission between humans is considered limited.</li>\n<li>Estimates suggest that only about 15% of close contacts of infected individuals become infected.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The CDC recommends the collection of two specimens, each from multiple lesions from different locations.</li>\n<li>Confirmed via isolation in <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> culture or by PCR for mpox virus DNA from a patient specimen.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which test is used in the detection of long term glucose tolerance?", "options": [{"label": "A", "text": "Fasting blood glucose", "correct": false}, {"label": "B", "text": "Random blood glucose", "correct": false}, {"label": "C", "text": "HbA1C", "correct": true}, {"label": "D", "text": "CBC", "correct": false}], "correct_answer": "C. HbA1C", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The below slide represents a gomori methenamine silver stained slide with acute angle branching and septate hyphae. What is the organism?", "options": [{"label": "A", "text": "Blastomycosis", "correct": false}, {"label": "B", "text": "Candida", "correct": false}, {"label": "C", "text": "Aspergillus", "correct": true}, {"label": "D", "text": "Mucor", "correct": false}], "correct_answer": "C. Aspergillus", "question_images": ["https://image.prepladder.com/content/4sOww6cxBwfWIzgauZEl1747375787.png"], "explanation_images": ["https://image.prepladder.com/content/0NFIc1Fdxg3NzU0jTaOJ1747375801.png", "https://image.prepladder.com/content/VD1xZSDK3ZNsLItYSmic1747375807.png", "https://image.prepladder.com/content/gcSMT2g5encVKr09cfQE1747375839.png", "https://image.prepladder.com/content/vs3BYd7osXvZfLnjQ43u1747375845.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Morphology of different <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fungi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Morphology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Microscopy </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspergillus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute angle <span class=\"customMeta\" data-dictid=\"4ce2edf4901692777186a86b62122e\">dichotomous</span> branching hyphae + <span class=\"customMeta\" data-dictid=\"55f411a4ea1692777198d8f2de73b0\">septate</span> h hi yphae</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Aspergillus#/media/File:Pulmonary_aspergillosis.jpg\" data-tags=\"\" height=\"460\" src=\"https://image.prepladder.com/content/0NFIc1Fdxg3NzU0jTaOJ1747375801.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/VD1xZSDK3ZNsLItYSmic1747375807.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucor and Rhizopus species </strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Broad, aseptate hyphae branching at 90 degree or more</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Yale Rosen\" data-hash=\"\" data-license=\"CC BY SA 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Zygomycosis,_mucormycosis_2.jpg\" data-tags=\"\" height=\"334\" src=\"https://image.prepladder.com/content/gcSMT2g5encVKr09cfQE1747375839.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Candida</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single-cell with or without pseudohyphae</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Y tambe\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:C_albicans_germ_tubes.jpg\" data-tags=\"\" height=\"415\" src=\"https://image.prepladder.com/content/vs3BYd7osXvZfLnjQ43u1747375845.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image illustrates which vitamin deficiency?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin E", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": false}, {"label": "D", "text": "Niacin (Vitamin B3) Deficiency", "correct": true}], "correct_answer": "D. Niacin (Vitamin B3) Deficiency", "question_images": ["https://image.prepladder.com/content/wMev1F02CIym3xqARRj61747374416.png"], "explanation_images": [], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"text-align:center\"><strong>Niacin (Vitamin B3)</strong></td>\n</tr>\n<tr>\n<td><strong>Chemical Structure</strong></td>\n<td>\n<ul>\n<li><strong>Niacin</strong>: Pyridine-3-carboxylic acid.</li>\n<li><strong>Niacinamide</strong>: Acid <span class=\"customMeta\" data-dictid=\"893810d3d51692777181098ec45a2b\">amide</span> derivative.</li>\n<li>Active tissue form: Niacinamide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Coenzyme Forms and Functions</strong></td>\n<td>\n<ul>\n<li><strong>NAD+</strong>: Generates 2.5 ATPs in <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> phosphorylation.</li>\n<li><strong>NADPH</strong>: Used in reductive <span class=\"customMeta\" data-dictid=\"859a34e1061692777183872a5e4441\">biosynthesis</span> (e.g., <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid synthesis).</li>\n<li>Provides ADP-ribose for protein <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> (ADP-ribosylation).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Synthesis and Metabolism</strong></td>\n<td>\n<ul>\n<li><strong>60 mg of <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> = 1 mg niacin</strong> (requires <span class=\"customMeta\" data-dictid=\"ad5806d5ad1692777196f1158adc4e\">pyridoxal</span> phosphate-dependent kynureninase).</li>\n<li>Niacin attaches to <span class=\"customMeta\" data-dictid=\"387285772b16927771979217d6cd30\">ribose</span> phosphate, forming a mononucleotide, then combines with AMP to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> dinucleotides.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Deficiency Causes</strong></td>\n<td>\n<ul>\n<li><strong>Dietary Deficiency: </strong>Staple diets like <strong>maize </strong>(bound niacin) or <strong>sorghum </strong>(leucine inhibits <span class=\"customMeta\" data-dictid=\"acad87464816927771937783e41318\">niacin</span> conversion).</li>\n<li><strong>Enzyme Defects: <span class=\"customMeta\" data-dictid=\"ad5806d5ad1692777196f1158adc4e\">Pyridoxal</span> deficiency</strong> inhibits <span class=\"customMeta\" data-dictid=\"97a025c2cc16927771915cf0fb9618\">kynureninase</span> activity.</li>\n<li><strong>Drugs: Isoniazid </strong>inhibits <span class=\"customMeta\" data-dictid=\"ad5806d5ad1692777196f1158adc4e\">pyridoxal</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> formation.</li>\n<li><strong>Congenital Disorders: Hartnup disease</strong> (impaired <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> and increased <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> excretion).</li>\n<li><strong>Carcinoid Syndrome</strong>: Excess <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> used for <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> synthesis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Clinical Condition</strong></td>\n<td>\n<ul>\n<li><strong>Pellagra</strong>: <span class=\"customMeta\" data-dictid=\"acad87464816927771937783e41318\">Niacin</span> or <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> causing<strong> \"rough skin\".</strong></li>\n<li><strong>Symptoms (3 Ds): <span class=\"customMeta\" data-dictid=\"fedc53b3161692777186553c8f8d7d\">Dermatitis</span> (Casal’s necklace), <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">Diarrhea</span> (may involve blood/mucus), <span class=\"customMeta\" data-dictid=\"41cc5ad93c169277718553c6b948a3\">Dementia</span> (irritability, poor memory, delirium).</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Sources</strong></td>\n<td>\n<ul>\n<li><strong>Richest: Dried yeast, rice polishing, liver, peanuts, cereals, legumes, meat, fish.</strong></li>\n<li>50% requirement <span class=\"customMeta\" data-dictid=\"fffe8d8cdd169277719212053c343d\">met</span> by <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> conversion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>RDA</strong></td>\n<td>\n<ul>\n<li>Adults<strong>: 20 mg/day</strong>; Additional 5 mg during lactation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Therapeutic Uses</strong></td>\n<td>\n<ul>\n<li>Lowers <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> cholesterol and Lp(a) by reducing free <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid <span class=\"customMeta\" data-dictid=\"d44646a1d3169277720326043cef85\">flux</span> from <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Toxicity</strong></td>\n<td>\n<ul>\n<li>Excess (&gt;50 mg/day): Vasodilation, itching, liver damage.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following uses CRISPR-Cas9 technology?", "options": [{"label": "A", "text": "DNA Editing", "correct": true}, {"label": "B", "text": "Post-transcriptional Modification", "correct": false}, {"label": "C", "text": "DNA Induction", "correct": false}, {"label": "D", "text": "DNA Editing Solution", "correct": false}], "correct_answer": "A. DNA Editing", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is used for the reversal of anesthesia?", "options": [{"label": "A", "text": "Neostigmine", "correct": true}, {"label": "B", "text": "Atropine", "correct": false}, {"label": "C", "text": "Glycopyrrolate", "correct": false}, {"label": "D", "text": "Midazolam", "correct": false}], "correct_answer": "A. Neostigmine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic alcoholic patient presents with agitation, confusion, and gait abnormalities. What vitamin deficiency is most likely responsible for these symptoms?", "options": [{"label": "A", "text": "Nicotinamide (Vitamin B3) deficiency", "correct": false}, {"label": "B", "text": "Folate (Vitamin B9) deficiency", "correct": false}, {"label": "C", "text": "Methylcobalamin (Vitamin B12) deficiency", "correct": true}, {"label": "D", "text": "Tyrosinase", "correct": false}], "correct_answer": "C. Methylcobalamin (Vitamin B12) deficiency", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:749px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features of Chronic Alcoholism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Vit. B12 Deficiency</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic alcohol use can lead to functional vitamin B12 deficiency, even if blood tests show normal levels.</li>\n<li>Alcohol interferes with vitamin B12 <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> and metabolism.</li>\n<li>Vitamin B12 is essential for DNA <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> and maintaining healthy nerves and red blood cells.</li>\n<li>Symptoms of B12 <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> include fatigue, weakness, numbness, and balance problems.</li>\n<li>Alcohol can damage the liver, which might cause falsely high B12 levels in blood tests, making diagnosis challenging.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Folate Deficiency</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Folate (vitamin B9) <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> is common in chronic alcoholics, affecting 6-80% of them.</li>\n<li>Alcohol disrupts <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> by impairing its absorption, transport, and liver storage.</li>\n<li>Poor diet in alcoholics worsens <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> deficiency.</li>\n<li>Folate is crucial for making red blood cells and DNA.</li>\n<li>Deficiency can cause<strong> megaloblastic anaemia </strong>and neurological issues like <strong>peripheral <span class=\"customMeta\" data-dictid=\"2d9476094c16927771933bcb162f19\">neuropathy</span> and cognitive problems.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hypoglycemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic alcohol consumption can cause low <span class=\"customMeta\" data-dictid=\"88b48cf7241692777183e5f5b8adf1\">blood sugar</span> (hypoglycemia), especially if not eating enough.</li>\n<li>Alcohol produces a high NADH/NAD+ ratio in the cytoplasm, the high NADH level favours the conversion of <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> to lactate, leading to <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis.</li>\n<li>Deficiency of <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> leads to inadequate formationof <span class=\"customMeta\" data-dictid=\"0aa20d5343169277719438bfdae95f\">oxaloacetate</span> which blocks gluconeogenesis</li>\n<li>This results in low <span class=\"customMeta\" data-dictid=\"88b48cf7241692777183e5f5b8adf1\">blood sugar</span> levels.</li>\n<li>Symptoms of alcohol-induced <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> include confusion, irritability, and, in severe cases, loss of consciousness.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following intravenous anesthetics functions as an NMDA receptor antagonist?", "options": [{"label": "A", "text": "Ketamine", "correct": true}, {"label": "B", "text": "Propofol", "correct": false}, {"label": "C", "text": "Thiopentone sodium", "correct": false}, {"label": "D", "text": "Midazolam", "correct": false}], "correct_answer": "A. Ketamine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vitamin deficiency leads to Laryngismus stridulus?", "options": [{"label": "A", "text": "Vitamin K", "correct": false}, {"label": "B", "text": "Vitamin E", "correct": false}, {"label": "C", "text": "Vitamin D", "correct": true}, {"label": "D", "text": "Vitamin A", "correct": false}], "correct_answer": "C. Vitamin D", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Hypocalcemia (rickets, hypoparathyroidism)</li>\n<li>GERD</li>\n<li>Viral infections</li>\n<li>Allergies</li>\n<li>Stress/emotions</li>\n<li>Cold air, smoke</li>\n<li>Rare: neurological issues</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Sudden stridor</li>\n<li>Breath-holding</li>\n<li>Cough/choke</li>\n<li>Cyanosis</li>\n<li>Anxiety</li>\n<li>Normal between attacks</li>\n<li>No fever (unless infection)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Serum calcium, phosphate, vitamin D</li>\n<li>Chest X-ray</li>\n<li>Laryngoscopy (if needed)</li>\n<li>pH <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> (for GERD)</li>\n<li>Allergy tests</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li><strong>Acute:</strong></li>\n<li>Calm child</li>\n<li>Humidified air</li>\n<li>Oxygen if needed</li>\n<li>Upright position</li>\n<li><strong>Underlying cause:</strong></li>\n<li>Correct calcium/vitamin D</li>\n<li>Treat GERD</li>\n<li>Avoid allergens</li>\n<li>Supportive care for infections</li>\n<li>Psychological support</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Adequate <span class=\"customMeta\" data-dictid=\"05bef24e711692777193a154b462b4\">nutrition</span> (vitamin D, calcium)</li>\n<li>Manage triggers</li>\n<li>Parental education</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following manifestations is associated with Vitamin A deficiency?", "options": [{"label": "A", "text": "Vogt's striae", "correct": false}, {"label": "B", "text": "Bitot's spots", "correct": true}, {"label": "C", "text": "Arlt's line", "correct": false}, {"label": "D", "text": "Horner's dots", "correct": false}], "correct_answer": "B. Bitot's spots", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ImVnuRGyewKLVNHwXhKw1747374436.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:476px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>XN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Night blindness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X1A: Conjunctival xerosis.</li>\n<li>X1B: Bitot spots.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal xerosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X3A: Corneal ulceration, less than one-third.</li>\n<li>X3B: Corneal ulceration, more than one-third.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>XS</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal scar.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>XF</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Xerophthalmic fundus.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the staging system used for Juvenile Nasopharyngeal Angiofibroma?", "options": [{"label": "A", "text": "Radkowski’s", "correct": true}, {"label": "B", "text": "TNM Staging", "correct": false}, {"label": "C", "text": "Ann Arbor Staging System", "correct": false}, {"label": "D", "text": "Dukes criteria", "correct": false}], "correct_answer": "A. Radkowski’s", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement limited to the nose or naso-pharynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extension into one or more sinuses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal extension into <span class=\"customMeta\" data-dictid=\"e10a7d508b16927771960a2f2fa92a\">pterygopalatine</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occupies the entire <span class=\"customMeta\" data-dictid=\"e10a7d508b16927771960a2f2fa92a\">pterygopalatine</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> with or without <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> арех</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of the <span class=\"customMeta\" data-dictid=\"5b1134ed2e169277719040dbf157ba\">infratemporal</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> with or without extension to the cheek or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>III A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erosion of the skull base (the middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa/base of the pterygoids), minimal <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>III B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erosion of the skull base, extensive <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension with or without <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> invasion</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following substances is used in a tube for collecting blood samples specifically for measuring alcohol concentration?", "options": [{"label": "A", "text": "Heparin + EDTA", "correct": false}, {"label": "B", "text": "Sodium fluoride + Potassium dichromate", "correct": true}, {"label": "C", "text": "Heparin", "correct": false}, {"label": "D", "text": "Sodium citrate", "correct": false}], "correct_answer": "B. Sodium fluoride + Potassium dichromate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pjF0ILKl7UCYfw2ZSRMw1747374536.png", "https://image.prepladder.com/content/N52DZRKQ05WLrdsHR1vI1747374545.png", "https://image.prepladder.com/content/h47yUky2eRdQaP7OxB9z1747374550.png", "https://image.prepladder.com/content/eP3JwtDAYx3xS7M4JtPU1747374571.png", "https://image.prepladder.com/content/bIyz3KSwMVxOItdgk53V1747374580.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:763px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Blood Collection Tubes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tube Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Additives &amp; Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Applications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coagulation Tube</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gene Hobbs \" data-hash=\"\" data-license=\"https://en.wikipedia.org/wiki/Partial_thromboplastin_time\tCC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Partial_thromboplastin_time\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/pjF0ILKl7UCYfw2ZSRMw1747374536.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sodium citrate</strong> binds <strong>calcium (Factor IV) </strong>to prevent clotting; <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> reversed by adding calcium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used for <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> studies.</li>\n<li>Must be filled completely.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Tube</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"AfroBrazilian\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Blood_collection_tube_(1_kind).jpg\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/N52DZRKQ05WLrdsHR1vI1747374545.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Glass/silica </strong>activates <strong>clotting (Factor XII)</strong>.</li>\n<li>Some include <span class=\"customMeta\" data-dictid=\"b0bdc3a1d416927771884d50c944ec\">gel</span> separators to prevent <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> contamination.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used for clinical chemistry, immunology, and serology.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Heparin Tube</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"350\" src=\"https://image.prepladder.com/content/h47yUky2eRdQaP7OxB9z1747374550.png\" width=\"350\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sodium/lithium <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">heparin</span> </strong>inhibits <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> and Factor Xa to prevent clotting.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common in biochemical tests.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>EDTA Tube</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Whispyhistory,\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:EDTA_(chelator_-_anticoagulant)_for_full_blood_count.jpg\" data-tags=\"\" height=\"100\" src=\"https://image.prepladder.com/content/eP3JwtDAYx3xS7M4JtPU1747374571.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>EDTA chelates <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> </strong>irreversibly, preventing clotting.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Preferred for hematology.</li>\n<li>Stable for <span class=\"customMeta\" data-dictid=\"11d4157da4169277718762144a4fe7\">enzymatic</span> studies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Glycolytic Inhibitor Tube</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Whispyhistory\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Grey_vacutainer.jpg\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/bIyz3KSwMVxOItdgk53V1747374580.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sodium fluoride</strong> inhibits glycolysis; may also include <strong>citrate, oxalate, or EDTA</strong> to prevent clotting.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used to measure <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> levels.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old patient presents with pellagra-like skin eruptions during the spring season for the past 5 years. Laboratory tests reveal normal levels of 5-Hydroxyindoleacetic Acid (HIAA), high aminoaciduria, and normal urinary indole levels. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Carcinoid tumor", "correct": false}, {"label": "B", "text": "Nutritional pellagra", "correct": false}, {"label": "C", "text": "Hartnup disorder", "correct": true}, {"label": "D", "text": "Essential fructosuria", "correct": false}], "correct_answer": "C. Hartnup disorder", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Autosomal recessive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mutation in SLC6A19 gene; Impaired transport of neutral <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids across intestinal and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> <span class=\"customMeta\" data-dictid=\"da5d70d6c016927771839e073ce917\">brush border</span> epithelium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Photosensitivity</li>\n<li>Pellagra-like <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> (Decreased <span class=\"customMeta\" data-dictid=\"acad87464816927771937783e41318\">Niacin</span> due to <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> deficiency)</li>\n<li>Neurologic symptoms (ataxia, emotional instability) - Decreased <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> due to <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> deficiency</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Biochemical defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deficiency of <span class=\"customMeta\" data-dictid=\"5eb9769383169277719347453a36cc\">nicotinamide</span> synthesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Aminoaciduria (neutral <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids) in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and plasma</li>\n<li>Demonstrate SLC6A19 defect</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Administration of nicotinamide/nicotinic acid</li>\n<li>Protection from sunlight</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are symptoms of Gradenigo syndrome?", "options": [{"label": "A", "text": "Ear discharge, retro-orbital pain, and diplopia", "correct": true}, {"label": "B", "text": "Nasal discharge, retro-orbital pain, and diplopia", "correct": false}, {"label": "C", "text": "Ear discharge, retro-orbital pain, and headache", "correct": false}, {"label": "D", "text": "Retro-orbital pain, Diplopia, and hearing loss", "correct": false}], "correct_answer": "A. Ear discharge, retro-orbital pain, and diplopia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following post-translational modifications is common to collagen, hemoglobin, and immunoglobulins?", "options": [{"label": "A", "text": "Hydroxylation", "correct": false}, {"label": "B", "text": "Subunit aggregation", "correct": true}, {"label": "C", "text": "Poly A tail addition", "correct": false}, {"label": "D", "text": "DNA mismatch repair", "correct": false}], "correct_answer": "B. Subunit aggregation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which structure does the anterior ethmoidal sinus drain into?", "options": [{"label": "A", "text": "Middle meatus", "correct": true}, {"label": "B", "text": "Inferior meatus", "correct": false}, {"label": "C", "text": "Superior meatus", "correct": false}, {"label": "D", "text": "Sphenoethmoidal recess", "correct": false}], "correct_answer": "A. Middle meatus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Air-filled cavities within the <strong>ethmoid bone</strong></li>\n<li>Part of the <strong>ethmoidal sinus</strong> system</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Between the <strong>nasal cavity</strong> and the <strong>orbit</strong></li>\n<li>Anterior group of <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> air cells (compared to middle/posterior groups)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Drainage Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>Drains into the <strong>middle meatus</strong> of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> via the <strong>infundibulum</strong> and <strong>hiatus semilunaris</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Innervation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>Supplied by the <strong>anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> nerve</strong>, a branch of the <strong>nasociliary nerve</strong> (from CN V1 – <span class=\"customMeta\" data-dictid=\"c09776e61f1692777194db295c590f\">ophthalmic</span> division)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Blood Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (branch of <strong>ophthalmic artery</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Clinical Relevance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Can be involved in <strong>sinusitis</strong> (especially if <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> is blocked)</li>\n<li>Close to <strong>orbit</strong> and <strong>anterior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong> — risk of <strong>orbital cellulitis</strong> or <strong>intracranial spread</strong> if infected</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man with a history of chronic alcoholism presents with skin lesions. His diet primarily consists of polished rice. Based on his symptoms and dietary history, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Phrynoderma", "correct": false}, {"label": "B", "text": "Beriberi", "correct": true}, {"label": "C", "text": "Psoriasis", "correct": false}, {"label": "D", "text": "Eczema", "correct": false}], "correct_answer": "B. Beriberi", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gastric lavage is contraindicated in which of the following poisonings?", "options": [{"label": "A", "text": "Strychnine", "correct": false}, {"label": "B", "text": "Paraldehyde", "correct": false}, {"label": "C", "text": "Hydrocarbons", "correct": true}, {"label": "D", "text": "Iron tablets", "correct": false}], "correct_answer": "C. Hydrocarbons", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VzTlorMGQ06ZTqpXpq021747374939.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient Positioning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trendelenburg: Head down to prevent aspiration</p>\n<p>Left <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> decubitus: Reduces chance of <span class=\"customMeta\" data-dictid=\"b437be3f051692777196d06a1fa93d\">poison</span> entering the duodenum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tube Placement Confirmation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inject air and listen for <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> bubbling sounds</p>\n<p>Watch for coughing or bubbles (indicates misplacement in trachea)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid Administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluid is administered and aspirated using a <span class=\"customMeta\" data-dictid=\"29863704261692777199d30fdfa6fa\">syringe</span> attached to the tube</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid Selection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tap water for most cases</p>\n<p>Normal <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> for infants</p>\n<p>Specific solutions (e.g., <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> permanganate) may be used for certain poisons</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Residual Fluid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leave a small amount of fluid to <span class=\"customMeta\" data-dictid=\"9c60f7b6b81692777193976e7f1d8e\">neutralize</span> remaining poison</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspiration </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs in ~10% of cases. Risk of lung injury</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal/Gastric Perforation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be life-threatening</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tube Misplacement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Misplaced into trachea, causing complications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bleeding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can occur with improper technique or pathology</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Alternative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Induce <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> in conscious patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dilution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large water <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> to <span class=\"customMeta\" data-dictid=\"e63a499e5716927771860681cef17d\">dilute</span> <span class=\"customMeta\" data-dictid=\"16a98a214c16927771852d7f6c344e\">corrosive</span> substances</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic/Surgical Removal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for toxic foreign bodies or drug packets</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common organ involved in seat-belt injury is?", "options": [{"label": "A", "text": "Spleen", "correct": false}, {"label": "B", "text": "Liver", "correct": false}, {"label": "C", "text": "Pancreas", "correct": false}, {"label": "D", "text": "Hollow viscus", "correct": true}], "correct_answer": "D. Hollow viscus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Cv7cw4sSO4DGgWLVPzYp1747375002.png", "https://image.prepladder.com/content/HHHpNNJVJE9NfxdPvguP1747375014.png", "https://image.prepladder.com/content/GD5ZBCAOHaV4Ikeb94QA1747375038.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patterned <span class=\"customMeta\" data-dictid=\"87fe0f103316927771851931d55a3a\">contusion</span> </strong>(known as<strong> Seat belt sign</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Drivers:</strong> starts from the right shoulder</li>\n<li><strong>Passengers: </strong>starts from the left shoulder</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Byard, Roger.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/The-neck-and-upper-torso-of-an-89-year-old-man-who-was-a-driver-in-a-fatal-vehicle-crash_fig1_355354627\" data-tags=\"\" height=\"356\" src=\"https://image.prepladder.com/content/HHHpNNJVJE9NfxdPvguP1747375014.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intra-abdominal </strong>(deceleration- compression)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Mesentery - most commonly affected </strong><strong>(Option D)</strong></li>\n<li>Small intestine: DJ <span class=\"customMeta\" data-dictid=\"13e47cfa68169277720299cd54beb4\">flexure</span> (primary),Ileocaecal <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> (secondary)</li>\n<li>Liver, Spleen, Pancreas<strong>(Option A, B and C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertebral injuries </strong>(distraction- compression)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Distraction(separation of joint):</strong> seen on <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> side</li>\n<li><strong>Compression: </strong>seen on <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> side</li>\n<li><strong>Chance fracture: </strong>fracture involving all 3 columns of spine</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\" James Heilman, MD\"' data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Chance_fracture\" data-tags=\"\" height=\"453\" src=\"https://image.prepladder.com/content/GD5ZBCAOHaV4Ikeb94QA1747375038.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Seat belt syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seat belt sign + <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> injuries + vertebral injuries</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents to the OPD with painful genital ulcers along with painful bubos. And he had a history of multiple sexual partners. Which of the following is the diagnosis?", "options": [{"label": "A", "text": "Chancroid", "correct": true}, {"label": "B", "text": "Donovanosis", "correct": false}, {"label": "C", "text": "Herpes genitalis", "correct": false}, {"label": "D", "text": "Chancre", "correct": false}], "correct_answer": "A. Chancroid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KNH8uSEt77yJ9HzatDVL1747209828.png", "https://image.prepladder.com/content/4OmAuSlyMV4irBZtyaTK1747209828.png", "https://image.prepladder.com/content/utxfnYlGvV97e1QlE8wJ1747209828.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ulcer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lymph Node</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Syphilis - <span class=\"customMeta\" data-dictid=\"9831f4be811692777200e41d827a02\">treponema</span> Pallidum</strong></p>\n<p><strong>(Option D) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> called a <strong>chancre</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-tender and rubbery in consistency.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Donovanosis- Klebsiella granulomatis</strong></p>\n<p><strong>(Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless, beefy red ulcers known as <strong>granulomas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pseudo-bubo </strong>(enlarged and tender but occurs due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and not infection)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Vanessa Ngan\" data-hash=\"\" data-license=\"NA\" data-source=\"https://dermnetnz.org/topics/granuloma-inguinale\" data-tags=\"\" height=\"324\" src=\"https://image.prepladder.com/content/KNH8uSEt77yJ9HzatDVL1747209828.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Herpes Simplex</strong></p>\n<p><strong>(Option C) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grouped vesicles or shallow erosions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple, enlarged and inflamed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Landon Jones, MD; and Richard M. Cantor, MD, FAAP, FACEP\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.acepnow.com/article/in-neonates-with-herpes-how-often-does-mom-have-genital-herpes/\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/4OmAuSlyMV4irBZtyaTK1747209828.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphogranuloma Venerum</p>\n<p>(Chlamydia)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Solitary and painless.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Swollen, inflamed, and <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes containing <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> material.</li>\n<li>Palpable <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> or <span class=\"customMeta\" data-dictid=\"27efa994461692777203a9c1696153\">furrow</span> that may be felt in the inguinal region due to the <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> and <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes. <strong>(Groove of Greenlat)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NAHerbert L. Fred, MD and Hendrik A. van Dijk \" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/Lymphogranuloma_venereum#/media/File:Lymphogranuloma_venerum_-_lymph_nodes.jpg\" data-tags=\"\" height=\"341\" src=\"https://image.prepladder.com/content/utxfnYlGvV97e1QlE8wJ1747209828.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy is brought to the pediatric clinic by his parents with complaints of multiple soft, pedunculated masses scattered across his torso and limbs. The parents mention that the child has recently developed some difficulty in reading and learning. Upon examination, the child has hyperpigmented macules with irregular borders on his back, and the ocular exam shows the findings below. What is the most likely diagnosis for this child?", "options": [{"label": "A", "text": "NF2", "correct": false}, {"label": "B", "text": "TSC1", "correct": false}, {"label": "C", "text": "TSC2", "correct": false}, {"label": "D", "text": "NF1", "correct": true}], "correct_answer": "D. NF1", "question_images": ["https://image.prepladder.com/content/qop2EBGROhcdkLwHEY0E1747380654.png"], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:372px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Café-au-lait macules (CALMs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;5 mm in prepubertal, &gt;15 mm in postpubertal.</p>\n<p><strong>6 or more</strong> needed for diagnosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Axillary/Inguinal Freckling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple hyperpigmented areas, 2-3 mm in diameter.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iris Lisch Nodules</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hamartomas in the iris, best seen with a slit-lamp.</p>\n<p><strong>2 or more</strong> needed for diagnosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurofibromas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two or more neurofibromas or one <span class=\"customMeta\" data-dictid=\"946db798c6169277719544d7b31041\">plexiform</span> neurofibroma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osseous Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sphenoid <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> or <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> thinning of long bones.</p>\n<p>Congenital <span class=\"customMeta\" data-dictid=\"81a01e0ea11692777196de7cd2dfe5\">pseudarthrosis</span> of the tibia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Gliomas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CNS tumor affecting the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Family History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First-degree relative with an NF1 diagnosis based on these criteria.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Unknown substance consumption leading to tachycardia and red-colored halo is seen with?", "options": [{"label": "A", "text": "Cannabis", "correct": false}, {"label": "B", "text": "Crack/ cocaine", "correct": false}, {"label": "C", "text": "LSD", "correct": true}, {"label": "D", "text": "Heroin", "correct": false}], "correct_answer": "C. LSD", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Bubo is seen in which of the following conditions?", "options": [{"label": "A", "text": "LGV", "correct": true}, {"label": "B", "text": "Herpes", "correct": false}, {"label": "C", "text": "Syphilis", "correct": false}, {"label": "D", "text": "Donovanosis", "correct": false}], "correct_answer": "A. LGV", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KRKhjXf40Xwrv0w5Pcic1747380712.png", "https://image.prepladder.com/content/6U1NsfPAU4dfyMtid8le1747380726.png", "https://image.prepladder.com/content/nc91SEEhi5irwGXEDFJe1747380763.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Secondary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tertiary</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3-30 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Days-weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Years after a chronic, untreated infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small papule/pustule/<br/>\n<strong>Non-indurated ulcer</strong> at the site of <span class=\"customMeta\" data-dictid=\"4d839b33ba16927771902944bde5b4\">inoculation</span> which <strong>heals spontaneously</strong> with <strong>no scarring.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lymphatic involvement of nodes that drain the primary lesion.</li>\n<li>Classic form: <strong>Tender</strong> <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> inguinal and/or <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"870b3521e21692777180ed5afdaf8b\">adenopathy</span> <strong>(Groove sign of Greenblatt).</strong></li>\n<li>The <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes may coalesce to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> a <strong>bubo </strong>or abscesses that may <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> spontaneously with the development of<br/>\n\t\t\t\tFistulae or <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tracts.</li>\n<li>There may be <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> features such as <span class=\"customMeta\" data-dictid=\"851667fa1916927771918db28ab877\">malaise</span> and fever.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphatic <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> due to <span class=\"customMeta\" data-dictid=\"e025d338b21692777184b4a309cbfb\">chronic inflammation</span> leads to <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> formation, strictures, and disfiguring conditions such as <strong>genital elephantiasis</strong> and <strong>esthiomene</strong>, which refers to <strong>hypertrophic <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> with <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> of the external genitalia.</strong></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ulcer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lymph Node</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Syphilis - <span class=\"customMeta\" data-dictid=\"9831f4be811692777200e41d827a02\">treponema</span> Pallidum</strong></p>\n<p><strong>(Option C) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> called a <strong>chancre</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-tender and rubbery in consistency.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Donovanosis- Klebsiella granulomatis</strong></p>\n<p><strong>(Option D) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless, beefy red ulcers known as <strong>granulomas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pseudo-bubo </strong>(enlarged and tender but occurs due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and not infection)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Vanessa Ngan\" data-hash=\"\" data-license=\"NA\" data-source=\"https://dermnetnz.org/topics/granuloma-inguinale\" data-tags=\"\" height=\"390\" src=\"https://image.prepladder.com/content/KRKhjXf40Xwrv0w5Pcic1747380712.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Herpes Simplex</strong></p>\n<p><strong>(Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grouped vesicles or shallow erosions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple, enlarged and inflamed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Landon Jones, MD; and Richard M. Cantor, MD, FAAP, FACEP\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.acepnow.com/article/in-neonates-with-herpes-how-often-does-mom-have-genital-herpes/\" data-tags=\"\" height=\"289\" src=\"https://image.prepladder.com/content/6U1NsfPAU4dfyMtid8le1747380726.png\" width=\"426\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphogranuloma Venerum</p>\n<p>(Chlamydia)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Solitary and painless.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Swollen, inflamed, and <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes containing <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> material.</li>\n<li>Palpable <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> or <span class=\"customMeta\" data-dictid=\"27efa994461692777203a9c1696153\">furrow</span> that may be felt in the inguinal region due to the <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> and <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes. <strong>(Groove of Greenlat)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NAHerbert L. Fred, MD and Hendrik A. van Dijk \" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://en.wikipedia.org/wiki/Lymphogranuloma_venereum#/media/File:Lymphogranuloma_venerum_-_lymph_nodes.jpg\" data-tags=\"\" height=\"343\" src=\"https://image.prepladder.com/content/nc91SEEhi5irwGXEDFJe1747380763.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most common organ injuries in air blast shock waves will be?", "options": [{"label": "A", "text": "Intestine", "correct": false}, {"label": "B", "text": "Lungs", "correct": true}, {"label": "C", "text": "Kidney", "correct": false}, {"label": "D", "text": "Heart", "correct": false}], "correct_answer": "B. Lungs", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Air Blast Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Underwater Blast Injuries</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most commonly injured:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tympanic <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (ear) - <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">Rupture</span> and <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> damage are common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tympanic <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (ear) - More likely to occur when the head is submerged.</li>\n<li>Gastrointestinal <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> - When the head is not submerged.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most severely injured:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lungs - Blast lung injury is a common cause of delayed mortality and can cause <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> contusion, air embolism, and other damage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastrointestinal <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> - Underwater blasts can cause more severe GI injuries due to pressure effects on <span class=\"customMeta\" data-dictid=\"3f9a320e1a169277718983ee3d1860\">hollow</span> organs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures is responsible for balance and hearing?", "options": [{"label": "A", "text": "Semicircular canal", "correct": false}, {"label": "B", "text": "Cochlea", "correct": false}, {"label": "C", "text": "Vestibule", "correct": true}, {"label": "D", "text": "Organ of Corti", "correct": false}], "correct_answer": "C. Vestibule", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The condition shown in the image below is seen in which vitamin deficiency?", "options": [{"label": "A", "text": "Pyridoxine", "correct": false}, {"label": "B", "text": "Cobalamin", "correct": false}, {"label": "C", "text": "Niacin", "correct": true}, {"label": "D", "text": "Riboflavin", "correct": false}], "correct_answer": "C. Niacin", "question_images": ["https://image.prepladder.com/content/3krWcVWq3hhH6kIrMW5r1747214536.png"], "explanation_images": ["https://image.prepladder.com/content/97V4PvYkzb5zHRCTscfy1747214576.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A fracture has occurred at the cribriform plate area of the ethmoid bone. The patient can present with which symptom?", "options": [{"label": "A", "text": "Hearing loss", "correct": false}, {"label": "B", "text": "Visual loss", "correct": false}, {"label": "C", "text": "CSF Rhinorrhoea", "correct": true}, {"label": "D", "text": "Diplopia", "correct": false}], "correct_answer": "C. CSF Rhinorrhoea", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temporal bone fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cribriform plate(most common)</strong></li>\n<li>Roof of <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> air cells</li>\n<li>Frontal sinus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphenoid sinus(following trauma)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CSF reaches the middle ear, escaping through the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube into the nose(CSF otorhinorrhea)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following courts has the authority to commute a death sentence?", "options": [{"label": "A", "text": "Session court", "correct": false}, {"label": "B", "text": "Additional session court", "correct": false}, {"label": "C", "text": "High court", "correct": true}, {"label": "D", "text": "Session court and additional session court", "correct": false}], "correct_answer": "C. High court", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/snnepBKcbqFPdqHfdwgp1747375082.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Court/Judge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Maximum Imprisonment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Maximum Fine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>1 (Highest)</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Supreme Court</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Any period, including death sentence</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Any amount</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>High Court</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Any period, including death sentence</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Any amount</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>District and Sessions Court <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Any period, including death sentence (needs confirmation by High Court)</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Any amount</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Assistant Sessions Judge <strong>(Option A and B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Up to 10 years</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Any amount</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Chief Judicial/Chief Metropolitan Magistrate</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Up to 7 years</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Any amount</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>First Class Judicial/Metropolitan Magistrate</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Up to 3 years</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Up to ₹ 10,000</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>7 (Lowest)</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Second Class Judicial Magistrate</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Up to 1 year</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Up to ₹ 5,000</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with progressive hearing loss that has been worsening over the past few years. Audiometry confirms conductive hearing loss, and a diagnosis of otosclerosis is made. What is the surgical treatment of choice for her condition?", "options": [{"label": "A", "text": "Stapedectomy with the placement of a prosthesis", "correct": true}, {"label": "B", "text": "Stapedotomy", "correct": false}, {"label": "C", "text": "Stapes mobilization", "correct": false}, {"label": "D", "text": "Lemperts Fenestration operation", "correct": false}], "correct_answer": "A. Stapedectomy with the placement of a prosthesis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small opening made in the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> footplate; a <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> is inserted.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> rates; preferred by many otologists.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete removal of the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> bone; replaced with a <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> device.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of complications.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old pregnant female presents to the emergency department with a BP of 220/120mm Hg, along with headache, seizure, and blurred vision. Which of the following is the preferred intravenous medication for the management of hypertension in pregnancy?", "options": [{"label": "A", "text": "IV Labetalol", "correct": true}, {"label": "B", "text": "IV nitroglycerine", "correct": false}, {"label": "C", "text": "IV hydralazine", "correct": false}, {"label": "D", "text": "IV sodium nitroprusside", "correct": false}], "correct_answer": "A. IV Labetalol", "question_images": [], "explanation_images": [], "explanation": "\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Beta-blockers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Labetalol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preferred. Generally safe and effective</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calcium channel blockers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nifedipine</strong></p>\n<p><strong>Amlodipine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Safe, less BP <span class=\"customMeta\" data-dictid=\"128186f064169277720116e786798a\">variability</span> compared to labetalol</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vasodilators</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hydralazine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reserved for cases with cardiac/renal dysfunction</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ACE inhibitors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Enalapril, Lisinopril</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated with severe <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> malformations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Angiotensin-receptor blockers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Losartan, Valsartan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not recommended at any point during pregnancy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "To perform MTP for a mentally challenged female, consent is obtained from?", "options": [{"label": "A", "text": "Husband/ partner", "correct": false}, {"label": "B", "text": "Legal guardian", "correct": true}, {"label": "C", "text": "Doctor", "correct": false}, {"label": "D", "text": "Magistrate", "correct": false}], "correct_answer": "B. Legal guardian", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug is used to test for Myasthenia Gravis?", "options": [{"label": "A", "text": "Pyridostigmine", "correct": false}, {"label": "B", "text": "Neostigmine", "correct": false}, {"label": "C", "text": "Edrophonium", "correct": true}, {"label": "D", "text": "Atropine", "correct": false}], "correct_answer": "C. Edrophonium", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PQaoPTtXdaKBrK5qYTe31747377620.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is punishable under the MTP Act?", "options": [{"label": "A", "text": "MTP done up to 24 weeks", "correct": false}, {"label": "B", "text": "Done by government-authorized center", "correct": false}, {"label": "C", "text": "Done by experienced RMP", "correct": false}, {"label": "D", "text": "Non-entry in MTP-register, not sending report to DDHS", "correct": true}], "correct_answer": "D. Non-entry in MTP-register, not sending report to DDHS", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug can be used to treat both HIV and Hepatitis B?", "options": [{"label": "A", "text": "Dolutegravir", "correct": false}, {"label": "B", "text": "Tenofovir", "correct": true}, {"label": "C", "text": "Zidovudine", "correct": false}, {"label": "D", "text": "Ritonavir", "correct": false}], "correct_answer": "B. Tenofovir", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tenofovir (Nucleotide <span class=\"customMeta\" data-dictid=\"22e0051a181692777181872183edb2\">analogue</span> RTI)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>No <span class=\"customMeta\" data-dictid=\"619ba5e99c16927771958308fb8687\">phosphorylation</span> is required (Option A)</strong></li>\n<li>Competitively inhibits <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> reverse transcriptase</li>\n<li>Incorporates into HIV DNA, causing chain <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">termination</span> (due to incomplete <span class=\"customMeta\" data-dictid=\"387285772b16927771979217d6cd30\">ribose</span> ring)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tenofovir disoproxil: short-acting, more side effects</li>\n<li>Tenofovir alafenamide: long-acting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>DOC for HIV</li>\n<li>DOC for Hepatitis B virus + HIV</li>\n<li>HIV pre-exposure <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> (in combination with emtricitabine)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nephrotoxic (Acute <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure)\n\t\t\t\t<ul>\n<li>Regular <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> and <span class=\"customMeta\" data-dictid=\"bfea0730ac16927771959eb551740f\">phosphorus</span> monitoring.</li>\n<li>Avoid with NSAIDs</li>\n</ul>\n</li>\n<li>Fanconi syndrome (causes damage to PCT of nephron)\n\t\t\t\t<ul>\n<li>Leads to <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> loss</li>\n<li>Hypophosphatemic rickets, osteoporosis</li>\n</ul>\n</li>\n<li>Hepatitis B <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> with abrupt discontinuation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contraindication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Renal disease (High creatinine)\n\t\t\t\t<ul>\n<li>Replace <span class=\"customMeta\" data-dictid=\"8ed4f962f416927772008ece0f551e\">tenofovir</span> with Zidovudine or Abacavir</li>\n</ul>\n</li>\n<li>Child &lt; 10 years</li>\n<li>Weight &lt; 30 kg</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is used in GERD?", "options": [{"label": "A", "text": "Ondansetron", "correct": false}, {"label": "B", "text": "Domperidone", "correct": true}, {"label": "C", "text": "Loperamide", "correct": false}, {"label": "D", "text": "Diphenoxylate", "correct": false}], "correct_answer": "B. Domperidone", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action (MOA) of Rivaroxaban?", "options": [{"label": "A", "text": "Inhibition of thrombin (Factor IIa)", "correct": false}, {"label": "B", "text": "Inhibition of Factor Xa", "correct": true}, {"label": "C", "text": "Activation of antithrombin III", "correct": false}, {"label": "D", "text": "Inhibition of platelet aggregation", "correct": false}], "correct_answer": "B. Inhibition of Factor Xa", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Direct <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">Thrombin</span> Inhibitors</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> (factor IIa) directly without cofactors.</p>\n<p><strong>(Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hirudin derivatives: </strong>Hirudin,<strong> Lepirudin.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-hirudin (Synthetic):</strong> Argatroban, Bivalirudin.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indirect <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">Thrombin</span> Inhibitors</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enhance <span class=\"customMeta\" data-dictid=\"fa202015a216927771814a0dc268ba\">antithrombin</span> III activity to <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> indirectly.</p>\n<p><strong>(Option C)</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Unfractionated Heparin: Heparin</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low Molecular Weight Heparin (LMWH):</strong> <strong>Enoxaparin,</strong> Dalteparin, Tinzaparin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultra Low Molecular Weight Heparin (ULMWH):</strong> <strong>Fondaparinux,</strong> Idraparinux, Danaparoid (not commonly used)</p>\n</td>\n</tr>\n</tbody>\n\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Direct Factor Xa Inhibitors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit Factor Xa directly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Apixaban,</strong> Rivaroxaban, Edoxaban, Betrixaban</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prophylaxis of <strong>venous thromboembolism</strong> following knee or hip replacement surgery.</li>\n<li>Prophylaxis of <strong>stroke</strong> in patients with <strong>atrial fibrillation.</strong></li>\n<li><strong>Treatment of deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</strong> and<strong> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages of novel anticoagulants over warfarin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid onset and offset of action.</li>\n<li>No need for routine laboratory monitoring.</li>\n<li>Lower risk of bleeding.</li>\n<li>Fewer drug interactions.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the half-life of lithium in adults?", "options": [{"label": "A", "text": "8 hours", "correct": false}, {"label": "B", "text": "12 hours", "correct": false}, {"label": "C", "text": "24 hours", "correct": true}, {"label": "D", "text": "48 hours", "correct": false}], "correct_answer": "C. 24 hours", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pharmacokinetics of Lithium</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Salt</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lithium <span class=\"customMeta\" data-dictid=\"fdae4d6e3a1692777183b5745d0c02\">carbonate</span> or citrate.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Route of administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral or IV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Half-life</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Healthy adults: <strong>24 hours.</strong></li>\n<li>Young:<strong> 12 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> in the young </strong></li>\n<li>Older:<strong> 36 hours in the elderly </strong>(or longer due to a <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> GFR).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is not metabolized in the body; it remains unchanged in the system.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Excretion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excreted unchanged in all body secretions</p>\n<ul>\n<li>Maximum in the urine</li>\n<li>Sweat, <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> and breast milk</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the preferred treatment for Plasmodium falciparum malaria?", "options": [{"label": "A", "text": "Chloroquine", "correct": false}, {"label": "B", "text": "Artemisinin-based combination therapy (ACT)", "correct": true}, {"label": "C", "text": "Primaquine", "correct": false}, {"label": "D", "text": "Doxycycline", "correct": false}], "correct_answer": "B. Artemisinin-based combination therapy (ACT)", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Plasmodium vivax or ovale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Plasmodium falciparum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mixed infection </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chloroquine + Primaquine</strong></p>\n<ul>\n<li>Chloroquine 25 mg for 3 days as 10 mg/kg on day 1, 10 mg/kg on day 2 and 5 mg/kg on day 3.</li>\n<li>Primaquine 0.25 mg/kg body wt for 14 days</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primaquine + ACT</strong></p>\n<ul>\n<li><strong>ACT (Artemisinin-based combination therapy):</strong>\n<ul>\n<li><strong>All Indian states (except northeastern):</strong> Artesunate (4 mg/kg body weight) + <span class=\"customMeta\" data-dictid=\"de9710a9f1169277719972667f51f1\">sulfadoxine</span> (25 mg/kg body weight) or <span class=\"customMeta\" data-dictid=\"1ddf70d55216927771960074a8225c\">pyrimethamine</span> (1.25 mg/kg body weight)</li>\n<li><strong>Northeastern states:</strong> Artemether (20 mg) + Lumefantrine (120 mg)</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ACT+ Primaquine 0.25 mg per kg body weight daily for 14 days</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the drug of choice (DOC) for treating morning sickness in pregnant women?", "options": [{"label": "A", "text": "Pyridoxine (Vitamin B6)", "correct": true}, {"label": "B", "text": "Domperidone", "correct": false}, {"label": "C", "text": "Ondansetron", "correct": false}, {"label": "D", "text": "Metoclopramide", "correct": false}], "correct_answer": "A. Pyridoxine (Vitamin B6)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures contain Ostmann fat pad?", "options": [{"label": "A", "text": "Ear lobule", "correct": false}, {"label": "B", "text": "Tip of nose", "correct": false}, {"label": "C", "text": "Eustachian tube", "correct": true}, {"label": "D", "text": "Buccal mucosa", "correct": false}], "correct_answer": "C. Eustachian tube", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with low mood, no mood to eat, always sleeping, and low energy presented to you with such symptoms for 2 months. She had similar symptoms 5 months ago, which subsided with medications. Identify the disorder.", "options": [{"label": "A", "text": "Depression", "correct": false}, {"label": "B", "text": "Recurrent depressive disorder", "correct": true}, {"label": "C", "text": "Dysthymia", "correct": false}, {"label": "D", "text": "Cyclothymia", "correct": false}], "correct_answer": "B. Recurrent depressive disorder", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disorder </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Duration for diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Brief <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> disorder</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1 Day - 1 Month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. Schizophreniform disorder</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 6 Months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. Schizophrenia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 6 Months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. Schizoaffective disorder</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 14 Days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5. Delusional disorder</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 1 Month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6. Depression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">2 Weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7. Persistent depressive disorder/ Cyclothymia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">2 Years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8. Bipolar disorder/ Mania</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1 Week</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9. Hypomania</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">4 Days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10. Obsessive-compulsive disorder (OCD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">2 Weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>11. Panic disorder</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1 Month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12. Generalised anxiety disorder (GAD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">6 Months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13. Phobia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">6 Months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>14. Acute stress disorder</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 1 Month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15. Post-traumatic stress disorder (PTSD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 1 Month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>16. Adjustment disorder</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 6 Months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>17. Attention deficit <span class=\"customMeta\" data-dictid=\"2e780c7fd416927771895c61217c12\">hyperactivity</span> disorder (ADHD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">&gt; 6 Months in 2 settings before 12 years</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a defence mechanism?", "options": [{"label": "A", "text": "Sublimation", "correct": false}, {"label": "B", "text": "Displacement", "correct": false}, {"label": "C", "text": "Replacement", "correct": true}, {"label": "D", "text": "Altruism", "correct": false}], "correct_answer": "C. Replacement", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/S5VeEsBUGvuqxK6iUCaZ1747216072.png", "https://image.prepladder.com/content/BjGhd9JfeIjHbp8XpHzq1747216160.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Narcissistic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Immature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Neurotic defences</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mature defences</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Projection</li>\n<li>Denial</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blocking</li>\n<li>Acting out</li>\n<li>Regression</li>\n<li>Introjection</li>\n<li>Projective identification</li>\n<li>Passive aggressive</li>\n<li>Somatisation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inhibition</li>\n<li>Intellectualisation</li>\n<li>Isolation of affect</li>\n<li>Displacement <strong>(Option B ruled out)</strong></li>\n<li>Dissociation</li>\n<li>Undoing</li>\n<li>Rationalisation</li>\n<li>Reaction formation</li>\n<li>Repression</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Altruism <strong>(Option D ruled out)</strong></li>\n<li>Anticipation</li>\n<li>Asceticism</li>\n<li>Sublimation <strong>(Option A ruled out)</strong></li>\n<li>Suppression</li>\n<li>Humor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Id</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Instinctive drives.</li>\n<li>Based on the <span class=\"customMeta\" data-dictid=\"70f7380ba21692777195b6db6ab9ca\">pleasure principle</span> (immediate gratification).</li>\n<li>Operates under primary processes.</li>\n<li>Lies in the <span class=\"customMeta\" data-dictid=\"6d87fbc02c16927772014ec4cead53\">unconscious</span> mind.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ego</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The executive organ of the mind.</li>\n<li>Maintains balance between <span class=\"customMeta\" data-dictid=\"e2ea69815816927771895dddb4390f\">Id</span> and Superego.</li>\n<li>Works on the reality principle.</li>\n<li>It lies in all three - conscious, preconscious, and <span class=\"customMeta\" data-dictid=\"6d87fbc02c16927772014ec4cead53\">unconscious</span> parts of the mind.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superego</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Moral compass insisting on socially acceptable behaviour.</li>\n<li>Develops after 5 years (after resolution of the oedipal complex).</li>\n<li>Predominantly present in the <span class=\"customMeta\" data-dictid=\"6d87fbc02c16927772014ec4cead53\">unconscious</span> part of the mind.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman with deafness presents for evaluation and is diagnosed with 50dB hearing loss. Which of the following structures is most likely responsible for this hearing loss?", "options": [{"label": "A", "text": "Ossicular fixation with an intact tympanic membrane", "correct": true}, {"label": "B", "text": "Ossicular fixation with a damaged tympanic membrane", "correct": false}, {"label": "C", "text": "Erosion with tympanic membrane injury", "correct": false}, {"label": "D", "text": "Erosion without tympanic membrane injury", "correct": false}], "correct_answer": "A. Ossicular fixation with an intact tympanic membrane", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xeIKTH9sXqcTByROdQEq1747372922.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was taking metronidazole for diarrhoea. He attended a party where he consumed alcohol. Following this, he developed red rashes, itching all over his body, and a headache. What is the most likely cause of his condition?", "options": [{"label": "A", "text": "Methanol poisoning", "correct": false}, {"label": "B", "text": "Disulfiram-like reaction", "correct": true}, {"label": "C", "text": "Cheese reaction", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Disulfiram-like reaction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SsbKFt0ONhmUMhnwPo151747384725.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with the curtain falling sign?", "options": [{"label": "A", "text": "Retinal detachment", "correct": true}, {"label": "B", "text": "Macular degeneration", "correct": false}, {"label": "C", "text": "Optic atrophy", "correct": false}, {"label": "D", "text": "Acute anterior uveitis", "correct": false}], "correct_answer": "A. Retinal detachment", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sdUvy10nqjS81sIkHTAe1747219467.png", "https://image.prepladder.com/content/xun1AuKyumQr79ogjNCM1747378890.png", "https://image.prepladder.com/content/4uZQp3gX4XvL4VgL7e5b1747378841.png", "https://image.prepladder.com/content/U4Yk2cEk9LHwy1MAqmQz1747219498.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> Detachment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rhegmatogenous <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> Detachment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Floaters </strong>(dark spots) due to rapid <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> degeneration.</li>\n<li><strong>Photopsia </strong>(flashes of light) caused by <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> from <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> movements.</li>\n<li>Gradual <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> loss, initially localized, progressing to total vision loss as <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> spreads.</li>\n<li><strong>Dark veil/Curtain falling sign/cloud in front of the eye</strong>, particularly when <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> reaches the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> region.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NYC Wanderer (Kevin Eng) \" data-hash=\"\" data-license=\"CC BY-SA 2.0\" data-source=\"https://en.wikipedia.org/wiki/Book#/media/File:Gutenberg_Bible,_Lenox_Copy,_New_York_Public_Library,_2009._Pic_01.jpg\" data-tags=\"\" height=\"255\" src=\"https://image.prepladder.com/content/sdUvy10nqjS81sIkHTAe1747219467.png\" width=\"367\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Sudden, painless vision loss in large, central detachment. </strong></li>\n<li>Retinal breaks may be round, horseshoe-shaped, slit-like, or large <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> dialysis.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Jesse Vislisel, MD\" data-hash=\"\" data-license=\"CC BY NC ND 3.0\" data-source=\"https://eyerounds.org/atlas/pages/rhegmatogenous-ret-detach.htm#gsc.tab=0\" data-tags=\"\" height=\"357\" src=\"https://image.prepladder.com/content/xun1AuKyumQr79ogjNCM1747378890.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li>Vitreous pigments (tobacco dusting or <strong>Shaffer sign</strong>) are seen in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> with <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> detachment.</li>\n<li>Old <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> shows <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> thinning, <span class=\"customMeta\" data-dictid=\"7c6ceacf801692777199b31cdb3fc6\">subretinal</span> <span class=\"customMeta\" data-dictid=\"6e26f8de1c1692777185d8f3885a0c\">demarcation</span> lines (high water marks), and secondary <span class=\"customMeta\" data-dictid=\"871f3dc691169277719044c0f27f98\">intraretinal</span> cysts.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tractional <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> Detachment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gradual, progressive visual loss</li>\n<li>Typically painless</li>\n<li>No associated flashes or floaters</li>\n<li><strong>Vitreoretinal bands present</strong></li>\n<li>No <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> breaks</li>\n<li>Detached area - <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> and localized</li>\n<li>No shifting fluid</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/4uZQp3gX4XvL4VgL7e5b1747378841.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exudative <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> Detachment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless and sudden or gradual visual loss</li>\n<li>No photopsia, holes/ tears, folds and undulations.</li>\n<li>Smooth and <span class=\"customMeta\" data-dictid=\"00ab88c6091692777185ea2685fa40\">convex</span> with <span class=\"customMeta\" data-dictid=\"45d1f54a631692777195670b446c7e\">pigmentary</span> disturbances</li>\n<li>Rounded and fixed with <span class=\"customMeta\" data-dictid=\"176e169d7a169277719341dbc83862\">neovascularization</span> on the tumor summit.</li>\n<li><strong>Shifting fluid </strong>- changing the position of the detached area with gravity - hallmark feature.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"Henry Zou Lauren Fletcher-Morehouse\"' data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Exudative-retinal-detachment-ERD-of-both-eyes-at-one-week-post-op_fig1_362643260\" data-tags=\"\" height=\"377\" src=\"https://image.prepladder.com/content/U4Yk2cEk9LHwy1MAqmQz1747219498.png\" width=\"377\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the normal conjunctival flora?", "options": [{"label": "A", "text": "Staph aureus", "correct": false}, {"label": "B", "text": "Staph Epidermidis", "correct": true}, {"label": "C", "text": "Strep. Pneumonia", "correct": false}, {"label": "D", "text": "H. influenzae", "correct": false}], "correct_answer": "B. Staph Epidermidis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KpvmEPKxClAfguJliSaG1747219727.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inflammation of inner structures of the eye (uveal tissue and retina) with exudates in the vitreous, anterior, and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> chambers. It spares sclera.</li>\n<li><strong>Acute bacterial <span class=\"customMeta\" data-dictid=\"d7e86ebfd9169277718767de545052\">endophthalmitis</span> happens 1-7 days post <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> surgery.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M/C <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Staphylococcus epidermidis (Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> pain</li>\n<li>Redness</li>\n<li>Lacrimation</li>\n<li>Photophobia</li>\n<li>Loss of vision</li>\n<li>Red and swollen lids</li>\n<li>Conjunctival chemosis</li>\n<li>Circumcorneal congestion</li>\n<li>Cloudy cornea</li>\n<li>Ring infiltration</li>\n<li>Yellow necrotic wound edges</li>\n<li>Hypopyon</li>\n<li>Oedematous and muddy iris</li>\n<li>Yellow <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> due to <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> exudation</li>\n<li>Vitreous <span class=\"customMeta\" data-dictid=\"1f6bbb967d16927771871c1894ea2e\">exudation</span> which causes amaurotic cat's-eye reflex</li>\n<li>Raised <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> pressure initially</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intravitreal antibiotics:\n\t\t\t\t<ul>\n<li>First choice: Vancomycin 1 mg + Ceftazidime 2.25 mg</li>\n<li>Second choice: Vancomycin 1 mg + Amikacin 0.4 mg</li>\n</ul>\n</li>\n<li>Topical antibiotics</li>\n<li>Systemic antibiotics</li>\n<li>Steroid Therapy</li>\n<li>Supportive Therapy</li>\n<li><strong>Vitrectomy - if no improvement in 48-72 hours or if severe infection with vision <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> to hand movements close to the face</strong></li>\n<li>If blind - no perception of light - Evisceration.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has sudden loss of vision and there is no fundus glow. There is no history of trauma, what could be the likely cause?", "options": [{"label": "A", "text": "Vitreous hemorrhage", "correct": true}, {"label": "B", "text": "Acute anterior uveitis", "correct": false}, {"label": "C", "text": "Optic neuritis", "correct": false}, {"label": "D", "text": "Acute congestive glaucoma", "correct": false}], "correct_answer": "A. Vitreous hemorrhage", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What diagnosis is suggested by having different refractive powers (+5D in one eye and +1D in the other eye)?", "options": [{"label": "A", "text": "Refractive errors", "correct": false}, {"label": "B", "text": "Amblyopia", "correct": false}, {"label": "C", "text": "Anisometropic amblyopia", "correct": true}, {"label": "D", "text": "Malingering", "correct": false}], "correct_answer": "C. Anisometropic amblyopia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Strabismic <span class=\"customMeta\" data-dictid=\"48ecf3114716927771818db0abb2a6\">Amblyopia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The brain suppresses input from one eye due to constant <span class=\"customMeta\" data-dictid=\"4d366430b5169277719914874d78a5\">squint</span> (strabismus).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common cause; underdevelopment of vision in the deviated eye.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stimulus Deprivation <span class=\"customMeta\" data-dictid=\"48ecf3114716927771818db0abb2a6\">Amblyopia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hindered vision due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> from early life (e.g., <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> cataracts, ptosis, dense central <strong>corneal opacity)</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lack of visual <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> affects normal development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anisometropic <span class=\"customMeta\" data-dictid=\"48ecf3114716927771818db0abb2a6\">Amblyopia</span> </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A significant difference in <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> error between eyes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The brain favours the <span class=\"customMeta\" data-dictid=\"55436411c216927771846e318f45ce\">clearer</span> eye, leading to <span class=\"customMeta\" data-dictid=\"48ecf3114716927771818db0abb2a6\">amblyopia</span> in the other.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ametropic Amblyopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High uncorrected <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> errors in both eyes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral; is less severe compared to other types.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meridional Amblyopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncorrected <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> affecting specific visual meridians.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects one or both eyes depending on the <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> degree.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient on antitubercular therapy (ATT) started experiencing visual problems. Which ATT drug is most likely responsible for this adverse effect?", "options": [{"label": "A", "text": "Rifampicin", "correct": false}, {"label": "B", "text": "Streptomycin", "correct": false}, {"label": "C", "text": "Ethambutol", "correct": true}, {"label": "D", "text": "Pyrazinamide", "correct": false}], "correct_answer": "C. Ethambutol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ethambutol</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits arabinosyl transferases involved in arabinogalactan synthesis, thereby <span class=\"customMeta\" data-dictid=\"653140d1dc16927771903445309f4e\">interfering</span> with mycolic acid <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> in cell wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutation of embAB genes, which encodes the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> arabinosyl transferase, reducing its <span class=\"customMeta\" data-dictid=\"227269f3ec1692777180d76a7898dd\">affinity</span> for ethambutol</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In the treatment of</p>\n<ul>\n<li>Mycobacterium tuberculosis</li>\n<li>Mycobacterium avium complex (MAC)</li>\n<li>Mycobacterium kansasii</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless loss of vision\n\t\t\t\t<ul>\n<li><strong>Field defects due to <span class=\"customMeta\" data-dictid=\"99ac6e31f71692777197220f87effc\">retrobulbar</span> <span class=\"customMeta\" data-dictid=\"6e951a16031692777193af1c351309\">neuritis</span> (Option C)</strong></li>\n<li>Loss of visual acuity</li>\n<li>Red-green colour blindness</li>\n</ul>\n</li>\n<li>Nausea, rashes, fever</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following do not represent the corrected refractive error?", "options": [{"label": "A", "text": "Myopia", "correct": false}, {"label": "B", "text": "Hyperopia", "correct": false}, {"label": "C", "text": "Presbyopia", "correct": true}, {"label": "D", "text": "Astigmatism", "correct": false}], "correct_answer": "C. Presbyopia", "question_images": ["https://image.prepladder.com/content/MK2ZYtOuwW3sNauDXfHk1747379027.png"], "explanation_images": ["https://image.prepladder.com/content/DPBSOYkagPpCSwY9xCtg1747379052.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Physiological <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> of <span class=\"customMeta\" data-dictid=\"c0682eacfc1692777180ad2c556c19\">accommodation</span> is typically associated with aging.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etio - Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age-related factors:</strong></p>\n<ul>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"d6c754309d16927771874142ec8ca4\">elasticity</span> of the lens capsule.</li>\n<li>Sclerosis of the lens.</li>\n<li>Possible decline in <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> muscle power.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Premature causes:</strong></p>\n<ul>\n<li>Uncorrected hypermetropia</li>\n<li>Chronic glaucoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Difficulty in near vision</li>\n<li>Asthenopic symptoms (eye fatigue)</li>\n<li>Intermittent diplopia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optical Treatment:</strong></p>\n<ul>\n<li>Convex <span class=\"customMeta\" data-dictid=\"9e8e9086691692777188b5a212bcc7\">glasses</span> based on age</li>\n<li>Correct <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> error for distance first</li>\n<li>Types of Glasses: Unifocal, bifocal, or progressive (varifocal).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacological therapy:1.25% Pilocarpine</strong>(FDA-approved)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical options:</strong></p>\n<ul>\n<li>Conductive keratoplasty</li>\n<li>LASIK (Monovision/presbyopic multifocal-LASIK)</li>\n<li>Corneal inlays</li>\n<li>Multifocal <span class=\"customMeta\" data-dictid=\"ffac6924ab16927771907dbb6fd7dd\">IOL</span> placement following lens extraction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old G2P2 requests immediate postpartum contraception after an uncomplicated vaginal delivery. She expresses interest in an intrauterine device (IUD). What is the recommended timeframe for safe postplacental IUD insertion?", "options": [{"label": "A", "text": "24 hours", "correct": false}, {"label": "B", "text": "48 hours", "correct": true}, {"label": "C", "text": "6 weeks", "correct": false}, {"label": "D", "text": "12 weeks", "correct": false}], "correct_answer": "B. 48 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-week pregnant woman presents with abdominal pain and vaginal bleeding. The uterus is tender. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Uterine rupture", "correct": false}, {"label": "B", "text": "Abruptio placenta", "correct": true}, {"label": "C", "text": "Vasa praevia", "correct": false}, {"label": "D", "text": "Placenta praevia", "correct": false}], "correct_answer": "B. Abruptio placenta", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Until what time after delivery can an Intrauterine contraceptive device (IUCD) be inserted postpartum?", "options": [{"label": "A", "text": "Within 24 hours", "correct": false}, {"label": "B", "text": "Within 48 hours", "correct": true}, {"label": "C", "text": "Within 6 weeks", "correct": false}, {"label": "D", "text": "Within 12 weeks", "correct": false}], "correct_answer": "B. Within 48 hours", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:587px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Timing Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Guidelines</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ideal time</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>During <span class=\"customMeta\" data-dictid=\"8bcfb5bdd31692777192c63fc31702\">menses</span> or first 5 days of menstruation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most preferred timing</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Postpartum (immediate postpartum): Post-placental</li>\n<li>Late postpartum: Within 48 hours of delivery up to 1 week</li>\n<li>Postpartum reports more cases of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> expulsion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Others</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Post-puerperal: Within 6 weeks of delivery</li>\n<li>Interval: Within 6 months</li>\n<li>Post-coital: up to 3-5 days of unprotected intercourse</li>\n<li>Post-abortion: After 1st <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> loss\n\t\t\t\t<ul>\n<li>Not recommended after 2nd <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> abortion</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following scenarios is early cord clamping typically performed?", "options": [{"label": "A", "text": "Eclamptic patient", "correct": false}, {"label": "B", "text": "Diabetic patient", "correct": false}, {"label": "C", "text": "Preterm delivery", "correct": false}, {"label": "D", "text": "Rh-negative mother", "correct": true}], "correct_answer": "D. Rh-negative mother", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old patient presents with anaemia. Investigations show low serum iron and ferritin levels, along with increased TIBC. Which of the following is most likely to be present?", "options": [{"label": "A", "text": "Iron Deficiency Anemia (IDA)", "correct": true}, {"label": "B", "text": "Myelodysplastic Syndrome", "correct": false}, {"label": "C", "text": "Aplastic Anemia", "correct": false}, {"label": "D", "text": "Anaemia of Chronic Disease", "correct": false}], "correct_answer": "A. Iron Deficiency Anemia (IDA)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZJHqMzVMKsxgMscGvUuK1747223300.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iron Study</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Interpretation in Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Ferritin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (&lt; 30 ng/mL) (depleted iron stores). <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Iron (Fe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low levels <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total Iron Binding Capacity (TIBC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased TIBC (increased capacity of <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> to bind iron in response to low iron stores). <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Red Cell Distribution Width (RDW)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased RDW</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">Aspiration</span> and Iron Staining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirmatory test</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microcytic (&lt;80 fL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normocytic (80-100 fL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Macrocytic (&gt;100 fL)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anaemia</li>\n<li>Thalassemia</li>\n<li>Sideroblastic anaemia</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anaemia of chronic disease</li>\n<li>Hemolytic anaemia</li>\n<li>Acute blood loss</li>\n<li>Renal disease (↓ Erythropoietin)</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver dysfunction</li>\n<li>Hypothyroidism</li>\n<li>B12 and <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> deficiency</li>\n<li>Cytotoxic drugs</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective approach to managing mild nausea and vomiting in pregnancy?", "options": [{"label": "A", "text": "Eat small, frequent meals", "correct": true}, {"label": "B", "text": "Use domperidone", "correct": false}, {"label": "C", "text": "Increase fluid intake", "correct": false}, {"label": "D", "text": "Use metoclopramide", "correct": false}], "correct_answer": "A. Eat small, frequent meals", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the ideal number of antenatal visits recommended during pregnancy according to Indian health care systems?", "options": [{"label": "A", "text": "13 visits", "correct": true}, {"label": "B", "text": "6 visits", "correct": false}, {"label": "C", "text": "8 visits", "correct": false}, {"label": "D", "text": "4 visits", "correct": false}], "correct_answer": "A. 13 visits", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>WHO Recommended Minimum ANC visits: 8</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Govt. Of India Recommended Minimum ANC Visits: 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ideal number of visits: 13 or 14</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1st Trimester: 1 visit. (within 12 weeks of gestation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1st visit: &lt;12 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upto 7 months: once every month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2nd Trimester: 2 visits. (weeks - 20 &amp; 26)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2nd visit: 14-26 weeks</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8th month: twice every month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3rd Trimester: 5 visits. (weeks - 30, 34, 36, 38 &amp; 40)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3rd visit: 28-32 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9th month: Once every week</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4th visit: 36 weeks to term</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on the given ECG, identify which wall of the myocardium was affected in this patient?", "options": [{"label": "A", "text": "Inferior wall", "correct": false}, {"label": "B", "text": "Anterior wall", "correct": true}, {"label": "C", "text": "Posterior wall", "correct": false}, {"label": "D", "text": "Lateral wall", "correct": false}], "correct_answer": "B. Anterior wall", "question_images": ["https://image.prepladder.com/content/QWV86mYwIOqqUA7IRgqG1747223488.png"], "explanation_images": ["https://image.prepladder.com/content/n1mbbhuU5In9SNaRH1f91747383330.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Infarct Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Affected Coronary Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Leads </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral Wall MI (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left Circumflex <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LCx)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V5, V6, I, aVL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Septal Wall MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Septal Branch of Left <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LAD)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V1, V2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior Wall MI (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LAD)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V1-V4, I, aVL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extensive <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> Wall MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left Main Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LMCA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V1-V6, I, aVL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior Wall MI (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (PDA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V1-V4 (ST depression), V7, V8, V9 (ST elevation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inferior Wall MI (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (RCA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leads II, III, aVF</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>NSTEMI (Anterior Wall)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (LAD)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often subtle changes in V1-V4</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the disorder associated with hexanucleotide repeat?", "options": [{"label": "A", "text": "Fragile X syndrome", "correct": false}, {"label": "B", "text": "Huntington disease", "correct": false}, {"label": "C", "text": "Myotonic dystrophy", "correct": false}, {"label": "D", "text": "Frontotemporal dementia", "correct": true}], "correct_answer": "D. Frontotemporal dementia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FTLD-tau</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>FTLD-TDP</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inclusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cytoplasmic <span class=\"customMeta\" data-dictid=\"349c5a4f5d169277720062d348498a\">tau</span> inclusions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inclusions contain TDP-43 (RNA-binding protein)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated mutations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with mutations in the <strong>MAPT gene (encoding tau)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Expansion of a<strong> </strong><strong>hexanucleotide repeat in the 5′ region of C9orf72</strong><strong>. </strong></li>\n<li>Mutations in the TARDBP gene (encoding TDP-43)</li>\n<li>Mutations in the GRN gene</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Medical termination of pregnancy (MTP) due to contraceptive failure can be done up to?", "options": [{"label": "A", "text": "20 weeks", "correct": true}, {"label": "B", "text": "24 weeks", "correct": false}, {"label": "C", "text": "32 weeks", "correct": false}, {"label": "D", "text": "12 weeks", "correct": false}], "correct_answer": "A. 20 weeks", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:587px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gestational Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Abortive method</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 7 weeks</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><strong>Medical Abortion. (99% success rate if done before 7 weeks) </strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Up to 9 weeks</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Up to 10 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medical Abortion</li>\n<li><strong>Suction <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Up to 12 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Suction evacuation</li>\n<li>Dilatation and Curettage (D&amp;C)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>12-20 weeks </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dilatation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20-24 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dilatation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E)</li>\n<li>Prostaglandin Induction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt;24 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hysterotomy</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for the patient with the given ABG analysis report: pH 7.17 Na= 139.7mEq.L pCO2 25.7mmHg K= 5.1mEq.L, pO2 97mm Hg Blood glucose 334mg/dL SatO2 99% HCO3 at 17.4mEq.L, BE of -8.6", "options": [{"label": "A", "text": "Respiratory Acidosis", "correct": false}, {"label": "B", "text": "Respiratory Alkalosis", "correct": false}, {"label": "C", "text": "Metabolic acidosis", "correct": true}, {"label": "D", "text": "Metabolic alkalosis", "correct": false}], "correct_answer": "C. Metabolic acidosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0Q0bt2Q2bjG3HMIO5mjL1747383386.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:788px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primary decrease in HCO3⁻ or increase in H⁺ ions</li>\n<li>Characterized by ↓ pH and ↓ HCO3⁻</li>\n<li>Compensatory mechanism: ↓ PaCO2 through <span class=\"customMeta\" data-dictid=\"e07ff4a5ce1692777189b9e95326f3\">hyperventilation</span> (Kussmaul breathing)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap (AG &gt; 12 mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap (AG 6-12 mEq/L)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(Mnemonic: MUDPILES)</strong></p>\n<ul>\n<li><strong>M</strong>: Methanol<strong> </strong></li>\n<li><strong>U</strong>: Uremia (Renal failure)<strong> </strong></li>\n<li><strong>D</strong>: <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> <span class=\"customMeta\" data-dictid=\"27b295ed331692777190e5e04eaa18\">ketoacidosis</span> (DKA)</li>\n<li><strong>P</strong>: Paraldehyde, Phenformin, Propylene glycol</li>\n<li><strong>I</strong>: Iron tablets, Isoniazid</li>\n<li><strong>L</strong>: Lactic acidosis</li>\n<li><strong>E</strong>: <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">Ethylene</span> glycol</li>\n<li><strong>S</strong>: Salicylates (late phase)</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(Mnemonic: HARD UP)</strong></p>\n<ul>\n<li><strong>H</strong>: Hyperalimentation (TPN)</li>\n<li><strong>A</strong>: Acetazolamide</li>\n<li><strong>R</strong>: Renal Tubular Acidosis</li>\n<li><strong>D</strong>: Diarrhea</li>\n<li><strong>U</strong>: Ureteral diversion</li>\n<li><strong>P</strong>: Pancreatic fistula</li>\n<li>GIT fistulas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>General Features:</p>\n<ul>\n<li>Lethargy</li>\n<li>Confusion</li>\n<li>Fatigue</li>\n<li>Nausea/vomiting</li>\n<li>Deep, rapid breathing (Kussmaul)</li>\n</ul>\n<p> </p>\n<p>Specific Features:</p>\n<ul>\n<li>DKA: Fruity breath, polyuria, polydipsia</li>\n<li>Uremia: Itching, volume overload</li>\n<li>Lactic acidosis: Shock, hypotension</li>\n<li>Toxic ingestion: Visual disturbances (methanol), <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> crystals (ethylene glycol)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following tests is the best for assessing long-term control of diabetes mellitus?", "options": [{"label": "A", "text": "Glycosylated Hemoglobin", "correct": true}, {"label": "B", "text": "Glycated Albumin", "correct": false}, {"label": "C", "text": "Serum Fructosamine", "correct": false}, {"label": "D", "text": "Urine Sugar", "correct": false}], "correct_answer": "A. Glycosylated Hemoglobin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old G2P1 woman at 41 weeks gestation is in active labor. She has a history of gestational diabetes and her previous baby weighed 4.2 kg. During delivery, the fetal head delivers normally, but afterward, despite gentle traction, the shoulders fail to deliver. During delivery, the head is delivered, but the shoulders become stuck. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cephalopelvic Disproportion (CPD)", "correct": false}, {"label": "B", "text": "Occipito-posterior Position", "correct": false}, {"label": "C", "text": "Shoulder Dystocia", "correct": true}, {"label": "D", "text": "Breech Presentation", "correct": false}], "correct_answer": "C. Shoulder Dystocia", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient presents with fever, headache, and vomiting that have persisted for the past 2 weeks. On examination, nuchal rigidity is noted. The results of a lumbar puncture (LP) are as follows: Opening Pressure: Elevated Cells: Predominantly polymorphonuclear leukocytes (PMNs) Sugar: 35 mg/dl Protein: 200 mg/dl Color: Slightly cloudy appearance Based on these findings, which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Meningoencephalitis", "correct": false}, {"label": "B", "text": "Viral Meningitis", "correct": false}, {"label": "C", "text": "Tuberculosis Meningitis", "correct": false}, {"label": "D", "text": "Bacterial Meningitis", "correct": true}], "correct_answer": "D. Bacterial Meningitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Predominant Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gross Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bacterial Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polymorphonuclear Neutrophils (PMNs)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Turbid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fungal/Tubercular Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Straw-colored (TB meningitis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Viral Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or</p>\n<p>Turbid</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old woman presents to her primary care physician expressing her desire to become pregnant in the next few months. She is currently not taking any medications or supplements and wants to know what preventive measures she should take before conception. Which vitamin is given to prevent neural tube defects?", "options": [{"label": "A", "text": "Vitamin B1 (Thiamine)", "correct": false}, {"label": "B", "text": "Vitamin B3 (Niacin)", "correct": false}, {"label": "C", "text": "Folic acid", "correct": true}, {"label": "D", "text": "Vitamin B12", "correct": false}], "correct_answer": "C. Folic acid", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old G1P0 woman has been pushing for 2 hours with minimal progression. The obstetrician is considering outlet forceps assistance. On examination, the fetal head is visible at the vaginal opening. Outlet forceps are applied at which station?", "options": [{"label": "A", "text": "Head 1/5th palpable per abdomen", "correct": false}, {"label": "B", "text": "0 station", "correct": false}, {"label": "C", "text": "Station +2", "correct": false}, {"label": "D", "text": "Head on perineum", "correct": true}], "correct_answer": "D. Head on perineum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CMLAwb1gDqoCwYPv2cdn1747384084.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Outlet forceps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Scalp is visible at the <span class=\"customMeta\" data-dictid=\"8cbc91fb361692777190be71b24f68\">introitus</span> without separating the labia</li>\n<li>Fetal skull has reached <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> floor</li>\n<li>Fetal head is at or on perineum</li>\n<li>Head is OA or OP or</li>\n<li>Head is right or left OA or OP position but <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> ≤45 degrees</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> (2 types)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fetal station is ≥+2 cm but not on the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> floor, and:</li>\n<li>(a) <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">Rotation</span> ≤45 degrees is required or</li>\n<li>(b) <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">Rotation</span> &gt;45 degrees is required</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Midforceps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fetal station is between 0 and +2 cm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prerequisites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Engaged head</li>\n<li>Vertex presentation</li>\n<li>Known <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head position</li>\n<li>CPD not suspected</li>\n<li>Fetal weight estimated</li>\n</ul>\n<ul>\n<li>Experienced operator</li>\n<li>Ruptured membranes</li>\n<li>Completely dilated cervix</li>\n<li>Adequate anesthesia</li>\n<li>Emptied <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> bladder</li>\n</ul>\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> coagulopathy</li>\n<li>No <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"0fb515adbf16927771853319e670ae\">demineralization</span> disorder</li>\n<li>Informed consent completed</li>\n<li>Willingness to abandon OVD</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CPD = <span class=\"customMeta\" data-dictid=\"6de56c3bcf1692777184daa7eb9660\">cephalopelvic</span> disproportion; OA = <span class=\"customMeta\" data-dictid=\"d4214cf5bc1692777194bd76243b92\">occiput</span> anterior; OP = <span class=\"customMeta\" data-dictid=\"d4214cf5bc1692777194bd76243b92\">occiput</span> posterior; OVD = <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> delivery.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with type 2 diabetes mellitus experiences hypoglycemia and sustains a fall. Due to incoherent speech, a CT scan is performed and reveals a substantial subdural hematoma (SDH) with a volume greater than 30 cc. What should be the immediate next step in management?", "options": [{"label": "A", "text": "Administer Mannitol", "correct": false}, {"label": "B", "text": "Administer Aspirin and Clopidogrel", "correct": false}, {"label": "C", "text": "Perform a Craniotomy", "correct": true}, {"label": "D", "text": "Stabilize the patient and urgently seek a neurosurgical consultation", "correct": false}], "correct_answer": "C. Perform a Craniotomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute SDH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Chronic SDH</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-72 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;3 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid deterioration</li>\n<li>Loss of consciousness</li>\n<li>Focal deficits</li>\n<li>High mortality</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gradual onset</li>\n<li>Confusion</li>\n<li>Headache</li>\n<li>Gait disturbance</li>\n<li>Better prognosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Young adults</li>\n<li>Coagulopathy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elderly</li>\n<li>Brain atrophy</li>\n<li>Anticoagulation</li>\n<li>Minor trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyperdense crescent</li>\n<li>Immediate mass effect</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypodense/mixed density</li>\n<li>Bilateral in 20-30%</li>\n<li>Gradual mass effect</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Emergency craniotomy</li>\n<li>Reverse coagulopathy</li>\n<li>ICU care</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Burr hole drainage</li>\n<li>Hold anticoagulation</li>\n<li>May observe small ones</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman at 34 weeks gestation presents for routine prenatal care. Her blood pressure is 118/72 mmHg, and routine laboratory studies reveal a platelet count of 120,000/µL. She is asymptomatic and has no history of bleeding disorders.What is the most common cause of thrombocytopenia in pregnancy?", "options": [{"label": "A", "text": "Immune Thrombocytopenic Purpura (ITP)", "correct": false}, {"label": "B", "text": "Gestational Thrombocytopenia", "correct": true}, {"label": "C", "text": "HELLP Syndrome", "correct": false}, {"label": "D", "text": "Pre-eclampsia", "correct": false}], "correct_answer": "B. Gestational Thrombocytopenia", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following scenarios is Rescue Percutaneous Coronary Intervention (PCI) indicated?", "options": [{"label": "A", "text": "Failed thrombolysis", "correct": true}, {"label": "B", "text": "Chronic stable angina", "correct": false}, {"label": "C", "text": "Prinzmetal's angina", "correct": false}, {"label": "D", "text": "NSTEMI", "correct": false}], "correct_answer": "A. Failed thrombolysis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OxRiNWeiMluzdttckRbG1747383446.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male complains of lower back pain with a 1-1.5 mm osteolytic lesion at the T10 vertebra. Histopathological findings are given below. Which of the following options is correct regarding this condition?", "options": [{"label": "A", "text": "Presence of Bence-Jones proteinuria", "correct": true}, {"label": "B", "text": "Absence of Rouleaux formation", "correct": false}, {"label": "C", "text": "Absence of free light chains", "correct": false}, {"label": "D", "text": "Decreased Calcium levels in the blood", "correct": false}], "correct_answer": "A. Presence of Bence-Jones proteinuria", "question_images": ["https://image.prepladder.com/content/DtEoOJUcK4tabc0KHZB21747377222.png"], "explanation_images": ["https://image.prepladder.com/content/T9thNfvErBaxN96m4bEh1747223937.png", "https://image.prepladder.com/content/a5lpJOOhtacft2JnVFdK1747223937.png", "https://image.prepladder.com/content/y5Y69NVAumJmoaEvkg6k1747223936.png", "https://image.prepladder.com/content/oWKsGWOaJJXwlddmGULI1747223937.png", "https://image.prepladder.com/content/j8Uh9PIIX1vj2cE9Qjpb1747223937.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Inclusion Bodies Seen In Multiple Myeloma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Russel bodies:</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Peter Maslak\" data-hash=\"\" data-license=\"American Society of hematology\" data-source=\"https://imagebank.hematology.org/imageset/890/russell-bodies\" data-tags=\"\" height=\"252\" src=\"https://image.prepladder.com/content/T9thNfvErBaxN96m4bEh1747223937.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Location:</strong> Intracytoplasmic</li>\n<li><strong>Composition:</strong>\n<ul style=\"list-style-type:circle\">\n<li>Eosinophilic</li>\n<li>Round</li>\n<li>Dilated <span class=\"customMeta\" data-dictid=\"c01a5a8c221692777187daa368ab62\">endoplasmic reticulum</span> <span class=\"customMeta\" data-dictid=\"11900fa000169277718475f5b54b45\">cisternae</span> filled with condensed immunoglobulin.</li>\n</ul>\n</li>\n</ul>\n<p>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dutcher bodies</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gabriel Caponetti\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dutcher_and_Russell_bodies.jpg\" data-tags=\"\" height=\"204\" src=\"https://image.prepladder.com/content/a5lpJOOhtacft2JnVFdK1747223937.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Location:</strong> Intranuclear.</li>\n<li><strong>Composition:</strong> Globular inclusions containing accumulated immunoglobulin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Plasma Cell Variants In Multiple Myeloma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mott cells </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mangla, Ankit &amp; Agarwal, Nikki &amp; Kim, George &amp; Catchatourian, Rosalind.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Mott-cells-Russell-bodies-seen-within-the-cytoplasm-as-vesicles-and-dilated-endoplasmic_fig3_305369257\" data-tags=\"\" height=\"268\" src=\"https://image.prepladder.com/content/y5Y69NVAumJmoaEvkg6k1747223936.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contain Grape-like cytoplasmic droplets.</li>\n<li><strong>Composition: </strong>Inclusion bodies, fibrils, <span class=\"customMeta\" data-dictid=\"35b1a3c6191692777185a1e2376fc0\">crystalline</span> rods, and globules.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Flame cells</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"University of Alberta\" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://pressbooks.openeducationalberta.ca/mlsci/chapter/plasma-cell-myeloma-multiple-myeloma/ Image: https://pressbooks.openeducationalberta.ca/app/uploads/sites/3/2018/08/0472FlameCell100x2-Gloria-Kwon-ARROW.jpg \" data-tags=\"\" height=\"239\" src=\"https://image.prepladder.com/content/oWKsGWOaJJXwlddmGULI1747223937.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Appearance</strong>: Fiery red cytoplasm.</li>\n<li><strong>Cause</strong>: High concentration of <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> as bright red granules within the cytoplasm.</li>\n<li>Often seen in <strong>IgA subtype myeloma.</strong></li>\n</ul>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rouleaux formation</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gabriel Caponetti\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Rouleaux.jpg\" data-tags=\"\" height=\"230\" src=\"https://image.prepladder.com/content/j8Uh9PIIX1vj2cE9Qjpb1747223937.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High levels of M protein in the blood cause red cells to stick to one another in <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> arrays in smears, a finding <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as rouleaux formation. <strong>(Option B ruled out)</strong></li>\n<li>It is also seen in s <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus and early HIV infection.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Criteria for Multiple myeloma:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>≥10% clonal <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells (or)<strong> </strong>a biopsy-proven bony or extra <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> plasmacytoma</li>\n</ul>\n<p><strong> + (PLUS)</strong></p>\n<ul>\n<li>Evidence of one or more <span class=\"customMeta\" data-dictid=\"652999e42416927771936e1f3246e3\">multiple myeloma</span> defining events (MDE): (CRAB features)\n\t\t\t\t<ul>\n<li>Hyper<strong>C</strong>alcemia <strong>(S.Ca2+ &gt;11g/dl)</strong><strong> </strong></li>\n<li><strong>R</strong>enal failure <strong>(S. Creatinine &gt;2mg/dl) </strong></li>\n<li><strong>A</strong>naemia <strong>(Hb &lt;10gm)</strong><strong> </strong></li>\n<li>Lytic <strong>B</strong>one lesions are attributable to the <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cell disorder.</li>\n</ul>\n</li>\n</ul>\n<p><strong> (OR)</strong></p>\n<ul>\n<li>One or more biomarkers of <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (SLIM criteria)\n\t\t\t\t<ul>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> clonal plasmacytosis<strong> </strong><strong>≥60%</strong> (<strong>S</strong>ixty per cent)</li>\n<li>Serum involved/uninvolved free <strong>Li</strong>ght chain (FLC) ratio<strong> </strong><strong>≥ 100</strong> (provided involved FLC is ≥100 mg/L)</li>\n<li><strong>&gt;1</strong> <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on<strong> M</strong>RI.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with symptoms of fatigue, pallor, and weakness. Laboratory tests reveal a low hemoglobin (Hb) level, but the reticulocyte count is normal. Based on these findings, which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Aplastic Anemia", "correct": false}, {"label": "B", "text": "Pure Red Cell Aplasia", "correct": true}, {"label": "C", "text": "Iron Deficiency Anemia", "correct": false}, {"label": "D", "text": "Hemolytic Anemia", "correct": false}], "correct_answer": "B. Pure Red Cell Aplasia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pure Red Cell Aplasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A condition characterized by anemia, reticulocytopenia, and absent or rare <span class=\"customMeta\" data-dictid=\"892718f3e916927771871389d2e1a3\">erythroid</span> <span class=\"customMeta\" data-dictid=\"ae13cdc5c3169277719683e9f6bda5\">precursor</span> cells in <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> with normal white cell and <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> production</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital:</p>\n<ul>\n<li>Diamond-Blackfan anemia</li>\n<li>Diagnosed at birth or early childhood</li>\n</ul>\n<p>Acquired:</p>\n<ul>\n<li>Thymoma</li>\n<li>MDS (5s- syndrome)</li>\n<li>Cancer</li>\n<li>Autoimmune conditions</li>\n<li>Viral infections (especially B19 parvovirus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Associations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thymoma (most frequent)</li>\n<li>Lymphoid malignancies</li>\n<li>Autoimmune disorders</li>\n<li>Chronic lymphocytic leukemia</li>\n<li>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</li>\n<li>Pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>T-cell mediated immune response</li>\n<li>Antibodies to erythropoietin</li>\n<li>Neutralizing antibodies to B19 parvovirus</li>\n<li>Direct chemical <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> or immune destruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>General Approach:</p>\n<ul>\n<li>Identify and treat underlying cause</li>\n<li>Regular monitoring of <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> levels</li>\n<li>Supportive care with transfusions</li>\n</ul>\n<p>Specific Treatments:</p>\n<ul>\n<li>Immunosuppression (corticosteroids, cyclosporine, ATG, azathioprine)</li>\n<li>Intravenous <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> for B19 <span class=\"customMeta\" data-dictid=\"4c37b9980316927771941adbff3e43\">parvovirus</span> infection</li>\n<li>Thymectomy if <span class=\"customMeta\" data-dictid=\"76ecb330ba169277720078d984ef2a\">thymoma</span> present</li>\n<li>Iron <span class=\"customMeta\" data-dictid=\"11199cbd1816927771841f1eb35b86\">chelation</span> as needed</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with ptosis, diplopia, and generalized muscle weakness that worsens with activity and improves with rest. She has difficulty chewing and swallowing, especially in the evening. A Tensilon test is positive. Which investigation is most likely to confirm the diagnosis?", "options": [{"label": "A", "text": "CT scan of the chest", "correct": false}, {"label": "B", "text": "SFEMG", "correct": true}, {"label": "C", "text": "Anti-acetylcholine receptor antibody test", "correct": false}, {"label": "D", "text": "MRI of the brain", "correct": false}], "correct_answer": "B. SFEMG", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Evaluation: Recognizing the Signs</strong></p>\n<ul>\n<li><strong>History:</strong>\n<ul>\n<li>Focus on the onset, progression, <span class=\"customMeta\" data-dictid=\"e127a25c621692777186ed98a403f9\">diurnal</span> variation and fluctuating muscle weakness.</li>\n</ul>\n</li>\n<li><strong>Physical Examination:</strong>\n<ul>\n<li>Assess muscle strength.</li>\n<li>Identify characteristic signs:\n\t\t\t\t\t<ul>\n<li>Ptosis</li>\n<li>Diplopia</li>\n<li>Cogan's lid <span class=\"customMeta\" data-dictid=\"4f7448b3e51692777201ff5cafde0d\">twitch</span> sign</li>\n</ul>\n</li>\n<li>Rule out other neurological conditions.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Tests: Confirming the Suspicion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tensilon Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Administers edrophonium <span class=\"customMeta\" data-dictid=\"749f9a02041692777183f4f13efcc5\">bromide</span> intravenously.</li>\n<li>May show <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> muscle function improvement; not highly reliable.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Repetitive Nerve <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">Stimulation</span> (RNS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Specialized nerve <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> study.</li>\n<li>Reveals a <span class=\"customMeta\" data-dictid=\"6c8c4bed32169277718685fa72d8d1\">decremental response</span> in <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> with repeated stimulation, indicating impaired <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> transmission.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Single Fiber Electromyography (SFEMG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>SFEMG techniques allow assessment of two important features of the motor unit: <span class=\"customMeta\" data-dictid=\"1d0e5cde0f169277719080688fceb7\">jitter</span> and <span class=\"customMeta\" data-dictid=\"2a75426b7c16927772022a333fb6fa\">fiber density</span> (FD).</li>\n<li>SFEMG is the<strong> most sensitive clinical test </strong>for <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> disease and is often <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> in clinically unaffected muscles in patients with <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">myasthenia</span> gravis (MG) and Lambert-Eaton <span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\">myasthenia</span> (LEM).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antibody Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Detects auto-antibodies related to MG.</li>\n<li><strong>Acetylcholine <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> (AChR) Antibodies:</strong> Most common, block AChR function.</li>\n<li><strong>Muscle-Specific Kinase (MuSK) Antibodies:</strong> Disrupt AChR clustering and stabilization.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thoracic CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Essential to rule out thymoma, especially in patients with negative AChR <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> tests.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old G1P0 woman presents for routine prenatal ultrasound at 18 weeks gestation. The ultrasonographer notes scalloping of the frontal bones creating a lemon-like appearance of the fetal skull. Which of the following conditions is associated with both the \"lemon sign\" and \"banana sign\" on a prenatal ultrasound?", "options": [{"label": "A", "text": "Neural Tube Defects (NTD) - Spina Bifida", "correct": true}, {"label": "B", "text": "Anencephaly", "correct": false}, {"label": "C", "text": "Down Syndrome", "correct": false}, {"label": "D", "text": "Brachycephaly", "correct": false}], "correct_answer": "A. Neural Tube Defects (NTD) - Spina Bifida", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XbmZMkCVF6lpJ6aE1FyB1747384135.png", "https://image.prepladder.com/content/0Da0aE2dABmdufsWORPN1747384155.png"], "explanation": "<p>Correct Answer A) &lt;span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\"&gt;Neural&lt;/span&gt; Tube Defects (NTD) - &lt;span class=\"customMeta\" data-dictid=\"78d32c50611692777199c6c6b9b525\"&gt;Spina&lt;/span&gt; B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man with a history of tuberculosis now complains of abdominal distension and pedal edema. On examination, his neck veins are prominent. His chest x-ray is given below. Which of the following findings will be likely seen in this patient?", "options": [{"label": "A", "text": "Pulsus biferiens", "correct": false}, {"label": "B", "text": "Kussmaul breathing", "correct": false}, {"label": "C", "text": "SBP falls from 80mmHg to 60mmHg", "correct": true}, {"label": "D", "text": "Fine crepitations", "correct": false}], "correct_answer": "C. SBP falls from 80mmHg to 60mmHg", "question_images": ["https://image.prepladder.com/content/TFKrHVYsfzDpUQg8hPWu1747224391.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cardiac Tamponade</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A condition where the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> chambers are compressed by a <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">tense</span> <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion, limiting <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> inflow. Fluid accumulation of as little as 200 ml to upwards of 2L may lead to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Beck's triad</strong></p>\n<ul>\n<li><strong>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Distension</strong>: Due to increased central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure. Prominent x <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> and an absent y descent.</li>\n<li><strong>Hypotension</strong>: Resulting from impaired <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</li>\n<li><strong>Muffled Heart Sounds</strong>: Caused by fluid accumulation in the <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> space, dampening heart sounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulsus Paradoxus</strong>: Hallmark finding. A drop in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP during inspiration, greater than 10 mm Hg.</p>\n<p>Causes of <span class=\"customMeta\" data-dictid=\"a507417e891692777196a900bd7993\">Pulsus</span> paradoxus:</p>\n<ul>\n<li><strong>Lung Conditions:</strong> Acute asthma, COPD, tension pneumothorax, pleural effusion, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism.</li>\n<li><strong>Heart Conditions:</strong> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> tamponade, <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">constrictive</span> pericarditis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following conditions is tandem radiotherapy commonly used?", "options": [{"label": "A", "text": "Cervical cancer", "correct": true}, {"label": "B", "text": "Ovarian cancer", "correct": false}, {"label": "C", "text": "Choriocarcinoma", "correct": false}, {"label": "D", "text": "Endometrial cancer", "correct": false}], "correct_answer": "A. Cervical cancer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:498px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ia1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;3 mm NO LVSI</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conization or extra fascial hysterectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ia1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;3 mm with LVSI</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Radical trachelectomy</p>\n<p>• Or radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> + <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> LAD</p>\n<p>• Or SLN</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IA2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥3 mm &lt;5 mm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Radical trachelectomy</p>\n<p>• Or radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> + <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> LAD</p>\n<p>• Or SLN</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IB1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥5 mm &lt;2 cm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Radical trachelectomy</p>\n<p>• Or radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> + <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> LAD</p>\n<p>• Or SLN</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IB2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥2 cm &lt;4 cm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">Hysterectomy</span> + <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> LAD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IB3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥4 cm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chemoradiation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IIA1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;4 cm + upper vagina</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">Hysterectomy</span> + <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> LAD or Chemoradiation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IIA2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥4 cm + upper vagina</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chemoradiation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old primigravida has just delivered a healthy baby vaginally at 39 weeks gestation. The newborn has good muscle tone, is breathing spontaneously, and has normal skin color. The delivery team is preparing for umbilical cord clamping and discussing the optimal timing. What is the ideal time for umbilical cord clamping after birth?", "options": [{"label": "A", "text": "Immediately after birth", "correct": false}, {"label": "B", "text": "Within 30 seconds of birth", "correct": false}, {"label": "C", "text": "Between 1-3 minutes after birth", "correct": true}, {"label": "D", "text": "More than 3 minutes after birth", "correct": false}], "correct_answer": "C. Between 1-3 minutes after birth", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C) Between 1-3 minutes after birth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a derived / calculated value in Arterial Blood Gas analysis?", "options": [{"label": "A", "text": "pH", "correct": false}, {"label": "B", "text": "PO₂", "correct": false}, {"label": "C", "text": "PCO₂", "correct": false}, {"label": "D", "text": "Bicarbonate", "correct": true}], "correct_answer": "D. Bicarbonate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not cause polyhydramnios?", "options": [{"label": "A", "text": "Neural tube defects", "correct": false}, {"label": "B", "text": "Twin gestation", "correct": false}, {"label": "C", "text": "Esophageal atresia", "correct": false}, {"label": "D", "text": "Renal agenesis", "correct": true}], "correct_answer": "D. Renal agenesis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:696px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>AFI Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5-24 cm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated with normal <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oligohydramnios</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 5 cm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Indicates lower-than-normal <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid volume and may lead to <strong>fetal growth restriction.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Polyhydramnios</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 24 cm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Indicates excessive <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid accumulation, increasing the risk of <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">preterm</span> labour, <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> abruption, and <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> cord complications.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Polyhydramnios</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Oligohydramnios</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fetal Factors</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fetal anomalies (e.g., anencephaly, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> atresia)</li>\n<li>Twin-to-twin <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> syndrome (TTTS) <strong>(Option B)</strong></li>\n<li>Hydrops fetalis</li>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> <strong>(Option C)</strong></li>\n<li>Neural tube defects <strong>(Option A)</strong></li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Renal agenesis</strong></li>\n<li>Post-term pregnancy</li>\n<li>Fetal growth restriction (IUGR)</li>\n<li>Amnion nodosum</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Maternal Factors</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diabetes mellitus</li>\n<li>Cardiac disease</li>\n<li>Renal disease</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Maternal hypertension</li>\n<li>Preeclampsia</li>\n<li>Placental insufficiency</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Placental Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chorioangioma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placental abruption</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the edges of the lesion given in the image:", "options": [{"label": "A", "text": "Everted", "correct": false}, {"label": "B", "text": "Rolled out", "correct": true}, {"label": "C", "text": "Sloping", "correct": false}, {"label": "D", "text": "Punched out", "correct": false}], "correct_answer": "B. Rolled out", "question_images": ["https://image.prepladder.com/content/8cNqGZwutSue4NZfM4Qn1747224752.png"], "explanation_images": ["https://image.prepladder.com/content/QrlC1enjl4hTNR7RGK3B1747385636.png", "https://image.prepladder.com/content/Nz2pXpgA7CjLw73K46Gd1747385656.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of edges</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sloping edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Healing ulcer</li>\n<li>Varicose ulcer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inner part: </strong>Red (healthy <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue)</li>\n<li><strong>Middle part:</strong> Blue (epithelial proliferation)</li>\n<li><strong>Outer part: </strong>White (scar/fibrous tissue)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Undermined edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tubercular ulcers</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disease process advances in the deeper plane (subcutaneous tissue), whereas (skin) <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> proliferates inwards</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Punched out edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Arterial / Ischemic ulcers</li>\n<li>Gummatous (syphilitic) ulcer</li>\n<li>Trophic ulcer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to endarteritis</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Raised &amp; <span class=\"customMeta\" data-dictid=\"db8c3d4b9e1692777182a03a530a28\">beaded</span> edge</strong></p>\n<p><strong>Rolled out / </strong></p>\n<p><strong>Pearly white edge</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rodent ulcer- Basal cell carcinoma</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Beads are due to proliferating active cells</p>\n<p> </p>\n<p>Pearly white in appearance</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Everted edge / </strong></p>\n<p><strong>Rolled out edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Squamous cell carcinoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to the spill of proliferating <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tissue over the normal skin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following intestinal pathologies is associated with dermatitis herpetiformis?", "options": [{"label": "A", "text": "Ulcerative colitis", "correct": false}, {"label": "B", "text": "Whipple’s disease", "correct": false}, {"label": "C", "text": "Celiac disease", "correct": true}, {"label": "D", "text": "Crohn’s disease", "correct": false}], "correct_answer": "C. Celiac disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9VyR0tkH6Xg7MU7aRxM91747377345.png", "https://image.prepladder.com/content/QpLYlktlxHWpqLUO10HQ1747224850.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Celiac Disease </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autoimmune disorder <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by ingesting gluten-containing foods in genetically <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> individuals.</p>\n<p>It is influenced by <strong>HLA-DQ2 or HLA-DQ8. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"650\" src=\"https://image.prepladder.com/content/9VyR0tkH6Xg7MU7aRxM91747377345.png\" width=\"650\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adults:</strong></p>\n<ul>\n<li>Commonly between the ages of 30 and 60.</li>\n<li>More frequent in females</li>\n<li>Silent <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> disease (positive <span class=\"customMeta\" data-dictid=\"6cffb1ffdd1692777198f0c11de8fe\">serology</span> and <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> without symptoms)</li>\n<li>Latent <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> disease (positive <span class=\"customMeta\" data-dictid=\"6cffb1ffdd1692777198f0c11de8fe\">serology</span> is not accompanied by <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> atrophy)</li>\n<li>It may be associated with chronic diarrhoea, bloating, chronic fatigue, or asymptomatic.</li>\n<li>Anaemia (iron and vitamin malabsorption).</li>\n<li>Dermatitis herpetiformis (itchy, blistering skin lesion) might be present. <strong>(Option C)</strong></li>\n</ul>\n<p> </p>\n<p><strong>Pediatric cases: </strong></p>\n<ul>\n<li>Both sexes were affected equally.</li>\n<li>It may present with malabsorption.</li>\n<li>Begins after the introduction of <span class=\"customMeta\" data-dictid=\"29771deef31692777188c19fb41999\">gluten</span> to the diet (6-24 months of age)</li>\n<li>Manifestations include irritability, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distention, anorexia, chronic diarrhoea, failure to thrive, weight loss, or muscle wasting.</li>\n<li>It may also present as <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, nausea, vomiting, bloating, or constipation.</li>\n<li>Extraintestinal complaints include <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> or joint pain, <span class=\"customMeta\" data-dictid=\"c267cc6e5716927771818c84304bbe\">aphthous</span> stomatitis, iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anaemia, delayed puberty, and short stature.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Serum markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>IgA antibodies against tissue <span class=\"customMeta\" data-dictid=\"4a47b71b801692777200d06df00a08\">transglutaminase</span> (tTG):</strong> <strong>Most sensitive.</strong></li>\n<li><strong>Anti-endomysial antibodies (EMA):</strong><strong> Most specific. </strong></li>\n<li>IgG antibodies against <span class=\"customMeta\" data-dictid=\"21f6d7d8df1692777188deb1006c47\">gliadin</span> (a component of gluten).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Biopsy of the second part of the <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> or <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> jejunum:</p>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> <strong>CD8+ T lymphocytes</strong> (intraepithelial lymphocytosis).</li>\n<li><strong>Crypt hyperplasia</strong> (Increased mitosis).</li>\n<li><strong>Villous atrophy</strong> (Reduced mucosal surface area, causing malabsorption).</li>\n<li>Inflammatory cell infiltration.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked structure:", "options": [{"label": "A", "text": "Splenogastric ligament", "correct": false}, {"label": "B", "text": "Lienorenal ligament", "correct": true}, {"label": "C", "text": "Greater omentum", "correct": false}, {"label": "D", "text": "Lesser omentum", "correct": false}], "correct_answer": "B. Lienorenal ligament", "question_images": ["https://image.prepladder.com/content/VVWO7GcZ6iRIKXBK8OrW1747373152.png"], "explanation_images": ["https://image.prepladder.com/content/On4JDHFltQP6wdGV4PJc1747373163.png", "https://image.prepladder.com/content/AzcTSaPuKFUDfwu1R1Hx1747373173.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:694px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>From</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Contains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Dorsal mesentery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Greater omentum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Greater <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of stomach (and spleen)</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Transverse colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>right and left <span class=\"customMeta\" data-dictid=\"4a2f01d90816927771883e2bc0844f\">gastroepiploic</span> vessels and fat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Gastrosplenic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Spleen</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Short <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery, Left <span class=\"customMeta\" data-dictid=\"4a2f01d90816927771883e2bc0844f\">gastroepiploic</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Gastrophrenic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">phrenic</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Gastrocolic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Transverse colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Right <span class=\"customMeta\" data-dictid=\"4a2f01d90816927771883e2bc0844f\">gastroepiploic</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Splenorenal ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Spleen</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Kidney</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Splenic artery, Tail of pancreas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Ventral mesentery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Lesser omentum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Lesser <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of the stomach (and duodenum)</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>The right free margin-hepatic artery, <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, and <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct,lymph nodes and the <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> vessels,hepatic <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> of nerve,all enclosed in <span class=\"customMeta\" data-dictid=\"a606b55b4316927771956c3cb0d383\">perivascular</span> <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> sheath. Along the lesser <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of the stomach-left and right <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery,the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> group of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes and lymphatics, branches from the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> nerve.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Hepatogastric ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Right and left <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Hepatoduodenal ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Duodenum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Hepatic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> proper, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nerves</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>From</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Contains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Dorsal mesentery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Mesentery proper</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> (jejunum and ileum)</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Superior mesenteric artery, accompanying veins, <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nerve plexuses, lymphatics, 100–200 <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes and <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue with fat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Transverse mesocolon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Transverse colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Middle colic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Sigmoid mesocolon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Sigmoid colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Pelvic wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Sigmoid arteries and superior rectal artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Mesoappendix</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Mesentery of ileum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Appendix</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Appendicular artery</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:728px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>From</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Contains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ventral mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Falciform ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Thoracic diaphragm, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Round <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of liver, <span class=\"customMeta\" data-dictid=\"a68186fa3d1692777194d7b1b06fdc\">paraumbilical</span> vein</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> vein</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Round <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of liver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Umbilicus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ventral mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Coronary ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Thoracic diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ductus venosus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Ligamentum venosum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Phrenicocolic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Left colic flexure</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Thoracic diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ventral mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Left triangular ligament, right triangular ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Umbilical folds</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Urinary bladder</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Ileocecal fold</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ileum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Cecum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Broad <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of the uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Uterus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Pelvic wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Mesovarium, mesosalpinx, mesometrium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Round <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Uterus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Inguinal canal</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Suspensory <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of the ovary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ovary</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Pelvic wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ovarian artery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is associated with Cryoglobulinemia?", "options": [{"label": "A", "text": "Hepatitis C infection", "correct": true}, {"label": "B", "text": "Ovarian cancer", "correct": false}, {"label": "C", "text": "Diabetes", "correct": false}, {"label": "D", "text": "Leukaemia", "correct": false}], "correct_answer": "A. Hepatitis C infection", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient following a road traffic accident (RTA) with a crush injury presents with crepitus and a reddish-brown wound within 3 days after amputation. What is the most likely condition?", "options": [{"label": "A", "text": "Gas gangrene", "correct": true}, {"label": "B", "text": "Impetigo", "correct": false}, {"label": "C", "text": "Tetanus", "correct": false}, {"label": "D", "text": "Cellulitis", "correct": false}], "correct_answer": "A. Gas gangrene", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gA2Tc0ReIPfLNB0R2SSg1747225173.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gas <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">Gangrene</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>A rapidly progressive, potentially fatal condition characterized by widespread <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> of muscles and soft-tissue destruction, often due to late-presenting missile wounds or crushing injuries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clostridium perfringens</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;24 hours but ranges from 1 hour to 6 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sources and <span class=\"customMeta\" data-dictid=\"80c0cb2a5f1692777196ba45847553\">predisposing</span> factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contaminated soil and feces.</li>\n<li>Wounds with necrotic or foreign material.</li>\n<li>Crush wounds, road traffic accidents, amputations.</li>\n<li>Anaerobic environments in the wound.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common sites of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Adductor region of the <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> and buttocks.</li>\n<li>Subscapular region in the upper limb.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe pain with limb <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> rapidly increases in severity.</li>\n<li>Serosanguineous discharge.</li>\n<li>Skin turns brown to blue-black with hemorrhagic bullae.</li>\n<li>Sweet, sticky <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> &amp; Soft-tissue crepitus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Septicaemia, toxemia, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure, liver failure.</li>\n<li>Circulatory failure, DIC, secondary infections.</li>\n<li>Death occurs in critically ill patients.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: Gas in soft tissues.</li>\n<li>Gram <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> &amp; blood culture: Large Gram-positive <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> without neutrophils.</li>\n<li>Biochemical profile: Metabolic acidosis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n<li>Peripheral blood smear: Haemolysis.</li>\n<li>CT scan for chest or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High-dose <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> and clindamycin, along with 3rd generation cephalosporins, are given intravenously.</li>\n<li>Polyvalent antiserums given intravenously.</li>\n<li>All dead tissues are excised, and debridement is performed until healthy tissue bleeds.</li>\n<li>Amputation done in severe cases</li>\n<li>Hyperbaric oxygen therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proper debridement of devitalized crushed wounds.</li>\n<li>Devitalized wounds should not be sutured.</li>\n<li>Adequate cleaning of wounds with H₂O₂ and normal saline.</li>\n<li>Penicillin - As a <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> antibiotic.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CNX OpenStax\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:OSC_Microbio_09_02_foot.jpg\" data-tags=\"\" height=\"285\" src=\"https://image.prepladder.com/content/gA2Tc0ReIPfLNB0R2SSg1747225173.png\" width=\"438\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following cells are located in the centre of the lumen in a venule?", "options": [{"label": "A", "text": "Lymphocytes", "correct": false}, {"label": "B", "text": "RBCs", "correct": true}, {"label": "C", "text": "Neutrophils", "correct": false}, {"label": "D", "text": "Platelets", "correct": false}], "correct_answer": "B. RBCs", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arrange the stages of wound healing in the correct sequence:", "options": [{"label": "A", "text": "Proliferation, hemostasis, inflammation, remodeling", "correct": false}, {"label": "B", "text": "Inflammation, remodeling, hemostasis, proliferation", "correct": false}, {"label": "C", "text": "Hemostasis, inflammation, proliferation, remodeling", "correct": true}, {"label": "D", "text": "Remodeling, proliferation, hemostasis, inflammation", "correct": false}], "correct_answer": "C. Hemostasis, inflammation, proliferation, remodeling", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition in the image shown below:", "options": [{"label": "A", "text": "Duodenal atresia", "correct": false}, {"label": "B", "text": "Jejunal atresia", "correct": true}, {"label": "C", "text": "Small bowel obstruction", "correct": false}, {"label": "D", "text": "Ileal atresia", "correct": false}], "correct_answer": "B. Jejunal atresia", "question_images": ["https://image.prepladder.com/content/NPiuHH0haa6bihHCsL1L1747225483.png"], "explanation_images": ["https://image.prepladder.com/content/rxq6Yv8QKndSVjCmzGBK1747381260.png", "https://image.prepladder.com/content/XIETIJvzHgW0vb4Vep4C1747381270.png", "https://image.prepladder.com/content/wOIYgOp8XktF0NrP6jVz1747381279.png", "https://image.prepladder.com/content/OMn53n8oN2KImRaButeT1747381288.png", "https://image.prepladder.com/content/IXidx7BCRkEtOm7Wl0HM1747381296.png", "https://image.prepladder.com/content/2caYWt4nfWr3neM4zXmF1747381321.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:728px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Radiological Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal Abdomen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Single bubble in the stomach</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A single air bubble seen in the left upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> corresponds to the <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> of the stomach. A large single bubble is seen in cases of pyloric atresia, GOO.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jeremy Jones\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/normal-abdominal-x-ray-1\" data-tags=\"\" height=\"485\" src=\"https://image.prepladder.com/content/rxq6Yv8QKndSVjCmzGBK1747381260.png\" width=\"359\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pyloric <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">Atresia</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>\"Single bubble\" sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A single distended stomach with no air in the small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> or beyond, caused by <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> at the pylorus.</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Samir,\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:GOO_AXR.jpg\" data-tags=\"\" height=\"452\" src=\"https://image.prepladder.com/content/XIETIJvzHgW0vb4Vep4C1747381270.png\" width=\"360\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duodenal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">Atresia</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>\"Double bubble\" sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distended stomach and <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> duodenum; no <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> gas due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> at the duodenum.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Pediatric Radiology Olgahospital Klinikum Stuttgart\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:DuodAtres.png\" data-tags=\"\" height=\"485\" src=\"https://image.prepladder.com/content/wOIYgOp8XktF0NrP6jVz1747381279.png\" width=\"386\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Jejunal Atresia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>\"Triple bubble\" sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Three distended loops of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> (stomach, duodenum, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> jejunum) with no <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> gas.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hisham Alwakkaa\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/jejunal-atresia-2#image-33384261\" data-tags=\"\" height=\"649\" src=\"https://image.prepladder.com/content/OMn53n8oN2KImRaButeT1747381288.png\" width=\"388\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ileal Atresia</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple air-fluid levels</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilated small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops with air-fluid levels and no gas in the large intestine, more <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> than jejunal atresia.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jones J, Campos A, Yap J, et al\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/ileal-atresia\" data-tags=\"\" height=\"529\" src=\"https://image.prepladder.com/content/IXidx7BCRkEtOm7Wl0HM1747381296.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How do you calculate the mid-parental height for a male child with a father who is 183 cm tall and a mother who is 175 cm tall?", "options": [{"label": "A", "text": "185.5", "correct": true}, {"label": "B", "text": "169.5", "correct": false}, {"label": "C", "text": "192.5", "correct": false}, {"label": "D", "text": "195.5", "correct": false}], "correct_answer": "A. 185.5", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4dLXx1pU3gQT8KGv5arJ1747384405.png", "https://image.prepladder.com/content/o3gcD0mnJ5xLqoMaDl6V1747384414.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is considered a “sure sign” of abdominal wound dehiscence in a post-operative hypotensive patient?", "options": [{"label": "A", "text": "Increased bowel sounds", "correct": false}, {"label": "B", "text": "Persistent abdominal pain", "correct": false}, {"label": "C", "text": "Serosanguinous drainage from the wound", "correct": true}, {"label": "D", "text": "Widening of the abdominal scar with palpable edges", "correct": false}], "correct_answer": "C. Serosanguinous drainage from the wound", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly chronic smoker male is diagnosed with squamous cell carcinoma of the lower lip with no lymph node involvement. What is the treatment of choice?", "options": [{"label": "A", "text": "Radiotherapy", "correct": false}, {"label": "B", "text": "Combined chemoradiotherapy", "correct": false}, {"label": "C", "text": "Wide local excision with negative borders", "correct": false}, {"label": "D", "text": "Wide local excision with frozen section", "correct": true}], "correct_answer": "D. Wide local excision with frozen section", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the radiological image of the condition given below.", "options": [{"label": "A", "text": "Paget's disease", "correct": true}, {"label": "B", "text": "Multiple myeloma", "correct": false}, {"label": "C", "text": "Hyperparathyroidism", "correct": false}, {"label": "D", "text": "Sickle cell anemia", "correct": false}], "correct_answer": "A. Paget's disease", "question_images": ["https://image.prepladder.com/content/idlWVOcOTTl9RgoBNbtz1747225581.png"], "explanation_images": ["https://image.prepladder.com/content/hIFIpkawgXWjpYlGNvGl1747381369.png", "https://image.prepladder.com/content/qEcu9oUsJvzo3LAsq04H1747381392.png", "https://image.prepladder.com/content/u6kMEYRkpGzspT1zmdzu1747381509.png", "https://image.prepladder.com/content/GSKiO5X3jBpfmqhFONH51747381583.png", "https://image.prepladder.com/content/KgEXPJkt40OId0Zs6jqU1747381593.png", "https://image.prepladder.com/content/t5S0pigFRfS0oMYmwSlM1747381604.png", "https://image.prepladder.com/content/f2Cw582Pu7lX5pPvobah1747381613.png", "https://image.prepladder.com/content/UgxCeXUuSSYN9zrtzX1L1747381650.png", "https://image.prepladder.com/content/6Xgw8hgwjWPaq67te1GM1747381631.png", "https://image.prepladder.com/content/o1lTs0Sw9A3ndLSCEUoq1747381718.png", "https://image.prepladder.com/content/ERZPUuSWGDSYhSJ2YXHM1747381745.png", "https://image.prepladder.com/content/i0neA6MH6ApouRlqDGSQ1747381773.png", "https://image.prepladder.com/content/7t73gSyTT1I5cCLd38wS1747381780.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Osteoporosis circumscripta:</strong> A <span class=\"customMeta\" data-dictid=\"89aa50eac91692777184c8f668d2cf\">circumscribed</span> patch of <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> in the skull.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Courtesy of Radiopaedia.org, rID: 7477\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.orthopaedia.com/pagets-disease/\" data-tags=\"\" height=\"371\" src=\"https://image.prepladder.com/content/hIFIpkawgXWjpYlGNvGl1747381369.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" Yi-Jin Kuok\" data-hash=\"\" data-license=\"CC BY NC SA 3.0\" data-source=\"https://pacs.de/term/osteoporosis-circumscripta-cranii#&amp;gid=1&amp;pid=2\" data-tags=\"\" height=\"596\" src=\"https://image.prepladder.com/content/qEcu9oUsJvzo3LAsq04H1747381392.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>The cotton <span class=\"customMeta\" data-dictid=\"eaae57387d1692777202060f299953\">wool</span> appearance of the skull</strong> (due to sclerosis)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Lee Chee Kean, Jeremy P, Simmrat Singh, Azura Mansor\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/b-Skull-radiograph-showed-the-pathognomonic-cotton-wool-appearance_fig3_226558659\" data-tags=\"\" height=\"262\" src=\"https://image.prepladder.com/content/u6kMEYRkpGzspT1zmdzu1747381509.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tam O'Shanter sign</strong>: The skull's expansion and flattened base create the appearance of the skull tilting over the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> structures (due to the thickening of the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> bone).</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Frank Gaillard \" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/images/295?case_id=2639\" data-tags=\"\" height=\"443\" src=\"https://image.prepladder.com/content/GSKiO5X3jBpfmqhFONH51747381583.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mapham, J (Sgt), No 5 Army Film &amp; Photographic Unit\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Neil_Ritchie.jpg\" data-tags=\"\" height=\"662\" src=\"https://image.prepladder.com/content/KgEXPJkt40OId0Zs6jqU1747381593.png\" width=\"496\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blade of grass appearance or candle flame sign:</strong> Flame-shaped <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> extending along the <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> of the bone.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Andrew Dixon\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/paget-disease-with-blade-of-grass-sign\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/t5S0pigFRfS0oMYmwSlM1747381604.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Picture frame vertebra:</strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> appear enlarged and have a thickened <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> bone due to excessive <span class=\"customMeta\" data-dictid=\"f8406817f21692777183176660cf3d\">bone remodeling</span> and disorganized osteoblastic activity.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Andrew Dixon\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/vertebral-paget-disease-with-picture-frame-appearance-1\" data-tags=\"\" height=\"580\" src=\"https://image.prepladder.com/content/f2Cw582Pu7lX5pPvobah1747381613.png\" width=\"333\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ivory vertebra:</strong></p>\n<p>The homogeneous, <span class=\"customMeta\" data-dictid=\"76584c702f1692777197ee90a74461\">radiopaque</span> appearance results from increased <span class=\"customMeta\" data-dictid=\"0b2564673b16927771836152f83121\">bone density</span> caused by <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> osteoblastic activity, leading to excessive bone formation.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD,\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Paget%27s_disease_in_vertebra_on_CT.jpg\" data-tags=\"\" height=\"594\" src=\"https://image.prepladder.com/content/UgxCeXUuSSYN9zrtzX1L1747381650.png\" width=\"556\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lincoln sign or Black Beard sign: </strong>Increased <span class=\"customMeta\" data-dictid=\"c5a32dfd6e1692777197db92b6aea1\">radiotracer</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in the <span class=\"customMeta\" data-dictid=\"55c062d44f16927771919375042b03\">mandible</span> gives it a distinctive black beard appearance that signifies <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> bone <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> in Paget’s disease.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kenneth R. Holmes, R. Davis Holmes , Montgomery Martin, Nicolas Murray\" data-hash=\"\" data-license=\"NA\" data-source=\"https://pubs.rsna.org/doi/full/10.1148/rg.2021200187\" data-tags=\"\" height=\"393\" src=\"https://image.prepladder.com/content/6Xgw8hgwjWPaq67te1GM1747381631.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Banana fractures: </strong>Occur in a region of <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> bone.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Matt A. Morgan\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/banana-fracture-paget-disease-1#image-8980707\" data-tags=\"\" height=\"590\" src=\"https://image.prepladder.com/content/o1lTs0Sw9A3ndLSCEUoq1747381718.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which chromosomal defect is suggested by the karyotyping results given below?", "options": [{"label": "A", "text": "Trisomy 18", "correct": true}, {"label": "B", "text": "Trisomy 13", "correct": false}, {"label": "C", "text": "Trisomy 21", "correct": false}, {"label": "D", "text": "Trisomy 11", "correct": false}], "correct_answer": "A. Trisomy 18", "question_images": ["https://image.prepladder.com/content/a1KbYr4yJCvvM10wbHWB1747384452.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In modified radical neck dissection, which of the following structures is NOT preserved?", "options": [{"label": "A", "text": "Sternocleidomastoid muscle", "correct": false}, {"label": "B", "text": "Internal jugular vein", "correct": false}, {"label": "C", "text": "Spinal accessory nerve", "correct": false}, {"label": "D", "text": "Submandibular gland", "correct": true}], "correct_answer": "D. Submandibular gland", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MxxPwUmFPaFL22086j7p1747225854.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Dissection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>LN removed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Other structures removed/Preserved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Radical Neck Dissection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">CN XI, IJV, and SCM removed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Modified Radical Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">Dissection</span> (MRND) I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">CN XI preserved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MRND II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">CN XI, IJV preserved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MRND III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">CN XI, IJV, SCM preserved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extended Neck Dissection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">CN XI, IJV, SCM removed + one/more LN groups +/- <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">Non</span> <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> structures</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Selective Neck Dissections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>LN removed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Primary site of cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Supra-omohyoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Oral cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extended Supra-omohyoid</strong></p>\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">I - IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Oral <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> and oropharynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Postero-Lateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">II - V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Skin over the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> and upper neck</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Lateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">II - IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Oropharynx, Hypopharynx, Larynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior/ Central</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">VI</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Thyroid/ Midline structures</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the procedure shown below which one of the following substances is uptaken by the cancer cells?", "options": [{"label": "A", "text": "Alanine", "correct": false}, {"label": "B", "text": "Glucose", "correct": true}, {"label": "C", "text": "Sodium", "correct": false}, {"label": "D", "text": "Calcium", "correct": false}], "correct_answer": "B. Glucose", "question_images": ["https://image.prepladder.com/content/brFxTrcgMp5FD8kWqSVz1747381884.png"], "explanation_images": ["https://image.prepladder.com/content/T30rrzO0XjhWoCIW6zts1747381894.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aerobic Glycolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cancer cells rely heavily on glycolysis, increasing <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and 18F-FDG uptake, even with oxygen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transport &amp; Trapping</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GLUT-1 transporters mediate <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> entry. 18F-FDG is phosphorylated and trapped inside cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor Heterogeneity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differences in tumor subtype, size, and <span class=\"customMeta\" data-dictid=\"3728deb0881692777192af3b093774\">microvasculature</span> affect 18F-FDG uptake.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Implication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognostic Indicator</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher 18F-FDG <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> correlates with <strong>worse prognosis</strong> (e.g., shorter DFS in <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> ductal carcinoma).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reverse Warburg Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cancer-associated fibroblasts (CAFs) increase <span class=\"customMeta\" data-dictid=\"185a500ee91692777188b3044db06d\">glycolysis</span> in tumor cells via <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> coupling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PET <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> tracks changes in 18F-FDG uptake, reflecting <strong>therapy responses</strong> <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> <span class=\"customMeta\" data-dictid=\"185a500ee91692777188b3044db06d\">glycolysis</span> or mitochondria.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A Diabetic patient's blood sample is kept in the given container. What will be added to the blood sample?", "options": [{"label": "A", "text": "Na fluoride", "correct": true}, {"label": "B", "text": "EDTA", "correct": false}, {"label": "C", "text": "Na citrate", "correct": false}, {"label": "D", "text": "Heparin", "correct": false}], "correct_answer": "A. Na fluoride", "question_images": ["https://image.prepladder.com/content/QDPgySahYXS5OQhvMoDl1747225447.png"], "explanation_images": ["https://image.prepladder.com/content/BnI2TKJUkOahGu7PMxVl1747225498.png", "https://image.prepladder.com/content/3VRj3LF1hTS34z6LvERe1747225498.png", "https://image.prepladder.com/content/XOh5Ql7gFiaDtTaMJzuY1747225498.png", "https://image.prepladder.com/content/tuJ3gv31wToYTtfjLBZB1747225498.png", "https://image.prepladder.com/content/y8UCUCKVpgOPNuIs84n51747225498.png", "https://image.prepladder.com/content/aIRCTceJ67xetZjBzXGN1747225498.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anti-coagulants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Whispyhistory,\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:EDTA_(chelator_-_anticoagulant)_for_full_blood_count.jpg\" data-tags=\"\" height=\"129\" src=\"https://image.prepladder.com/content/BnI2TKJUkOahGu7PMxVl1747225498.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Purple/Lavender </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>EDTA (Ca2+ chelating anticoagulant)</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CBC, Peripheral Smear, ESR, HbA1c</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Gene Hobbs \" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Partial_thromboplastin_time\" data-tags=\"\" height=\"325\" src=\"https://image.prepladder.com/content/3VRj3LF1hTS34z6LvERe1747225498.png\" width=\"202\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Light Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trisodium Citrate (Ca2+ chelating anticoagulant)</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ESR, PT, aPTT</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"AfroBrazilian\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Blood_collection_tube_(1_kind).jpg\" data-tags=\"\" height=\"838\" src=\"https://image.prepladder.com/content/XOh5Ql7gFiaDtTaMJzuY1747225498.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Red</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No anti-coagulant is added.</p>\n<p>Clot <span class=\"customMeta\" data-dictid=\"a095f733351692777180a29940c98a\">activator</span> without gel</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serum studies (Proteins, enzymes, hormones)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Whispyhistory\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Yellow_vacutainer.jpg\" data-tags=\"\" height=\"825\" src=\"https://image.prepladder.com/content/tuJ3gv31wToYTtfjLBZB1747225498.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Yellow </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clot activator/Gel separator</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serum studies (Proteins, enzymes, hormones)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Whispyhistory\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Grey_vacutainer.jpg\" data-tags=\"\" height=\"714\" src=\"https://image.prepladder.com/content/y8UCUCKVpgOPNuIs84n51747225498.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Grey</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sodium Fluoride<strong> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood Glucose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/aIRCTceJ67xetZjBzXGN1747225498.png\" width=\"300\"/></p>\n<p><strong>Green </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heparin<strong> </strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ABG, Osmotic fragility, flow cytometry, immunophenotyping</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which ganglia is located in the marked area?", "options": [{"label": "A", "text": "Otic ganglia", "correct": false}, {"label": "B", "text": "Ciliary ganglia", "correct": false}, {"label": "C", "text": "Pterygopalatine ganglia", "correct": true}, {"label": "D", "text": "Submandibular ganglia", "correct": false}], "correct_answer": "C. Pterygopalatine ganglia", "question_images": ["https://image.prepladder.com/content/SZHKQcs31GlC7FVJGsjm1747373843.png"], "explanation_images": ["https://image.prepladder.com/content/PNqfRcTpiKtM5jOwtBT11747373910.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman with a known history of beta-thalassemia undergoes a blood transfusion. During the transfusion, she develops symptoms of anxiety, hypotension, and fever. What is the next appropriate step in the management of this patient?", "options": [{"label": "A", "text": "Stop the blood transfusion and restart after stabilization", "correct": true}, {"label": "B", "text": "Continue the blood transfusion and perform an ECG", "correct": false}, {"label": "C", "text": "Investigate for clerical errors in the blood transfusion process", "correct": false}, {"label": "D", "text": "Administer corticosteroids and monitor vital signs", "correct": false}], "correct_answer": "A. Stop the blood transfusion and restart after stabilization", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Immediate <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">Transfusion</span> Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Delayed <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">Transfusion</span> Reactions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Onset Time</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Within hours of transfusion</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Days to weeks after transfusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Immunologic reactions, <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> or non-hemolytic</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Immune-mediated, often involving minor <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> sensitization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Presentation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Fever, chills, Dyspnea (TRALI, TACO), <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> (TRALI), Pulmonary oedema (TACO), hypothermia, <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> abnormalities, coagulopathy, acid-base disorders and hyperkalemia</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Fever, jaundice, Gradual decline in haemoglobin levels (hemolysis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Can range from mild to life-threatening</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Generally less severe than immediate reactions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<ul>\n<li>Febrile non-hemolytic reaction (FNHTR)</li>\n<li>Transfusion-related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> lung injury (TRALI)</li>\n<li>Transfusion-associated <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> (TACO)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Delayed <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> reaction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old boy is brought to the OPD with pain, redness, and swelling around his great toe. His serum uric acid level is 9.4 mg/dL. His mother also mentions that he frequently bites his lips and has symptoms of spasticity and dystonia. Which enzyme is most likely deficient in this condition?", "options": [{"label": "A", "text": "Cystathionine beta-synthase", "correct": false}, {"label": "B", "text": "Dihydrothymidine oxidase", "correct": false}, {"label": "C", "text": "Hypoxanthine-guanine phosphoribosyltransferase", "correct": true}, {"label": "D", "text": "Xanthine oxidase", "correct": false}], "correct_answer": "C. Hypoxanthine-guanine phosphoribosyltransferase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lesch-Nyhan syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deficiency of <strong>hypoxanthine-guanine <span class=\"customMeta\" data-dictid=\"95180751f316927771959f3ad459d2\">phosphoribosyltransferase</span> (HPRT)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-linked recessive</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variants</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Classic Lesch-Nyhan syndrome</strong>: Undetectable HPRT levels.</li>\n<li><strong>Kelley-Seegmiller syndrome</strong>: Partial HPRT <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> with variable neurological dysfunction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Self-injurious behaviour</strong>: Biting lips, fingers, tongue; begins with tooth eruption.</li>\n<li><strong>Cognitive impairment</strong>: Intellectual disability ranging from mild to severe.</li>\n<li><strong>Movement disorder</strong>: Starts with hypotonia, progresses to dystonia, choreoathetosis, <span class=\"customMeta\" data-dictid=\"38cacb86921692777194fd25551f4e\">oromandibular</span> dystonia, and inspiratory stridor.</li>\n<li><strong>Oculomotor apraxia</strong>: Difficulty controlling eye movements.</li>\n<li><strong>Dysarthric speech</strong>: Difficulty speaking clearly.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hyperuricemia</strong>: Causes <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> stones.</li>\n<li><strong>Neurological symptoms</strong>: Abnormalities in the <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> system, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> transporters.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Allopurinol</strong>: Reduces <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid levels and manages hyperuricemia.</li>\n</ul>\n<ul>\n<li><strong>Symptom management</strong>: Controls movement disorders and self-injurious behaviours.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A road traffic accident patient has presented to you with features of a nerve injury involving right upper limb. On examination, the patient is able to carry out flexion at metacarpo-phalangeal joint and extension at interphalangeal joint. The most likely nerve involved is?", "options": [{"label": "A", "text": "Median nerve", "correct": true}, {"label": "B", "text": "Anterior interosseous nerve", "correct": false}, {"label": "C", "text": "Ulnar nerve", "correct": false}, {"label": "D", "text": "Radial nerve", "correct": false}], "correct_answer": "A. Median nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female patient presents with complaints of abdominal pain; further investigations show elevated PTH levels and renal calculi. Which of the following investigations should be done next?", "options": [{"label": "A", "text": "USG thyroid", "correct": false}, {"label": "B", "text": "TC 99m sestamibi scan", "correct": true}, {"label": "C", "text": "Dexa scan", "correct": false}, {"label": "D", "text": "Radioactive iodine uptake test", "correct": false}], "correct_answer": "B. TC 99m sestamibi scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5pZycAVR3rFl9qv1Ldk41747381984.png", "https://image.prepladder.com/content/vpfqXgmNvzn16Ruu6J9D1747381998.png", "https://image.prepladder.com/content/MbMXZRFLitQkI3HObMxe1747382005.png", "https://image.prepladder.com/content/x6V5VIxeaRlGoX8lBLrV1747382013.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hyperparathyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Functions of the <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increase the level of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> in the body (Subperiosteal bone resorption).</li>\n<li>Decrease the level of <span class=\"customMeta\" data-dictid=\"bfea0730ac16927771959eb551740f\">phosphorus</span> in the body (Urinary <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of phosphorus).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary hyperparathyroidism</strong> (parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> and <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> hyperplasia)</li>\n<li><strong>Secondary hyperparathyroidism</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiological features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Subperiosteal resorption</strong> usually starts in the middle <span class=\"customMeta\" data-dictid=\"e9451cd23d1692777195fe471f486e\">phalanx</span> of the index finger's <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> side, leading to a <span class=\"customMeta\" data-dictid=\"5725f054721692777184f74b5fa780\">concavity</span> of bone<strong> (the earliest bone change).</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Bennett, Jackson &amp; Suliburk, James &amp; Morón, Fanny.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Subperiosteal-resorption-of-the-radial-aspect-of-the-middle-phalanges-of-the-second-and_fig1_339432582\" data-tags=\"\" height=\"388\" src=\"https://image.prepladder.com/content/5pZycAVR3rFl9qv1Ldk41747381984.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>The \"salt and pepper\" appearance, or pepper pot skull</strong> (lytic lesions in the skull).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dra. María Ferretti Diez\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/salt-and-pepper-skull#image-51937521 \" data-tags=\"\" height=\"282\" src=\"https://image.prepladder.com/content/vpfqXgmNvzn16Ruu6J9D1747381998.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Brown tumor or <span class=\"customMeta\" data-dictid=\"dc4ced4b86169277719422ad2689a5\">osteitis</span> fibrosa cystica:</strong> <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> lesions resulting from excessive <span class=\"customMeta\" data-dictid=\"fc8c28347a16927771945680bd00be\">osteoclastic</span> <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> appear as low-density, multiloculated cysts that can cause bone expansion, often accompanied by <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> and <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue (more common in primary hyperparathyroidism).</li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Frank Gaillard \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Osteitis_fibrosa_cystica#/media/File:Brown_tumours_of_the_hands.jpg\" data-tags=\"\" height=\"315\" src=\"https://image.prepladder.com/content/MbMXZRFLitQkI3HObMxe1747382005.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Rugger jersey spine:</strong> Characterized by <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> black and white striations, with sclerosed white end plates and black vertebral bodies; commonly seen in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"303281f8d5169277719437cf04ebaf\">osteodystrophy</span> (secondary hyperparathyroidism).</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Arambewela, Maulee &amp; Liyanarachchi, Kamani &amp; Somasundaram, Noel &amp; Pallewatte, Aruna &amp; Punchihewa, Gamini. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/ray-spine-showing-rugger-jersey-spine_fig3_318615259\" data-tags=\"\" height=\"489\" src=\"https://image.prepladder.com/content/x6V5VIxeaRlGoX8lBLrV1747382013.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which structure is located approximately 25 cm from the central incisor?", "options": [{"label": "A", "text": "Cricopharynx", "correct": false}, {"label": "B", "text": "Arch of Aorta", "correct": true}, {"label": "C", "text": "Left principal bronchus", "correct": false}, {"label": "D", "text": "Diaphragm", "correct": false}], "correct_answer": "B. Arch of Aorta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QESmR9tUZdJ3fs9i1NFS1747374196.png", "https://image.prepladder.com/content/4CoXWE43gdFL3tVwRmv51747374210.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child immediately cries after breastfeeding, followed by vomiting and diarrhea. Which enzyme deficiency might be responsible?", "options": [{"label": "A", "text": "Aldolase B", "correct": false}, {"label": "B", "text": "Phenylalanine Hydroxylase", "correct": false}, {"label": "C", "text": "Galactose-1-Phosphate Uridyl Transferase", "correct": true}, {"label": "D", "text": "Glucocerebrosidase", "correct": false}], "correct_answer": "C. Galactose-1-Phosphate Uridyl Transferase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Galactosemia </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Galactose-1-phosphate uridylyltransferase (GALT) - <strong>Classical type</strong></li>\n<li>Galactokinase - <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> disease with only<strong> oil drop cataract.</strong></li>\n<li>Epimerase - <strong>SNHL </strong>+ symptoms of classical type</li>\n</ul>\n<p>(Low galactose-based diet can be given, which is contraindicated in the classical type)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Accumulation of galactose-1-phosphate <strong>(toxic causing jaundice, and liver damage)</strong></li>\n<li>Inability to metabolize <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> from milk</li>\n<li>Damage to liver, kidney, and brain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatic: Jaundice, hepatomegaly</li>\n<li>GI: Vomiting, diarrhea, failure to thrive</li>\n<li>CNS: Seizures, intellectual disability</li>\n<li>Eyes: Oil drop cataracts</li>\n<li>Increased risk of E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> sepsis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reducing substance in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (positive) <strong>(Positive Benedict test but negative <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> test)</strong></li>\n<li>Direct <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> (GALT) assay</li>\n<li>Genetic testing <strong>(Perinatal diagnosis is possible)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lactose-free diet</li>\n<li>Breast Milk contraindicated</li>\n<li>Soy-based or elemental formulas</li>\n<li>Calcium supplementation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the lining epithelium of the trachea?", "options": [{"label": "A", "text": "Simple squamous epithelium", "correct": false}, {"label": "B", "text": "Transitional epithelium", "correct": false}, {"label": "C", "text": "Stratified squamous epithelium", "correct": false}, {"label": "D", "text": "Pseudostratified ciliated columnar", "correct": true}], "correct_answer": "D. Pseudostratified ciliated columnar", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZNiDNfE4HDqXfxAZSkaH1747374268.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the surgical procedure for Patent Ductus Arteriosus, the structure that is in close relation to it can be damaged. Which of the following can be the structure?", "options": [{"label": "A", "text": "Left recurrent laryngeal nerve", "correct": true}, {"label": "B", "text": "Right recurrent laryngeal nerve", "correct": false}, {"label": "C", "text": "Thoracic duct", "correct": false}, {"label": "D", "text": "Hemiazygos vein", "correct": false}], "correct_answer": "A. Left recurrent laryngeal nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Right <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> Laryngeal Nerve (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Left <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> Laryngeal Nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Pathway</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Loops around the right <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Loops around the <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> of the aorta</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Relation to <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> Artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lies between the branches of the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (can be <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> or posterior)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lies <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Course</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Shorter course in the neck</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Longer course in the neck</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Prone to Injury In</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Thyroid surgeries (more <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to injury than left side)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Mediastinal pathologies (due to its longer course)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Affected by Mediastinal Pathologies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>No, as it loops around the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (outside the mediastinum)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Yes, as it loops around the aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> (within the mediastinum)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Clinical Condition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Less affected by <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> pathologies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Ortner’s Syndrome</strong> (Mitral <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> → Left <span class=\"customMeta\" data-dictid=\"425c9b69db1692777182955542b3b0\">atrial enlargement</span> → Compression of left <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve → Hoarseness of voice)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following primitive reflexes do not disappear?", "options": [{"label": "A", "text": "Rooting reflex", "correct": false}, {"label": "B", "text": "Parachute reflex", "correct": true}, {"label": "C", "text": "Moro's reflex", "correct": false}, {"label": "D", "text": "Palmar grasp reflex", "correct": false}], "correct_answer": "B. Parachute reflex", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Name of the reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Appears at (weeks of gestation)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disappears at (Postnatal age)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rooting <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">Reflex</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">32 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1 month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moro’s <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">Reflex</span> </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">28-37 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">3-6months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palmar/Plantar Grasp <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">Reflex</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">28 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">4 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ATNR (Asymmetric <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">Tonic</span> Neck Reflex)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">35 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">3 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>STNR (symmetric <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">tonic</span> neck reflex)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">6-9 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">9-11 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parachute reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">8-9 months</p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Landau reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">3 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1 year</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neck righting reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Birth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">5 years of age</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old female who is a known case of sickle cell anaemia was rushed to the emergency department with a complaint of extreme pain in the legs and fingers for the past 4 hours. Further examination revealed pain and tenderness in the right upper quadrant, and investigations showed sickle cells on peripheral blood smear and high bilirubin(indirect). What is the diagnosis?", "options": [{"label": "A", "text": "IDA", "correct": false}, {"label": "B", "text": "Thalassemia", "correct": false}, {"label": "C", "text": "Anaemia of chronic disease", "correct": false}, {"label": "D", "text": "Sickle cell crisis", "correct": true}], "correct_answer": "D. Sickle cell crisis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lyybY2TCthQ1gjbrbTzd1747377457.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who has been treated for TB in the past now presented with hemoptysis. Make a diagnosis based on the given X-ray.", "options": [{"label": "A", "text": "Bronchogenic carcinoma", "correct": false}, {"label": "B", "text": "Aspergilloma", "correct": true}, {"label": "C", "text": "Hydatid cyst", "correct": false}, {"label": "D", "text": "Lung abscess", "correct": false}], "correct_answer": "B. Aspergilloma", "question_images": ["https://image.prepladder.com/content/sfufevGw0522pUFxCZrd1747382178.png"], "explanation_images": ["https://image.prepladder.com/content/PbhrhPhLhlDRkzPuFM031747382193.png", "https://image.prepladder.com/content/N2rzjzY78oynORdBTisU1747382219.png", "https://image.prepladder.com/content/mOCUHSdLHCNSc7sR60un1747382240.png", "https://image.prepladder.com/content/nEAVzoBNLrQauJQJYJ7I1747382248.png", "https://image.prepladder.com/content/kFUiAuF9unLnVElsUQnL1747382260.png", "https://image.prepladder.com/content/SITm33uvhR2b5PytMi6I1747382279.png", "https://image.prepladder.com/content/lDmPXlwkWHJ8Fw76EG7g1747382289.png", "https://image.prepladder.com/content/eUNaMaD93022Ygnneetu1747382298.png", "https://image.prepladder.com/content/mMuIQyXoj2LQIEb9Agkk1747382311.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Allergic Bronchopulmonary Aspergillosis (ABPA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"M. Kalil, A. Fernandes, Aline Cristiane da Silva Curzel, Márcio Zamuner Cortez, Gláucia Lima\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Allergic-bronchopulmonary-aspergillosis-presenting-Kalil-Fernandes/8332df9d3e4acd3389c885330535fac931554267\" data-tags=\"\" height=\"563\" src=\"https://image.prepladder.com/content/PbhrhPhLhlDRkzPuFM031747382193.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li>ABPA is a <strong>hypersensitivity reaction </strong>affecting the major upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> airways leading to upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> bronchiectasis.</li>\n<li>It is associated with Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> IgE levels, Positive <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> precipitins for Aspergillus, Respiratory symptoms similar to asthma, Skin <span class=\"customMeta\" data-dictid=\"d4b70f945316927771972d75389cf0\">reactivity</span> to Aspergillus</li>\n</ul>\n<p> </p>\n<p><strong>Radiographic Findings</strong>:</p>\n<ul>\n<li><strong>Non-segmental opacities</strong> primarily in the upper lobes</li>\n<li>Lobar collapse</li>\n<li>Branching thick <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> opacities due to <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> and <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> (known as the <strong>\"finger-in-glove sign\"</strong> or \"Y\" shape)</li>\n<li>Occasional <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> cavitation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspergillus Mycetomas/ Aspergilloma/ Fungal Ball </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Cheo, Seng Wee &amp; Ng, Khai &amp; Low, Qj. (2021). A diabetic lady with difficulty in breathing. Malaysian Family Physician. 16. 126-128. 10.51866/tyk1188. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Chest-radiograph-showing-Monods-sign_fig1_356699949\" data-tags=\"\" height=\"287\" src=\"https://image.prepladder.com/content/N2rzjzY78oynORdBTisU1747382219.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li>Aspergillus mycetomas are <span class=\"customMeta\" data-dictid=\"626a8495ab169277719806e670a934\">saprophytic</span> growths that inhabit<strong> preexisting lung cavities</strong>,</li>\n<li>These are predominantly found in the<strong> upper lobes</strong> and <strong>superior segments </strong>of the <strong>lower lobes</strong>.</li>\n</ul>\n<p> </p>\n<p><strong>CT Characteristics</strong>:</p>\n<ul>\n<li>Appears as a mass with soft-tissue <span class=\"customMeta\" data-dictid=\"22818451b71692777182237914a233\">attenuation</span> within a lung cavity.</li>\n<li>The mass is usually separated from the <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> wall by an airspace, known as the <strong>\"Air crescent\" or Monod sign</strong>.</li>\n<li>The position of the mass may change between <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> and <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> orientations, demonstrating its mobility.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Angioinvasive Aspergillosis</strong><strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Bell D, Weerakkody Y, Al Kabbani A\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/halo-sign-chest-3\" data-tags=\"\" height=\"238\" src=\"https://image.prepladder.com/content/mOCUHSdLHCNSc7sR60un1747382240.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Fig: <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">Halo</span> sign</strong></p>\n<p> </p>\n<ul>\n<li>Primarily occurs in<strong> immunocompromised</strong> individuals,</li>\n<li>Involves invasion and <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> of small to medium <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> arteries.</li>\n<li>Leads to the formation of<strong> necrotic hemorrhagic nodules</strong> or infarcts.</li>\n</ul>\n<p> </p>\n<p><strong>CT Findings</strong>:</p>\n<ul>\n<li>Commonly presented as multiple nodules surrounded by a <span class=\"customMeta\" data-dictid=\"95af91681416927771887742113c38\">halo</span> of <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> attenuation<strong> \"halo sign\" </strong>or pleural-based wedge-shaped consolidations. <strong>(Option A)</strong></li>\n<li>The<strong> bronchial cut-off sign</strong> indicates<strong> central necrosis</strong>.</li>\n<li>Nodular opacities tend to be widespread across several lung lobes, unlike the clustered <span class=\"customMeta\" data-dictid=\"d54aac1d5516927771958b92a04d85\">peribronchial</span> opacities seen in bacterial infections.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of intracranial hemorrhage is most likely depicted in the image given below?", "options": [{"label": "A", "text": "Extradural hemorrhage", "correct": false}, {"label": "B", "text": "Subarachnoid hemorrhage", "correct": false}, {"label": "C", "text": "Subdural hematoma", "correct": true}, {"label": "D", "text": "Intraparenchymal hemorrhage", "correct": false}], "correct_answer": "C. Subdural hematoma", "question_images": ["https://image.prepladder.com/content/keKfO02wUwLEyfCOxP4g1747226141.png"], "explanation_images": ["https://image.prepladder.com/content/LqhBRzGSWR1F5GKszUTL1747226386.png", "https://image.prepladder.com/content/TSSnlnkD1CTP6Kvts2421747226392.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subdural Hematoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extradural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Arachnoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Skull</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Crescent-shaped</strong></li>\n<li><strong>Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Biconvex or lens-shaped </strong></li>\n<li>Well-defined &amp; Localized,</li>\n<li><strong>Won’t cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tearing of <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> veins</strong>, often due to <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma / acceleration-deceleration injuries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rupture of the middle meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or vein</strong> due to skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Develop over days to weeks; Acute SDH can occur rapidly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually develop rapidly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Craniotomy / Craniectomy</strong>, if significant.</li>\n<li>Conservative management for smaller, stable cases.</li>\n<li><strong>Burr hole <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> </strong>is preferred for significant chronic cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> for significant or deteriorating cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"https://en.wikipedia.org/wiki/Subdural_hematoma#/media/File:Subduralandherniation.PNG\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"James Heilman, MD\" data-tags=\"\" height=\"279\" src=\"https://image.prepladder.com/content/LqhBRzGSWR1F5GKszUTL1747226386.png\" width=\"223\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sharma, Dr Anand &amp; Dewan, Yashbir.\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/A-NCCT-head-right-fronto-parietal-acute-extradural-hematoma-with-midline-shift-towards_fig1_283980160\" data-tags=\"\" height=\"267\" src=\"https://image.prepladder.com/content/TSSnlnkD1CTP6Kvts2421747226392.png\" width=\"227\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a triage setting, which of the following categories requires the highest priority intervention?", "options": [{"label": "A", "text": "Red", "correct": true}, {"label": "B", "text": "Yellow", "correct": false}, {"label": "C", "text": "Green", "correct": false}, {"label": "D", "text": "Black", "correct": false}], "correct_answer": "A. Red", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Colour </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Priority </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Medical Need </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Status </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Critical, but likely to survive if treatment is given early</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> trauma</li>\n<li>Tension pneumothorax</li>\n<li>Profuse external bleeding</li>\n<li>Haemothorax</li>\n<li>Flail chest</li>\n<li>Major <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> bleed</li>\n<li>Extradural haematomas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow (Option B)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Second</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urgent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Critical, but likely to survive if treatment is given within hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Compound fractures</li>\n<li>Degloving injuries</li>\n<li>Ruptured <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> viscus</li>\n<li>Pelvic fracture</li>\n<li>Spinal injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Green (Option C)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Third</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Urgent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stable, likely to survive even if treatment is delayed for hours to days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple fractures</li>\n<li>Sprains</li>\n<li>Minor lacerations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Black (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Last</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unsalvageable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not breathing, pulseless, so severely injured that no medical care is likely to help.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe brain damage</li>\n<li>Very extensive burns</li>\n<li>Major disruption/ loss of chest or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall structures</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old male child was brought to the OPD with complaints of low-grade fever, headache and mild upper respiratory tract symptoms for the last 4 days. On examination, an erythematous rash was found on the cheeks. The parents said the rash developed on the cheeks first and then spread out to involve his trunk and limbs. The causative agent of this disease has a single-stranded DNA. What is the diagnosis?", "options": [{"label": "A", "text": "Hand, foot and mouth disease", "correct": false}, {"label": "B", "text": "Measles", "correct": false}, {"label": "C", "text": "Erythema infectiosum", "correct": true}, {"label": "D", "text": "Rubella", "correct": false}], "correct_answer": "C. Erythema infectiosum", "question_images": ["https://image.prepladder.com/content/vmKAdHMOboK5vAXakjss1747226752.png"], "explanation_images": ["https://image.prepladder.com/content/5b6pkLhPfz2DcIPBkII31747226844.png", "https://image.prepladder.com/content/8nvxkUU2deu3sCYRNVQo1747384570.png", "https://image.prepladder.com/content/q0T9TFNrfUzXT2BiPVlz1747226921.png", "https://image.prepladder.com/content/KFPJ7uHRhkhKLXvkLyU81747226932.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Erythema Infectiosum (Fifth disease)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Parvovirus B19</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age group affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 to 15 years (70% of cases)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-28 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Respiratory droplets. Transmission rates among contacts are 15-30%.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Prodromal phase:</strong> <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">Low-grade</span> fever, headache, and mild upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection symptoms.</li>\n<li>The characteristic <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in this condition is a <strong>\"slapped cheek appearance”, </strong>presenting as erythematous flushing on the face.</li>\n<li>The erythematous <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> spreads to the trunk and <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> extremities as a <strong>lacy or <span class=\"customMeta\" data-dictid=\"be3e391d521692777197393aff460d\">reticulated</span> pattern.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"Ahmet Metin Nursel Dilek Serap Gunes Bilgili\"' data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/Candida-intertrigo-on-the-infra-mammary-folds-of-a-middle-aged-woman_fig1_324568949\" data-tags=\"\" height=\"363\" src=\"https://image.prepladder.com/content/5b6pkLhPfz2DcIPBkII31747226844.png\" width=\"330\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Renata Robl, Marjorie Uber, Mayara Schulze Cosechen Rosvailer, Susana Giraldi, Vânia Oliveira Carvalho\" data-hash=\"\" data-license=\"NA\" data-source=\"https://ep.bmj.com/content/100/6/306\" data-tags=\"\" height=\"823\" src=\"https://image.prepladder.com/content/8nvxkUU2deu3sCYRNVQo1747384570.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Self-limiting disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: 1. IL-5 A. Regulates acute phase reactants 2. IL-6 B. T cell maturation 3. IL-7 C. Neutrophil recruitment 4. IL-8 D. Eosinophils activation", "options": [{"label": "A", "text": "1-B, 2-C, 3-D, 4-A", "correct": false}, {"label": "B", "text": "1-D, 2-A, 3-B, 4-C", "correct": true}, {"label": "C", "text": "1-C, 2-D, 3-B, 4-A", "correct": false}, {"label": "D", "text": "1-D, 2-C, 3-B, 4-A", "correct": false}], "correct_answer": "B. 1-D, 2-A, 3-B, 4-C", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IL-5 (Interleukin-5)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eosinophils activation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IL-6 (Interleukin-6)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regulates <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> phase reactants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IL-7 (Interleukin-7)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T cell maturation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IL-8 (Interleukin-8)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neutrophil recruitment</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is the most common parotid gland tumour?", "options": [{"label": "A", "text": "Pleomorphic adenoma", "correct": true}, {"label": "B", "text": "Warthin’s tumor", "correct": false}, {"label": "C", "text": "Adenoid cystic carcinoma", "correct": false}, {"label": "D", "text": "Mucoepidermoid carcinoma", "correct": false}], "correct_answer": "A. Pleomorphic adenoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qzvQ1MJFC6hz2cmapq0s1747227174.png"], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> tumors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common<strong> benign</strong> tumour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Pleomorphic adenoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common <strong>benign</strong> tumour of infants and young children</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Hemangioma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common<strong> malignan</strong>t tumour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mucoepidermoid carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common <strong>malignant</strong> tumour in children and young adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mucoepidermoid carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The most common<strong> malignant</strong> tumour of Minor salivary glands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Adenoid <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> carcinoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient in the first decade of life presents with grade II splenic injury with no active bleeding. What is the management?", "options": [{"label": "A", "text": "Splenectomy", "correct": false}, {"label": "B", "text": "Splenorrhaphy", "correct": false}, {"label": "C", "text": "Embolization", "correct": false}, {"label": "D", "text": "Conservative", "correct": true}], "correct_answer": "D. Conservative", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>American Association for the Surgery of Trauma - AAST <span class=\"customMeta\" data-dictid=\"6a4861c8d71692777199aeb1d55c85\">Spleen</span> Injury scale</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade I (Minor Injury):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> affects less than 10% of the splenic surface area.</li>\n<li>Capsular tear that is less than 1 cm in depth without active bleeding.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade II:</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving 10-50% of the splenic surface area.</li>\n<li>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> less than 5 cm in diameter.</li>\n<li>Laceration between 1 and 3 cm in depth that doesn't involve trabecular vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade III:</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Subcapsular <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> covering more than 50% of the splenic surface area or expanding hematoma.</li>\n<li>Intraparenchymal <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> greater than 5 cm or expanding.</li>\n<li>Laceration is more than 3 cm in depth or involves trabecular vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade IV:</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Laceration affects <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> or hilar vessels, with evidence of devascularisation involving more than 25% of the spleen.</li>\n<li>Injury to the splenic <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> that results in major blood loss.</li>\n<li>Any injury in the presence of splenic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury or active <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> within the splenic capsule</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade V (Severe Injury):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Completely shattered spleen.</li>\n<li>Vascular injury involving the splenic <span class=\"customMeta\" data-dictid=\"4fe753e1a91692777189b7bdb3e2e1\">hilum</span> that results in complete <span class=\"customMeta\" data-dictid=\"ddadff81201692777186bff3a36612\">devascularization</span> of the spleen.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient reports to the outpatient department with complaints of fatigue. Investigation results indicate a Hb of 5.9, increased RDW and TIBC, and low ferritin. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Sideroblastic anemia", "correct": false}, {"label": "B", "text": "IDA", "correct": true}, {"label": "C", "text": "Anaemia of chronic disease", "correct": false}, {"label": "D", "text": "Hemolytic anemia", "correct": false}], "correct_answer": "B. IDA", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WSPNN1WTR9bugGJgXioL1747227561.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Iron Study</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Interpretation in Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Ferritin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low (&lt; 30 ng/mL) (depleted iron stores).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serum Iron (Fe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total Iron Binding Capacity (TIBC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased TIBC (increased capacity of <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> to bind iron in response to low iron stores).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Red Cell Distribution <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">Width</span> (RDW)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased RDW (Red Cell Distribution Width)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">Aspiration</span> and Iron Staining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confirmatory test</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Serum Iron</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Transferrin saturation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Serum Ferritin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>TIBC</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sideroblastic Anemia</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anaemia of Chronic Disease</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemolytic Anemia</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a young patient under 5 years of age presenting with a painless, soft, fluctuating mass on the lateral side of the neck?", "options": [{"label": "A", "text": "Thyroglossal cyst", "correct": false}, {"label": "B", "text": "Cystic hygroma", "correct": true}, {"label": "C", "text": "Cervical lymphadenopathy", "correct": false}, {"label": "D", "text": "Ranula", "correct": false}], "correct_answer": "B. Cystic hygroma", "question_images": ["https://image.prepladder.com/content/xxOG5jX5cliIDVJGhEOw1747227568.png"], "explanation_images": ["https://image.prepladder.com/content/dwszgAuTBhS8hfs3hF2r1747227596.png", "https://image.prepladder.com/content/XMGup4Y1rFOCnaaO4QIF1747227601.png", "https://image.prepladder.com/content/FBGkLBb1u9C3JmkfHxiw1747227606.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for an adult male patient with a history of intermittent purulent discharge with a slight blood tinge from an external opening located in the perianal region?", "options": [{"label": "A", "text": "Hemorrhoids", "correct": false}, {"label": "B", "text": "Pilonidal sinus", "correct": false}, {"label": "C", "text": "Perianal abscess", "correct": false}, {"label": "D", "text": "Fistula in ano", "correct": true}], "correct_answer": "D. Fistula in ano", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7fxaLB3QNQjbapXAVZ5a1747227847.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>\n<p>Idiopathic/Cryptoglandular: The most common cause, often associated with prior <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> sepsis.</p>\n</li>\n<li>\n<p>Associated Conditions:</p>\n<ul>\n<li>\n<p>Crohn’s disease</p>\n</li>\n<li>\n<p>Tuberculosis</p>\n</li>\n<li>\n<p>Lymphogranuloma venereum</p>\n</li>\n<li>\n<p>Actinomycosis</p>\n</li>\n<li>\n<p>Rectal duplication</p>\n</li>\n<li>\n<p>Foreign bodies</p>\n</li>\n<li>\n<p>Malignancy (rare, can develop within a longstanding fistula)</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Intermittent <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge: This may be bloody and purulent. Discomfort typically increases until the <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> discharges, providing temporary relief.</p>\n</li>\n<li>\n<p>Previous history of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">Anorectal</span> abscess</p>\n</li>\n<li>\n<p>Passage of <span class=\"customMeta\" data-dictid=\"c952bab9c2169277720207dd4f48d0\">flatus</span> or faeces: Through the external opening, (indicative of a rectal rather than an anal internal opening).</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Inter- sphincteric (most common, 70%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Trans- sphincteric (25%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 3 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Supra- sphincteric (4%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type 4 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Extra- sphincteric (1%)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are correct about NETs except?", "options": [{"label": "A", "text": "May result in SLE", "correct": false}, {"label": "B", "text": "Phagocytosis", "correct": true}, {"label": "C", "text": "Sepsis", "correct": false}, {"label": "D", "text": "Arginine needed", "correct": false}], "correct_answer": "B. Phagocytosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/g9TJ1zuu3v62tLCPhBZ61747227893.png", "https://image.prepladder.com/content/vWVYLDO0OQINYuLXUNPF1747227893.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the most common pancreatic islet tumor associated with MEN-1 syndrome.", "options": [{"label": "A", "text": "VIPoma", "correct": false}, {"label": "B", "text": "Gastrinoma", "correct": true}, {"label": "C", "text": "Insulinoma", "correct": false}, {"label": "D", "text": "Lipoma", "correct": false}], "correct_answer": "B. Gastrinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Gastrinoma</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of Multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">Endocrine</span> Neoplasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MEN Type IV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Defect of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>11q13</strong> causing <strong>MEN 1 gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></li>\n<li>Also called <strong>Wermer’s syndrome</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Defect of chr.10 leading to <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> of <strong>RET gene</strong></li>\n<li>Also called <strong>Sipple’s syndrome </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Also called <strong>MEN II B</strong>, it is a <strong>variant of Type 2 </strong>MEN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defect of chr.12 causing <strong>CDKN1B gene</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumors</strong></p>\n<p><strong>Included</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid adenoma </strong>(most common)</p>\n<ul>\n<li>It presents with primary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> (↑ PTH and ↑ Ca)</li>\n<li>All the 4 glands can be included.</li>\n<li><strong>Rx: </strong>Total/subtotal <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> resection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (</strong>most common, and <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> can be normal)</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> (</strong>most common)</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (</strong>Presents as hypercalcemia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreatic adenoma</strong></p>\n<ul>\n<li>Presents as <strong>Gastrinoma or Zollinger-Ellison syndrome</strong></li>\n<li>This leads to <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease in the duodenum, which is the leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> in this type.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pheochromocytoma</strong>.</p>\n<p> </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pheochromocytoma </strong>(Most important <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">criterion</span> for both <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 2 and <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 3): Presents with elevated blood pressure.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma, causing <span class=\"customMeta\" data-dictid=\"5d8a1011e31692777181375a96c9c8\">amenorrhea</span> and Infertility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</strong></p>\n<ul>\n<li>Calcitonin is the <span class=\"customMeta\" data-dictid=\"19ae68448b16927772016d48bd7fc3\">tumor marker</span> present</li>\n<li>Cold nodules are seen on the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> scan</li>\n<li>Metastasis can be traced with PET scan</li>\n<li>Visible neck mass, causing dysphagia</li>\n<li><strong>Rx</strong>- Prophylactic thyroidectomy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reproductive <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> tumors</strong></p>\n<ul>\n<li>Testicular tumors</li>\n<li>Neuroendocrine tumor (Cervix)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Angiofibroma</li>\n<li>Collagenoma</li>\n<li>Adrenocortical tumor</li>\n<li>Carcinoid tumors/Argentaffinoma</li>\n<li>Pheochromocytoma (only in 1%)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Congenital aganglionosis,</li>\n<li>Hirschsprung disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Marfanoid habitus</li>\n<li>Medullated corneal nerve fibers</li>\n<li>Mucosal neuromas</li>\n<li>Megacolon and Multiple diverticulae</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occasionally with</p>\n<ul>\n<li>Renal tumor</li>\n<li>Adrenal tumor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A barium swallow radiographic image of a woman with dysphagia is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Achalasia", "correct": true}, {"label": "B", "text": "Distal esophageal spasm", "correct": false}, {"label": "C", "text": "Jackhammer esophagus", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Achalasia", "question_images": ["https://image.prepladder.com/content/NiuTuWHhNf5G4MN5yH7M1747284621.png"], "explanation_images": ["https://image.prepladder.com/content/t6SKR9GKVAH60UlmZJTU1747284717.png", "https://image.prepladder.com/content/fgFwkYqlzEI5o78qi7dF1747284729.png", "https://image.prepladder.com/content/6tKjxNqLbzKvOLveJrLU1747386737.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Achalasia cardia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is characterised by the progressive <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> cells in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall. This leads to a loss of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the lower <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> and failure of the lower <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> (LES) to relax during swallowing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dysphagia: May initially affect liquids more than solids.</li>\n<li>Regurgitation</li>\n<li>Halitosis</li>\n<li>Chest Pain</li>\n<li>Weight Loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Esophageal Manometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gold Standard: This is the <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test for achalasia. It measures the pressure and pattern of muscle contractions in the esophagus. <strong>(Option A)</strong></p>\n<ul>\n<li>Elevated resting LES pressure (typically &gt; 45 mmHg).</li>\n<li>Incomplete LES relaxation.</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> body.</li>\n<li>Periodic contractions with normal <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> or high <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> contractions (type I and II achalasia).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Barium Swallow (Esophagram)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with a narrowing at the LES (Bird <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">beak</span> appearance).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Farnoosh Farrokhi, Michael F. Vaezi\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Acha.JPG\" data-tags=\"\" height=\"411\" src=\"https://image.prepladder.com/content/t6SKR9GKVAH60UlmZJTU1747284717.png\" width=\"208\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endoscopy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> but may show dilated <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> with possible food debris, It is important to rule out other causes of dysphagia, such as tumors.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of skin graft is used in the image shown?", "options": [{"label": "A", "text": "Split thickness", "correct": true}, {"label": "B", "text": "Full thickness", "correct": false}, {"label": "C", "text": "Wolfe graft", "correct": false}, {"label": "D", "text": "Local flap", "correct": false}], "correct_answer": "A. Split thickness", "question_images": ["https://image.prepladder.com/content/IBRYhGiL28SAxxuIzI4o1747284898.png"], "explanation_images": ["https://image.prepladder.com/content/kuW2DUd284ITkoXgA1a81747386858.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Thiersch Graft (Split-Thickness Skin Graft)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Wolfe Graft (Full-Thickness Skin Graft)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of Skin Grafting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Split-thickness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Full-thickness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epidermis + part of dermis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epidermis + full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of dermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Graft Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large grafts can be taken</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only small grafts can be taken</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Graft Survival</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Easier</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More difficult</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Donor Site Healing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heals spontaneously, allowing repeated grafts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Permanent <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> develops, preventing repeated grafts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Graft Contraction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Significant contraction, leading to poor <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lesser contraction, better <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Donor Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inner thigh, upper arm, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> aspect of forearm, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper eyelid, retro <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> skin, <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> skin, <span class=\"customMeta\" data-dictid=\"116f4dd59e169277718172685cecb2\">antecubital</span> skin, <span class=\"customMeta\" data-dictid=\"5f4a18606116927771909db4d0fe2f\">inframammary</span> skin, inguinal skin, <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> skin, <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Donor Site Exclusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Axilla is not used as a donor site</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages of Harvesting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allows <span class=\"customMeta\" data-dictid=\"b24aa5ceb516927771836a4cb7dd29\">calibration</span> of <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> and large area coverage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calibration of <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> for small but thick grafts</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent bronchoscopy, during the procedure a perforation occurred at 25 cm. Which structure is most likely to be damaged?", "options": [{"label": "A", "text": "Diaphragm", "correct": false}, {"label": "B", "text": "Arch of aorta", "correct": true}, {"label": "C", "text": "Pharyngoesophageal junction", "correct": false}, {"label": "D", "text": "T10", "correct": false}], "correct_answer": "B. Arch of aorta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CjuJTpXLl1LPnB6ExFjE1747386907.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the operative procedure shown in the image.", "options": [{"label": "A", "text": "Primary closure of perforation", "correct": false}, {"label": "B", "text": "Resection and Anastomosis", "correct": true}, {"label": "C", "text": "Ileostomy", "correct": false}, {"label": "D", "text": "Resection alone", "correct": false}], "correct_answer": "B. Resection and Anastomosis", "question_images": ["https://image.prepladder.com/content/YEYJAxfWWh1PBD6hAenN1747387012.png"], "explanation_images": ["https://image.prepladder.com/content/e1wvZifhme9Ud2ZAVGs91747387024.png", "https://image.prepladder.com/content/VQ6xSg2es5Mq01O63G8m1747285429.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the condition depicted in the given image, and what is the next investigation required for management?", "options": [{"label": "A", "text": "Erythroplakia and biopsy", "correct": true}, {"label": "B", "text": "Erythroplakia and observation", "correct": false}, {"label": "C", "text": "Leukoplakia and biopsy", "correct": false}, {"label": "D", "text": "Leukoplakia and observation", "correct": false}], "correct_answer": "A. Erythroplakia and biopsy", "question_images": ["https://image.prepladder.com/content/PO9xAHqQ0XLjM6nV2Hf71747285618.png"], "explanation_images": ["https://image.prepladder.com/content/CEDyMtd3NpRlNLj6d90t1747285666.png", "https://image.prepladder.com/content/ubRqJD9nC8mY5UXMZZ2u1747285672.png", "https://image.prepladder.com/content/px9qk3dgD0i1jMcz7lEG1747285685.png"], "explanation": "\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Leukoplakia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Oral <span class=\"customMeta\" data-dictid=\"39ca145a0f1692777183a33d06e96d\">candidiasis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Premalignant lesion</li>\n<li>Causes: Pan masala chewing, Tobacco chewing, Betel quid</li>\n<li>Can be seen in adults above 40 years.</li>\n<li>White patch or plaque</li>\n<li>Surgical excision, CO<sub>2</sub> laser, and medications can be used to treat.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Premalignant lesion</li>\n<li>Caused by Candida albicans</li>\n<li>Seen in immunosuppressed</li>\n<li>White curdy lesions</li>\n<li>Treated by <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> antifungals, surgery, or lasers.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presents to the outpatient department 10 days postpartum with complaints of a fluctuant breast mass with tenderness, high-grade fever, and cracked nipples. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Breast engorgement", "correct": false}, {"label": "B", "text": "Breast abscess", "correct": true}, {"label": "C", "text": "Acute mastitis", "correct": false}, {"label": "D", "text": "Fibroadenoma", "correct": false}], "correct_answer": "B. Breast abscess", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Breast Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pus-filled <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> within breast tissue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Lactational Abscess: </strong>Associated with breastfeeding.</li>\n<li><strong>Non-Lactational Abscess: </strong>Occurs in non-lactating women, e.g., <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">periductal</span> mastitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes and Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lactation:\n\t\t\t\t<ul>\n<li>Incidence: 3% to 20% in lactating mothers.</li>\n<li>Common pathogen: <strong>Staphylococcus aureus </strong>(methicillin-resistant strains in hospital settings).</li>\n<li>Entry points: <strong>Cracked/retracted nipple, blocked <span class=\"customMeta\" data-dictid=\"8ef2f22a3f1692777191d43bb00fb2\">lactiferous</span> ducts.</strong></li>\n</ul>\n</li>\n<li>Non-Lactation:\n\t\t\t\t<ul>\n<li>Often in<strong> <span class=\"customMeta\" data-dictid=\"341daa40bb169277719303fbd1ce1a\">nulliparous</span> women or post-lactation.</strong></li>\n<li>Conditions:<strong> <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">Periductal</span> mastitis, <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> mastitis, <span class=\"customMeta\" data-dictid=\"daf5ee63361692777201129f498a4d\">tubercular</span> mastitis.</strong></li>\n<li><strong>Smoking and diabetes </strong>as risk factors.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Signs and symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fever, leukocytosis, erythema, pain and tenderness, swelling, malaise, difficulty feeding, enlarged and tender axillary nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ultrasonography:\n\t\t\t\t<ul>\n<li>Detects cellulitis, <span class=\"customMeta\" data-dictid=\"8170dc8ad81692777191ec56a3f27c\">liquefaction</span> necrosis.</li>\n<li>Confirms <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> size, location, and loculation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lactational Mastitis:\n\t\t\t\t<ul>\n<li>Antibiotics: Anti-staphylococcal (e.g., cloxacillin, flucloxacillin, erythromycin).</li>\n<li>Breast emptying: Frequent <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> or pumping.</li>\n<li>Support: Breast support garment, cold compresses, analgesia.</li>\n<li>Drainage: Ultrasound-guided preferred over <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> incision.</li>\n<li>Follow-up: Regular clinical and ultrasonographic reviews, culture-based <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> modification.</li>\n</ul>\n</li>\n<li>Non-Lactational Mastitis:\n\t\t\t\t<ul>\n<li>Broad-spectrum antibiotics for <span class=\"customMeta\" data-dictid=\"ba2454588016927771996f5f346221\">subareolar</span> infections.</li>\n<li>Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> for <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> drainage.</li>\n<li>Major milk <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for complications like <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> or fistula.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 160 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "In a follow-up case of prostate cancer, what do we need to check?", "options": [{"label": "A", "text": "Alkaline phosphatase", "correct": false}, {"label": "B", "text": "PSA", "correct": true}, {"label": "C", "text": "Testosterone", "correct": false}, {"label": "D", "text": "Acid phosphatase", "correct": false}], "correct_answer": "B. PSA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance in <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> Cancer Follow-Up</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PSA (Prostate-Specific Antigen)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most important marker; rising levels indicate <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> or metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaline <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">Phosphatase</span> (ALP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marker for <strong>bone metastases</strong>, but not routinely used for follow-up</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acid <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">Phosphatase</span> (PAP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Older marker, now largely replaced by PSA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testosterone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Checked in hormone-sensitive cases on ADT to confirm <strong>castrate levels</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person's father had colon cancer. He had bloody stool. So,he just came for a check-up. Before he had not undergone any screening. He was recommended to do a colonoscopy for screening. Screening is which level of prevention?", "options": [{"label": "A", "text": "Primordial", "correct": false}, {"label": "B", "text": "Primary", "correct": false}, {"label": "C", "text": "Secondary", "correct": true}, {"label": "D", "text": "Tertiary", "correct": false}], "correct_answer": "C. Secondary", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Levels of prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primordial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prevention of establishment of risk factors.</li>\n<li>It aims to discourage people from adopting harmful habits.</li>\n<li>Avoiding smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Health promotion and specific protection.</li>\n<li>Prevention of onset of disease in a high-risk group/individual.</li>\n<li>It aims to protect the health of those who are at risk.</li>\n<li>Reduces the <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of the disease.</li>\n<li>Quit smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Secondary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Disease <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> can be prevented at an early stage (Disease is reversible).</li>\n<li>It aims to reduce the <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of the disease by early identification and prompt treatment of diseases, and it also prevents complications.</li>\n<li>Screening for diabetes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tertiary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prevention or limitation of <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> and disability in a diseased patient who has developed complications due to the disease and the disease has become irreversible.</li>\n<li>It aims to minimize a patient's suffering and maximize potential years of useful life.</li>\n<li>Disability limitation and rehabilitation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Quaternary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prevention of the risk of overmedicalization of a patient or population.</li>\n<li>Aims to prevent prescription of unnecessary medications and <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> medical interventions.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient scheduled for elective hip surgery is currently taking aspirin, enalapril, a multivitamin, and metoprolol. The surgery is planned in 5 days. What is the appropriate perioperative management for this patient?", "options": [{"label": "A", "text": "Stop enalapril", "correct": true}, {"label": "B", "text": "Stop aspirin to minimize perioperative bleeding risk", "correct": false}, {"label": "C", "text": "Stop metoprolol to increase cardiac output", "correct": false}, {"label": "D", "text": "Increase aspirin dosage for additional analgesic benefit", "correct": false}], "correct_answer": "A. Stop enalapril", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medication discontinuation before surgery </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continued or stopped preoperatively </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antithyroid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antiepileptic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antidepressants</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspirin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta Blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smoking</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stop at least 6-8 weeks prior</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Steroid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anticonvulsants</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monoamine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">Oxidase</span> Inhibitors (MAOIs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Discontinue 2-3 weeks before surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pill</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Discontinue at least 6 weeks before</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Herbal Supplements</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Discontinue at least 2 weeks before surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors (Enalapril)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stop 24 hours before surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Angiotensin II <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Blockers (ARBs) (Telmisartan)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stop 24 hours before surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcium Channel Blockers (Amlodipine)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continue</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with Hollman miller's sign in the CT image given below?", "options": [{"label": "A", "text": "Juvenile nasopharyngeal angiofibroma", "correct": true}, {"label": "B", "text": "Maxillary sinusitis", "correct": false}, {"label": "C", "text": "Nasal polyp", "correct": false}, {"label": "D", "text": "Rhinosporidiosis", "correct": false}], "correct_answer": "A. Juvenile nasopharyngeal angiofibroma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations of <span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\">Juvenile</span> <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contrast-Enhanced CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Investigation of choice</strong>; shows tumor size, location, and bony involvement.</li>\n<li>Pathognomonic sign: Holman-Miller sign (bowing of maxillary wall).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluates soft tissue and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension, differentiates between <span class=\"customMeta\" data-dictid=\"a479c9f4081692777187a3308ccd27\">extradural</span> and <span class=\"customMeta\" data-dictid=\"ebcba023d81692777190e9eef5bcc2\">intradural</span> spread.<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Digital <span class=\"customMeta\" data-dictid=\"408be3f8d81692777199619278702d\">Subtraction</span> <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">Angiography</span> (DSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visualizes tumor vascularity, identifies <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> vessels and aids in <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">preoperative</span> <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> to reduce <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> blood loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasopharyngoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides a direct view of the tumor, but <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is generally avoided due to high <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> caused by <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube obstruction; establishes <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> and monitors post-treatment hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biopsy is<strong> contraindicated</strong> due to risk of profuse bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify A and B in the image of the mosquito larvae given", "options": [{"label": "A", "text": "A-Culex, B-Aedes", "correct": false}, {"label": "B", "text": "A-Anopheles, B-Culex", "correct": true}, {"label": "C", "text": "A-Culex, B-Anopheles", "correct": false}, {"label": "D", "text": "A-Anopheles, B-Mansonia", "correct": false}], "correct_answer": "B. A-Anopheles, B-Culex", "question_images": ["https://image.prepladder.com/content/z7GBU2ILTvDOHSPtnk6q1747855857.png"], "explanation_images": ["https://image.prepladder.com/content/AFbAOBQnLGAshrmbvTnS1741104759.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:765px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anopheles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aedes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mansonoides</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Larvae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>No <span class=\"customMeta\" data-dictid=\"9d59eae3ce16927771982e99e0035f\">siphon</span> tube</strong></li>\n<li>Rests <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to water surface</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Longer <span class=\"customMeta\" data-dictid=\"9d59eae3ce16927771982e99e0035f\">siphon</span> tubes</li>\n<li>Rests at an angle to water surface</li>\n</ul>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Shorter <span class=\"customMeta\" data-dictid=\"9d59eae3ce16927771982e99e0035f\">siphon</span> tubes</li>\n<li>Rests at an angle to water surface</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eggs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lays singly</li>\n<li><strong>Boat shaped</strong></li>\n<li><strong>Lateral floats</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lays in clusters (100-250 in a single cluster)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lays singly</li>\n<li><strong>Cigar shaped</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lays in clusters</li>\n<li><strong>Star-shaped</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Habitat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exophilic: outside house</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exophilic: day</p>\n<p>Endophilic: night</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endophilic: inside house</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exophilic</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn male presents with urinary retention, lethargy and a distended bladder. Antenatal ultrasound showed a \"keyhole sign\" with a thickened bladder wall. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypospadias", "correct": false}, {"label": "B", "text": "Vesicoureteral reflux", "correct": false}, {"label": "C", "text": "Posterior urethral valves", "correct": true}, {"label": "D", "text": "Neurogenic bladder", "correct": false}], "correct_answer": "C. Posterior urethral valves", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Posterior urethral valves </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in male infants from membranous folds in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> urethra.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> from oligohydramnios.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I: <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> urethral folds</p>\n<p>Type II: Membranes at <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> neck</p>\n<p>Type III: Round <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> at verumontanum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital, unclear embryological origin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> pressure → hypertrophy, <span class=\"customMeta\" data-dictid=\"639b2545551692777201eeadb06d68\">vesicoureteric</span> reflux, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tools</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound, <span class=\"customMeta\" data-dictid=\"1fbf40a1d316927772018a8e73e615\">VCUG</span> (voiding cystourethrogram) and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> scintigraphy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antenatal Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound: Dilated <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> (\"keyhole sign\"), thickened walls.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postnatal Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary retention, infections, lethargy, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antenatal: Vesicostomy, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> ablation</li>\n<li>Postnatal: Stabilization, <span class=\"customMeta\" data-dictid=\"8a8a7309fc169277718529cb457969\">cystoscopic</span> ablation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depends on severity; long-term care needed for CKD, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> dysfunction, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> UTIs.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the nodal ministry of disaster management?", "options": [{"label": "A", "text": "Ministry of Health and Family Welfare", "correct": false}, {"label": "B", "text": "Ministry of Home Affairs", "correct": true}, {"label": "C", "text": "Ministry of Human Resource and Development", "correct": false}, {"label": "D", "text": "Ministry of Education", "correct": false}], "correct_answer": "B. Ministry of Home Affairs", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disaster Management Act (2005):</strong></p>\n<ul>\n<li>Established the National Disaster Management Authority (NDMA) and State Disaster Management Authorities (SDMAs).</li>\n<li>Provides a legal framework for disaster management in India.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>National Disaster Management Authority (NDMA):</strong></p>\n<ul>\n<li>Prepares national-level disaster management plans and oversees their execution.</li>\n<li>Key agency for disaster management <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> in India.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>National Institute of Disaster Management:</strong></p>\n<ul>\n<li>Located in New Delhi, it focuses on capacity building, training, and research.</li>\n<li>Aims to strengthen national disaster response capabilities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Role of State Governments:</strong></p>\n<ul>\n<li>Direct responsibility for executing relief efforts post-disaster.</li>\n<li>Supported by the Union government through the Calamity Relief Fund (3:1 contribution ratio).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ministry of Home Affairs (MHA): (Option B)</strong></p>\n<ul>\n<li>Nodal ministry for overall <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> of disaster management.</li>\n<li>Chaired by the Prime Minister, it oversees disaster response at the national level.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>National Crisis Management Committee (NCMC) and Cabinet Committee on Security (CCS):</strong></p>\n<ul>\n<li>Involved in high-level decision-making for disaster management in India.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emergency Medical Relief Wing:</strong></p>\n<ul>\n<li>Operates under the Ministry of Health and Family Welfare, coordinates health-related activities during disasters.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old woman laborer presented with visible, soft, and fluctuating swelling in front of the knee, over the patella and some discomfort or difficulty with knee movement, MRI findings are given below. What is the diagnosis?", "options": [{"label": "A", "text": "Housemaid's knee", "correct": true}, {"label": "B", "text": "Subdermal abscess", "correct": false}, {"label": "C", "text": "Gout", "correct": false}, {"label": "D", "text": "Rheumatoid arthritis", "correct": false}], "correct_answer": "A. Housemaid's knee", "question_images": ["https://image.prepladder.com/content/kSgdyCTvx5ybPDKqxOwf1741086749.png"], "explanation_images": ["https://image.prepladder.com/content/HJo7OcylK66RdhynYjTj1741086180.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A girl presents with microcephaly and a high-pitched cry. Which of the following is the most likely chromosomal abnormality?", "options": [{"label": "A", "text": "Deletion", "correct": true}, {"label": "B", "text": "Isochromosome", "correct": false}, {"label": "C", "text": "Trisomy", "correct": false}, {"label": "D", "text": "Mosaicism", "correct": false}], "correct_answer": "A. Deletion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old woman presents with irregular periods, acne &amp;amp; excessive hair growth. What is the first line management?", "options": [{"label": "A", "text": "Metformin", "correct": false}, {"label": "B", "text": "Lifestyle modifications", "correct": true}, {"label": "C", "text": "OCPs", "correct": false}, {"label": "D", "text": "Clomiphene citrate", "correct": false}], "correct_answer": "B. Lifestyle modifications", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benefits</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>OCPs (First-line for <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> regulation &amp; hirsutism)</strong><strong> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Estrogen increases SHBG, reducing free testosterone; <span class=\"customMeta\" data-dictid=\"5a7ee002c71692777196c96d5ada60\">Progestogen</span> suppresses LH &amp; <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> production</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regulates cycles, reduces <span class=\"customMeta\" data-dictid=\"8b61bc6e361692777180695ac33e91\">acne</span> &amp; hirsutism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-androgenic OCPs (Preferred)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cyproterone <span class=\"customMeta\" data-dictid=\"47765053a81692777180738f50cd4e\">acetate</span> or Drospirenone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best for <span class=\"customMeta\" data-dictid=\"b1cab43c3216927771897f8f15cbbd\">hirsutism</span> &amp; acne</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spironolactone + OCPs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> receptors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces <span class=\"customMeta\" data-dictid=\"b1cab43c3216927771897f8f15cbbd\">hirsutism</span> &amp; acne</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eflornithine Cream (Topical)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits hair growth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> hirsutism</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:704px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benefits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Letrozole (Preferred Over Clomiphene Citrate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aromatase inhibitor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No anti-estrogenic effects on <span class=\"customMeta\" data-dictid=\"2f1603da6716927771878d0cbdd372\">endometrium</span> &amp; <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> → higher pregnancy rates, monofollicular stimulation, no ovarian <span class=\"customMeta\" data-dictid=\"97cdd1c214169277718992e2918f2c\">hyperstimulation</span> syndrome (OHSS)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Drowsiness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clomiphene <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">Citrate</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Selective <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> modulator</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Induces <span class=\"customMeta\" data-dictid=\"264a9eb50d1692777194427a13247b\">ovulation</span> in 80%, conception in 40-45%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti-estrogenic effects on <span class=\"customMeta\" data-dictid=\"2f1603da6716927771878d0cbdd372\">endometrium</span> &amp; <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> lower fertility, OHSS in &lt;1%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tamoxifen (Resistant Cases)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Estrogen <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> modulator</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used when Clomiphene fails (80-160 mg for 5 days)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>–</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dexamethasone (Adjunct)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lowers <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> androgens</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Improves <span class=\"customMeta\" data-dictid=\"264a9eb50d1692777194427a13247b\">ovulation</span> outcomes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>–</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benefits and side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metformin</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Improves <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity, reduces <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> production, lowers <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benefits: Increases <span class=\"customMeta\" data-dictid=\"264a9eb50d1692777194427a13247b\">ovulation</span> (70-80%), conception (30-40%).<br/>\n\t\t\t </p>\n<p>S/E: GI disturbances, <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis, avoid in liver/kidney disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N-acetylcysteine (NAC) + Micronutrients</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lowers homocysteine, improves <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alternative to Metformin in some cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acarbose (Alternative to Metformin)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delays <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> absorption</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used if Metformin is contraindicated</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has a history of a flying foreign body injury to the eye. Hemochromatosis is subsequently diagnosed. Which of the following substances is most likely involved in the deposition?", "options": [{"label": "A", "text": "Iron", "correct": true}, {"label": "B", "text": "Aluminum", "correct": false}, {"label": "C", "text": "Wood", "correct": false}, {"label": "D", "text": "Glass", "correct": false}], "correct_answer": "A. Iron", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:660px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraocular Foreign Bodies (IOFBs)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An IOFB can lodge in any part of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> segments, causing mechanical damage, infection, or toxic effects on <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> structures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inert: </strong>Glass, wood, plastic, rubber, gold, silver, platinum</p>\n<p><strong>Reactive: </strong>Organic and <span class=\"customMeta\" data-dictid=\"fae9d02cdc1692777190a3151d6fef\">Inorganic</span> (iron causing siderosis, <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> causing chalcosis).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>History.</li>\n<li>Examination (wound examination, foreign body location, associated signs such as lid <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> and <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> segment damage should be noted).</li>\n<li><strong>CT (investigation of choice) </strong>with <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> and <span class=\"customMeta\" data-dictid=\"dad5b2152216927771851a3d10cd41\">coronal</span> cuts detects and localizes a <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> IOFB.</li>\n<li>MRI is contraindicated (metallic IOFB).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Magnetic removal (metallic IOFB)</li>\n<li>Forceps removal through <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> <span class=\"customMeta\" data-dictid=\"2d0756b0d11692777195ef3bcd110d\">plana</span> vitrectomy</li>\n<li>Prophylaxis against infection (topical/systemic antibiotics)<strong> </strong></li>\n<li>Conservative and supportive management (topical corticosteroids, analgesics, etc).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In paracetamol poisoning, N-acetylcysteine is administered as an antidote. How does it act to prevent toxicity?", "options": [{"label": "A", "text": "Inhibits the toxin", "correct": false}, {"label": "B", "text": "Removes the toxin", "correct": false}, {"label": "C", "text": "Restores glutathione levels", "correct": true}, {"label": "D", "text": "Neutralizes liver enzymes", "correct": false}], "correct_answer": "C. Restores glutathione levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"fcdd3383341692777194cf2cd4e400\">Paracetamol</span> poisoning</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gastric Lavage</strong></li>\n<li>Administer <span class=\"customMeta\" data-dictid=\"5dd23480451692777180e299cc38bc\">activated charcoal</span> or <span class=\"customMeta\" data-dictid=\"8cbc9195731692777184663e492746\">cholestyramine</span> (effective within 30 minutes of ingestion)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N-acetylcysteine (NAC) Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initiate within <strong>8 hours</strong> of ingestion; may be partially effective up to <strong>24–36 hours</strong> post-overdose.</li>\n<li><strong>Administration</strong>:</li>\n</ul>\n<ul>\n<li>IV: 140 mg/kg <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose over 1 hour, followed by 70 mg/kg every 4 hours for 15–20 doses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>NAC acts as a <span class=\"customMeta\" data-dictid=\"1a1b98a5d7169277719914104ae697\">sulfhydryl</span> donor, replenishing glutathione.</li>\n<li>Neutralizes toxic metabolites and prevents binding to cell proteins, reducing the severity of <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> necrosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver Transplantation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Considered in cases of <strong>hepatic failure</strong> (jaundice, coagulopathy, confusion).</li>\n<li><strong>King's College Criteria</strong> is used to predict the need for a liver transplant in patients with paracetamol-induced <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> liver failure :</li>\n</ul>\n<ul>\n<li>Arterial blood pH &lt; 7.30</li>\n</ul>\n<p>Or all of the following:</p>\n<ul>\n<li>Prothrombin time (PT) &gt; 100 seconds (INR &gt; 6.5)</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> &gt; 300 μmol/L</li>\n<li>Grade III or IV <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> encephalopathy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the emergency department with confusion. On examination, he opens his eyes to pain, shows abnormal flexion to pain, and is disoriented in speech. What is his Glasgow Coma Scale (GCS) score?", "options": [{"label": "A", "text": "11", "correct": false}, {"label": "B", "text": "12", "correct": false}, {"label": "C", "text": "10", "correct": false}, {"label": "D", "text": "9", "correct": true}], "correct_answer": "D. 9", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:441px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Response Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient's Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexion withdrawal from pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total <span class=\"customMeta\" data-dictid=\"e37b435fd416927771886af66a9675\">GCS</span> Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 + 4 + 3</strong> = <strong>9</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:406px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To voice</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oriented</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localizes pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexion (abnormal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extension (abnormal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presents to the outpatient department with a swelling on his wrist. He reports fluctuation in size , mild numbness in the hand , and occasional pain . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Lipoma", "correct": false}, {"label": "B", "text": "Ganglion cyst", "correct": false}, {"label": "C", "text": "Dermoid cyst", "correct": true}, {"label": "D", "text": "Hematoma", "correct": false}], "correct_answer": "C. Dermoid cyst", "question_images": ["https://image.prepladder.com/content/gqjIclGrXM8GneTDx6Nq1741106569.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<th><strong>Condition</strong></th>\n<th><strong>Characteristics</strong></th>\n<th><strong>Pain</strong></th>\n<th><strong>Fluctuation in Size</strong></th>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Numbness</strong></p>\n</td>\n</tr>\n<tr>\n<td><strong>Lipoma</strong></td>\n<td>Soft, mobile, <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> fat mass</td>\n<td>No</td>\n<td>No</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n</tr>\n<tr>\n<td><strong>Ganglion cyst</strong></td>\n<td>Fluid-filled, over joint or <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> sheath, translucent</td>\n<td>Occasional</td>\n<td>Yes</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td><strong>Dermoid cyst</strong></td>\n<td>Congenital, contains ectodermal elements (hair/sebum)</td>\n<td>Rare</td>\n<td>Rare</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n</tr>\n<tr>\n<td><strong>Hematoma</strong></td>\n<td>Post-trauma, discoloured, self-resolving</td>\n<td>Yes (initially)</td>\n<td>No</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 9-month-old baby was admitted in the ICU with history of recurrent sinusitis and otitis media by staph aureus. Laboratory examination showed decreased serum IgA, IgG, IgM, IgE, and plasma B cells. Which of the following is the condition is described here?", "options": [{"label": "A", "text": "Ataxia telangiectasia", "correct": false}, {"label": "B", "text": "Chronic granulomatosis disease", "correct": false}, {"label": "C", "text": "Bruton syndrome", "correct": true}, {"label": "D", "text": "Di George syndrome", "correct": false}], "correct_answer": "C. Bruton syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn child is brought to the emergency department with respiratory difficulty. The doctor evaluated, and the child was found to have a posterolateral defect, as shown in the x-ray given. What is the diagnosis?", "options": [{"label": "A", "text": "Bochdalek hernia", "correct": true}, {"label": "B", "text": "Morgagni hernia", "correct": false}, {"label": "C", "text": "Hiatal hernia", "correct": false}, {"label": "D", "text": "Traumatic diaphragmatic hernia", "correct": false}], "correct_answer": "A. Bochdalek hernia", "question_images": ["https://image.prepladder.com/content/jSkknhPwrwYaa7hAhffh1741087237.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child presents with epiphora, and probing reveals a soft block at 7 mm. What is the best treatment option for this condition?", "options": [{"label": "A", "text": "Endonasal Dacryocystorhinostomy (DCR)", "correct": false}, {"label": "B", "text": "Conjunctival Dacryocystorhinostomy (DCR)", "correct": true}, {"label": "C", "text": "External Dacryocystorhinostomy (DCR)", "correct": false}, {"label": "D", "text": "Dacryocystectomy", "correct": false}], "correct_answer": "B. Conjunctival Dacryocystorhinostomy (DCR)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ylqEyp78Mczp5esU8UGZ1741088366.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a child presenting with diarrhoea, the following finding is noted. What is the likely micronutrient deficiency?", "options": [{"label": "A", "text": "Zinc", "correct": true}, {"label": "B", "text": "Copper", "correct": false}, {"label": "C", "text": "Vitamin A", "correct": false}, {"label": "D", "text": "Vitamin C", "correct": false}], "correct_answer": "A. Zinc", "question_images": ["https://image.prepladder.com/content/08O2Y8BouWdFAwm1OKHY1741087950.png"], "explanation_images": ["https://image.prepladder.com/content/RznW20SIAbUvx3cyrUdu1741088010.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following describes the chloride ion exchange in red blood cells, where bicarbonate ions are exchanged for chloride ions to maintain electrical neutrality?", "options": [{"label": "A", "text": "Haldane effect", "correct": false}, {"label": "B", "text": "Root effect", "correct": false}, {"label": "C", "text": "Bohr effect", "correct": false}, {"label": "D", "text": "Chloride shift", "correct": true}], "correct_answer": "D. Chloride shift", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chloride shift</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reverse <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> shift</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tissues</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lungs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Process</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CO₂ enters RBCs, forming H₂CO₃ → H⁺ + HCO₃⁻. HCO₃⁻ exits in exchange for Cl⁻</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CO₂ exits RBCs. HCO₃⁻ re-enters RBCs in exchange for Cl⁻</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect on RBCs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chloride influx causes water influx, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> RBCs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chloride efflux balances HCO₃⁻ re-entry, CO₂ is released</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impact on haematocrit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"2e114d4cdc169277718882a0a01076\">hematocrit</span> due to <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> swelling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily facilitates CO₂ release, indirectly affecting hematocrit</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a neck mass and laboratory findings of increased T4 and decreased TSH. The patient has a history of I-131 ablation therapy. Which of the following is a likely side effect of the treatment?", "options": [{"label": "A", "text": "Acute Thyroiditis", "correct": false}, {"label": "B", "text": "Hypothyroidism", "correct": false}, {"label": "C", "text": "Hyperthyroidism", "correct": true}, {"label": "D", "text": "Thyroid Storm", "correct": false}], "correct_answer": "C. Hyperthyroidism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypothyroidism (Correct Answer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Destruction of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> tissue → <strong>↓ T4, ↑ TSH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most patients post-I-131 therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Thyroiditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiation-induced <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> → temporary <strong>thyroid pain, swelling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early post-treatment phase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperthyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thyrotoxic phase</strong> due to sudden hormone release from damaged cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, transient</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thyroid Storm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Massive release of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormones <strong>(life-threatening)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very rare, usually in untreated Graves'</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient undergoing general anesthesia develops left lung collapse following intubation. On auscultation, breath sounds are heard only on the right side. What is the most likely cause of this condition?", "options": [{"label": "A", "text": "Right endobronchial intubation", "correct": true}, {"label": "B", "text": "Mucus secretions obstructing the endotracheal tube", "correct": false}, {"label": "C", "text": "Pneumothorax on the left side due to positive pressure ventilation", "correct": false}, {"label": "D", "text": "Bronchospasm", "correct": false}], "correct_answer": "A. Right endobronchial intubation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which gene mutation is most commonly associated with Burkitt's lymphoma?", "options": [{"label": "A", "text": "C-myc", "correct": true}, {"label": "B", "text": "P-21", "correct": false}, {"label": "C", "text": "Rb", "correct": false}, {"label": "D", "text": "p53", "correct": false}], "correct_answer": "A. C-myc", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child was brought to the casualty with complaints of vomiting and loose stools with a history of laxative use. On examination, arrhythmia is present. What will be the abnormality present?", "options": [{"label": "A", "text": "Hyponatremia", "correct": false}, {"label": "B", "text": "Hypocalcemia", "correct": false}, {"label": "C", "text": "Hypokalemia", "correct": true}, {"label": "D", "text": "Hyperkalemia", "correct": false}], "correct_answer": "C. Hypokalemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications for IV <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> Supplementation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptomatic patients</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> (&lt;2.5 mEq/L)</li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> abnormalities</li>\n<li>Unable to tolerate oral feeds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">Chloride</span> Supplementation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dosage:</strong> 0.5-1 mEq/kg per dose</li>\n<li><strong>Administration:</strong> IV <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> over 1-2 hours</li>\n<li><strong>Infusion Rate:</strong> Do not exceed 1 mEq/kg per hour</li>\n<li><strong>Potassium Concentration:</strong>\n<ul>\n<li>Maximum of 60 mEq/L for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> lines</li>\n<li>Maximum of 80 mEq/L for central lines</li>\n</ul>\n</li>\n<li>Avoid using glucose-containing fluids to prevent insulin-mediated <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> shift.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> Supplementation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dosage:</strong> 2-4 mEq/kg per day, divided into 3-4 doses</li>\n<li><strong>Common Preparations:</strong>\n<ul>\n<li>Potassium <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> (10%; 20 mEq/15 mL)</li>\n<li>Potassium <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> (especially for <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis)</li>\n</ul>\n</li>\n<li><strong>Administration Tip:</strong> Liquid preparations can be bitter; <span class=\"customMeta\" data-dictid=\"e63a499e5716927771860681cef17d\">dilute</span> with juice or water to improve taste.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following factors causes a rightward shift in the oxygen-hemoglobin dissociation curve?", "options": [{"label": "A", "text": "Increase in CO₂", "correct": true}, {"label": "B", "text": "Increase in O₂", "correct": false}, {"label": "C", "text": "Decrease in CO₂", "correct": false}, {"label": "D", "text": "Decrease in temperature", "correct": false}], "correct_answer": "A. Increase in CO₂", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NAGQk0B2wtbH5rgNp2oY1741087175.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Bohr Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:top\">\n<p>A shift of the oxygen-hemoglobin <span class=\"customMeta\" data-dictid=\"18fb34ab321692777186e9bc95a726\">dissociation</span> curve to the right in response to increases in blood CO2 and H+ levels has a significant effect by enhancing the release of O2 from the blood in the tissues and enhancing <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> of the blood in the lungs</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:top\">\n<ul>\n<li>Increase in CO<sub>2</sub>: CO<sub>2</sub> diffuses from tissues into the blood, forming <span class=\"customMeta\" data-dictid=\"95585a69c21692777183b817f72e70\">carbonic acid</span> (H₂CO₃), dissociating into H+ and HCO<sub>3</sub>-. This increase in H+ lowers blood pH.</li>\n<li>Decrease in pH: Lower pH shifts the oxygen-haemoglobin <span class=\"customMeta\" data-dictid=\"18fb34ab321692777186e9bc95a726\">dissociation</span> curve to the right, causing haemoglobin to release O2 more readily.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Effects in Tissues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Higher CO2 and lower pH cause haemoglobin to release O2, delivering more O2 to metabolically active tissues.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Effects in Lungs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Expelling CO2 in the lungs decreases blood CO2 levels and increases pH, shifting the <span class=\"customMeta\" data-dictid=\"18fb34ab321692777186e9bc95a726\">dissociation</span> curve to the left and allowing haemoglobin to bind O2 more readily for transport.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Factors Influencing the Bohr Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:top\">\n<ul>\n<li>Increased CO2 concentration</li>\n<li>Increased blood temperature</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"5eb010f3041692777182726fdec300\">2,3-bisphosphoglycerate</span> (BPG) concentration: BPG binds to haemoglobin, reducing its <span class=\"customMeta\" data-dictid=\"227269f3ec1692777180d76a7898dd\">affinity</span> for O2 and promoting O2 release.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the hormonal check for pregnancy at home?", "options": [{"label": "A", "text": "Beta-HCG", "correct": true}, {"label": "B", "text": "Estrogen", "correct": false}, {"label": "C", "text": "Progesterone", "correct": false}, {"label": "D", "text": "HPL", "correct": false}], "correct_answer": "A. Beta-HCG", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ENDOCRINE CHANGES IN PREGNANCY</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>INCREASE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DECREASE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>UNCHANGED</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prolactin</li>\n<li>Growth Hormone</li>\n<li>ACTH</li>\n<li>Cortisol</li>\n<li>Aldosterone</li>\n<li>Testosterone</li>\n<li>Calcitriol</li>\n<li>Thyroid-binding <span class=\"customMeta\" data-dictid=\"1a8bcc07ca16927771882f63452d6e\">globulin</span> (TBG)</li>\n<li>Total T4</li>\n<li>Total T3</li>\n<li>hCG</li>\n<li>Human <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">Placental</span> <span class=\"customMeta\" data-dictid=\"e4f0a280e61692777191be9d18ee25\">Lactogen</span> (hPL)</li>\n<li>Insulin</li>\n<li>PTH</li>\n<li>Calcitonin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>FSH</li>\n<li>LH</li>\n<li>DHEAS (Dehydro <span class=\"customMeta\" data-dictid=\"a4072435d916927771872434d3eeb1\">epiandrosterone</span> sulfate)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Free T3</li>\n<li>Free T4</li>\n<li>Vasopressin (ADH)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Spot the image.", "options": [{"label": "A", "text": "Balloon Tamponade", "correct": true}, {"label": "B", "text": "Umbrella pack", "correct": false}, {"label": "C", "text": "Parachute pack", "correct": false}, {"label": "D", "text": "Cervical ablation", "correct": false}], "correct_answer": "A. Balloon Tamponade", "question_images": ["https://image.prepladder.com/content/vqAISbNCov4KwaWpEUGH1741098073.png"], "explanation_images": ["https://image.prepladder.com/content/1CXiQ0UWTXnWyYI5BwON1741098254.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the American Heart Association (AHA), what is the 6th link added to the chain of survival?", "options": [{"label": "A", "text": "Rapid defibrillation", "correct": false}, {"label": "B", "text": "Recovery and rehabilitation", "correct": true}, {"label": "C", "text": "High-quality CPR", "correct": false}, {"label": "D", "text": "Advanced airway management", "correct": false}], "correct_answer": "B. Recovery and rehabilitation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wFhZiURrLA5C7kVNdZS01741085790.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male undergoes an open appendectomy for acute appendicitis. The choice of incision was McBurney's incision. Postoperatively, after a few days, he presents with pain and bulging in the right lower quadrant, which is diagnosed as an indirect inguinal hernia. Which nerve injury during the appendectomy is most likely responsible for this complication?", "options": [{"label": "A", "text": "Ilioinguinal nerve", "correct": true}, {"label": "B", "text": "Femoral nerve", "correct": false}, {"label": "C", "text": "Genitofemoral nerve", "correct": false}, {"label": "D", "text": "Pudendal nerve", "correct": false}], "correct_answer": "A. Ilioinguinal nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Wound infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <strong>MC <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> complication</strong> involves infection at the <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> site.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. Intraabdominal abscess</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> within the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cavity, typically due to infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. Ileus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary cessation of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> function, leading to <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension and discomfort.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> leading to embolism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formation of blood clots in the veins, which can travel to the lungs or other parts of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5. <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> pyaemia (Pylephlebitis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection and <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of the <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, a rare but serious complication.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6. <span class=\"customMeta\" data-dictid=\"396cb274df16927771803e151a1109\">Adhesive</span> intestinal obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formation of <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue causing <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction; <strong>MC late complication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7. Fecal fistula</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leakage from the <span class=\"customMeta\" data-dictid=\"23c46c5fc916927771813b486e3774\">appendiceal</span> stump.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8. Nerve injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Injury to the <span class=\"customMeta\" data-dictid=\"108e66d0571692777189ff4a5e8740\">Ilioinguinal</span> nerve and <span class=\"customMeta\" data-dictid=\"240b25374316927771890d8646eda8\">iliohypogastric</span> nerve</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with diffuse severely contaminated peritonitis underwent laparotomy and was left open after surgery. Which of the following might help?", "options": [{"label": "A", "text": "VAC", "correct": true}, {"label": "B", "text": "Normal saline soaked gauze", "correct": false}, {"label": "C", "text": "Prefer closure after laparotomy", "correct": false}, {"label": "D", "text": "Antibiotic soaked gauze", "correct": false}], "correct_answer": "A. VAC", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Option</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effectiveness in Open Abdomen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Considerations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VAC Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Highly effective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces infection, removes fluids, aids healing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">Saline</span> Soaked Gauze</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary benefit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keeps wound moist but does not actively remove exudates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">Closure</span> After Laparotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not preferred in contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome &amp; infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotic-Soaked Gauze</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited benefit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Does not provide <span class=\"customMeta\" data-dictid=\"befa0a72121692777193663f2ca836\">negative pressure</span> drainage</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The development of cataracts in patients with Diabetes Mellitus is primarily due to the accumulation of which of the following substances in the lens?", "options": [{"label": "A", "text": "Sorbitol", "correct": true}, {"label": "B", "text": "Dulcitol", "correct": false}, {"label": "C", "text": "Mannitol", "correct": false}, {"label": "D", "text": "Galactitol", "correct": false}], "correct_answer": "A. Sorbitol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve will be involved in the following finding on rest?", "options": [{"label": "A", "text": "Ulnar", "correct": true}, {"label": "B", "text": "Median", "correct": false}, {"label": "C", "text": "Musculocutaneous", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "A. Ulnar", "question_images": ["https://image.prepladder.com/content/fVELYacsj2fd8tinw56l1741092176.png"], "explanation_images": ["https://image.prepladder.com/content/XOAlT145EZ8iI9vzQxnu1741059038.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Clawing:</strong> <span class=\"customMeta\" data-dictid=\"2ad2fb4cc8169277718925a677620c\">Hyperextension</span> of the <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joints and <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints.</li>\n<li>Clawing is seen in 2 <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> fingers only.</li>\n<li>Seen in <strong>pure <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve injury</strong>.</li>\n<li>Also known as the true <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clawing of all 4 fingers.</li>\n<li>Seen in combined<strong> <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> + <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> </strong>nerve palsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tardy <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Slow-onset (over years) <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy.</li>\n<li>Seen with <span class=\"customMeta\" data-dictid=\"5a7668926a1692777185299ac4cf5a\">cubitus</span> <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> seen in <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other deformities:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wasting of <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">hypothenar</span> muscles &amp; <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> muscles of the hand.</li>\n<li>Hollow inter-metacarpal spaces in hand.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Static procedure (removal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Zancolli Lasso procedure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dynamic procedures (tendon transfer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Modified Bunnel technique</li>\n<li>Brand’s operation</li>\n<li>Fowler’s operation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old female presents with complaints of a yellowish-green, foul-smelling vaginal discharge. She reports painful urination and pain during intercourse &amp;amp; no itching. On speculum examination, her vulva and vaginal walls appear inflamed. What is the causative agent?", "options": [{"label": "A", "text": "Trichomonas vaginalis", "correct": true}, {"label": "B", "text": "Candida albicans", "correct": false}, {"label": "C", "text": "Gardnerella vaginalis", "correct": false}, {"label": "D", "text": "Neisseria gonorrhoeae", "correct": false}], "correct_answer": "A. Trichomonas vaginalis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The cover-uncover test is performed to diagnose various eye conditions. Which of the following is not detected by this test?", "options": [{"label": "A", "text": "Latent Squint", "correct": false}, {"label": "B", "text": "Manifest Squint", "correct": false}, {"label": "C", "text": "Lateral Nystagmus", "correct": false}, {"label": "D", "text": "Amblyopia", "correct": true}], "correct_answer": "D. Amblyopia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xid5Y49PckvPBSIgjrej1741088211.png", "https://image.prepladder.com/content/FNLz61QtW6J0TjCyYz3O1741088228.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Identifies latent deviations or tropias.</li><li>↳ latent deviations or tropias.</li><li>↳ Procedure: Cover one eye and then observe the covered eye when the cover is removed. If the eye reverts to fixation, it indicates a phoria or intermittent tropia . If the eye remains deviated, it suggests a tropia with fixation preference for the fellow eye.</li><li>↳ Procedure:</li><li>↳ Cover one eye and then observe the covered eye when the cover is removed. If the eye reverts to fixation, it indicates a phoria or intermittent tropia . If the eye remains deviated, it suggests a tropia with fixation preference for the fellow eye.</li><li>↳ Cover one eye and then observe the covered eye when the cover is removed.</li><li>↳ If the eye reverts to fixation, it indicates a phoria or intermittent tropia .</li><li>↳ phoria or intermittent tropia</li><li>↳ If the eye remains deviated, it suggests a tropia with fixation preference for the fellow eye.</li><li>↳ tropia with fixation preference for the fellow eye.</li><li>↳ Alternate Cover Test: Detects phorias by dissociating the visual axes.</li><li>↳ Alternate Cover Test:</li><li>↳ Alternate covering each eye to maximize visual axis dissociation. Care must be taken to permit time for each eye to reside behind the cover (the cover must not be “fanned” before the eyes). Use prisms to quantify phorias or tropias. If measurements are unclear, estimate the midpoint between defined movements.</li><li>↳ Alternate covering each eye to maximize visual axis dissociation.</li><li>↳ Care must be taken to permit time for each eye to reside behind the cover (the cover must not be “fanned” before the eyes).</li><li>↳ Use prisms to quantify phorias or tropias. If measurements are unclear, estimate the midpoint between defined movements.</li><li>↳ Lateral Nystagmus (Option C): Nystagmus is involuntary, rhythmic eye movements. The cover-uncover test might exacerbate nystagmus, though it is not the primary test for detecting it.</li><li>↳ Lateral Nystagmus (Option C):</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vaccine is contraindicated in pregnancy?", "options": [{"label": "A", "text": "Influenza", "correct": false}, {"label": "B", "text": "Varicella", "correct": true}, {"label": "C", "text": "Rabies", "correct": false}, {"label": "D", "text": "TDaP", "correct": false}], "correct_answer": "B. Varicella", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is positive for HBsAg and anti-HBc IgM. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute hepatitis", "correct": true}, {"label": "B", "text": "Chronic hepatitis", "correct": false}, {"label": "C", "text": "Recovery phase", "correct": false}, {"label": "D", "text": "Vaccination", "correct": false}], "correct_answer": "A. Acute hepatitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:714px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>HBsAg</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>HBeAg</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBc </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBs </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBe </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Interpretation </strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">- </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection</strong></p>\n<p style=\"text-align: center;\">Highly infectious</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chronic <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection</strong>, highly infectious</p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Chronic <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection, low infectivity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Recovery </strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Window period</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Post-vaccination</strong></p>\n<p style=\"text-align: center;\"><strong>(Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient undergoing surgery is administered succinylcholine for muscle relaxation. Shortly after administration, he develops hyperthermia, muscle rigidity, tremors, and tachycardia. What is the most appropriate treatment for this condition?", "options": [{"label": "A", "text": "Neostigmine", "correct": false}, {"label": "B", "text": "Dantrolene sodium", "correct": true}, {"label": "C", "text": "Atropine", "correct": false}, {"label": "D", "text": "Midazolam", "correct": false}], "correct_answer": "B. Dantrolene sodium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 y/o male suddenly experiences an intense headache, described as the worst headache of his life, followed by vomiting and photophobia. O/E he has neck stiffness and a dilated pupil on the right side. A CT scan reveals bleeding in the subarachnoid space. Which of the following is the most common cause of this condition?", "options": [{"label": "A", "text": "Hypertension", "correct": false}, {"label": "B", "text": "Intracranial aneurysm", "correct": true}, {"label": "C", "text": "Arteriovenous malformation (AVM)", "correct": false}, {"label": "D", "text": "Brain tumour", "correct": false}], "correct_answer": "B. Intracranial aneurysm", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following methods is used to measure fetal anemia?", "options": [{"label": "A", "text": "Umbilical artery Doppler", "correct": false}, {"label": "B", "text": "Cord blood sampling", "correct": false}, {"label": "C", "text": "Chorionic villus sampling", "correct": false}, {"label": "D", "text": "Peak systolic velocity in the fetal middle cerebral artery (MCA)", "correct": true}], "correct_answer": "D. Peak systolic velocity in the fetal middle cerebral artery (MCA)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Utility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Invasiveness</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MCA-PSV <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> (Correct Answer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gold standard for <strong>non-invasive</strong> <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> anemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Umbilical <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> Doppler</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <strong>placental insufficiency</strong> (not <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> anemia)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cord blood <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> (PUBS - <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">Percutaneous</span> <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">Umbilical</span> Blood Sampling)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Directly measures <strong>fetal <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> and hematocrit</strong> but has high risk of complications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invasive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chorionic <span class=\"customMeta\" data-dictid=\"b0bb7d5b6716927772028625a93e1e\">villus</span> <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> (CVS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for <strong>genetic testing</strong> in the first trimester, not <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> anemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invasive</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate was born to a controlled gestational diabetes mother. At the time of birth, he was fine but 4 days later, he developed dyspnea with Spo2 80% at room air. What is the initial management?", "options": [{"label": "A", "text": "Give 21% to 30% O2", "correct": false}, {"label": "B", "text": "Give 100% O2", "correct": true}, {"label": "C", "text": "Give 50% O2", "correct": false}, {"label": "D", "text": "Observation", "correct": false}], "correct_answer": "B. Give 100% O2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old patient presents with absolute constipation and abdominal distension. And the X-ray abdomen is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Caecal Volvulus", "correct": false}, {"label": "B", "text": "Sigmoid Volvulus", "correct": true}, {"label": "C", "text": "Intestinal Obstruction", "correct": false}, {"label": "D", "text": "Small Bowel Volvulus", "correct": false}], "correct_answer": "B. Sigmoid Volvulus", "question_images": ["https://image.prepladder.com/content/DSpTmQBW5S2JhnoneQBq1741057455.png"], "explanation_images": ["https://image.prepladder.com/content/OFB2juCfEkwFX2tZXqkq1741057520.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:573px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sigmoid Volvulus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic constipation, long redundant <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coffee bean sign on X-ray, bird’s <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">beak</span> sign on contrast enema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominal distension, pain, absolute constipation, vomiting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic <span class=\"customMeta\" data-dictid=\"dfd87633931692777186f47063d1c2\">detorsion</span> (if no gangrene), surgery for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A corneal wisp test was performed, and the corneal reflex was elicited. Which of the following nerves is responsible for the afferent limb of this reflex?", "options": [{"label": "A", "text": "Facial Nerve", "correct": false}, {"label": "B", "text": "Trigeminal Nerve", "correct": true}, {"label": "C", "text": "Oculomotor Nerve", "correct": false}, {"label": "D", "text": "Abducens Nerve", "correct": false}], "correct_answer": "B. Trigeminal Nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Afferent Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Efferent Nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Accommodation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>II (Optic nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>III (Oculomotor nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Corneal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₁ (Ophthalmic, <span class=\"customMeta\" data-dictid=\"cdd6d30ff216927771933bc53be84b\">nasociliary</span> branch)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bilateral VII (Facial nerve, <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> branch - orbicularis oculi)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cough</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve, also <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">phrenic</span> and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerves)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gag</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IX (Glossopharyngeal nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Jaw Jerk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₃ (Mandibular branch, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> from masseter)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₃ (Mandibular branch, motor to masseter)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lacrimation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₁ (Ophthalmic branch) (loss of <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> does not preclude emotional tears)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>VII (Facial nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pupillary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>II (Optic nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>III (Oculomotor nerve)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer presents with fever and subconjunctival hemorrhage. The microscopic agglutination test turns to be positive. What is the diagnosis?", "options": [{"label": "A", "text": "Brucella", "correct": false}, {"label": "B", "text": "Leptospira", "correct": true}, {"label": "C", "text": "E coli", "correct": false}, {"label": "D", "text": "Staph aureus", "correct": false}], "correct_answer": "B. Leptospira", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1hfmsMr1jo6VdBvrGORq1741092435.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leptospira interrogans (bacteria)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Zoonotic disease</li>\n<li><strong>Indirect: </strong>Contact with water, moist soil, or surfaces contaminated with animal urine.</li>\n<li><strong>Direct: </strong>Contact with <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> or <span class=\"customMeta\" data-dictid=\"720552f298169277719434da81c0ef\">parturition</span> products from infected animals.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis Phases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Septicemic Phase: </strong>Entry through <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> or skin, dissemination via <span class=\"customMeta\" data-dictid=\"a813884d6016927771838d2d1f9d1d\">bloodstream</span> to organs.</li>\n<li><strong>Immune Phase:</strong> Antibodies develop, spirochetes disappear from blood; antigen-antibody complexes form, and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"d9e023242c16927771840efda08ae3\">colonization</span> occurs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Syndromes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Mild <span class=\"customMeta\" data-dictid=\"034b17cc011692777181338eb131f6\">Anicteric</span> Illness: </strong>Seen in 90% of cases, flu-like symptoms with <strong>fever</strong>, headache, <strong>conjunctival suffusion</strong>, nausea, vomiting, and myalgia.</li>\n<li><strong>Weil’s Disease:</strong> Severe icteric illness in 10% of cases; rapid progression, fatality rate of 5-15%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture Media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ellinghausen-McCullough-Johnson-Harris (EMJH) </strong>medium is commonly used for culturing <span class=\"customMeta\" data-dictid=\"6ca28c6bc31692777191173bb04186\">Leptospira</span> species showing <strong>Dinger’s ring.</strong></li>\n</ul>\n<p><strong></strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/1hfmsMr1jo6VdBvrGORq1741092435.png\" width=\"787\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li>It is a semi-solid or liquid medium that supports the slow-growing leptospires, often requiring <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> for weeks.</li>\n<li><strong>Specimen Sources:</strong> Blood, urine, or <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF) samples are often used, depending on the stage of infection.</li>\n<li>Other culture media are <strong>Korthoff and Fletcher.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Microscopic <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">Agglutination</span> Test (MAT)</strong><strong>: </strong>Considered the<strong> gold standard for <span class=\"customMeta\" data-dictid=\"6ca28c6bc31692777191173bb04186\">Leptospira</span> detection</strong>, <span class=\"customMeta\" data-dictid=\"4a466821d51692777191eed0c276f5\">MAT</span> measures antibodies in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> samples.</li>\n<li>The <strong>Modified Faine’s Criteria</strong> used to aid in the diagnosis of leptospirosis, especially in <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> areas.This scoring system combines <strong>clinical, epidemiological and laboratory data </strong>to increase <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> accuracy.</li>\n<li><strong>PCR (Polymerase Chain Reaction): </strong>Provides a faster diagnosis by detecting <span class=\"customMeta\" data-dictid=\"6ca28c6bc31692777191173bb04186\">leptospira</span> DNA in blood or urine, especially effective in the early stage.</li>\n<li><strong>ELISA</strong>: Used for <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> and is helpful for confirming infection in the later stages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotics</strong>: Early <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy is crucial and often involves:</p>\n<ul>\n<li><strong>Doxycycline</strong>: Typically used for mild cases and prophylaxis.</li>\n<li><strong>Penicillin or Ampicillin: </strong>Preferred for severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby presents with the clinical features shown in the image, including characteristic perioral and perianal rash along with a history of diarrhea. Which of the following is the most likely deficiency responsible for this condition?", "options": [{"label": "A", "text": "Zinc Deficiency", "correct": true}, {"label": "B", "text": "Niacin Deficiency", "correct": false}, {"label": "C", "text": "Selenium Deficiency", "correct": false}, {"label": "D", "text": "Magnesium Deficiency", "correct": false}], "correct_answer": "A. Zinc Deficiency", "question_images": ["https://image.prepladder.com/content/WIdfU4lhyCPE8giN92XV1747645788.png"], "explanation_images": ["https://image.prepladder.com/content/YLA12nZCwzsPVV4Gaemo1747645519.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zinc Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital (SLC39A4 mutation) or <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> (malnutrition, chronic diarrhea)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Skin Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perioral, perianal, and <span class=\"customMeta\" data-dictid=\"b01b22718a169277718096920a80e7\">acral</span> <span class=\"customMeta\" data-dictid=\"fedc53b3161692777186553c8f8d7d\">dermatitis</span> with erythematous, <span class=\"customMeta\" data-dictid=\"a37fd1603c1692777198f87a4a51dc\">scaly</span> plaques</p>\n<p style=\";\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2333\" src=\"https://image.prepladder.com/content/YLA12nZCwzsPVV4Gaemo1747645519.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth retardation, diarrhea, alopecia, immune dysfunction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Zinc supplementation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with recurrent Staphylococcus infections. Laboratory examination shows very low levels of immunoglobulins (G, A, M, E), and a low quantity of B cells. There is a normal reaction to environmental antigens on the skin. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bruton's agammaglobulinemia", "correct": true}, {"label": "B", "text": "DiGeorge syndrome", "correct": false}, {"label": "C", "text": "Hyper IgM syndrome", "correct": false}, {"label": "D", "text": "Common variable immunodeficiency", "correct": false}], "correct_answer": "A. Bruton's agammaglobulinemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of pneumonia develops pleural effusion. What is the expected finding in the pleural analysis for parapneumonic effusion?", "options": [{"label": "A", "text": "Pleural protein/plasma protein ratio less than 0.5", "correct": false}, {"label": "B", "text": "Pleural LDH less than 2/3rd of plasma LDH", "correct": false}, {"label": "C", "text": "Pleural pH less than 7.2", "correct": true}, {"label": "D", "text": "Pleural LDH less than 0.6 of plasma LDH", "correct": false}], "correct_answer": "C. Pleural pH less than 7.2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:710px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parapneumonic effusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition: </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">parapneumonic</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> is a pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> that occurs in association with bacterial pneumonia, lung abscess, or bronchiectasis.</li>\n<li>These effusions develop in about 40-60% of patients with bacterial pneumonia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types:</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Parapneumonic effusions can be categorized into three stages: simple (uncomplicated), complicated, and empyema.\n\t\t\t\t<ul>\n<li><strong>Simple <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">parapneumonic</span> effusions</strong>, the pleural fluid is <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> and can resolve with <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy alone.</li>\n<li><strong>Complicated <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">parapneumonic</span> effusions</strong> contain bacteria and require <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> in addition to antibiotics.</li>\n<li><strong>Empyema</strong> represents the most advanced stage where frank <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> is present in the pleural space.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simple <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">Parapneumonic</span> Effusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appearance: Serous</li>\n<li>PMN++, <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> fluid (negative bacterial culture)</li>\n<li>pH &gt;7.3, <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &lt;500 U/L, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &gt;80 mg/dL</li>\n<li>Fluid-glucose: serum-glucose &gt;0.5</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complicated <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">Parapneumonic</span> Effusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appearance: Turbid</li>\n<li>PMN++, bacterial culture may be + or -</li>\n<li><strong>pH &lt;7.1,</strong> <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt;1000 U/L, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt;40 mg/dL</li>\n<li>Fluid-glucose: serum-glucose &lt;0.5</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Empyema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appearance: Pus</li>\n<li>PMN++, bacterial culture positive or negative</li>\n<li>pH &lt;7.1, <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt;1000 U/L, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt;40 mg/dL</li>\n<li>Fluid-glucose: serum-glucose &lt;0.5</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management: </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Drain with antibiotics; small-bore drains (10-14 gauge) are often preferable. Consider thoracoscopic <span class=\"customMeta\" data-dictid=\"980a3fc15c1692777185d2c3e2e17f\">decortication</span> if these fail.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "KAT G mutation associated with:", "options": [{"label": "A", "text": "Isoniazid", "correct": true}, {"label": "B", "text": "Rifampicin", "correct": false}, {"label": "C", "text": "Levofloxacin", "correct": false}, {"label": "D", "text": "Ethambutol", "correct": false}], "correct_answer": "A. Isoniazid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0lvXK8DWvPLkFDYEuIJN1741086720.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mechanisms of <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> Resistance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KatG gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>INH</strong> is a prodrug, converted to the active <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> by catalase-peroxidase produced by the <span class=\"customMeta\" data-dictid=\"0ed7b29b0216927771900d7c5f7eb0\">Kat</span> G gene. The mutated <span class=\"customMeta\" data-dictid=\"553253f1ce1692777183d395babc1b\">catalase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> does not <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the active drug</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KasA gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Component of <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> mycolic acid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>InhA gene overexpression </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes <span class=\"customMeta\" data-dictid=\"9a6a6e737e1692777185f1b77971e2\">cross-resistance</span> to <span class=\"customMeta\" data-dictid=\"765ad61235169277718731b19650f4\">Ethionamide</span> (second-line drug)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which antihypertensive drug is contraindicated in pregnancy?", "options": [{"label": "A", "text": "Methyldopa", "correct": false}, {"label": "B", "text": "Enalapril", "correct": true}, {"label": "C", "text": "Labetalol", "correct": false}, {"label": "D", "text": "Nifedipine", "correct": false}], "correct_answer": "B. Enalapril", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:659px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adverse Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypotension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decrease in blood pressure, especially upon <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> of therapy or with <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">dosage</span> increases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> secretion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cough</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent dry cough, possibly due to <span class=\"customMeta\" data-dictid=\"3c5739595d16927771839e61a5855c\">bradykinin</span> buildup in the lungs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Angioedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to increased <span class=\"customMeta\" data-dictid=\"3c5739595d16927771839e61a5855c\">bradykinin</span> levels, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of deeper layers of skin, particularly around the eyes and lips, can be life-threatening.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rashes/Urticaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin reactions like rashes or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> occur in a small percentage of users.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dysgeusia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reversible taste changes are more common with captopril.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rare Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Granulocytopenia (low white blood cells) and <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> (excess protein in urine) are more concerning in patients with <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible in patients with <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> due to decreased <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> filtration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fetal Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ACE inhibitors are contraindicated during pregnancy due to potential harm to the fetus, including <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage due to <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> renin-angiotensin system.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient diagnosed with Cryptococcal meningitis. What is the treatment?", "options": [{"label": "A", "text": "Flucytosine", "correct": false}, {"label": "B", "text": "Fluconazole", "correct": false}, {"label": "C", "text": "L.Amp", "correct": false}, {"label": "D", "text": "Flucytosine + L.Amp", "correct": true}], "correct_answer": "D. Flucytosine + L.Amp", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cryptococcus neoformans </strong>(most common)</li>\n<li>Candida</li>\n<li>Histoplasma</li>\n<li>Blastomyces</li>\n<li>Coccidioides</li>\n<li>Sporothrix</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immunocompromised patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headache</li>\n<li>Altered mental status, lethargy</li>\n<li>Fever</li>\n<li>Neck stiffness</li>\n<li>Nausea and vomiting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lumbar Puncture:</strong> Low <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and high protein levels. <span class=\"customMeta\" data-dictid=\"3c1935637a1692777202a9c50cc6f5\">White cell count</span> can be normal or higher than 20 microL and have a <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> predominance.</li>\n<li>India ink <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> shows <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells.</li>\n<li>CSF <span class=\"customMeta\" data-dictid=\"3e4873f1941692777187410ddeb16a\">ELISA</span> for CRAG (Cryptococcal Antigen).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>LAMB</strong> (Liposomal Amphotericin-B) and <strong>5-Fluorocytosine</strong> (Flucytosine) for 2 weeks</li>\n<li><strong>Fluconazole </strong>is given subsequently for 8-10 weeks.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of cartilage?", "options": [{"label": "A", "text": "Hyaline cartilage", "correct": true}, {"label": "B", "text": "Elastic cartilage", "correct": false}, {"label": "C", "text": "Fibro cartilage", "correct": false}, {"label": "D", "text": "Calcified cartilage", "correct": false}], "correct_answer": "A. Hyaline cartilage", "question_images": ["https://image.prepladder.com/content/gQ6gvhMAV2WHHkM4uapQ1741105781.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old female presents with irregular menstrual cycles, acne, and excessive hair growth. An ultrasound reveals multiple ovarian cysts. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Polycystic Ovary Syndrome (PCOS)", "correct": true}, {"label": "B", "text": "Endometriosis", "correct": false}, {"label": "C", "text": "Hypothyroidism", "correct": false}, {"label": "D", "text": "Ovarian hyperstimulation syndrome (OHSS)", "correct": false}], "correct_answer": "A. Polycystic Ovary Syndrome (PCOS)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most likely abnormality in a patient of recurrent vomiting with pH 7.5, pCO2 48mm Hg, and HCO3- 33?", "options": [{"label": "A", "text": "Metabolic acidosis", "correct": false}, {"label": "B", "text": "Metabolic alkalosis", "correct": true}, {"label": "C", "text": "Respiratory acidosis", "correct": false}, {"label": "D", "text": "Respiratory alkalosis", "correct": false}], "correct_answer": "B. Metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Alkalosis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Metabolic <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> is characterized by an <strong>increase in arterial pH</strong>, <strong>elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> [HCO3−], and increased PaCO2</strong> due to <strong>compensatory hypoventilation.</strong></li>\n<li>Often presents with <strong>hypochloremia </strong>and <strong>hypokalemia</strong>.</li>\n<li>Occurs as a mixed disorder with <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> or <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> or alkalosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Exogenous <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">Bicarbonate</span> Loads</strong>\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b802ae0373169277718153c4d4fbaf\">alkali</span> administration</li>\n<li>Milk-alkali syndrome</li>\n</ul>\n</li>\n<li><strong>Effective ECFV <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">Contraction</span> (Normotension, K+ Deficiency, Secondary Hyperreninemic Hyperaldosteronism)</strong>\n<ul>\n<li>Gastrointestinal Origin: Vomiting, <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> aspiration, <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> chloridorrhea, gastrocystoplasty, <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> adenoma</li>\n<li>Renal Origin: <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">Diuretic</span> use (thiazides, loop diuretics), posthypercapnic state, hypercalcemia/hypoparathyroidism, recovery from acidosis, non-resorbable anions (e.g., penicillin), Mg²⁺ deficiency, K⁺ depletion, Bartter's syndrome, Gitelman's syndrome</li>\n</ul>\n</li>\n<li><strong>ECFV Expansion, Hypertension, K+ Deficiency, and <span class=\"customMeta\" data-dictid=\"35933061bb1692777192630f88863d\">Mineralocorticoid</span> Excess</strong>\n<ul>\n<li>High Renin: <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis, accelerated hypertension, renin-secreting tumor, <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> therapy</li>\n<li>Low Renin: Primary <span class=\"customMeta\" data-dictid=\"881ff8b2a21692777181fdd87352f8\">aldosteronism</span> (adenoma, hyperplasia, carcinoma), <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> defects (11β-hydroxylase, 17α-hydroxylase deficiency), Cushing’s syndrome, substances like licorice, carbenoxolone</li>\n<li>Genetic <span class=\"customMeta\" data-dictid=\"276be2047116927771989f7bf5ed02\">Sodium Channel</span> <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">Mutation</span> (Liddle's Syndrome)</li>\n<li>Gain-of-function <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule, causing ECFV expansion, hypertension, K⁺ deficiency, and hypo-reninemic-hypoaldosteronism</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurological: Mental confusion, obtundation, potential seizures</li>\n<li>Peripheral Nervous System: Paresthesias, muscle cramps, <span class=\"customMeta\" data-dictid=\"3d62cb9e271692777200980467ea01\">tetany</span> (similar to <span class=\"customMeta\" data-dictid=\"59f10ee7c31692777189a8544bb404\">hypocalcemia</span> effects)</li>\n<li>Cardiovascular: Aggravation of arrhythmias, particularly in <span class=\"customMeta\" data-dictid=\"6a75d857ea1692777185f9245b02b8\">COPD</span> patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electrolyte Imbalances:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Potassium (K⁺): Hypokalemia, especially in cases involving secondary <span class=\"customMeta\" data-dictid=\"982551b8f81692777189e20f09de85\">hyperaldosteronism</span> or <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> use.</li>\n<li>Chloride (Cl⁻): Hypochloremia, frequently accompanying alkalosis, especially in cases of <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> or <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> use.</li>\n<li>Calcium (Ca²⁺): Symptoms may <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> <span class=\"customMeta\" data-dictid=\"59f10ee7c31692777189a8544bb404\">hypocalcemia</span> despite normal levels.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which factor is most useful for distinguishing Acute Kidney Injury (AKI) from Chronic Kidney Disease (CKD)?", "options": [{"label": "A", "text": "Creatinine levels", "correct": false}, {"label": "B", "text": "Albumin levels", "correct": true}, {"label": "C", "text": "Urinary output", "correct": false}, {"label": "D", "text": "Blood urea nitrogen (BUN)", "correct": false}], "correct_answer": "B. Albumin levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease is defined as the presence of an <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> structure or function persisting for more than 3 months.</li>\n<li>This includes 1 or more of the following:\n\t\t\t\t<ul>\n<li>GFR less than 60 mL/min</li>\n<li><strong>Albuminuria </strong>(ie, <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> ≥30 mg/24 hours or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> albumin-to-creatinine ratio [ACR] ≥30 mg/g)</li>\n<li>Abnormalities in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> sediment, <span class=\"customMeta\" data-dictid=\"ebf8f256f3169277718992ac1b2330\">histology</span> or <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> suggestive of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> disorders</li>\n<li>History of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> transplantation.</li>\n</ul>\n</li>\n<li>Evaluation for the <span class=\"customMeta\" data-dictid=\"4711a65634169277718737b781005d\">etiology</span> of <span class=\"customMeta\" data-dictid=\"e6dc8586b11692777184b083672593\">CKD</span> should be guided by a patient’s clinical history, physical examination, and <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> by 0.3 mg/dL or more (26.5 μmol/L or more) within 48 hours.</li>\n<li>Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> to 1.5 times or more than the <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> of the prior 7 days.</li>\n<li>Urine volume less than 0.5 mL/kg/h for at least 6 hours.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure given in the image below", "options": [{"label": "A", "text": "Buccopharyngeal fascia", "correct": true}, {"label": "B", "text": "Prevertebral fascia", "correct": false}, {"label": "C", "text": "Pharyngobasilar fascia", "correct": false}, {"label": "D", "text": "Alar fascia", "correct": false}], "correct_answer": "A. Buccopharyngeal fascia", "question_images": ["https://image.prepladder.com/content/NuyPAK8WJt3XFzSAuuTw1741087227.png"], "explanation_images": ["https://image.prepladder.com/content/LgryenCQv761t9dxV5et1741063734.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A total of 60 patients were diagnosed with COVID-19. Out of which,12 cases of deaths were reported. Calculate the Case fatality rate?", "options": [{"label": "A", "text": "20%", "correct": true}, {"label": "B", "text": "30%", "correct": false}, {"label": "C", "text": "40%", "correct": false}, {"label": "D", "text": "10%", "correct": false}], "correct_answer": "A. 20%", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FsaQjUTOszdRgzc4z94r1741062054.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:596px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Virulence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The degree of severity or harmfulness of a disease, measuring the proportion of severe or fatal cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infectivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The ability of a <span class=\"customMeta\" data-dictid=\"ed4634701d16927771942c4408495f\">pathogen</span> to establish an infection and spread among a population.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The ability of a <span class=\"customMeta\" data-dictid=\"03aede3b101692777192c7f7a5e99c\">microorganism</span> to cause disease determines whether an infection will manifest as an illness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmissibility</strong></p>\n<p>(Communicability)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The ability of a disease to be transmitted from one host to another indicates how easily it spreads. This is measured by the secondary attack rate.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with unilateral throbbing pain, photophobia, nausea, and vomiting. The symptoms improve after taking sumatriptan. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Migraine", "correct": true}, {"label": "B", "text": "Tension headache", "correct": false}, {"label": "C", "text": "Cluster headache", "correct": false}, {"label": "D", "text": "Sinus headache", "correct": false}], "correct_answer": "A. Migraine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features of Migraine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Premonitory (Prodromal) Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neck discomfort</li>\n<li>Cognitive <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> (brain “fog”)</li>\n<li>Mood changes</li>\n<li>Fatigue</li>\n<li>Yawning/sleepiness</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"01cdc9604816927772010d5f2b7e82\">urination</span> and thirst</li>\n<li>Food cravings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aura</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurologic disturbances (e.g., visual disturbances like scintillating scotoma)</li>\n<li>Due to Cerebral vasoconstriction. Therefore prevention is by Vasodilators.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Headache Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain</li>\n<li>Nausea/vomiting</li>\n<li>Sensory sensitivities:\n\t\t\t\t<ul>\n<li>Photophobia (sensitivity to light)</li>\n<li>Phonophobia (sensitivity to sound)</li>\n<li>Osmophobia (sensitivity to smells)</li>\n<li>Allodynia (pain from non-painful stimuli)</li>\n<li>Vertigo</li>\n</ul>\n</li>\n<li>Due to cerebral vasodilation. So treatment is Vasoconstrictors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postdrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tiredness</li>\n<li>Weariness</li>\n<li>Impaired concentration</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:583px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Simplified <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Criteria for <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">Migraine</span> by International Headache Society </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Repeated attacks of headache lasting 4–72h in patients with a normal physical examination, no other reasonable cause for the headache, and:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>At least 2 of the following features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Plus at least 1 of the following features:</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Unilateral pain</strong></li>\n<li><strong>Throbbing pain</strong></li>\n<li>Aggravation by movement</li>\n<li>Moderate or severe intensity</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Nausea/vomiting</strong></li>\n<li><strong>Photophobia and phonophobia</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which electrolyte abnormality will lead to cardiac arrhythmia in patients with severe vomiting?", "options": [{"label": "A", "text": "Hypokalemia", "correct": true}, {"label": "B", "text": "Hyponatremia", "correct": false}, {"label": "C", "text": "Hyperkalemia", "correct": false}, {"label": "D", "text": "Hypocalcemia", "correct": false}], "correct_answer": "A. Hypokalemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-month-old child has a respiratory rate of 56/min with no chest indrawing and no danger signs. As per IMNCI what is the most appropriate diagnosis?", "options": [{"label": "A", "text": "Pneumonia", "correct": true}, {"label": "B", "text": "Cold and cough", "correct": false}, {"label": "C", "text": "Severe Pneumonia", "correct": false}, {"label": "D", "text": "Allergy", "correct": false}], "correct_answer": "A. Pneumonia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Ask</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Look</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Able to drink or breastfeed?</li>\n<li>Does the child <span class=\"customMeta\" data-dictid=\"e66d63de4e16927772027ffae57751\">vomit</span> everything?</li>\n<li>H/O convulsions during this illness?</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Lethargic or unconscious?</li>\n<li>Currently convulsing?</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>If any danger signs are present, the child needs URGENT attention.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Severe <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">Pneumonia</span> or Very Severe Disease (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Any general danger sign</li>\n</ul>\n<p style=\"text-align: center;\">OR</p>\n<ul>\n<li>Oxygen <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> &lt;90%</li>\n<li>Stridor in calm child</li>\n<li>Central cyanosis</li>\n<li>Convulsions</li>\n<li>AVPU = V, P, or U</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Start oxygen therapy if <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> &lt; 90%.</li>\n<li>Administer <span class=\"customMeta\" data-dictid=\"670fd69d0f1692777182f40b22be72\">Benzyl</span> <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">Penicillin</span> &amp; Gentamicin.</li>\n<li>Give <span class=\"customMeta\" data-dictid=\"80d3ceeba61692777186f4f5da691f\">diazepam</span> if convulsing.</li>\n<li>Prevent low blood sugar.</li>\n<li>Treat <span class=\"customMeta\" data-dictid=\"c804829f4416927772026f34ff3e31\">wheeze</span> if present.</li>\n<li>Urgent referral or admission.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pneumonia </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Chest indrawing in calm child</li>\n</ul>\n<p style=\"text-align: center;\">OR</p>\n<ul>\n<li><strong>Fast breathing</strong></li>\n</ul>\n<p style=\"text-align: center;\">AND</p>\n<ul>\n<li><strong>No signs of severe pneumonia</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Administer <span class=\"customMeta\" data-dictid=\"d1e73ea72b1692777181fe0162bd92\">Amoxicillin</span> <span class=\"customMeta\" data-dictid=\"cbb3e1bab11692777186c622a68d44\">Dispersible</span> Tablet.</li>\n<li>Give Vitamin A.</li>\n<li>Treat <span class=\"customMeta\" data-dictid=\"c804829f4416927772026f34ff3e31\">wheeze</span> if present.</li>\n<li>Follow up in 5 days</li>\n<li>Advise on immediate return signs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>No Pneumonia: <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">Cough</span> or Cold</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>No signs of <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> or very severe disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Treat <span class=\"customMeta\" data-dictid=\"c804829f4416927772026f34ff3e31\">wheeze</span> if present - <span class=\"customMeta\" data-dictid=\"479585b1c81692777198b4f752d734\">salbutamol</span> for 5 days</li>\n<li>Advise on immediate return signs.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman with a history of type 2 diabetes presents for a routine follow-up. Her serum creatinine and potassium levels are normal, but she has microalbuminuria and an HbA1c of 8%. Her blood pressure and pulse are within normal limits, and she is currently on metformin for diabetes management. What should be the next step in her management?", "options": [{"label": "A", "text": "Begin a thiazide diuretic", "correct": false}, {"label": "B", "text": "Start insulin therapy", "correct": false}, {"label": "C", "text": "Stop Metformin and start a different OHA", "correct": false}, {"label": "D", "text": "Start an ACE inhibitor", "correct": true}], "correct_answer": "D. Start an ACE inhibitor", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> nephropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">Hypoglycemic</span> agents (OHAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>SGLT2 inhibitors </strong>lower the risk of <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> events and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure; they are also recently approved for HFpEF.</li>\n<li>For HbA1C &lt; 9.5%, OHAs can be used</li>\n<li><strong>Metformin</strong> is <strong>withheld</strong> if <strong>eGFR is &lt; 30 mL/min/1.73 m2 </strong><strong>(Option C)</strong>, and drugs safe in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure can be used like\n\t\t\t\t<ul>\n<li>Glipizide</li>\n<li>Linagliptin</li>\n<li>Repaglinide</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insulin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>80% of the calculated dose is started if <strong>HbA1C &gt; 9.5% </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antihypertensives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In the presence of microalbuminuria, ACEi and ARBs have shown evidence to slow the <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> if started in early stages.</li>\n<li>In hypertension, for BP &gt; 130/90, ACEi or ARBs are preferred</li>\n<li>If BP is still not under control, <strong>Calcium channel <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> (CCB)</strong> can be added</li>\n<li><strong>Thiazide diuretic</strong> - in the presence of oedema <strong>(Option A)</strong></li>\n<li>If eGFR &lt;30 ml/min, then the <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> used - <strong>Metolazone.</strong></li>\n<li>ACEi/ARB <span class=\"customMeta\" data-dictid=\"89f5610ffd1692777184b03f1f88cc\">comes</span> with a <span class=\"customMeta\" data-dictid=\"79506a117416927771988bbe7a8302\">side effect</span> of hyperkalemia; hence, regular monitoring of <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> is necessary.</li>\n<li>In the presence of <strong>hyperkalemia</strong>, ACEi/ARB is replaced by CCB</li>\n<li><strong>Alpha <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> (Prazosin) </strong>- <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> in ESRD.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>K Binding resins</strong> (Bind to <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> in the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> and promote its excretion)</p>\n<ul>\n<li>Sodium <span class=\"customMeta\" data-dictid=\"8904ca22bf1692777196567c8fff23\">polystyrene</span> sulfonate</li>\n<li>Patiromer</li>\n<li>Sodium zirconate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Transplant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>If eGFR is &lt; 20 mL/min/1.73</strong><strong>m2</strong><strong>.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a study based in Delhi, doctors followed 100 people who did exercise for a year and later they checked who all had developed coronary heart disease. Which type of study is this?", "options": [{"label": "A", "text": "Case Control Study", "correct": false}, {"label": "B", "text": "Prospective Study", "correct": false}, {"label": "C", "text": "Cross Sectional Study", "correct": false}, {"label": "D", "text": "Cohort study", "correct": true}], "correct_answer": "D. Cohort study", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A doctor asked the patient what her age is and she told him that she is married to an older man, and she has 2 kids of 15 and 18 years, and she is 39 years old. What is the disorder present?", "options": [{"label": "A", "text": "Derailment", "correct": false}, {"label": "B", "text": "Circumstantial speech", "correct": true}, {"label": "C", "text": "Flight of ideas", "correct": false}, {"label": "D", "text": "Tangentiality", "correct": false}], "correct_answer": "B. Circumstantial speech", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with high blood pressure accompanied by a decrease in heart rate. What is the most likely physiological mechanism responsible for this response?", "options": [{"label": "A", "text": "Stimulation of baroreceptors", "correct": true}, {"label": "B", "text": "Inhibition of baroreceptors", "correct": false}, {"label": "C", "text": "Bezold-Jarisch reflex (J reflex)", "correct": false}, {"label": "D", "text": "Stimulation of chemoreceptors", "correct": false}], "correct_answer": "A. Stimulation of baroreceptors", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Baroreceptors in the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> and the aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> detect BP changes</li>\n<li>Increased BP <span class=\"customMeta\" data-dictid=\"ad337177ee1692777199de941a0cda\">stretches</span> receptors, sending signals to <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> via <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> and <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> nerves</li>\n<li>Medulla inhibits <span class=\"customMeta\" data-dictid=\"52abfe100916927772011ad20f3fda\">vasoconstrictor</span> center and stimulates <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> center</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Actions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vasodilation of blood vessels</li>\n<li>Decreased heart rate and <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> strength</li>\n<li>Reduced BP due to lower <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> resistance and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Maintains BP stability during activities like standing</li>\n<li>Fastest acting</li>\n<li>Tends to reset within 1-2 days for long-term regulation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the context of mitral stenosis, which clinical feature is typically observed?", "options": [{"label": "A", "text": "Loud S1", "correct": true}, {"label": "B", "text": "Absent S1", "correct": false}, {"label": "C", "text": "S3 gallop", "correct": false}, {"label": "D", "text": "Muffled heart sounds", "correct": false}], "correct_answer": "A. Loud S1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral Stenosis: Clinical Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rheumatic fever (predominant cause)</li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disorders</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> with <span class=\"customMeta\" data-dictid=\"4c3d2d86ec1692777191af6eda4772\">leaflet</span> involvement</li>\n<li>SLE, RA</li>\n<li>Myxoma</li>\n<li>Large <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> vegetations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normal <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> area: 4-6 cm²</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> when area &lt; 2 cm²</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> when area &lt; 1.5 cm²</li>\n<li>Elevated LA pressure required to maintain normal <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output</li>\n<li>Development of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output during exertion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Exertional dyspnea</li>\n<li>Orthopnea</li>\n<li>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> dyspnea</li>\n<li>Hemoptysis</li>\n<li>Right-sided <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> symptoms in advanced cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Loud S1</strong></li>\n<li>Opening snap after A2</li>\n<li>Mid-diastolic rumbling <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> with <span class=\"customMeta\" data-dictid=\"46f491f18c1692777196fb409699bc\">presystolic</span> accentuation\n\t\t\t\t<ul>\n<li>Best heard at apex</li>\n<li>With bell of stethoscope</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> position</li>\n</ul>\n</li>\n<li>Signs of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension\n\t\t\t\t<ul>\n<li>Loud P2</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> heave</li>\n</ul>\n</li>\n<li>Irregular pulse (if <span class=\"customMeta\" data-dictid=\"e6a04221a41692777182825f0f08da\">atrial fibrillation</span> present)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ECG\n\t\t\t\t<ul>\n<li>Left atrial enlargement</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> in advanced cases</li>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> may be present</li>\n</ul>\n</li>\n<li>Chest X-ray\n\t\t\t\t<ul>\n<li>Straightening of upper <span class=\"customMeta\" data-dictid=\"9a065f288c1692777191f5b93fa49b\">left heart</span> border</li>\n<li>Double density sign</li>\n<li>Kerley B lines</li>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> congestion</li>\n</ul>\n</li>\n<li>Echocardiogram\n\t\t\t\t<ul>\n<li>Valve area measurement</li>\n<li>Transvalvular gradient</li>\n<li>Assessment of <span class=\"customMeta\" data-dictid=\"4c3d2d86ec1692777191af6eda4772\">leaflet</span> <span class=\"customMeta\" data-dictid=\"650eb29fb9169277719270ea0fbea5\">mobility</span> and calcification</li>\n<li>Evaluation of associated lesions</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What stage of embryonic development is shown in the following image?", "options": [{"label": "A", "text": "Morula", "correct": false}, {"label": "B", "text": "Ova", "correct": false}, {"label": "C", "text": "Blastocyst", "correct": true}, {"label": "D", "text": "Gastrula", "correct": false}], "correct_answer": "C. Blastocyst", "question_images": ["https://image.prepladder.com/content/BM0GF6GxIX5H6Xvl3sH31741106646.png"], "explanation_images": ["https://image.prepladder.com/content/77SZbev0YK6h0yWBWOFz1741106688.png", "https://image.prepladder.com/content/l3c1NLnfDTf6YK2uVIU01741106772.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DAY</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>EVENT</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fertilization: The <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> fertilizes the egg in the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube, forming a <span class=\"customMeta\" data-dictid=\"0052ecdccc1692777202bad37cc0f1\">zygote</span> (single <span class=\"customMeta\" data-dictid=\"52d06e3e001692777186400050f388\">diploid</span> cell)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two cell stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Four cell stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twelve cell stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morula Formation:</strong> The <span class=\"customMeta\" data-dictid=\"0052ecdccc1692777202bad37cc0f1\">zygote</span> becomes a solid ball of <strong>16-32 cells.</strong><strong> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blastocyst Formation:</strong> The <span class=\"customMeta\" data-dictid=\"b02677c64d1692777192214107ce39\">morula</span> continues to divide and develops a blastocoel, trophoblast, and inner cell mass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 6&amp;7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Implantation begins: </strong>Blastocyst attaches to the endometrial lining of the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> and <span class=\"customMeta\" data-dictid=\"b307523a5616927772006c03caff44\">trophoblast</span> begins to invade the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall to start implantation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 14–21</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrulation begins: </strong>The <span class=\"customMeta\" data-dictid=\"c53ef2f424169277719061a7a3fc0f\">inner cell mass</span> differentiates into three <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> layers (ectoderm, mesoderm, and endoderm), forming the<strong> gastrula.</strong><strong> (Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the emergency department with complaints of blurred vision, dizziness, and severe headache after ingesting an unknown quantity of homemade alcohol earlier in the day. On examination, he is disoriented. Laboratory tests reveal severe metabolic acidosis with a high anion gap. Which metabolite is primarily responsible for the toxicity in this case?", "options": [{"label": "A", "text": "Methanol", "correct": false}, {"label": "B", "text": "Formic acid", "correct": true}, {"label": "C", "text": "Formaldehyde", "correct": false}, {"label": "D", "text": "Acetic acid", "correct": false}], "correct_answer": "B. Formic acid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Adulteration in Country liquor.</strong></li>\n<li>Solvent in industrial processes.</li>\n<li>Antifreeze.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Methanol ö <span class=\"customMeta\" data-dictid=\"59e3af5975169277720384661ff5bf\">Formaldehyde</span> (oxidation by alcohol dehydrogenase).</li>\n<li>Formaldehyde ö <span class=\"customMeta\" data-dictid=\"46ef53b3061692777203313130b967\">Formic acid</span> (oxidation by <span class=\"customMeta\" data-dictid=\"126202981a1692777181f2970b8c7f\">aldehyde</span> dehydrogenase).</li>\n<li>Formic Acid ö Inhibition of Cytochrome c Oxidase ö Cellular Hypoxia and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> Acidosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features of Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CNS: <strong>Headache</strong>, dizziness, confusion, ataxia, seizures</li>\n<li>Ocular: <strong>Blurred (</strong>\"snowfield\" vision).</li>\n<li>Gastrointestinal: <strong>Nausea, vomiting</strong>,<strong> fruity breath</strong> and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Metabolic: <strong>Severe <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis, elevated <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mnemonic: <strong>SHAFE</strong></p>\n<ul>\n<li><strong>S</strong>odium Bicarbonate to correct <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis</li>\n<li><strong>H</strong>emodialysis to remove <span class=\"customMeta\" data-dictid=\"c578fa95fe16927771927ea57020f0\">methanol</span> and its metabolites</li>\n<li><strong>A</strong>ntidote:<strong> F</strong>omepizole or <strong>E</strong>thanol to <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> ADH</li>\n<li><strong>F</strong>olinic acid or <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> to enhance <span class=\"customMeta\" data-dictid=\"8723cfd7d21692777203cc8312c239\">formate</span> metabolism.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During laparoscopic surgery, where shouldn't the trocar be inserted?", "options": [{"label": "A", "text": "Superior epigastric artery", "correct": false}, {"label": "B", "text": "Inferior epigastric artery", "correct": false}, {"label": "C", "text": "Abdominal aorta", "correct": false}, {"label": "D", "text": "Both A and B", "correct": true}], "correct_answer": "D. Both A and B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trocar Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>At Risk Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Precautions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Umbilical (Primary)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insert at <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> alba</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supraumbilical (Upper Trocar)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior Epigastric Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Avoid midline <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infraumbilical/Midclavicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior Epigastric Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insert <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palmar’s Point (LUQ Trocar)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used in difficult access cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the jugular venous pressure (JVP) waveform, the \"a\" wave corresponds to:", "options": [{"label": "A", "text": "Right Atrial contraction", "correct": true}, {"label": "B", "text": "Tricuspid valve bulging into Right atria", "correct": false}, {"label": "C", "text": "Right Atrial relaxation", "correct": false}, {"label": "D", "text": "Right atrial filling", "correct": false}], "correct_answer": "A. Right Atrial contraction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jfXFwVgw4dcJ2e0oF6Ku1741087032.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>a wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by atrial systole.</li>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> results in a temporary halt in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> inflow.</li>\n<li>Some blood flows back into the veins, causing a rise in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>c wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Arises from the increase in atrial pressure during isovolumetric <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> contraction.</li>\n<li>Pressure is transmitted through the closed and bulging <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>x descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ventricular <span class=\"customMeta\" data-dictid=\"13941ea4ec1692777199fc8cfd1a7a\">systole</span> pulls the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> down</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>v wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Corresponds to the rise in atrial pressure as blood fills the atria.</li>\n<li>Occurs during <span class=\"customMeta\" data-dictid=\"11d448b6c4169277718635a922383c\">diastole</span> while the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> is still closed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>y descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Opening of <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> causing <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> of right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> into ventricle</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "75% of iatrogenic ureteric injuries are due to gynaecological procedures. Which hysterectomy route has the least risk of ureteric injury?", "options": [{"label": "A", "text": "Laparoscopic", "correct": false}, {"label": "B", "text": "Abdominal", "correct": false}, {"label": "C", "text": "Vaginal", "correct": true}, {"label": "D", "text": "Robotic", "correct": false}], "correct_answer": "C. Vaginal", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaginal <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdominal <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small uterus, minimal <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pathology, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> organ descent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> masses, adhesions, oophorectomy, cancer staging, complex cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recovery Time</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Faster recovery and shorter hospital stay.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Longer recovery, longer hospital stay, increased <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postoperative Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain and risk of wound infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Operating Time</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shorter operating time compared to the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> approach.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Longer operating time than <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> or <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> approaches.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Injury Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lower <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> injury risk.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> injury. <strong>(Option B)</strong></p>\n<p><strong>Lower <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> injury risk.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complexity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires less technical expertise.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires higher technical expertise, especially in complex cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Access to Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited access to <span class=\"customMeta\" data-dictid=\"a45b36c1c716927771840ee63f1cba\">concurrent</span> procedures.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Greater access to <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> organs, ovaries, and upper <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> for cancer <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> or additional surgeries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suitability for Larger Uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not ideal for large <span class=\"customMeta\" data-dictid=\"7ed30519d816927772013f317e9a66\">uteri</span> or complex conditions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preferred for large <span class=\"customMeta\" data-dictid=\"7ed30519d816927772013f317e9a66\">uteri</span> or complex conditions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cancer Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preferred for non-cancer cases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caution with <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> power <span class=\"customMeta\" data-dictid=\"1550c9b88416927771923c01e78d72\">morcellation</span> in potential cancer cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risks of Infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower risk of infection.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> fever and wound infection.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male patient with a history of hypertension presents to the emergency department in acute distress. He is diaphoretic, tachycardic, and complains of severe chest pain. His ECG is given below. Given the patient's condition, what is the most appropriate immediate management for this patient?", "options": [{"label": "A", "text": "Amiodarone", "correct": false}, {"label": "B", "text": "Radiofrequency catheter ablation", "correct": false}, {"label": "C", "text": "Digoxin", "correct": false}, {"label": "D", "text": "Synchronized cardioversion", "correct": true}], "correct_answer": "D. Synchronized cardioversion", "question_images": ["https://image.prepladder.com/content/hYmLOPcvfcclQnAcQqSB1741079515.png"], "explanation_images": ["https://image.prepladder.com/content/Hy7EyWWEFFmCLrDJeEI61741079510.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:683px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Atrial Flutter</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> is characterized by a large re-entry circuit, usually within the right atrium, encircling the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"2889a63cdd1692777181f9102ed608\">annulus</span> originating from the cavotricuspid isthmus.</li>\n</ul>\n<ul>\n<li>The atrial rate is approximately <strong>300 beats per minute</strong>.</li>\n<li>It is typically associated with 2:1, 3:1, or 4:1 AV block, resulting in <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> rates of 150, 100, or 75 beats per minute.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> shows<strong> saw-tooth <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves</strong>, often <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as <strong>\"F-waves.\"</strong></li>\n<li>With a 2:1 AV block, <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves may be buried in QRS complexes and T waves, making them difficult to identify.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ewingdo\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ECG_Atrial_Flutter_294_bpm.jpg\" data-tags=\"\" height=\"2506\" src=\"https://image.prepladder.com/content/Hy7EyWWEFFmCLrDJeEI61741079510.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> should be suspected in narrow-complex <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> at a rate of 150 beats per minute.</li>\n<li>Carotid <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> pressure or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"d3f6a49b7416927771802124ccddf0\">adenosine</span> may help reveal <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves by temporarily increasing the degree of AV block.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Rhythm Control:</strong></p>\n<ul>\n<li><strong>Acute Management:</strong>\n<ul>\n<li>Hemodynamically <strong>Unstable</strong> Patients: Synchronized cardioversion.</li>\n<li><strong>Stable </strong>Patients:\n\t\t\t\t\t<ul>\n<li>Electrical <span class=\"customMeta\" data-dictid=\"f6c133a4ba1692777183c42bc77b81\">cardioversion</span> (if no <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> thrombus).</li>\n<li>Pharmacological cardioversion:\n\t\t\t\t\t\t<ul>\n<li>Antiarrhythmic drugs:\n\t\t\t\t\t\t\t<ul>\n<li>Amiodarone</li>\n<li>Class IA: Procainamide, Quinidine, Disopyramide</li>\n<li>Class IC: Flecainide, Propafenone</li>\n</ul>\n</li>\n<li>Calcium Channel Blockers: Verapamil, Diltiazem</li>\n<li>Beta-Blockers: Metoprolol, Carvedilol, Esmolol</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</li>\n<li><strong>Long-Term Management:</strong>\n<ul>\n<li>Radiofrequency <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> of the cavotricuspid isthmus.</li>\n</ul>\n</li>\n</ul>\n<p><strong>2. Rate Control:</strong></p>\n<ul>\n<li>First-Line Agents:\n\t\t\t\t<ul>\n<li>Calcium Channel Blockers (e.g., Verapamil, Diltiazem)</li>\n<li>Beta-Blockers (e.g., Metoprolol, Carvedilol, Esmolol)</li>\n<li>Digoxin (use cautiously due to toxicity).</li>\n</ul>\n</li>\n<li>Goal: Heart rate &lt; 110 beats per minute.</li>\n</ul>\n<p><strong>3. Anticoagulation:</strong></p>\n<ul>\n<li>Assess stroke risk using the CHADS2-VASC score:</li>\n<li>Anticoagulation Recommendations:\n\t\t\t\t<ul>\n<li>2 or more points: Strong recommendation for anticoagulation.</li>\n<li>1 point: Consider either <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> or full anticoagulation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lady presents to the hospital after having a fight with her husband. She reports that she is unable to speak However, all neurological and physical examinations are normal, and she does not seem concerned about her health status, What is the most likely diagnosis?", "options": [{"label": "A", "text": "Malingering", "correct": false}, {"label": "B", "text": "La belle indifférence", "correct": true}, {"label": "C", "text": "Adaptation", "correct": false}, {"label": "D", "text": "Somatic symptom", "correct": false}], "correct_answer": "B. La belle indifférence", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was presented to the OPD with a sudden onset of shortness of breath. Identify the condition with the radiological image given below.", "options": [{"label": "A", "text": "Epiglottitis", "correct": false}, {"label": "B", "text": "Laryngotracheobronchitis", "correct": true}, {"label": "C", "text": "Bronchitis", "correct": false}, {"label": "D", "text": "Laryngomalacia", "correct": false}], "correct_answer": "B. Laryngotracheobronchitis", "question_images": ["https://image.prepladder.com/content/pXP0cG2CsnwVDGv6TPNg1741063322.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with eyelid crusting and a thready sensation between the cornea and lids. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Chronic Blepharitis", "correct": true}, {"label": "B", "text": "Dry Eye Syndrome", "correct": false}, {"label": "C", "text": "Meibomian Gland Dysfunction", "correct": false}, {"label": "D", "text": "Conjunctivitis", "correct": false}], "correct_answer": "A. Chronic Blepharitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic infection of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of the lid margin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Synonyms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> blepharitis</li>\n<li>Staphylococcal blepharitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Organisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Most commonly <span class=\"customMeta\" data-dictid=\"0520f732541692777199acffcfd9ba\">Staphylococci</span> (coagulase positive)</strong></li>\n<li>Rarely Streptococci, <span class=\"customMeta\" data-dictid=\"77ba04808316927771963f119df5a5\">Propionibacterium</span> acnes, and Moraxella</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic irritation</li>\n<li>Itching</li>\n<li>Mild lacrimation</li>\n<li>Gluing of cilia</li>\n<li>Mild photophobia</li>\n<li>Yellow crusts at the root of cilia</li>\n<li>Small ulcers that bleed easily when crusts are removed</li>\n<li>Red, thickened lid margins with dilated blood vessels</li>\n<li>Mild <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> <span class=\"customMeta\" data-dictid=\"6ce77d5f5e1692777185cf7f8a67cd\">conjunctivitis</span> and conjunctival hyperemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lid Hygiene:\n\t\t\t\t<ul>\n<li>Warm compresses</li>\n<li>Cotton buds dipped in <span class=\"customMeta\" data-dictid=\"e63a499e5716927771860681cef17d\">dilute</span> baby shampoo or 3% sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> solution</li>\n<li>Avoid touching</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Antibiotics</li>\n<li>Topical Steroids</li>\n<li>Ocular Lubricants</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While evaluating a 3-year-old with short stature, height is measured at 90cm and the lower segment is 45 cm. What is the likely diagnosis?", "options": [{"label": "A", "text": "Achondroplasia", "correct": false}, {"label": "B", "text": "Congenital hypothyroidism", "correct": false}, {"label": "C", "text": "Rickets", "correct": false}, {"label": "D", "text": "Spondyloepiphyseal dysplasia", "correct": true}], "correct_answer": "D. Spondyloepiphyseal dysplasia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:717px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Proportionate <span class=\"customMeta\" data-dictid=\"89170298ec1692777198eac32ce789\">Short Stature</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conditions Causing <span class=\"customMeta\" data-dictid=\"89170298ec1692777198eac32ce789\">Short Stature</span> with US &gt; LS </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conditions Causing <span class=\"customMeta\" data-dictid=\"89170298ec1692777198eac32ce789\">Short Stature</span> with US &lt; LS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Growth hormone deficiency</li>\n<li>Genetic syndromes: Noonan syndrome, Prader-Willi syndrome, 3M syndrome</li>\n<li>Environmental pollutants: Lead, calcium, hexachlorobenzene, polychlorinated biphenyl</li>\n<li>Family history</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Achondroplasia <strong>(Option A)</strong></li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">hypothyroidism</span> <strong>(Option B)</strong></li>\n<li>Turner syndrome</li>\n<li>Diastrophic dysplasia</li>\n<li>Rickets <strong>(Option C)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Spondyliepiphyseal <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> (Option D)</strong></li>\n<li>Morquio syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with proptosis that increases when bending down. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Orbital Varices", "correct": true}, {"label": "B", "text": "Thyroid Eye Disease", "correct": false}, {"label": "C", "text": "Cavernous Sinus Thrombosis", "correct": false}, {"label": "D", "text": "Orbital Cellulitis", "correct": false}], "correct_answer": "A. Orbital Varices", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orbital Varices</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dilated <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> channels in the orbit (part of the spectrum of developmental <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> anomalies)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most cases are <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> and the most frequent site is upper nasal.</p>\n<p>Slowly progressive <strong>intermittent proptosis</strong> which worsens with head position changes, bending forward, or Valsalva maneuver.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May involve one large vessel or multiple ectatic veins with fibrotic walls.</p>\n<p>Thrombosed lumens can contain phleboliths from calcified thrombi.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT</strong> - serpiginous, dense structures that enlarge with Valsalva, <strong>enhances with contrast</strong> administration.</p>\n<p><strong>MRI</strong> - T1 images show low <span class=\"customMeta\" data-dictid=\"ad45f1e11716927771901f3d9b18eb\">isointense</span> signal, T2 shows dark signal <span class=\"customMeta\" data-dictid=\"3ea4fc34801692777202b98af71861\">void</span> from flowing blood. <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">Enhancement</span> with <span class=\"customMeta\" data-dictid=\"e3767003061692777187b931c6a08f\">Gadolinium</span> is marked, except in areas of thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No treatment</strong> needed for mild symptoms;</p>\n<p><strong>Surgical or embolization</strong> options for severe cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Good</strong> unless large lesions <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve, risking vision loss.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with micrognathia and low-set ears. These clinical features are commonly associated with which type of genetic abnormality?", "options": [{"label": "A", "text": "Deletion", "correct": true}, {"label": "B", "text": "Translocation", "correct": false}, {"label": "C", "text": "Amplification", "correct": false}, {"label": "D", "text": "Inversion", "correct": false}], "correct_answer": "A. Deletion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The CSF findings in bacterial meningitis would include which of the following?", "options": [{"label": "A", "text": "Elevated protein and decreased glucose", "correct": true}, {"label": "B", "text": "Normal white blood cell count", "correct": false}, {"label": "C", "text": "Decreased protein and elevated glucose", "correct": false}, {"label": "D", "text": "Elevated WBC count with normal glucose", "correct": false}], "correct_answer": "A. Elevated protein and decreased glucose", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:698px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predominant Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gross Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bacterial Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Polymorphonuclear Neutrophils (PMNs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elevated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreased</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Turbid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fungal/Tubercular Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Straw-colored (TB meningitis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Viral Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or</p>\n<p>Turbid</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with right-sided field defects in both eyes, but central vision remains unaffected. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Homonymous Hemianopia with Macular Sparing", "correct": true}, {"label": "B", "text": "Heteronymous Hemianopia with Central Sparing", "correct": false}, {"label": "C", "text": "Optic Chiasm Lesion", "correct": false}, {"label": "D", "text": "Optic Tract Lesion", "correct": false}], "correct_answer": "A. Homonymous Hemianopia with Macular Sparing", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ezkdRPntaZnPng2qGzrl1741022029.png", "https://image.prepladder.com/content/BYHZfQtacQwkn2VXPDdp1741022053.png", "https://image.prepladder.com/content/UF4vrJZmRQkYMPTdGZmT1741022071.png", "https://image.prepladder.com/content/snK6ikphebHvnxAfv8aH1741022091.png", "https://image.prepladder.com/content/T9Z2jm7cfZ7El3O9QB1n1741022123.png", "https://image.prepladder.com/content/LhQAZiJP8btuZrL6RVno1741022283.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">Pathway</span> Lesions and Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibers Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Field Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> + <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"763\" src=\"https://image.prepladder.com/content/BYHZfQtacQwkn2VXPDdp1741022053.png\" width=\"184\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Anopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Chiasma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1574\" src=\"https://image.prepladder.com/content/UF4vrJZmRQkYMPTdGZmT1741022071.png\" width=\"1600\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Bitemporal Hemianopia</strong></p>\n<p><strong>(Heteronymous Hemianopia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Optic Tract</strong></li>\n<li><strong>Lateral <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">Geniculate</span> Body (LGB Lesion)</strong></li>\n<li><strong>Optic Radiation</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/snK6ikphebHvnxAfv8aH1741022091.png\" width=\"1600\"/></p>\n<p><strong>Homonymous Hemianopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">Cortex</span> without the involvement of tip</strong></p>\n<p><strong>(Post. Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers except <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> representation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/T9Z2jm7cfZ7El3O9QB1n1741022123.png\" width=\"1600\"/></p>\n<p><strong>Homonymous <span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\">Hemianopia</span> with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">Macular</span> Sparing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tip of Visual Cortex</strong></p>\n<p><strong>(Middle Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Macular Representation of <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">Ipsilateral</span> <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> and <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/LhQAZiJP8btuZrL6RVno1741022283.png\" width=\"1599\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Macular <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">Homonymous</span> Hemianopia</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of throat infection presents with a water hammer pulse. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Rheumatic fever with aortic regurgitation", "correct": true}, {"label": "B", "text": "Infective endocarditis", "correct": false}, {"label": "C", "text": "Mitral stenosis", "correct": false}, {"label": "D", "text": "Aortic stenosis", "correct": false}], "correct_answer": "A. Rheumatic fever with aortic regurgitation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conditions Associated</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Water-Hammer (Collapsing) Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Aortic regurgitation</strong></li>\n<li>Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus</li>\n<li>Hyperdynamic <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> (e.g., fever, anemia)</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> and aortic regurgitation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Parvus et Tardus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aortic stenosis</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus <span class=\"customMeta\" data-dictid=\"e506039a4916927771831191786c58\">Bisferiens</span> (Collapsing + Slow Rising)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aortic regurgitation</li>\n<li>Hypertrophic obstructive cardiomyopathy</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> and aortic regurgitation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Alternans</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> failure</li>\n<li>Dilated cardiomyopathy</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease</li>\n<li>Hypertrophic obstructive cardiomyopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dicrotic Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe sepsis</li>\n<li>Shock (especially <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock)</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output states</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jerky Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe aortic stenosis</li>\n<li>Hyperdynamic circulation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Paradoxus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cardiac tamponade</li>\n<li>Constrictive pericarditis</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> or COPD</li>\n<li>Airway obstruction</li>\n<li>Superior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bounding Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aortic regurgitation</li>\n<li>Hyperthyroidism</li>\n<li>Paget's disease</li>\n<li>Fever (hyperdynamic circulation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Bigeminus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ventricular <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> beats</li>\n<li>Severe arrhythmias</li>\n<li>Myocardial infarction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Tardus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aortic stenosis</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the formula for sensitivity?", "options": [{"label": "A", "text": "TP/(TP+FP)x100", "correct": false}, {"label": "B", "text": "TP/(TP+FN)x100", "correct": true}, {"label": "C", "text": "TN/(TN+FP)x100", "correct": false}, {"label": "D", "text": "TN/(TN+FN)x100", "correct": false}], "correct_answer": "B. TP/(TP+FN)x100", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TiAmZhcfs1e6ZtocIwuU1741064617.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the correct arrangement about the levels of health care?", "options": [{"label": "A", "text": "1- Medical colleges and hospitals are primary level, 2- CHC is secondary level, 3- Sub Centre and PHC are tertiary", "correct": false}, {"label": "B", "text": "1- Sub Centre and PHC are primary level, 2- CHC is secondary level, 3- Medical colleges and hospitals are tertiary", "correct": true}, {"label": "C", "text": "1- CHC is primary level, 2- Sub Centre and PHC are secondary level, 3- Medical colleges and hospitals are tertiary", "correct": false}, {"label": "D", "text": "1- PHC is primary level, 2- Sub Centre is secondary level, 3- Medical colleges and hospitals are tertiary", "correct": false}], "correct_answer": "B. 1- Sub Centre and PHC are primary level, 2- CHC is secondary level, 3- Medical colleges and hospitals are tertiary", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "MOA of botulinum toxin is", "options": [{"label": "A", "text": "Inhibits Elongation factor 2", "correct": false}, {"label": "B", "text": "Inhibits the release of GABA", "correct": false}, {"label": "C", "text": "Inhibits the release of Acetylcholine", "correct": true}, {"label": "D", "text": "Increases cAMP", "correct": false}], "correct_answer": "C. Inhibits the release of Acetylcholine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3yAHaQPZfdTNy5tPrnDp1741086418.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38 Y/o woman presents with complaints of heavy menstrual bleeding, pelvic discomfort, and frequent urination. On physical examination, her uterus is found to be irregularly enlarged. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Endometriosis", "correct": false}, {"label": "B", "text": "Ovarian cyst", "correct": false}, {"label": "C", "text": "Leiomyoma", "correct": true}, {"label": "D", "text": "Polycystic ovary syndrome (PCOS)", "correct": false}], "correct_answer": "C. Leiomyoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 39-year-old patient with HIV and a CD4 count of 139 cells/μL presents with altered sensorium and impaired consciousness. CSF examination using an India ink preparation reveals a positive result. Which organism is most likely responsible?", "options": [{"label": "A", "text": "Cryptococcus neoformans", "correct": true}, {"label": "B", "text": "Aspergillus fumigatus", "correct": false}, {"label": "C", "text": "Histoplasma capsulatum", "correct": false}, {"label": "D", "text": "Candida albicans", "correct": false}], "correct_answer": "A. Cryptococcus neoformans", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/X6XPOLaMmG1g8DZkIoOH1741084613.png", "https://image.prepladder.com/content/fT8oxh5IZgYbBtBnpKwe1741084655.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:729px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features of <span class=\"customMeta\" data-dictid=\"e828e24db216927771854e0dd69280\">Cryptococcosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory System </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cryptococcus typically enters the body via <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> and can cause <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infection / <span class=\"customMeta\" data-dictid=\"5a679034841692777196d988b49eb5\">pneumonitis</span> - primary site of infection</li>\n<li>Patients may present with cough, pleuritic chest pain, and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress.</li>\n<li>Imaging shows a <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> nodule</li>\n<li>Dissemination of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infection leads to the involvement of other organs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central Nervous System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meningitis:</strong> Characterized by severe headaches, fever, <strong>altered mental status</strong>, <strong>sensory and memory loss</strong>, <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve <span class=\"customMeta\" data-dictid=\"fec3fca4a316927771949da843f588\">paresis</span> and loss of vision</p>\n<p>It is the most serious type of <span class=\"customMeta\" data-dictid=\"6bd3522c4516927771855962983e97\">cryptococcal</span> infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cutaneous Cryptococcosis:</strong> Causes skin lesions, particularly in <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> patients.</p>\n<p>Associated with C.neoformans var neoformans (serotype D)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver, spleen, and bones maybe involved in <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> infections</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:761px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis </strong><strong>of Cryptococcosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>India ink</strong><strong>:</strong> <strong>Demonstrates the capsule</strong>, which appears as<strong> clear space surrounding the round <span class=\"customMeta\" data-dictid=\"38e3eb755216927771834bb7e72a61\">budding</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2803\" src=\"https://image.prepladder.com/content/X6XPOLaMmG1g8DZkIoOH1741084613.png\" width=\"4167\"/></p>\n<ul>\n<li><strong>Mucicarmine stain:</strong> It stains the carminophilic <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> of C. neoformans</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sabouraud <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> Agar</strong>, forming smooth, mucoid, cream-coloured colonies.</li>\n<li><strong>Niger seed <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> </strong>and <strong>bird seed agar</strong>: Demonstrates <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> production (brown colored colonies) due to <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> oxidase/laccase enzyme.</li>\n<li>The ability to grow at <strong>37°C</strong> and <strong>hydrolyse <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> </strong>differentiates C. neoformans from non-pathogenic cryptococci.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3864\" src=\"https://image.prepladder.com/content/fT8oxh5IZgYbBtBnpKwe1741084655.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antigen <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Demonstration of the capsular <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> by <strong>Precipitation </strong>and <strong>Latex agglutination</strong> <strong>test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial Treatment with <strong>liposomal <span class=\"customMeta\" data-dictid=\"2aca559df7169277718182de664e44\">Amphotericin B</span> </strong>and <strong>Flucytosine</strong></li>\n<li>Maintenance Therapy<strong> </strong>with <strong>Fluconazole</strong> for 6-12 months, depending on immune status.</li>\n</ul>\n<ul>\n<li>Monitoring: Regularly check <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> for fungal clearance, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, and electrolytes.</li>\n</ul>\n<ul>\n<li>Management of Underlying Conditions: Optimize ART to reduce <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked area in the image given.", "options": [{"label": "A", "text": "Morrison's pouch", "correct": false}, {"label": "B", "text": "Vesicouterine pouch", "correct": false}, {"label": "C", "text": "Pouch of Douglas", "correct": true}, {"label": "D", "text": "Ischioanal Fossa", "correct": false}], "correct_answer": "C. Pouch of Douglas", "question_images": ["https://image.prepladder.com/content/6PaS0cDdV811bSQUtvm51741089398.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a history of vomiting. Arterial blood gas analysis reveals the following: pH : 7.5 pCO₂ : 48 mm Hg HCO₃⁻ : 30 mm Hg What is the most likely acid-base abnormality?", "options": [{"label": "A", "text": "Metabolic alkalosis", "correct": true}, {"label": "B", "text": "Metabolic acidosis", "correct": false}, {"label": "C", "text": "Respiratory acidosis", "correct": false}, {"label": "D", "text": "Respiratory alkalosis", "correct": false}], "correct_answer": "A. Metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with a right transverse palmar crease, a cardiac defect, survival into childhood, and mild intellectual impairment. What is the chromosomal abnormality most likely associated with these findings?", "options": [{"label": "A", "text": "Tetralogy", "correct": false}, {"label": "B", "text": "Haploid", "correct": false}, {"label": "C", "text": "Monosomy", "correct": false}, {"label": "D", "text": "Mosaicism", "correct": true}], "correct_answer": "D. Mosaicism", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the fIPV dose schedule under the National Immunization Schedule?", "options": [{"label": "A", "text": "6 weeks, 10 weeks, 14 weeks", "correct": false}, {"label": "B", "text": "At birth, 6 weeks, 10 weeks, 14 weeks, 16-24 months, 5 years", "correct": false}, {"label": "C", "text": "6 weeks, 14 weeks, 9 months", "correct": true}, {"label": "D", "text": "6 weeks, 10 weeks, 12 weeks", "correct": false}], "correct_answer": "C. 6 weeks, 14 weeks, 9 months", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>IPV (salk type)</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>OPV (sabin type)</strong></p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Type of vaccine</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Killed formalised virus</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Live attenuated virus</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Mode of administration</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>S/C or IM (0.5 mL)</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Oral (2 drops)</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Type of immunity</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Only humoral</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Humoral and intestinal</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Prevention of</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Paralysis</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Paralysis + Intestinal re-infection</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Control of epidemics</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Not useful</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Effective</p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Storage &amp; transport</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less stringent conditions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires sub-zero temperatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shelf life</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Longer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VAPP (Vaccine Associated <span class=\"customMeta\" data-dictid=\"14bba9af561692777194c8cadacf13\">Paralytic</span> Polio)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Zero incidences</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 per 1 million vaccines</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old female visited the clinician with a solitary thyroid nodule and was advised for thyroid function tests where Tsh level is 27.3mU/L, T3 is 1.24 ng/ml, and T4 is 4.87 microgram/ml. Which of the following manifestations is true regarding the condition?", "options": [{"label": "A", "text": "Heat intolerance", "correct": false}, {"label": "B", "text": "Tachycardia", "correct": false}, {"label": "C", "text": "Diarrhea", "correct": false}, {"label": "D", "text": "Weight gain", "correct": true}], "correct_answer": "D. Weight gain", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:572px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hyperthyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> rate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> rate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight gain, puffiness, dry skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased appetite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased appetite</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bradycardia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachycardia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cold intolerance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heat intolerance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Constipation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diarrhea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Menorrhagia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amenorrhea, infertility</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiomegaly, <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiovascular complications such as atrial fibrillation, cardiomyopathy, and Congestive heart failure.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Altered mental status, coma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-month-old baby is brought by the mother with complaints of the left upper eyelid moving up and down during breastfeeding or thumb sucking, which disappears when the baby is not being fed. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Marcus Gunn Jaw-Winking Syndrome", "correct": true}, {"label": "B", "text": "Lagophthalmos", "correct": false}, {"label": "C", "text": "Myasthenia Gravis", "correct": false}, {"label": "D", "text": "3rd CN palsy", "correct": false}], "correct_answer": "A. Marcus Gunn Jaw-Winking Syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lYed476bmt0uk0xXWNvS1741088005.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is shown in the image below (circled)?", "options": [{"label": "A", "text": "Columella", "correct": false}, {"label": "B", "text": "Osteomeatal complex", "correct": true}, {"label": "C", "text": "Nasal valve", "correct": false}, {"label": "D", "text": "Crest of maxilla", "correct": false}], "correct_answer": "B. Osteomeatal complex", "question_images": ["https://image.prepladder.com/content/PmLeHcnGCTKIp53FWuuD1741087320.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate on examination has bilateral cataracts and, after investigations, is found to have a patent ductus arteriosus and salt &amp;amp; paper retinopathy. What is the most likely congenital infection?", "options": [{"label": "A", "text": "Rubella", "correct": true}, {"label": "B", "text": "CMV", "correct": false}, {"label": "C", "text": "Toxoplasma", "correct": false}, {"label": "D", "text": "Varicella", "correct": false}], "correct_answer": "A. Rubella", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yYlWqwJQ4qqZphA2OJ9A1741087376.png", "https://image.prepladder.com/content/KmEopIBujdsYAfsB7TOI1741087340.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Congenital Rubella</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rubella (German measles) is a mild disease in infants and children but can cause <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> syndrome (CRS) if contracted during pregnancy.</li>\n<li>The risk is highest in the first trimester, especially within the first 8 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Viremia is most intense from 10 to 17 days after infection.</li>\n<li>Viral shedding is from day 10 of infection up to 2 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of Defects by Gestational Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Highest in the first 12 weeks of <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> and decreases significantly thereafter, with defects being rare after 20 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features of <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hearing loss (most common)</li>\n<li>Vision problems (<strong>cataracts</strong>, glaucoma, <strong>salt and pepper</strong><strong> </strong><strong>retinopathy</strong>).\n\t\t\t\t<ul>\n<li>Cataracts are the most common <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> associated with <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> rubella.</li>\n</ul>\n</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"336\" src=\"https://image.prepladder.com/content/yYlWqwJQ4qqZphA2OJ9A1741087376.png\" width=\"687\"/></p>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/KmEopIBujdsYAfsB7TOI1741087340.png\" width=\"3846\"/>\n<ul>\n<li>Heart defects (<strong>patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus</strong> &gt; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> (right &gt; left) &gt; <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> septal defect)</li>\n<li><strong>Low birth weight</strong></li>\n<li>Neurological issues (microcephaly, intellectual disabilities, encephalitis, behavioural issues)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronicity and Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic presence of the virus can cause ongoing damage</li>\n<li>The risk of progressive <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> <span class=\"customMeta\" data-dictid=\"871ad2a8051692777194a3f7cd0309\">panencephalitis</span> (PRP) years later is a rare complication.</li>\n<li>Less common complications: Growth retardation, hepatitis, bone lesions.</li>\n<li>Risk of diabetes and <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> dysfunction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rubella <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> <span class=\"customMeta\" data-dictid=\"9660c7ea2116927771894b30a0f80b\">immunosorbent</span> <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">assay</span> (detects antibodies)</li>\n<li>Viral isolation (growing the virus from samples)</li>\n<li>Polymerase chain reaction (PCR) (detects <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> RNA)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"a4a589776216927771991b881f95b1\">specific treatment</span> for CRS; supportive care is key</li>\n<li>Early intervention for complications (e.g., hearing loss) is crucial</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Standard with <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> <span class=\"customMeta\" data-dictid=\"43ce88387a1692777196387ed2c267\">precaution</span> in hospitalized cases</li>\n<li>Rubella <span class=\"customMeta\" data-dictid=\"f23be6aa561692777201ca2e1aaa27\">vaccination</span> RA 27/3 live attenuated vaccine (MMR or <span class=\"customMeta\" data-dictid=\"dfad3b2dd41692777192eef4355bc3\">MMRV</span> with varicella) effectively prevents <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> and CRS</li>\n<li>MMR vaccine has a 95% <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> after one dose and 99% after two doses</li>\n<li>Vaccination side effects: fever, rash, joint pain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Considerations for Pregnant Women</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immunoglobulin </strong>may be considered if pregnancy is not terminated, though it does not guarantee prevention of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> infection</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vaccines is C/I in pregnancy?", "options": [{"label": "A", "text": "Influenza", "correct": false}, {"label": "B", "text": "Varicella", "correct": true}, {"label": "C", "text": "Rabies", "correct": false}, {"label": "D", "text": "TDaP", "correct": false}], "correct_answer": "B. Varicella", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Varicella <span class=\"customMeta\" data-dictid=\"03350c16f71692777202dbca70976e\">zoster</span> <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> (VZIG)</strong></p>\n\t\t\t \n\n\t\t\t<p>VZIG is given within 72 hours of exposure and is recommended for the prevention of <span class=\"customMeta\" data-dictid=\"d5b9e7187c16927771847488b5f135\">chickenpox</span> in exposed individuals like:</p>\n<ul>\n<li>HIV/AIDS or <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> persons</li>\n<li>Immunosuppressive therapy patients</li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> immunodeficiency</li>\n<li>Pregnant females, early neonates, <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> infants or low birth weights</li>\n<li>Given to neonates if their mothers get <span class=\"customMeta\" data-dictid=\"d5b9e7187c16927771847488b5f135\">chickenpox</span> 5 days before or 2 days after delivery.</li>\n</ul>\n<p>Dose: 12.5 units/kg with a maximum of 625 units, repeat the dose in 3 weeks if the high-risk patient remains exposed.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Live vaccine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5 ml <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> route.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schedule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Given in 2 doses, it is recommended for all.</p>\n<ul>\n<li>If given &lt; 13 years, the duration between two dosages should be 1-3 months</li>\n<li>For &gt;13 years, the duration between two doses is 4-6 weeks</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Combination</strong></p>\n<p><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chickenpox vaccine can be given as MMRV– <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> <span class=\"customMeta\" data-dictid=\"f61c340e77169277719339e74267c4\">mumps</span> <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> varicella.</p>\n<ul>\n<li>MMRV– administered to 9 months to 12 years of age</li>\n<li>Two doses schedule with an interval of 4 weeks</li>\n<li>However, it is preferred that the second dose be administered 6 weeks to 3 months after the first dose or at 4-6 years of age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post Exposure</strong></p>\n<p><strong>Prophylaxis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This can be done if there is known exposure to <span class=\"customMeta\" data-dictid=\"cf329b8cef169277720107b1efa15b\">varicella</span> virus; the vaccine should be given within 5 days of exposure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vaccine is contraindicated</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the CTG pattern?", "options": [{"label": "A", "text": "Early deceleration", "correct": true}, {"label": "B", "text": "Late decelarations", "correct": false}, {"label": "C", "text": "Variable", "correct": false}, {"label": "D", "text": "Normal", "correct": false}], "correct_answer": "A. Early deceleration", "question_images": ["https://image.prepladder.com/content/6wIT8gO4caxs7qfjMJ521741097152.png"], "explanation_images": ["https://image.prepladder.com/content/qdQPzBmr6o69eWN9c1fO1741097352.png", "https://image.prepladder.com/content/mBVx14iIg9oXC4QeP5Bx1741097388.png", "https://image.prepladder.com/content/EmkKzEYMOxfEQnDJHz7J1741097538.png", "https://image.prepladder.com/content/WB0XqrdHDBUNUb4cl8sB1741097782.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Decelerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual decline and recovery of FHR that coincide with the onset and recovery of the contraction. The nadir of the <span class=\"customMeta\" data-dictid=\"7be129d4bb1692777185fa5706fe88\">deceleration</span> occurs <strong>≥30 seconds</strong> after onset. The nadir of the <span class=\"customMeta\" data-dictid=\"7be129d4bb1692777185fa5706fe88\">deceleration</span> occurs <strong>≥30 seconds</strong> after onset.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fetal head compression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual decrease mirroring contractions.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1041\" src=\"https://image.prepladder.com/content/qdQPzBmr6o69eWN9c1fO1741097352.png\" width=\"1041\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late Decelerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual decline in FHR that begins <strong>at or after</strong> the contraction’s peak and recovers after the <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> ends. The nadir occurs <strong>≥30 seconds</strong> after onset.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fetal hypoxia, <span class=\"customMeta\" data-dictid=\"091c4fd1e61692777201ec50806bc4\">uteroplacental</span> insufficiency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Begin after <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> peak, uniform U-shaped.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1041\" src=\"https://image.prepladder.com/content/mBVx14iIg9oXC4QeP5Bx1741097388.png\" width=\"1041\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variable Decelerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abrupt FHR drop (≥15 bpm) with onset varying between contractions. Onset-to-nadir &lt;30 sec, duration ≥15 sec but &lt;2 min.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Umbilical cord compression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abrupt, irregular, \"V\" or \"W\" shapes.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4160\" src=\"https://image.prepladder.com/content/EmkKzEYMOxfEQnDJHz7J1741097538.png\" width=\"4160\"/></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following CVS changes are not seen in pregnancy?", "options": [{"label": "A", "text": "Soft Systolic murmur", "correct": false}, {"label": "B", "text": "Diastolic murmur", "correct": true}, {"label": "C", "text": "S3", "correct": false}, {"label": "D", "text": "Loud S1 splitting", "correct": false}], "correct_answer": "B. Diastolic murmur", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemodynamic changes during pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Change</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiac output (L/min)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases +40%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stroke volume (ml)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases +27%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heart rate (per minute)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases +17%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An unaffected or mid-pregnancy drop of <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">diastolic pressure</span> by 5-10 mm Hg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Venous pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases +100%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colloid <span class=\"customMeta\" data-dictid=\"5d369be246169277719451754ab37a\">oncotic</span> pressure (mmHg)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreases -14%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance (SVR)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreases -21%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance (PVR)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreases -34%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given instrument.", "options": [{"label": "A", "text": "Veress needle", "correct": true}, {"label": "B", "text": "Hasson's cannula", "correct": false}, {"label": "C", "text": "Jamshidi needle", "correct": false}, {"label": "D", "text": "3 mm Trocar", "correct": false}], "correct_answer": "A. Veress needle", "question_images": ["https://image.prepladder.com/content/C1gY2W6LEluDhcPuVqK81741108912.png"], "explanation_images": ["https://image.prepladder.com/content/ZHbblWdREHDVZXKlV4201741108932.png", "https://image.prepladder.com/content/mLgIqP5CtUHgpcAjsK4T1741069125.png", "https://image.prepladder.com/content/AhVvenpxAlOSG9Eyrxeg1741069144.png", "https://image.prepladder.com/content/aEOWFP9nAbqHWYIm3wMM1741108962.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:402px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Creates <span class=\"customMeta\" data-dictid=\"8c36ab9b0516927771962c88c4ada4\">pneumoperitoneum</span> for laparoscopy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spring-loaded <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> <span class=\"customMeta\" data-dictid=\"a1244e4821169277719985dd460729\">stylet</span> for safety</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insertion Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly at the umbilicus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alternative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hasson’s open technique</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Artificial creation of gas <span class=\"customMeta\" data-dictid=\"0bb08aec621692777190d80a74d35c\">insufflation</span> in the peritoneal <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> to facilitate <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Gas Used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carbon <span class=\"customMeta\" data-dictid=\"0bd01a042116927771868e3482910e\">dioxide</span> (CO₂) due to its rapid absorption, non-combustibility, and high <span class=\"customMeta\" data-dictid=\"a9295e67a41692777198dce0de3f34\">solubility</span> in blood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Closed technique</strong>: Uses <span class=\"customMeta\" data-dictid=\"4726929e261692777201a665a56fa7\">Veress needle</span> for insufflation.</p>\n<p><strong>Open technique</strong>: Uses Hasson’s <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> without prior insufflation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insufflation Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-15 mmHg (optimal for maintaining <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> space while minimizing complications).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gas-related</strong>: Hypercapnia, acidosis, gas embolism.</p>\n<p><strong>Entry-related</strong>: <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> injury, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury, <span class=\"customMeta\" data-dictid=\"707b8e89cd1692777196474be04ff0\">preperitoneal</span> insufflation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention of Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Correct needle placement confirmation (aspiration test, <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> drop test).</p>\n<p>Slow controlled insufflation.</p>\n<p>Monitoring <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO₂ levels.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient reports difficulty switching between movements and experiences uncontrollable hand movements. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Dysdiadochokinesis", "correct": true}, {"label": "B", "text": "Intentional Tremor", "correct": false}, {"label": "C", "text": "Metamorphosis", "correct": false}, {"label": "D", "text": "Resting Tremor", "correct": false}], "correct_answer": "A. Dysdiadochokinesis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypotonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased muscle tone, often on the same side as the cerebellar lesion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ataxia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncoordinated movements, often leading to a \"drunken\" gait.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysdiadochokinesia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inability to perform rapid <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> movements, such as flipping the hands back and forth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysmetria (Past pointing)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Movements that overshoot or undershoot the intended target.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intention tremor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tremors occurring when moving toward a target</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysarthria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jumbled speech due to lack of <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> in the muscles involved in speech</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nystagmus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid, tremulous eye movements</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rebound Phenomenon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limb jerking back after resistance is suddenly removed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decomposition of movement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can't move multiple joints simultaneously.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> deficit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not typically present in cerebellar diseases.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked in the image given below.", "options": [{"label": "A", "text": "Buccopharyngeal fascia", "correct": false}, {"label": "B", "text": "Capsule", "correct": false}, {"label": "C", "text": "Superior constrictor muscle", "correct": false}, {"label": "D", "text": "Pharyngobasilar fascia", "correct": true}], "correct_answer": "D. Pharyngobasilar fascia", "question_images": ["https://image.prepladder.com/content/LB2zMYRgAaL92DPoB0s11741090319.png"], "explanation_images": ["https://image.prepladder.com/content/DFtNa1AR3JlLzkOLPChB1741024952.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:406px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structures forming the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">Tonsillar</span> bed</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscles forming the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> bed</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Superior <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">Constrictor</span> Muscle</li>\n<li>Styloglossus Muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures close to the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> bed (outside the superior <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle)</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Facial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (Tonsillar Branch): Major blood supply to the tonsils, at risk for haemorrhage during surgery.</li>\n<li>Paratonsillar Vein: <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of the tonsil, risk of <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> during tonsillectomy.</li>\n<li>Submandibular Salivary Gland</li>\n<li>Posterior Belly of <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">Digastric</span> Muscle</li>\n<li>Medial <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">Pterygoid</span> Muscle</li>\n<li>Mandible</li>\n<li>Glossopharyngeal Nerve: Provides <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the tonsils.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A post menopausal women presents with irregular bleeding, endometrium biopsy shows endometrial hyperplasia without atypia. What is the likely management?", "options": [{"label": "A", "text": "OCP", "correct": false}, {"label": "B", "text": "Estradiol", "correct": false}, {"label": "C", "text": "LNG-IUS", "correct": true}, {"label": "D", "text": "Danazol", "correct": false}], "correct_answer": "C. LNG-IUS", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2vO2xqkNHmzAI5bnktUI1741106930.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman with a history of chronic obstructive pulmonary disease (COPD) presents with increased breathlessness, cough, and sputum production over the last two days. She appears distressed and has a respiratory rate of 28 breaths per minute. Her oxygen saturation is 88% on room air. Which of the following management strategies is most appropriate for her immediate treatment?", "options": [{"label": "A", "text": "Initiate high-flow oxygen therapy to maintain oxygen saturation above 95%", "correct": false}, {"label": "B", "text": "Start nebulised bronchodilator therapy with salbutamol and ipratropium", "correct": true}, {"label": "C", "text": "Begin intravenous glucocorticoids immediately", "correct": false}, {"label": "D", "text": "Order a chest X-ray before any treatment is provided", "correct": false}], "correct_answer": "B. Start nebulised bronchodilator therapy with salbutamol and ipratropium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Arterial blood gases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess severity of hypoxaemia, hypercapnia, acidaemia; guide oxygen therapy and ventilation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identify complications such as pneumonia, pneumothorax, or pleural effusion. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Oxygen Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Administer<strong> controlled oxygen at 24% or 28%</strong> to maintain PaO2 &gt; 8 kPa (60 mmHg) or SaO2 &gt; 90%. <strong>(Option A ruled out)</strong></li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> gas monitoring to adjust therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bronchodilators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Use nebulised short-acting β2-agonists (e.g., salbutamol, terbutaline) with anticholinergics (e.g., ipratropium).</li>\n<li>If oxygen sensitivity is a concern, use compressed air for nebulisation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Administer oral <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> (30 mg for 10 days) to reduce symptoms and improve lung function.Reduces frequency and severity of exacerbations.</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> for repeated courses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antibiotic Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Indicated for increased <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> purulence, volume, or breathlessness.</li>\n<li>Use simple regimens (aminopenicillin, tetracycline, macrolide); <span class=\"customMeta\" data-dictid=\"dd4d53634b1692777184851322327e\">co-amoxiclav</span> in areas with β-lactamase organisms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Non-Invasive <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (NIV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Safe for mild to moderate <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis; helps reduce <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> need and mortality.</li>\n<li>Not suitable for patients unable to protect their airway.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanical Ventilation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consider if there is a <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> cause, no prior <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, or if <span class=\"customMeta\" data-dictid=\"0e4135f3bc1692777193047657d8c5\">NIV</span> has failed/contraindicated.</li>\n<li>Decisions should involve the patient, family, and GP.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Additional Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diuretics for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> oedema.</li>\n<li>Limited evidence for <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> aminophylline; consider <span class=\"customMeta\" data-dictid=\"5280ec6ae91692777182aa6322ae68\">arrhythmia</span> risk.</li>\n<li>Doxapram may be used short-term for low <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rates.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presents to the OPD with a 3 cm breast lump in the upper medial quadrant . The lump has an uneven, bosselated surface , and the overlying skin is mildly ulcerated . Microscopic examination reveals the given findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Phyllodes tumor", "correct": true}, {"label": "B", "text": "Galactocele", "correct": false}, {"label": "C", "text": "Fibroadenoma", "correct": false}, {"label": "D", "text": "Paget's disease", "correct": false}], "correct_answer": "A. Phyllodes tumor", "question_images": ["https://image.prepladder.com/content/DOhXoukvwuwXNLuszAAc1741075420.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:344px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-50 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid, large <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> mass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surface</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uneven, bosselated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stromal overgrowth, leaf-like pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> / mastectomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male patient presented with localized pain, which is gradual in onset and worsened over time. X-ray showed the following finding. What is the diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": true}, {"label": "B", "text": "Ewing sarcoma", "correct": false}, {"label": "C", "text": "Chondrosarcoma", "correct": false}, {"label": "D", "text": "Gout", "correct": false}], "correct_answer": "A. Osteosarcoma", "question_images": ["https://image.prepladder.com/content/k1uA6n8wczOZOfLcBr761741058451.png"], "explanation_images": ["https://image.prepladder.com/content/BJCDTsXfCE7Lr7WDJXo91741058567.png", "https://image.prepladder.com/content/K1XAuTM1yB4RiZdTwFL81741058609.png", "https://image.prepladder.com/content/k1uA6n8wczOZOfLcBr761741058451.png", "https://image.prepladder.com/content/ADfGkyLin0Bi82sdfaXl1741058724.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following tests is most appropriate for diagnosing this condition?", "options": [{"label": "A", "text": "Nikolsky Test", "correct": false}, {"label": "B", "text": "Asboe-Hansen test", "correct": false}, {"label": "C", "text": "Grattage Test", "correct": true}, {"label": "D", "text": "Tzanck Smear", "correct": false}], "correct_answer": "C. Grattage Test", "question_images": ["https://image.prepladder.com/content/1q6owN5zmAbaGCK8y1rG1741088923.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came to the hospital with muscle weakness, diarrhea, and bradycardia. He was diagnosed with organophosphate poisoning for which atropine was administered. After atropine administration, which of the following changes are not seen?", "options": [{"label": "A", "text": "Bradycardia", "correct": false}, {"label": "B", "text": "Muscle weakness", "correct": true}, {"label": "C", "text": "Diaphoresis", "correct": false}, {"label": "D", "text": "Nasal discharge", "correct": false}], "correct_answer": "B. Muscle weakness", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iMu7d6R9pWHJD80lFcYo1741020944.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Muscarinic: </strong>Lethargy, Salivation, Diarrhea, Lacrimation, Urination, Miosis, Muscle weakness, Bronchorrhea, Bronchospasm, Bradycardia, Emesis (Mnemonic: DUMBBELLS)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nicotinic: </strong>Muscle weakness, Fasciculation, Areflexia, Muscle paralysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CNS: </strong>Headache, Tremor, Confusion, Slurred speech, Coma, Convulsion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Laboratory Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>RBC/True Cholinesterase</strong> (specific)</li>\n<li><strong>Plasma/Pseudocholinesterase</strong> (Most common)\n\t\t\t\t<ul>\n<li>Falls rapidly with <span class=\"customMeta\" data-dictid=\"8e1f460230169277719463930573a7\">organophosphorus</span> poisoning</li>\n<li>Inexpensive, sensitive)</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Atropine test</strong>: If 2 mg of <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">Atropine</span> relieves symptoms, it confirms OP poisoning</li>\n<li><strong>P-nitro <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> test</strong> for confirmation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Resuscitative measures (Airway-Breathing-Circulation)</li>\n<li>Decontamination</li>\n<li>Gastric <span class=\"customMeta\" data-dictid=\"b625b3e881169277719169ef4e1af3\">lavage</span> with 1:5000 KMnO4</li>\n<li>Activated charcoal</li>\n<li><strong>Atropine sulfate</strong> (2-4 mg IV every 10-15 minutes until atropinization)</li>\n<li><strong>Signs of atropinization:</strong> Heart rate&gt;80 beats/min, pupils no longer pinpoint, clear chest on <span class=\"customMeta\" data-dictid=\"b2f0dbabe516927771821b0ec5ba85\">auscultation</span> with no wheeze, <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP&gt;80mmHg, Dry axillae</li>\n<li>Oximes (Pralidoxime) to decrease <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> and CNS symptoms\n\t\t\t\t<ul>\n<li>removes <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> group</li>\n<li>reduces <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> requirement</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause of Death</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Respiratory Muscle <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">Paralysis</span> (RMP)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Option</strong></th>\n<th><strong>Explanation</strong></th>\n<th><strong>Seen after atropine?</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Bradycardia</strong></td>\n<td>Reversed by <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> (muscarinic blockade)</td>\n<td>Not seen</td>\n</tr>\n<tr>\n<td>Muscle weakness</td>\n<td>Nicotinic effect; not reversed by atropine</td>\n<td>Seen</td>\n</tr>\n<tr>\n<td>Diaphoresis</td>\n<td>Muscarinic effect; reversed by atropine</td>\n<td>Seen before, improves</td>\n</tr>\n<tr>\n<td>Nasal discharge</td>\n<td>Muscarinic effect; reversed by atropine</td>\n<td>Seen before, improves</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a primary use of this imaging modality?", "options": [{"label": "A", "text": "Staging of esophageal cancer", "correct": true}, {"label": "B", "text": "Evaluation of gastroesophageal reflux disease (GERD)", "correct": false}, {"label": "C", "text": "Identifying the cause of dysphagia", "correct": false}, {"label": "D", "text": "Assessing cardiac and aortic pathology", "correct": false}], "correct_answer": "A. Staging of esophageal cancer", "question_images": ["https://image.prepladder.com/content/dX6ygIOTIo4YCuad18YV1741087794.png"], "explanation_images": ["https://image.prepladder.com/content/df3MKhXZiv3Sqfwa7TMC1741087906.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Application</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staging of <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> cancer</strong> (Correct Answer)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluates tumor depth and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pancreatic lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects and biopsies pancreatic cysts, tumors, or chronic pancreatitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subepithelial GI tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Differentiates between leiomyomas, GISTs, and <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biliary pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"92128a6d941692777184f9d2f7ef4d\">choledocholithiasis</span> and <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> strictures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rectal cancer staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Determines depth of invasion and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old male presents with sudden onset acute abdominal pain , constipation for 1 day , persistent hiccups , and occasional vomiting . An abdominal X-ray was performed. Identify the pathology.", "options": [{"label": "A", "text": "Sigmoid volvulus", "correct": true}, {"label": "B", "text": "Caecal volvulus", "correct": false}, {"label": "C", "text": "Intussusception", "correct": false}, {"label": "D", "text": "Dynamic obstruction", "correct": false}], "correct_answer": "A. Sigmoid volvulus", "question_images": ["https://image.prepladder.com/content/Yw1ZeYZhWd6f3QV3hMzU1741070969.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sigmoid Volvulus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caecal Volvulus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twisting of <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> on its mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twisting of <span class=\"customMeta\" data-dictid=\"603036123f1692777183f87e582e3e\">caecum</span> &amp; <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Coffee bean\" or \"Omega loop\" sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Comma\" or \"Kidney bean\" sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bowel Dilatation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sigmoid <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> massively distended</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilated caecum, displaced medially</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic <span class=\"customMeta\" data-dictid=\"dfd87633931692777186f47063d1c2\">detorsion</span> or surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery (right <span class=\"customMeta\" data-dictid=\"b8e6dbcc40169277718814cf80f864\">hemicolectomy</span> if gangrenous)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An unvaccinated 5-year-old child of a migrant worker family was brought to the causality with fever and a characteristic skin rash. Upon eye examination, Bitot’s spot was seen. What is the appropriate management?", "options": [{"label": "A", "text": "Isolate and give nutritional supply with vitamin A supplement", "correct": true}, {"label": "B", "text": "Give measles vaccine and vitamin A supplement", "correct": false}, {"label": "C", "text": "Institutional Isolation, nutritional management with vitamin A supplement", "correct": false}, {"label": "D", "text": "Only measles vaccine", "correct": false}], "correct_answer": "A. Isolate and give nutritional supply with vitamin A supplement", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/w2WRPFFlILWMUgcEhAwV1741087579.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measles (rubeola) is a highly <span class=\"customMeta\" data-dictid=\"6f6ef8bf7c1692777184dfdf8cf45d\">communicable</span> childhood <span class=\"customMeta\" data-dictid=\"4f279b047716927771872685599ba9\">exanthematous</span> illness caused by the <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> virus, an <strong>RNA virus</strong> from the <strong>Paramyxoviridae family.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contact with <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> aerosols (through the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or conjunctiva)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary viremia</strong> occurs, resulting in infection of the <span class=\"customMeta\" data-dictid=\"77c058b3b21692777197f5fd539d12\">reticuloendothelial</span> system, followed by<strong> secondary viremia,</strong> which results in <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8-12 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Period of infectivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>From 3 days before to 4 days after the <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> onset.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common in preschool children</li>\n<li><strong>Prodromal phase: </strong><strong>Fever </strong>(before rash), rhinorrhea, conjunctival <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and a <strong>dry hacking cough</strong>.</li>\n<li><strong>Koplik spots</strong>, <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> for measles, appear on the 2nd or<strong> </strong>3rd day of illness<strong> </strong>as grey-white, sand-like lesions with surrounding <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> on the <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">buccal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> opposite the lower second molars.</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"440\" src=\"https://image.prepladder.com/content/w2WRPFFlILWMUgcEhAwV1741087579.png\" width=\"434\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The erythematous <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> appears on the 4th day, starting behind the ears, along the hairline, and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cheeks, then <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> to the rest of the body over the next 2-3 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isolation</strong>.</p>\n<p><strong>Symptomatic and conservative</strong> (antipyretics, maintenance of hygiene, <strong>ensuring adequate fluid and <span class=\"customMeta\" data-dictid=\"39156a37b21692777183372a301aa8\">caloric</span> intake</strong>, and humidification).</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Under 6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>50,000 IU once daily on D1, D2, and 4 weeks later</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>6 to 12 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>100,000 IU once daily on D1, D2, and 4 weeks later</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Over 1 year</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>200,000 IU once daily on D1, D2, and 4 weeks later</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 1.5-month-old male infant presents to the outpatient department with vomiting after feeding and failure to thrive . On examination, a firm, olive-shaped mass is palpated in the upper abdomen . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Subacute Intestinal Obstruction", "correct": false}, {"label": "B", "text": "Pyloric Stenosis", "correct": true}, {"label": "C", "text": "GERD", "correct": false}, {"label": "D", "text": "Esophageal Atresia", "correct": false}], "correct_answer": "B. Pyloric Stenosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UIu3Uu2ja3gXkt5yywRZ1741075174.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:421px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age of Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-6 weeks of life</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Projectile, non-bilious vomiting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Exam</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Olive-shaped mass in epigastrium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound: Pyloric muscle hypertrophy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ramstedt's pyloromyotomy</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the usual method of collecting a sample of urine to detect UTI?", "options": [{"label": "A", "text": "Early morning sample", "correct": false}, {"label": "B", "text": "Midstream catch", "correct": true}, {"label": "C", "text": "Supra pubic catheter", "correct": false}, {"label": "D", "text": "Starting stream collection", "correct": false}], "correct_answer": "B. Midstream catch", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with vision problems and has a history of cataract surgery. OCT finding is shown below. What is the syndrome most likely associated with these findings?", "options": [{"label": "A", "text": "Posner-Schlossman Syndrome", "correct": false}, {"label": "B", "text": "Irvine-Gass Syndrome", "correct": true}, {"label": "C", "text": "Central Serous Retinopathy", "correct": false}, {"label": "D", "text": "Elschnig Pearls", "correct": false}], "correct_answer": "B. Irvine-Gass Syndrome", "question_images": ["https://image.prepladder.com/content/7Ot9ZQPwXx4E3MM2CYfI1741088058.png"], "explanation_images": ["https://image.prepladder.com/content/lYpGjzMJzJR40s8v8pOu1741088094.png", "https://image.prepladder.com/content/4p3RWJoZu7tHqhjxm0fU1741088112.png", "https://image.prepladder.com/content/ZxnuBLwUaqyv9hG1xAFB1741088166.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person came with the H/o thorn prick a week ago. A few days later, he developed ulcers along lymphatic drainage. Choose the correct organism.", "options": [{"label": "A", "text": "Coccidioides immitis", "correct": false}, {"label": "B", "text": "Aspergillus flavus", "correct": false}, {"label": "C", "text": "Sporothrix schenckii", "correct": true}, {"label": "D", "text": "Trichophyton rubrum", "correct": false}], "correct_answer": "C. Sporothrix schenckii", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lrLRxu6nru8RicCs2Zto1741085614.png", "https://image.prepladder.com/content/sO0vOtDKku1ax5i3sWFc1741085639.png", "https://image.prepladder.com/content/XfQqJpACv7qk4t48XpPJ1741085661.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sporotrichosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dimorphic <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> <span class=\"customMeta\" data-dictid=\"9163b9f3c51692777199fc6798ccf0\">Sporothrix</span> schenckii.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in <strong>gardeners</strong>, forest workers, and manual labourers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Route of Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minor trauma or<strong> thorn prick.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic infection affects cutaneous, subcutaneous, and <strong>lymphatic tissue.</strong></li>\n<li>Lesions <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> at sites of minor trauma or thorn pricks, starting as nodules.</li>\n<li>Nodules <strong>ulcerate </strong>and necrose; infection <strong>spreads through <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> channels.</strong></li>\n</ul>\n<p><strong></strong><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3650\" src=\"https://image.prepladder.com/content/lrLRxu6nru8RicCs2Zto1741085614.png\" width=\"4167\"/></p>\n<p> </p>\n<ul>\n<li><strong>Lymphocutaneous sporotrichosis: </strong>Secondary ulcers on <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes; lymphatics become hardened and cord-like.</li>\n<li><strong>Systemic dissemination: </strong>Can affect bones, joints, and meninges.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Specimens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aspiration from nodules and <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> material.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopy:</strong></p>\n<ul>\n<li>KOH mounts or histopathological sections stained by <span class=\"customMeta\" data-dictid=\"cb3712727816927771925665b0b1e0\">methenamine</span> silver <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> show <strong>asteroid bodies (Splendore hoeppli phenomenon)</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/sO0vOtDKku1ax5i3sWFc1741085639.png\" width=\"3238\"/></p>\n<ul>\n<li><strong>Yeast phase: Cigar-shaped cells. </strong><strong>(Option C)</strong></li>\n</ul>\n<p><strong>Culture:</strong> Thin <span class=\"customMeta\" data-dictid=\"55f411a4ea1692777198d8f2de73b0\">septate</span> hyphae with flower-like clusters of small conidia; <strong>pear-shaped <span class=\"customMeta\" data-dictid=\"774c1b33a916927771844f6c75dcff\">conidia</span> in rosette-like clusters</strong> in mycelial phase.</p>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2778\" src=\"https://image.prepladder.com/content/XfQqJpACv7qk4t48XpPJ1741085661.png\" width=\"4167\"/>\n<p><strong>Serological tests: </strong>Helpful for extracutaneous or <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medications:</p>\n<ul>\n<li>Itraconazole</li>\n<li>Terbinafine</li>\n<li>Amphotericin B: For <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> infection</li>\n</ul>\n<p>Cryotherapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with dilated tortuous veins of the leg presented to the OPD and is diagnosed with varicose vein of grade C4a. What is the best preferred treatment?", "options": [{"label": "A", "text": "Compression", "correct": false}, {"label": "B", "text": "Endothermal ablation", "correct": true}, {"label": "C", "text": "Non endothermal non tumescent ablation", "correct": false}, {"label": "D", "text": "Open surgery", "correct": false}], "correct_answer": "B. Endothermal ablation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CEAP Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preferred Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No visible/palpable signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No treatment needed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Telangiectasias or <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conservative (compression)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varicose veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compression, ablation, or surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Edema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endothermal ablation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pigmentation/eczema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endothermal ablation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lipodermatosclerosis or <span class=\"customMeta\" data-dictid=\"b04fb2c703169277718295309e32d6\">atrophie</span> blanche</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endothermal or open surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Healed <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endothermal <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> + <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> care</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Active <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multimodal therapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "It is shoulder dystocia when the anterior shoulder is delivered after what time of head delivery?", "options": [{"label": "A", "text": "15 sec", "correct": false}, {"label": "B", "text": "30 sec", "correct": false}, {"label": "C", "text": "45 sec", "correct": false}, {"label": "D", "text": "60 sec", "correct": true}], "correct_answer": "D. 60 sec", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Maternal Complications</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Neonatal Complications</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Soft tissue injuries</strong>: Lacerations of the bladder, urethra, vagina, anal sphincter, or rectum</li>\n<li><strong>Nerve injury</strong>: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> neuropathy</li>\n<li><strong>Postpartum hemorrhage</strong></li>\n<li><strong>Pelvic injury</strong>: Symphyseal separation</li>\n<li><strong>Uterine rupture</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fetal death</strong></li>\n<li><strong>Hypoxic-ischemic <span class=\"customMeta\" data-dictid=\"b37b211cbc169277718725f07b5473\">encephalopathy</span> (HIE)</strong></li>\n<li><strong>Fractures</strong>: <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">Clavicle</span> or humerus</li>\n<li><strong>Neurologic injuries</strong>:\n\t\t\t\t<ul>\n<li>Brachial <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> injury</li>\n<li>Diaphragmatic paralysis</li>\n<li>Facial nerve injury</li>\n<li>Horner syndrome (ptosis, miosis, anhidrosis)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a food adulteration disease?", "options": [{"label": "A", "text": "Lathyrism", "correct": false}, {"label": "B", "text": "Fluorosis", "correct": true}, {"label": "C", "text": "Dropsy", "correct": false}, {"label": "D", "text": "Aflatoxicosis", "correct": false}], "correct_answer": "B. Fluorosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9F9EdgiA8sU1d0BK9Zyt1741075856.png", "https://image.prepladder.com/content/HNkDU8Ud93iD8Hi3Rtt81741075875.png", "https://image.prepladder.com/content/sdIVLxVSZxUivTM4HL9f1741075899.png", "https://image.prepladder.com/content/XaZO5tEkiKVDzfkKjkgB1741075919.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:587px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluorine content in water</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Related symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.5mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dental caries</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"225\" src=\"https://image.prepladder.com/content/9F9EdgiA8sU1d0BK9Zyt1741075856.png\" width=\"281\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;1.5mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dental fluorosis</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"176\" src=\"https://image.prepladder.com/content/HNkDU8Ud93iD8Hi3Rtt81741075875.png\" width=\"317\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-6mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skeletal fluorosis</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"287\" src=\"https://image.prepladder.com/content/sdIVLxVSZxUivTM4HL9f1741075899.png\" width=\"216\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;10mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crippling fluorosis</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"253\" src=\"https://image.prepladder.com/content/XaZO5tEkiKVDzfkKjkgB1741075919.png\" width=\"291\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly man presents with an ulcerative lesion at the inner canthus of his eye with pearly margins. On microscopic examination, it shows a palisading arrangement of cells. Identify the lesion:", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": false}, {"label": "B", "text": "Basal cell carcinoma", "correct": true}, {"label": "C", "text": "Keratoacanthoma", "correct": false}, {"label": "D", "text": "Melanocytic melanoma", "correct": false}], "correct_answer": "B. Basal cell carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/M33byyPD710YLq93m0jo1741061580.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with a Graham-Steel murmur?", "options": [{"label": "A", "text": "Ventricular septal defect (VSD)", "correct": false}, {"label": "B", "text": "Hypertrophic obstructive cardiomyopathy (HOCM)", "correct": false}, {"label": "C", "text": "Pulmonary regurgitation", "correct": true}, {"label": "D", "text": "Aortic regurgitation", "correct": false}], "correct_answer": "C. Pulmonary regurgitation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Murmur Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-pitched <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> with an opening snap, best heard at the apex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crescendo-decrescendo <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur, radiates to carotids, best heard at the right upper sternal border</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">Ductus</span> Arteriosus (PDA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous, machine-like murmur, best heard at the left <span class=\"customMeta\" data-dictid=\"71409dc88a1692777190aedbc558b6\">infraclavicular</span> area</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertrophic <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">Cardiomyopathy</span> (HOCM) </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Harsh <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> with a crescendo-decrescendo pattern, best heard at the left sternal border, increases with Valsalva maneuver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (MR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Holosystolic murmur, best heard at the apex, radiates to the axilla</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (AR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early diastolic decrescendo murmur, best heard at the left sternal border</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (VSD) </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Harsh <span class=\"customMeta\" data-dictid=\"b1b77428461692777189ac124a6fa6\">holosystolic</span> murmur, best heard at the left lower sternal border (LLSB)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atrial Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (ASD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur, best heard at the left upper sternal border (LUSB), with fixed, widely split S2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tricuspid <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (TR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Holosystolic murmur, best heard at the left lower sternal border,<strong> increases with inspiration (Carvallo’s sign)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Murmur</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Cause &amp; Characteristics</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Graham-Steel <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">Murmur</span> (Pulmonary <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Hypertension)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4>Early diastolic decrescendo murmur, best heard at the left upper sternal border, caused by <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"9a02ac20c3169277719094af57128d\">incompetence</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension</h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Austin <span class=\"customMeta\" data-dictid=\"9f2591dc721692777202895079015f\">Flint Murmur</span> </strong></h4>\n<h4><strong>(Severe Aortic Regurgitation)</strong></h4>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4>Low-pitched, rumbling diastolic murmur, best heard at the apex, due to <span class=\"customMeta\" data-dictid=\"66c04c3ac01692777201f1d43f0964\">turbulent flow</span> in the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> compressing the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve</h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Mammary <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">Murmur</span> (Physiologic in Pregnancy)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4>Continuous hissing murmur, heard over the left second and third <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> spaces, caused by increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> through internal mammary vessels</h4>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the active management of the third stage of labor, which intervention is recommended to prevent postpartum hemorrhage primarily due to uterine atony?", "options": [{"label": "A", "text": "Immediate administration of 20 units of undiluted oxytocin intravenously", "correct": false}, {"label": "B", "text": "Oxytocin 10 units IM with crowning", "correct": false}, {"label": "C", "text": "Vigorous fundal massage combined with a uterotonic agent", "correct": true}, {"label": "D", "text": "Controlled cord traction with immediate removal of the placenta", "correct": false}], "correct_answer": "C. Vigorous fundal massage combined with a uterotonic agent", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uterine Massage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Always <span class=\"customMeta\" data-dictid=\"5aabcb1ee8169277719447f2dd6c2c\">palpate</span> the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> after <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> delivery.</li>\n<li>Vigorous <span class=\"customMeta\" data-dictid=\"651c76a8c91692777203be09fa3dd6\">fundal</span> massage, combined with a <span class=\"customMeta\" data-dictid=\"9c6928089d1692777201892110e175\">uterotonic</span> agent, is recommended to prevent PPH due to <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> atony.</li>\n<li>During immediate PPH, perform <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"c515f6a71d16927771919f574f1ee9\">massage</span> while evaluating for other <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> sources and administering <span class=\"customMeta\" data-dictid=\"9c6928089d1692777201892110e175\">uterotonic</span> agents.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oxytocin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recommended by WHO as a first-line <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> treatment for <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage.</li>\n<li>Administer 20 units of <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">oxytocin</span> in 1,000 mL of <span class=\"customMeta\" data-dictid=\"745d08a9151692777185b2d2527097\">crystalloid</span> solution intravenously at 10 mL/min for a dose of 200 mU/min.</li>\n<li>Never administer <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">oxytocin</span> as an undiluted <span class=\"customMeta\" data-dictid=\"8d138d554c16927771835be732558c\">bolus</span> due to risks of severe <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> or <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.<strong>(Option A)</strong></li>\n<li>Intravenous <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">oxytocin</span> is also a first-line treatment for <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> atony.</li>\n<li>Oxytocin 10 units can be given IM with the delivery of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> shoulder <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delayed Cord Clamping/Controlled Cord <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">Traction</span> (CCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>If <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> separation is evident, perform expression via <span class=\"customMeta\" data-dictid=\"651c76a8c91692777203be09fa3dd6\">fundal</span> pressure or controlled cord traction.</li>\n<li>If the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> is not separated, perform manual removal under general anaesthesia.</li>\n<li>Delivery of the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> by cord <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> before <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> separation especially in an atonic <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> may cause <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> inversion. <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A Tzanck smear prepared from a vesicle shows multinucleated giant cells. What is the diagnosis?", "options": [{"label": "A", "text": "HIV", "correct": false}, {"label": "B", "text": "HSV", "correct": true}, {"label": "C", "text": "HPV", "correct": false}, {"label": "D", "text": "EBV", "correct": false}], "correct_answer": "B. HSV", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6n95r1nbfJi6935v5xfT1741085759.png", "https://image.prepladder.com/content/MkJki5EaRLemxUYPaLXZ1741085781.png", "https://image.prepladder.com/content/DOskERgZc7KV4ofzoKjR1741085805.png", "https://image.prepladder.com/content/aCUrzcD9nLTBfI21U1cS1741086251.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Herpes Simplex Virus:</strong></p>\n<ul>\n<li><strong>Tzanck smear: <span class=\"customMeta\" data-dictid=\"aa085932ce1692777193be7e5198bf\">Multinucleated</span> giant cells</strong> with faceted <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> and homogeneously stained 'ground-glass' <span class=\"customMeta\" data-dictid=\"77399c6ee0169277718492fb8fd58f\">chromatin</span> (<strong>Tzanck cells</strong>).</li>\n<li>Formation of<strong> Lipschutz bodies (Cowdry type A).</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3168\" src=\"https://image.prepladder.com/content/6n95r1nbfJi6935v5xfT1741085759.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HHV 8 (human <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">herpes</span> virus type 8):</strong></p>\n<ul>\n<li><strong>Castleman disease: </strong>Onion skinning of lymphocytes and blood vessels, giving the appearance of <strong>“Lollipop follicles”</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3279\" src=\"https://image.prepladder.com/content/MkJki5EaRLemxUYPaLXZ1741085781.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of botulinum toxin?", "options": [{"label": "A", "text": "Inhibits acetylcholine release from the presynaptic terminal", "correct": true}, {"label": "B", "text": "Inhibits acetylcholine reuptake", "correct": false}, {"label": "C", "text": "Blocks the postsynaptic acetylcholine receptor", "correct": false}, {"label": "D", "text": "Inhibits acetylcholinesterase", "correct": false}], "correct_answer": "A. Inhibits acetylcholine release from the presynaptic terminal", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the management of a HIV positive patient with multiple dog bites ?", "options": [{"label": "A", "text": "Rabies vaccine + wound management", "correct": false}, {"label": "B", "text": "Immunoglobulin only", "correct": false}, {"label": "C", "text": "Wound management", "correct": false}, {"label": "D", "text": "Rabies vaccine + Immunoglobulin + Wound management", "correct": true}], "correct_answer": "D. Rabies vaccine + Immunoglobulin + Wound management", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exposure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Licks and touch on intact skin (skin integrity not broken)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Local wound management: soap, running water, <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> <span class=\"customMeta\" data-dictid=\"c24e790aa2169277720062b62227ae\">tincture</span> for 15-20 min.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abrasion, <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> (skin integrity broken)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Local wound management</li>\n<li>Immediate <span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\">Rabies</span> vaccination</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding, licks on mucosa/ broken skin, deep tissue injury, all wild animal or bat bite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wound management (avoid suturing)</li>\n<li>Rabies vaccination</li>\n<li>Rabies immunoglobulin</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the investigation shown in the image?", "options": [{"label": "A", "text": "Intravenous Pyelogram (IVP)", "correct": true}, {"label": "B", "text": "Retrograde Pyelogram", "correct": false}, {"label": "C", "text": "Computed Tomography (CT) Urography", "correct": false}, {"label": "D", "text": "Magnetic Resonance Urography", "correct": false}], "correct_answer": "A. Intravenous Pyelogram (IVP)", "question_images": ["https://image.prepladder.com/content/AIiZVt4yOlBlFrDp4G1K1741088084.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:466px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">Pyelogram</span> (IVP)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X-ray with IV contrast</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary stones, hydronephrosis, <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> → <span class=\"customMeta\" data-dictid=\"b02f35d9471692777198bf98bee1f7\">serial</span> <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> taken at intervals</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> defects, delayed excretion</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following amino acids primarily acts as a buffer in blood due to its ability to accept and donate protons at physiological pH?", "options": [{"label": "A", "text": "Histidine", "correct": true}, {"label": "B", "text": "Arginine", "correct": false}, {"label": "C", "text": "Tryptophan", "correct": false}, {"label": "D", "text": "Tyrosine", "correct": false}], "correct_answer": "A. Histidine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amino Acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Buffering Ability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reason</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histidine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strong buffer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imidazole group has pKa ~6.0, close to <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> pH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arginine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor buffer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Guanidinium group has pKa ~12.5, too high to act as a <span class=\"customMeta\" data-dictid=\"9d374d494a169277718337f2820f3a\">buffer</span> at pH 7.4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tryptophan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal buffering</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indole group is non-ionizable at <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> pH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tyrosine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal buffering</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phenol group has pKa ~10.1, too high to be effective</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A body brought for autopsy is cold and has developed rigor mortis in all 4 limbs and livor mortis at the back/fixed, but no signs of putrefaction. What will be the estimated time since death?", "options": [{"label": "A", "text": "12-24 hrs", "correct": true}, {"label": "B", "text": "6-12 hrs", "correct": false}, {"label": "C", "text": "24-48 hrs", "correct": false}, {"label": "D", "text": "36-48 hrs", "correct": false}], "correct_answer": "A. 12-24 hrs", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d4iyyvsvCUC1XeunFfc01741019957.png"], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Observation</strong></th>\n<th><strong>Interpretation</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Body cold to touch</strong></td>\n<td>Suggests death occurred <strong>more than 8–12 hours</strong> ago (body cools gradually)</td>\n</tr>\n<tr>\n<td><strong>Rigor mortis in all four limbs</strong></td>\n<td>Fully established <span class=\"customMeta\" data-dictid=\"1e5d9c18d816927771972634f9a13f\">rigor</span> occurs <strong>around 12 hours</strong> post-death and lasts up to 24 hrs</td>\n</tr>\n<tr>\n<td><strong>Livor mortis fixed at the back</strong></td>\n<td>Lividity becomes <strong>fixed after 6–12 hours</strong></td>\n</tr>\n<tr>\n<td><strong>No signs of putrefaction</strong></td>\n<td>Putrefaction usually begins <strong>after 24–36 hours</strong>, depending on environment</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Feature</strong></th>\n<th><strong>Details</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Other names</strong></td>\n<td>Cadaveric lividity, <span class=\"customMeta\" data-dictid=\"88bcb684bf169277719687b1e4d84b\">postmortem</span> staining, suggillations, vibices, \"darkening of death\"</td>\n</tr>\n<tr>\n<td><strong>Site</strong></td>\n<td>Superficial <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> (capillaries and venules)</td>\n</tr>\n<tr>\n<td><strong>Mechanism</strong></td>\n<td>Gravitational settling of deoxygenated blood → purple-blue skin discolouration in dependent areas</td>\n</tr>\n<tr>\n<td><strong>Onset</strong></td>\n<td>Begins in <strong>30 minutes – 1 hour</strong> after death</td>\n</tr>\n<tr>\n<td><strong>Fully developed by</strong></td>\n<td>~<strong>4 hours</strong></td>\n</tr>\n<tr>\n<td><strong>Fixation time</strong></td>\n<td>Becomes <strong>fixed in 6–12 hours</strong></td>\n</tr>\n<tr>\n<td><strong>Confirmation of fixation</strong></td>\n<td>Apply pressure → if colour does not blanch, it is fixed</td>\n</tr>\n<tr>\n<td><strong>Primary lividity</strong></td>\n<td>Max intensity seen by <strong>6–12 hours</strong></td>\n</tr>\n<tr>\n<td><strong>Secondary lividity</strong></td>\n<td>Lividity may shift if the body is moved within a few hours of death</td>\n</tr>\n<tr>\n<td><strong>Duration</strong></td>\n<td>Persists until <span class=\"customMeta\" data-dictid=\"cb6efad46e16927771961e21da0ce6\">putrefaction</span> begins</td>\n</tr>\n<tr>\n<td><strong>Image</strong></td>\n<td>\n<p style=\"\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"861\" src=\"https://image.prepladder.com/content/d4iyyvsvCUC1XeunFfc01741019957.png\" width=\"1600\"/></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Phase</strong></th>\n<th><strong>Description</strong></th>\n<th><strong>Timeframe</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Primary Relaxation</strong></td>\n<td>Muscles are flaccid; ATP levels are 100%. Sphincters relax, leading to the release of urine/feces.</td>\n<td>0–1 hour after death</td>\n</tr>\n<tr>\n<td><strong>Rigor Mortis Onset</strong></td>\n<td>Begins as ATP falls to 85%; actin-myosin <span class=\"customMeta\" data-dictid=\"2cf4952c63169277718543a0883583\">cross-linking</span> causes stiffening. Appears in smaller muscles first (eyelids, jaw), progresses to limbs.</td>\n<td>Begins 1–2 hrs; full by 12 hrs</td>\n</tr>\n<tr>\n<td><strong>Rigor Resolution</strong></td>\n<td>Due to proteolysis, <span class=\"customMeta\" data-dictid=\"9ab07bba3016927771976de44bf865\">rigidity</span> dissipates. <span class=\"customMeta\" data-dictid=\"1e5d9c18d816927771972634f9a13f\">Rigor</span> fades by <strong>24–36 hours</strong> depending on conditions.</td>\n<td>12–36 hours after death</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Position</strong></th>\n<th><strong>Lividity Location</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Supine</td>\n<td>Back of head, neck, trunk, and limbs (excluding pressure areas)</td>\n</tr>\n<tr>\n<td>Prone</td>\n<td>Chest, face, front of limbs</td>\n</tr>\n<tr>\n<td>Side</td>\n<td>Dependent side</td>\n</tr>\n<tr>\n<td>Head-down</td>\n<td>Face and neck blackened</td>\n</tr>\n<tr>\n<td>Vertical suspension</td>\n<td>Legs, hands, external <span class=\"customMeta\" data-dictid=\"a6a00bd30e169277718892b3a6076c\">genitalia</span> (glove and stocking pattern)</td>\n</tr>\n<tr>\n<td>Drowning</td>\n<td>Face, chest, hands, feet, calves</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hormone responsible?", "options": [{"label": "A", "text": "Oxytocin", "correct": true}, {"label": "B", "text": "TSH", "correct": false}, {"label": "C", "text": "GH", "correct": false}, {"label": "D", "text": "FSH", "correct": false}], "correct_answer": "A. Oxytocin", "question_images": ["https://image.prepladder.com/content/ay0XFxN54WDrMQbsIwnl1741106017.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male patient was brought to the emergency department following a road traffic accident.O/E, he had multiple injuries all over his body and was found to be in class III hemorrhagic shock. The percentage of blood loss would be between:", "options": [{"label": "A", "text": "5-15%", "correct": false}, {"label": "B", "text": "30-40%", "correct": true}, {"label": "C", "text": "&amp;gt;40%", "correct": false}, {"label": "D", "text": "15-30%", "correct": false}], "correct_answer": "B. 30-40%", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class I (Compensated Shock)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class II (Hypoxemia)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class IV (Refractory Shock)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 15%<strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-30% <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-40%<strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 40%<strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compensatory mechanisms maintain <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalized vasoconstriction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decompensated shock.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Refractory shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;100/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100-120/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>120-140/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;140/min</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marked hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Profound hypotension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;30 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-30 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-15 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mental Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alert, normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anxious, mildly agitated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused, altered mental status</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comatose, lethargic</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents to the hospital with auditory hallucinations and inability to recognize his own family members. He reports his last alcohol intake was 48 hours ago. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Delirium tremens", "correct": true}, {"label": "B", "text": "Alcoholic hallucinosis", "correct": false}, {"label": "C", "text": "Alcohol-induced psychosis", "correct": false}, {"label": "D", "text": "Schizophrenia", "correct": false}], "correct_answer": "A. Delirium tremens", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:696px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset after last drink</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Mild anxiety</p>\n<p>• Tremulousness</p>\n<p>• Nausea</p>\n<p>• Headache</p>\n<p>• Palpitations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-12 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alcoholic <span class=\"customMeta\" data-dictid=\"f43e09e4621692777188050c41c06a\">hallucinosis</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Visual, auditory, or <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> hallucinations</p>\n<p>• Intact orientation</p>\n<p>• Normal vital signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Withdrawal seizures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> seizures</p>\n<p>• Usually brief and self-limited</p>\n<p>• Also known as rum fits</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>24-48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delirium tremens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Severe agitation</p>\n<p>• Confusion and disorientation</p>\n<p>• Hallucinations (often visual)</p>\n<p>• <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">Autonomic</span> <span class=\"customMeta\" data-dictid=\"2e780c7fd416927771895c61217c12\">hyperactivity</span> (tachycardia, hypertension, fever)</p>\n<p>• Profound sweating</p>\n<p>• Tremors</p>\n<p>• Insomnia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>48-96 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with fever, neck rigidity, headache, vomiting, and petechial rashes on the lower limbs. What is the most likely causative organism?", "options": [{"label": "A", "text": "Neisseria meningitidis", "correct": true}, {"label": "B", "text": "Clostridium perfringens", "correct": false}, {"label": "C", "text": "Cryptococcus neoformans", "correct": false}, {"label": "D", "text": "Clostridium difficile", "correct": false}], "correct_answer": "A. Neisseria meningitidis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:537px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cerebrospinal Fluid (CSF) Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Appearance</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cloudy or purulent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>White <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">Blood Cell Count</span> (WBC)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated (pleocytosis), typically &gt;1,000 cells/µL, with predominance of neutrophils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Protein</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Glucose</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gram Stain</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">gram-negative</span> diplococci</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Culture</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth of <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitidis on chocolate <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> or Thayer-Martin agar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Polymerase Chain Reaction (PCR)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detection of <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitidis DNA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Latex <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">Agglutination</span> Test</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive for <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitidis antigens</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Blood Tests</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Culture</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth of <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitidis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>White Blood Cell Count</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\">leukocytosis</span> with left shift</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female patient presents to the clinic for evaluation of her fertility status. She has been trying to conceive for over a year without success. Which of the following is the single best test for assessing her ovarian reserve?", "options": [{"label": "A", "text": "Follicle-stimulating hormone (FSH) on day 3", "correct": false}, {"label": "B", "text": "Estradiol on day 3", "correct": false}, {"label": "C", "text": "Anti-Müllerian hormone (AMH)", "correct": true}, {"label": "D", "text": "Serum inhibin levels on day 5", "correct": false}], "correct_answer": "C. Anti-Müllerian hormone (AMH)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Test Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-Müllerian Hormone (AMH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A hormone produced by ovarian antral follicles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood test reflecting the remaining quantity of eggs.</li>\n<li><strong>Not affected by the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle.</strong></li>\n<li><strong>The single best test for assessing her ovarian reserve</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antral <span class=\"customMeta\" data-dictid=\"b0c3f6b8901692777203d0446fe1f4\">Follicle</span> Count (AFC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound count of the small follicles (antral follicles) within the ovaries.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Direct visual assessment.</li>\n<li>Can vary with the cycle.</li>\n<li>Baseline assessment and monitoring.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Follicle-stimulating hormone (FSH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures the level of FSH, which stimulates the growth of ovarian follicles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood test done on day 3 of the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle.</li>\n<li>Initial screening of ovarian function.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Estradiol (E2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures the level of estradiol, an <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> produced by growing follicles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood test done on day 3 of the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle.</li>\n<li>High levels can mask high <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> levels, so they are used in conjunction with FSH.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inhibin B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures the level of <span class=\"customMeta\" data-dictid=\"310439225b1692777190ac31461dbd\">inhibin</span> B, which reflects the number of antral follicles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood test on day 5 of the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clomiphene <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">Citrate</span> Challenge Test (CCCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> and <span class=\"customMeta\" data-dictid=\"d8cc09346f16927771878d48ba1ce8\">estradiol</span> before and after taking clomiphene citrate.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Two blood tests: day 3 and day 10.</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> levels on day 10 indicate lower reserve.</li>\n<li>Used for detailed functional assessment.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Histological section is given below. Identify the marked cell.", "options": [{"label": "A", "text": "Stellate cell", "correct": false}, {"label": "B", "text": "Basket cell", "correct": false}, {"label": "C", "text": "Purkinje cell", "correct": true}, {"label": "D", "text": "Granular cell", "correct": false}], "correct_answer": "C. Purkinje cell", "question_images": ["https://image.prepladder.com/content/e9wwGmut9KNn9sWJpRMi1741090058.png"], "explanation_images": ["https://image.prepladder.com/content/QF0JAJ2Ft17hKDEiEs401741090082.png", "https://image.prepladder.com/content/O9dvQEj0i3Q73W1NzmFE1741032851.png", "https://image.prepladder.com/content/LH8aeiiNhpPmp7Zt2jQG1741032868.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Layers of the cerebellar cortex</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular (plexiform) layer</strong></p>\n<p><strong>(Options A, B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purkinje cell layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granular layer</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It primarily contains numerous <span class=\"customMeta\" data-dictid=\"77f797c5e8169277718535480fa7fd\">dendritic</span> branches from Purkinje cells, with relatively few widely spaced nerve cells.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It consists of a single row of large flask-shaped cells, the <strong>Purkinje cells</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The inner <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> layer is made up of many closely packed small<strong> <span class=\"customMeta\" data-dictid=\"fd69fc99d41692777188cc051aafa5\">granule</span> cells</strong>, along with a few larger <strong>Golgi cells.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These nerve cells are of two types:</p>\n<p>(a) Basket cells</p>\n<p>(b) <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">Stellate</span> cells.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The axons of Purkinje cells are the only output from the <span class=\"customMeta\" data-dictid=\"8c584f1d6a16927771847eabd3ce01\">cerebellar cortex</span> and have an <strong>inhibitory</strong> effect on the <span class=\"customMeta\" data-dictid=\"892754df9f169277719002da27f662\">intracerebellar</span> nuclei.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Golgi cells are<strong> inhibitory</strong> while the <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> cells are <strong>excitatory.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common defect in a ventricular septal defect?", "options": [{"label": "A", "text": "Muscular defect", "correct": false}, {"label": "B", "text": "Membranous defect", "correct": true}, {"label": "C", "text": "Non-development of the perimembranous part of the septum", "correct": false}, {"label": "D", "text": "Incomplete fusion of the septum", "correct": false}], "correct_answer": "B. Membranous defect", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The given image is of an ulcer, identify the marked structure?", "options": [{"label": "A", "text": "Margin", "correct": false}, {"label": "B", "text": "Edge", "correct": true}, {"label": "C", "text": "Floor", "correct": false}, {"label": "D", "text": "Base", "correct": false}], "correct_answer": "B. Edge", "question_images": ["https://image.prepladder.com/content/3n8GoJsAETkxnp4HVJly1741111534.png"], "explanation_images": ["https://image.prepladder.com/content/PV1RL6iYEdLsFJET3bJi1741111552.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Part</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Margin </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Outer limit of the ulcer, usually blending into the surrounding skin/mucosa.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The border between the margin and the <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> floor, may be raised (malignant), undermined (tuberculous), or <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> (syphilitic).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Floor </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The exposed surface inside the ulcer, may contain slough, <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, or necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Base </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The structure beneath the ulcer, which can be soft tissue, bone, or a vessel.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A hypertensive patient’s lab results reveal hypernatremia, hypokalemia, and metabolic alkalosis. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Conn's Syndrome", "correct": true}, {"label": "B", "text": "Addison’s Disease", "correct": false}, {"label": "C", "text": "Diabetes Insipidus", "correct": false}, {"label": "D", "text": "Cushing's Disease", "correct": false}], "correct_answer": "A. Conn's Syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During starvation, which of the following hormones is primarily produced to maintain blood glucose levels?", "options": [{"label": "A", "text": "Glucagon", "correct": true}, {"label": "B", "text": "Insulin", "correct": false}, {"label": "C", "text": "Amylase", "correct": false}, {"label": "D", "text": "Somatostatin", "correct": false}], "correct_answer": "A. Glucagon", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect in Starvation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucagon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increases</strong> to stimulate <span class=\"customMeta\" data-dictid=\"724a9faafe1692777188ca8840ec5c\">gluconeogenesis</span> and glycogenolysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insulin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreases</strong> to reduce <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> by tissues.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cortisol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increases</strong> to promote protein <span class=\"customMeta\" data-dictid=\"67f82f0d211692777183f709777947\">catabolism</span> for gluconeogenesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epinephrine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increases</strong> to enhance <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">glycogen</span> <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> and lipolysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth Hormone (GH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increases</strong> to reduce <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"6aee31718c16927772019237286270\">utilization</span> and promote lipolysis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with CSOM was presented to the OPD with seizures. On examination and evaluation, homonymous hemianopia and epilepsy were present. Identify the condition with the CT scan given below?", "options": [{"label": "A", "text": "Temporal abscess", "correct": true}, {"label": "B", "text": "Cerebellar abscess", "correct": false}, {"label": "C", "text": "Extradural abscess", "correct": false}, {"label": "D", "text": "Meningitis", "correct": false}], "correct_answer": "A. Temporal abscess", "question_images": ["https://image.prepladder.com/content/jojksr3JpyU3ptperaiM1741063106.png"], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary mechanism behind tissue damage in long-standing diabetes?", "options": [{"label": "A", "text": "Insulin resistance", "correct": false}, {"label": "B", "text": "Sorbitol accumulation", "correct": false}, {"label": "C", "text": "Hyperglycemia", "correct": true}, {"label": "D", "text": "Decreased insulin secretion", "correct": false}], "correct_answer": "C. Hyperglycemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male with chronic stable angina presents with worsening chest pain during routine activities. His current medications include aspirin, clopidogrel, metoprolol, and atorvastatin, but his symptoms persist. ECG shows ST-segment depression in V5-V6, and coronary angiography reveals 80% stenosis of the left anterior descending (LAD) artery. What is the most appropriate intervention?", "options": [{"label": "A", "text": "Increase the dose of beta-blockers", "correct": false}, {"label": "B", "text": "Add ranolazine to medical therapy", "correct": false}, {"label": "C", "text": "Percutaneous coronary intervention (PCI) with drug-eluting stent (DES)", "correct": true}, {"label": "D", "text": "Refer for coronary artery bypass grafting (CABG)", "correct": false}], "correct_answer": "C. Percutaneous coronary intervention (PCI) with drug-eluting stent (DES)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medication Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Function/Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side Effects/</strong></p>\n<p style=\"text-align: center;\"><strong>Contraindication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nitrates</strong></p>\n<p>Sublingual <span class=\"customMeta\" data-dictid=\"7cfca041201692777193da668f40be\">nitroglycerin</span> (0.4 or 0.6 mg)</p>\n<p>Long-acting forms (oral, transdermal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic venodilation</li>\n<li>Reduces LV <span class=\"customMeta\" data-dictid=\"437bfd6ffb1692777187b5a7a706d5\">end-diastolic volume</span> and pressure</li>\n<li>Releases <span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\">nitric</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> (NO) to relax <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> smooth muscle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina relief</li>\n<li>Preemptive use before activities</li>\n<li>Improves exercise tolerance</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Tolerance</strong> development</li>\n<li>Headaches, dizziness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-Blocker</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduces heart rate, arterial pressure, and myocardial contractility</li>\n<li>Improves survival post-MI</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina relief</li>\n<li><strong>Reduces mortality </strong>and reinfarction rates</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Asthma</strong></li>\n<li>AV <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> disturbances</li>\n<li>Severe bradycardia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Channel Blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Coronary vasodilators</li>\n<li>Reduces myocardial oxygen demand and arterial pressure</li>\n<li>Dihydropyridines (e.g., amlodipine) and non-dihydropyridines (e.g., verapamil)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina treatment when <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> blockers are ineffective</li>\n<li>Variant angina</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bradyarrhythmias</li>\n<li>May aggravate LV failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiplatelet Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Aspirin</strong>: inhibits <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> activation</li>\n<li><strong>Clopidogrel 75mg</strong>: blocks <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> aggregation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> events in high-risk populations</li>\n<li>Stent placement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk of bleeding</li>\n<li>Gastrointestinal issues, allergies</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Percutaneous <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> Intervention (PCI) </strong><strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PCI involves balloon <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> and stenting for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> <span class=\"customMeta\" data-dictid=\"b72de43dd6169277718942f907b87c\">IHD</span> with suitable stenoses in epicardial <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> arteries.</p>\n<ul>\n<li><strong>Indications</strong>:\n\n\t\t\t\t<ul>\n<li>Symptom-limiting <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> despite <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> medical therapy.</li>\n<li>Evidence of <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> during stress tests.</li>\n</ul>\n</li>\n<li><strong>Post-PCI Management</strong>:\n\t\t\t\t<ul>\n<li><strong>Aspirin </strong>is administered indefinitely, and P2Y12 antagonists for 1-3 months.</li>\n<li>Current-generation<strong> drug-eluting stents</strong> reduce <span class=\"customMeta\" data-dictid=\"46b2c025701692777197ebd5938ea9\">restenosis</span> but require prolonged dual <span class=\"customMeta\" data-dictid=\"257da9409416927771815e64ee5df1\">antiplatelet</span> therapy (DAPT).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">Bypass</span> <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">Grafting</span> (CABG) </strong><strong> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves bypassing obstructive lesions using<strong> internal mammary arteries</strong>, <strong>radial arteries</strong>, or <strong>saphenous veins</strong>.</p>\n<ul>\n<li><strong>Indications</strong>:\n\n\t\t\t\t<ul>\n<li>Safe with low mortality in patients without serious comorbidities and normal LV function.</li>\n<li>Effective for patients with <strong>left main <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis</strong>, <strong>multivessel disease</strong>, or <strong>impaired LV function</strong>.</li>\n</ul>\n</li>\n<li><strong>Outcomes</strong>:\n\t\t\t\t<ul>\n<li>Angina relief in ~90% of patients after complete revascularization.</li>\n<li>Long-term survival benefits in specific populations, particularly those with <strong>diabetes</strong> or<strong> impaired LV function</strong>.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of breast cancer underwent Cobalt-60 radiotherapy. She now presents with respiratory distress, and imaging shows haziness in the left lung. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Radiation Pneumonitis", "correct": true}, {"label": "B", "text": "Recurrence of Breast Cancer", "correct": false}, {"label": "C", "text": "Pulmonary Embolism", "correct": false}, {"label": "D", "text": "Infective Pneumonia", "correct": false}], "correct_answer": "A. Radiation Pneumonitis", "question_images": ["https://image.prepladder.com/content/NibuZI2xe1tLqfV4nvUr1741087739.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiation damage to lung tissue, commonly from <strong>breast, lung, or <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> cancer radiotherapy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4-12 weeks</strong> post-radiotherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dry cough, dyspnea, <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> fever, chest pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hazy opacities in the <strong>irradiated lung field</strong> (CT: <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> opacities, consolidation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corticosteroids (prednisone), supportive care</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old pregnant woman at 33 weeks gestation presents for a routine prenatal visit. She reports decreased fetal movements over the past two days. She has a history of gestational diabetes, and her pregnancy has been otherwise uneventful. The doctor decides to perform antepartum fetal surveillance. Which of the following is the most appropriate initial test to assess the fetal well-being in this scenario?", "options": [{"label": "A", "text": "Amniotic fluid index", "correct": false}, {"label": "B", "text": "Biophysical profile Contraction Stress test Non Stress test", "correct": false}, {"label": "C", "text": "Contraction Stress test", "correct": false}, {"label": "D", "text": "Non Stress test", "correct": true}], "correct_answer": "D. Non Stress test", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fetal movement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maternal observation and recording of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> movements to assess <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being and activity levels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-stress test (NST)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monitors <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heart rate <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> in response to <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> movements to assess <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biophysical profile (BPP)</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being based on <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heart rate accelerations, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> movements, muscle tone, breathing movements, and <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid volume</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Doppler velocimetry</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> to assess <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> in <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> vessels like <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> artery,middle cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (MCA), and <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> venosus aiding in the evaluation of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being and <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amniotic fluid index (AFI)</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures the depth of <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid to assess <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being and detect potential complications like <span class=\"customMeta\" data-dictid=\"41fc142ae61692777194c3f69d3d74\">oligohydramnios</span> or polyhydramnios</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contraction stress test (CST)</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluates <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heart rate response to <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions to assess <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being and <span class=\"customMeta\" data-dictid=\"091c4fd1e61692777201ec50806bc4\">uteroplacental</span> function under controlled stress conditions.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50 year old female presented with a breast mass that was operated and the microscopic examination in given. What is the diagnosis?", "options": [{"label": "A", "text": "Lobular carcinoma breast", "correct": false}, {"label": "B", "text": "Medullary carcinoma", "correct": false}, {"label": "C", "text": "Mucinous carcinoma breast", "correct": true}, {"label": "D", "text": "Phylloids tumour", "correct": false}], "correct_answer": "C. Mucinous carcinoma breast", "question_images": ["https://image.prepladder.com/content/vvJJ4UZ1lehI5eE0h6Jv1741063384.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby presents with chronic diarrhea and a rash resembling acrodermatitis on the skin. Based on the clinical picture, what is the most likely deficiency?", "options": [{"label": "A", "text": "Zinc deficiency", "correct": true}, {"label": "B", "text": "Selenium deficiency", "correct": false}, {"label": "C", "text": "Niacin deficiency", "correct": false}, {"label": "D", "text": "Magnesium deficiency", "correct": false}], "correct_answer": "A. Zinc deficiency", "question_images": ["https://image.prepladder.com/content/5R6bsVjwlznnd5LiCAqv1741088845.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for nephrotic syndrome in children?", "options": [{"label": "A", "text": "Steroids", "correct": true}, {"label": "B", "text": "Steroids and cyclophosphamide", "correct": false}, {"label": "C", "text": "Cyclophosphamide", "correct": false}, {"label": "D", "text": "ACE inhibitors", "correct": false}], "correct_answer": "A. Steroids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steroid-Responsive <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steroid-Resistant <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic syndrome that responds well to <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> treatment.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic syndrome that does not improve despite adequate <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> treatment (e.g., <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> at 2 mg/kg/day for 6 weeks).</p>\n<p><strong>Types:</strong></p>\n<ul>\n<li><strong>Initial <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">Steroid</span> Resistance:</strong> Lack of response from the onset.</li>\n<li><strong>Late <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">Steroid</span> Resistance:</strong> Resistance develops after initial response.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minimal Change <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome (MCNS)</strong> accounts for about 80% of cases in children.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is often associated with <strong>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">Segmental</span> <span class=\"customMeta\" data-dictid=\"9b496e768c1692777188421dbac69f\">Glomerulosclerosis</span> (FSGS) </strong>or genetic mutations affecting podocytes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosed without <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> biopsy; characterised by heavy proteinuria, low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> albumin, and no significant <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> damage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Further investigation (e.g., <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> biopsy) is required to determine the underlying cause.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Responds to high-dose corticosteroids (e.g., prednisolone)</strong><strong>,</strong> leading to <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> of <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> and oedema within 10-14 days.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment may include <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> agents, <span class=\"customMeta\" data-dictid=\"746f157681169277718323a004b1d4\">calcineurin</span> inhibitors, or other therapies, as corticosteroids are often ineffective.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the instrument:", "options": [{"label": "A", "text": "Bohler braun splint", "correct": true}, {"label": "B", "text": "Thomas splint", "correct": false}, {"label": "C", "text": "Volkmann splint", "correct": false}, {"label": "D", "text": "Cramer wire", "correct": false}], "correct_answer": "A. Bohler braun splint", "question_images": ["https://image.prepladder.com/content/VIPn9QRNyw9mbPcPCZA91741089331.png"], "explanation_images": ["https://image.prepladder.com/content/mGhcVlckSObxqQzakuBt1741059431.png", "https://image.prepladder.com/content/Q9DnAAi5h5lJsf4Xl2RM1741059475.png", "https://image.prepladder.com/content/sgL0lzIaDQy9ZSZjuowe1741059546.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old male presents with a one-week history of fever, headache, retro-orbital pain, and myalgia. Skin examination reveals multiple purpura and petechiae on the left shoulder, trunk, and legs. Similar cases have been reported linked to increased incidence of mosquito breeding. What is the most common neurological complication associated with this condition?", "options": [{"label": "A", "text": "Encephalopathy", "correct": true}, {"label": "B", "text": "Guillain-Barré Syndrome", "correct": false}, {"label": "C", "text": "Stroke", "correct": false}, {"label": "D", "text": "Encephalitis", "correct": false}], "correct_answer": "A. Encephalopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dengue encephalopathy</strong> is <strong>most commonly encountered neurological complication</strong> of <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> virus\n\t\t\t\t<ul>\n<li>linked primarily to <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> hemorrhagic fever and <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> shock syndrome</li>\n<li>EEG may show abnormalities such as burst <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> and seizures</li>\n<li>CSF profiles typically remain normal.</li>\n<li>Neuroimaging can be normal or reveal <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> cerebral edema.</li>\n</ul>\n</li>\n<li><strong>Encephalitis</strong></li>\n<li><strong>GBS</strong></li>\n<li><strong>Stroke</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiomyopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dengue virus-induced dilated <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> should always be considered if a <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> fever patient has <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> shock and signs and symptoms of congestive heart failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatic injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver involvement in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> is a crucial feature</li>\n<li>The effect ranges from an <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> rise in liver enzymes to the development of ALF</li>\n<li>The <strong>most common <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> manifestation</strong> reported was hepatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumonia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Staphylococcus <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> is an important accompanying problem seen in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> patient</li>\n<li>co-infection between <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> and <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> can result in <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> of pneumonia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orchitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Orchitis usually occurs together with epididymitis</li>\n<li>Commonly seen in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> between 14 and 35 years of age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue Hemorrhagic Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All of the following:</p>\n<ul>\n<li>Acute onset of fever</li>\n<li>2-7 days duration</li>\n<li>Hemorrhagic manifestations\n\t\t\t\t<ul>\n<li>Positive <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> test/Petechiae</li>\n<li>Ecchymosis</li>\n<li>Purpura/Bleeding from mucosa, GIT, <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">Injection</span> sites, etc</li>\n</ul>\n</li>\n<li>Platelet count ≤ 100,000 cells/cu.mm.</li>\n<li>Plasma leakage\n\t\t\t\t<ul>\n<li>Rising hematocrit\n\t\t\t\t\t<ul>\n<li>Hemoconcentration &gt;20%</li>\n</ul>\n</li>\n<li>Pleural effusion, ascites/Hypoproteinemia)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue Shock Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>DHF criteria plus Signs of Shock</li>\n<li>Tachycardia/Cool extremities/Weak pulse/Lethargy/Restlessness</li>\n<li>Pulse pressure &lt;20 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> with increased <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">Diastolic pressure</span> (e.g. 100/80)</li>\n<li>Hypotension (Systolic &lt;80 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for age &lt;5 years/80-90 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for older child and adults)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pulmonary oedema", "correct": true}, {"label": "B", "text": "Hydrothorax", "correct": false}, {"label": "C", "text": "Pleural effusion", "correct": false}, {"label": "D", "text": "Pulmonary fibrosis", "correct": false}], "correct_answer": "A. Pulmonary oedema", "question_images": ["https://image.prepladder.com/content/jC7m9GoC35vYWYGaGp1B1741088166.png"], "explanation_images": ["https://image.prepladder.com/content/l1qCE3cPb5oBdKZR1Ook1741088285.png", "https://image.prepladder.com/content/PAXM9NlkheiMDtBRIa7X1741088581.png", "https://image.prepladder.com/content/9bpwzviQXnkHsQpNQUr51741088224.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Edema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Edema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left heart failure, volume overload</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ARDS, infections, sepsis, toxins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A-A</strong>lveolar oedema (Bat wings)</p>\n<p><strong>B-</strong>Kerley <strong>B</strong> lines</p>\n<p><strong>C-C</strong>ardiomegaly</p>\n<p><strong>D-D</strong>ilated Upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> vessels</p>\n<p><strong>E</strong>-Pleural <strong>E</strong>ffusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse alveolar infiltrates, normal heart size</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dyspnea, orthopnea, pink frothy sputum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe hypoxia, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diuretics, nitrates, and oxygen treat CHF</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oxygen, and <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> support, treat the underlying cause</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a normal distribution, the mean value is 82, the SD is 1.5. Calculate the range of two standard deviations?", "options": [{"label": "A", "text": "79-85", "correct": true}, {"label": "B", "text": "60-68", "correct": false}, {"label": "C", "text": "50-57", "correct": false}, {"label": "D", "text": "40-49", "correct": false}], "correct_answer": "A. 79-85", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient sustained blunt trauma to the eye 6 months ago and now presents with blurring of vision. What is the most likely condition?", "options": [{"label": "A", "text": "Iridodialysis", "correct": true}, {"label": "B", "text": "Ankyloblepharaon", "correct": false}, {"label": "C", "text": "Vossius Ring", "correct": false}, {"label": "D", "text": "Cycloiriditis", "correct": false}], "correct_answer": "A. Iridodialysis", "question_images": ["https://image.prepladder.com/content/pVvzA0zGY1D5e3eB5ph01741087416.png"], "explanation_images": ["https://image.prepladder.com/content/8EtAhjrEd0JW5mpqD8u41741087450.png", "https://image.prepladder.com/content/5dwlXBblN74zK1FKMSV71741087492.png", "https://image.prepladder.com/content/eujieKwkgl4nItjGZsvf1741087622.png", "https://image.prepladder.com/content/QdxXv5YiUwmvYhJUZScE1741087685.png", "https://image.prepladder.com/content/5DARlcpICbanYswk87eF1741087845.png", "https://image.prepladder.com/content/fwHl2jOWXhCZgieQbVEa1741087870.png", "https://image.prepladder.com/content/TKHDSUdG6TVeUTXga5oH1741087898.png", "https://image.prepladder.com/content/Ejz0G0GnGqtIBLQQELlf1741087953.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a child presenting with a beaded appearance in the chest with the following X-ray, what is the diagnosis?", "options": [{"label": "A", "text": "Scurvy", "correct": false}, {"label": "B", "text": "Rickets", "correct": true}, {"label": "C", "text": "Beri Beri", "correct": false}, {"label": "D", "text": "Pellagra", "correct": false}], "correct_answer": "B. Rickets", "question_images": ["https://image.prepladder.com/content/LE5U20fmU5aCX7Ja9MUX1741088659.png"], "explanation_images": ["https://image.prepladder.com/content/SRkby1ipMLFDKZ5js7De1741088700.png", "https://image.prepladder.com/content/qvFZnVxPrRNxEidRh8j41741088875.png", "https://image.prepladder.com/content/9dbFWqspUHgg6yKZ7bGz1741088743.png", "https://image.prepladder.com/content/OdYZ10xtshst9x4z2mLJ1741088804.png", "https://image.prepladder.com/content/7hwrx64VrxVzPTQdmJEP1741088777.png", "https://image.prepladder.com/content/EQoWb0Pf5lxs5H8DVXPW1741088896.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>General:</strong>\n<ul>\n<li>Failure to thrive (malnutrition)</li>\n<li>Listlessness</li>\n<li>Protruding abdomen</li>\n<li>Muscle weakness (especially proximal)</li>\n<li>Hypocalcemic dilated cardiomyopathy</li>\n<li>Fractures (pathologic, minimal trauma)</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure</li>\n</ul>\n</li>\n<li><strong>Head:</strong>\n<ul>\n<li>Craniotabes: <span class=\"customMeta\" data-dictid=\"f469f168b3169277719839870c0ce5\">Softening</span> of <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> bones</li>\n<li>Frontal bossing</li>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"4fe2c29428169277720397dcedda57\">fontanel</span> <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> (usually closed by 2 yr)</li>\n<li>Delayed dentition</li>\n<li>Craniosynostosis</li>\n</ul>\n</li>\n<li><strong>Hypocalcemic Symptoms: </strong>\n<ul>\n<li>Tetany</li>\n<li>Seizures</li>\n<li>Stridor caused by laryngeal spasm</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest:</strong>\n<ul>\n<li>Rachitic rosary: Due to widening of the <span class=\"customMeta\" data-dictid=\"bfa9e996381692777185cdc8709772\">costochondral</span> junction</li>\n<li>Harrison groove: <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">Horizontal</span> depression along the lower <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chest due to pulling of softened ribs by the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> during inspiration</li>\n<li>Respiratory infections and atelectasis</li>\n</ul>\n</li>\n<li><strong>Back: </strong>\n<ul>\n<li>Scoliosis</li>\n<li>Kyphosis</li>\n<li>Lordosis</li>\n</ul>\n</li>\n<li><strong>Extremities: </strong>\n<ul>\n<li>Enlargement of wrists and ankles: Due to <span class=\"customMeta\" data-dictid=\"3480d51034169277718862050fed12\">growth plate</span> widening</li>\n<li>Valgus or <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> deformities</li>\n<li>Windswept <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (valgus <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of one leg with <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of other leg)</li>\n<li>Anterior bowing of <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> and femur</li>\n<li>Coxa vara</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:633px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Age </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Daily dose of vitamin D3 for 12 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Alternative <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> dose regimen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Daily <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> supplementation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Daily <span class=\"customMeta\" data-dictid=\"c673060f4c16927771917496b672c8\">maintenance dose</span> (follow-up)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">2000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Not recommended</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">30-75 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">400 IU</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>6-12 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">2000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">The equivalent of 2000 IU/ day may be given on a weekly or monthly basis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">30-75 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">400 IU</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>&gt;12 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">3000IU</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">60,000 IU every 2 weeks for 5 doses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">30-75 mg/kg/day (up to 500 mg)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">600 IU</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the sign given in the image below:", "options": [{"label": "A", "text": "Beta 2 transferrin sign", "correct": false}, {"label": "B", "text": "Double target sign", "correct": true}, {"label": "C", "text": "Handkerchief sign", "correct": false}, {"label": "D", "text": "Tear drop sign", "correct": false}], "correct_answer": "B. Double target sign", "question_images": ["https://image.prepladder.com/content/ZaPwSORmz8zWcsfNDJfK1741087152.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the early sign of pregnancy on TVS?", "options": [{"label": "A", "text": "G sac", "correct": true}, {"label": "B", "text": "Yolk sac", "correct": false}, {"label": "C", "text": "Cardiac activity", "correct": false}, {"label": "D", "text": "Fetal pole", "correct": false}], "correct_answer": "A. G sac", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:442px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gestational <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> (1<sup>st</sup> <span class=\"customMeta\" data-dictid=\"250ea353d2169277719853a4313f1b\">sonographic</span> evidence of pregnancy)<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-5 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5.5 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fetal pole and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> activity <strong>(Options C and D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-6 weeks</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72 y/o woman presents with severe chest pain and shortness of breath after a stressful argument. She is post-menopausal with no history of heart disease. O/E, she is slightly tachycardic with normal blood pressure. An echocardiogram shows left ventricular ballooning during systole, and cardiac enzymes are minimally elevated. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypertensive Heart Disease", "correct": false}, {"label": "B", "text": "Takotsubo Cardiomyopathy", "correct": true}, {"label": "C", "text": "Coronary Artery Disease", "correct": false}, {"label": "D", "text": "Pulmonary Embolism", "correct": false}], "correct_answer": "B. Takotsubo Cardiomyopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Takotsubo <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> (Gebrochenes-Herz syndrome)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Takotsubo cardiomyopathy, also known as broken-heart syndrome or stress-induced cardiomyopathy, is a non-ischemic condition primarily affecting post-menopausal women.</li>\n<li>It features temporary left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> that resembles a <span class=\"customMeta\" data-dictid=\"881eca638f16927771889ba405ef07\">heart attack</span> but with minimal <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> release and no significant obstructive <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease.</li>\n<li>The name \"Takotsubo\" is derived from Japanese, meaning <span class=\"customMeta\" data-dictid=\"73fcea5285169277719431e7e4e696\">octopus</span> trap, reflecting the <span class=\"customMeta\" data-dictid=\"0d20ef4049169277718261e9075cbc\">ballooning</span> shape of the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> during contraction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Catecholamine Hypothesis:</strong> Elevated catecholamines (norepinephrine, epinephrine, dopamine) indicate stress-induced <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> overdrive, leading to <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> spasms and myocardial injury.</li>\n<li><strong>Microvascular Dysfunction:</strong> Impaired function is suggested by abnormalities in <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> flow reserve and <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> resistance.</li>\n<li><strong>Inflammation:</strong> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> may show myocardial oedema, necrosis, and fibrosis, with conditions like <span class=\"customMeta\" data-dictid=\"b37b57210716927771933ee216a834\">myocarditis</span> and <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> diseases potentially triggering TC.</li>\n<li><strong>Estrogen Deficiency:</strong> Exaggerated <span class=\"customMeta\" data-dictid=\"3f0b42b17016927772014c586d44b7\">vasoconstriction</span> and increased <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> activity in post-menopausal women contribute to TC.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Takotsubo <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> often mimics <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> syndrome.(MI)</li>\n<li><strong>Common Triggers:</strong>\n<ul>\n<li><strong>Emotional Stress:</strong> Events like the unexpected death of a loved one, domestic abuse, or financial loss.</li>\n<li><strong>Physical Stress:</strong> Serious medical diagnoses or natural disasters.</li>\n</ul>\n</li>\n<li><strong>Symptoms:</strong> Chest pain, dyspnea, and syncope. Some patients may have signs of heart failure, such as tachyarrhythmias or bradyarrhythmias.</li>\n<li>A late-peaking <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> may be present due to LVOTO.</li>\n<li>About 10% of patients may develop <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> shock.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common cause of bloody nipple discharge?", "options": [{"label": "A", "text": "Breast cancer", "correct": false}, {"label": "B", "text": "Fibroadenoma", "correct": false}, {"label": "C", "text": "Intraductal papilloma", "correct": true}, {"label": "D", "text": "Duct Ectasia", "correct": false}], "correct_answer": "C. Intraductal papilloma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">Nipple</span> Discharge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bloody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intraductal <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">Papilloma</span> (Most Common)</li>\n<li>Breast Carcinoma</li>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serous </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibrocystic Disease (Most Common)</li>\n<li>Breast Carcinoma</li>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Greenish/Blackish</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Milk (Galactorrhea)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Physiological (e.g., Pregnancy, Lactation)</li>\n<li>Hyperprolactinemia (e.g., <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">Pituitary</span> Adenoma, Hypothyroidism)</li>\n<li>Medications (e.g., Antipsychotics, Antidepressants, Oral Contraceptives)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purulent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breast Abscess</li>\n<li>Mastitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male presents with pain and swelling over the distal radius. X-ray shows an expansile lytic lesion in the metaphysis. Fine needle aspiration (FNA) reveals a bloody aspirate with hemosiderin-laden macrophages. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Giant cell tumor", "correct": false}, {"label": "B", "text": "Aneurysmal bone cyst", "correct": true}, {"label": "C", "text": "Osteosarcoma", "correct": false}, {"label": "D", "text": "Chondroblastoma", "correct": false}], "correct_answer": "B. Aneurysmal bone cyst", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aneurysmal Bone <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> (ABC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Giant Cell Tumor (GCT)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily affects children and teenagers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common in young adults (15-35 years)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Equal distribution between males and females</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in females (Female: Male ratio 1.5:1)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metaphyses</strong> of long bones (femur, tibia, humerus), spine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epiphyses</strong> of long bones (lower end of femur, upper end of tibia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain and swelling</strong>; <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> lesions may cause neurological issues</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Swelling without pain</strong>; late stages show joint limitation and <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fracture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>FNAC: <strong>Hemosiderin +</strong></li>\n<li>Blood-filled <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces separated by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> septae</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>FNAC: <strong>No hemosiderin</strong></li>\n<li>Abundant giant cells with multiple <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> (&gt;150), <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> cells indicating malignancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteolytic lesion, multiple septations and fluid-fluid levels on MRI</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin <span class=\"customMeta\" data-dictid=\"d983a6cd671692777198ec423b3b90\">septa</span> with <strong>soap-bubble appearance</strong> on X-ray, <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> thin and expanded, no <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> reaction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Curettage, debridement, and in some cases radiation (cautiously)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with PMMA or bone grafting; Denosumab and bisphosphonates as <span class=\"customMeta\" data-dictid=\"e405fcd2f2169277718034536f004a\">adjunct</span> therapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 160 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which anti-tubercular drug is associated with mutations in the KATG gene?", "options": [{"label": "A", "text": "Rifampicin", "correct": false}, {"label": "B", "text": "Isoniazid", "correct": true}, {"label": "C", "text": "Moxifloxacin", "correct": false}, {"label": "D", "text": "Ethambutol", "correct": false}], "correct_answer": "B. Isoniazid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/P1RB2BcpTtULStTLkxx01741070348.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of resistance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KatG gene mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>INH is a prodrug, converted to the active <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> by catalase-peroxidase produced by the KATg gene. The mutated <span class=\"customMeta\" data-dictid=\"553253f1ce1692777183d395babc1b\">catalase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> does not <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the active drug</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KasA gene mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Component of <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> mycolic acid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>InhA gene overexpression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes <span class=\"customMeta\" data-dictid=\"9a6a6e737e1692777185f1b77971e2\">cross-resistance</span> to <span class=\"customMeta\" data-dictid=\"765ad61235169277718731b19650f4\">Ethionamide</span> (second-line drug)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with arthritis, and arthroscopy reveals blackening of the joints. Which enzyme deficiency is most likely responsible for this condition?", "options": [{"label": "A", "text": "Homogentisate oxidase", "correct": true}, {"label": "B", "text": "Branched-chain alpha-ketoacid dehydrogenase", "correct": false}, {"label": "C", "text": "Tyrosinase", "correct": false}, {"label": "D", "text": "Fumarase", "correct": false}], "correct_answer": "A. Homogentisate oxidase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaptonuria (Homogentisate <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">Oxidase</span> Deficiency)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deficient Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogentisate oxidase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Accumulated Metabolite</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogentisic acid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Black <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (on standing), <span class=\"customMeta\" data-dictid=\"5aac9eb00e1692777194b0cca49c62\">ochronosis</span> (dark <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue pigmentation), early-onset arthritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Areas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Joints, <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> (ear, sclera, <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> discs)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urine darkening with alkalization, elevated <span class=\"customMeta\" data-dictid=\"d442747c48169277718942db69fa7e\">homogentisic acid</span> in urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-protein diet (restricting <span class=\"customMeta\" data-dictid=\"5e52c07d0f1692777195dd08cc451f\">phenylalanine</span> &amp; tyrosine), vitamin C, <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> management</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male presented with weakness in the lower half of the right side of his face, with drooping of the angle of his mouth. He is unable to raise his eyebrows and close his eyes on both sides. Which of the following is the most appropriate diagnosis?", "options": [{"label": "A", "text": "Infranuclear facial palsy on right side", "correct": true}, {"label": "B", "text": "Supranuclear facial palsy on left side", "correct": false}, {"label": "C", "text": "Infranuclear facial on left side", "correct": false}, {"label": "D", "text": "Supranuclear facial on right side", "correct": false}], "correct_answer": "A. Infranuclear facial palsy on right side", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Upper <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">Motor Neuron</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">Lesion</span> (Supranuclear)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Lower <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">Motor Neuron</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">Lesion</span> (Infranuclear)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lesion Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Motor cortex, connection from motor <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> to <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> in pons</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Facial nucleus, anywhere along CN VII</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Affected Side</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Contralateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Ipsilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Muscles Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lower muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Upper and lower muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Forehead Involved?</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Spared, due to <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> UMN innervation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Affected</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Variable; depends on size of lesion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Incomplete eye <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> (dry eyes, corneal ulceration), hyperacusis, loss of taste sensation to <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> tongue</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which sign of pregnancy denotes the following?", "options": [{"label": "A", "text": "Hegar Sign", "correct": true}, {"label": "B", "text": "Goodell Sign", "correct": false}, {"label": "C", "text": "Osiander sign", "correct": false}, {"label": "D", "text": "Palmer sign", "correct": false}], "correct_answer": "A. Hegar Sign", "question_images": ["https://image.prepladder.com/content/DSRtgSzoCveA6MLnYSAX1741058341.png"], "explanation_images": ["https://image.prepladder.com/content/ArMXi6LBuvkpP03Yz5NW1741105739.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Signs of Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Week of Pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hegar's sign</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Softening of the lower <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> segment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"05493772261692777201c10c4ee537\">vascularity</span> and <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> of the smooth muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-8 weeks of gestation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chadwick's sign</strong></p>\n<p><strong>(Jacquemier’s sign)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bluish discoloration of the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> and vagina</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/ArMXi6LBuvkpP03Yz5NW1741105739.png\" width=\"4167\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"05493772261692777201c10c4ee537\">vascularity</span> in response to hormonal changes in pregnancy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8th week</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Goodell's sign</strong><br/>\n<strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Softening of the cervix</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased vascularisation and edema.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6th week</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Piskacek's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymmetric <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the uterus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"52007706a216927771899e36747712\">implantation</span> of fertilised ovum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palmer's sign</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular and rhythmic <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to increased <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> levels, and the <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> adaptations of the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> preparing for labor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-8 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osiander's sign</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased pulsations felt through <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> fornices</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> by the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8th-12th week</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hartman’s sign/ <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">Placental</span> sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Implantation bleeding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Attachment of fertilized <span class=\"customMeta\" data-dictid=\"7c1d9800e2169277719426cf66bb68\">ovum</span> to the endometrium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not caused by food adulteration?", "options": [{"label": "A", "text": "Fluorosis", "correct": true}, {"label": "B", "text": "Epidemic dropsy", "correct": false}, {"label": "C", "text": "Neurolathyrism", "correct": false}, {"label": "D", "text": "Endemic ascites", "correct": false}], "correct_answer": "A. Fluorosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is excreted in the urine of patients with pentosuria?", "options": [{"label": "A", "text": "L-Xylulose", "correct": true}, {"label": "B", "text": "D-Ribose", "correct": false}, {"label": "C", "text": "D-Ribulose", "correct": false}, {"label": "D", "text": "D-Lactose", "correct": false}], "correct_answer": "A. L-Xylulose", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:430px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Essential Pentosuria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deficiency of <strong>L-xylulose reductase</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of <strong>L-xylulose</strong> in urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None (asymptomatic)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urine sugar analysis + Chromatography</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No treatment needed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the treatment option with the image given below:", "options": [{"label": "A", "text": "Type 1 Tympanoplasty", "correct": false}, {"label": "B", "text": "Type 2 tympanoplasty", "correct": false}, {"label": "C", "text": "Type 3 tympanoplasty", "correct": true}, {"label": "D", "text": "Type 4 tympanoplasty", "correct": false}], "correct_answer": "C. Type 3 tympanoplasty", "question_images": ["https://image.prepladder.com/content/AS0HT1SHGyfwWT28CNES1747846067.png"], "explanation_images": ["https://image.prepladder.com/content/3fYknAREzgQf0ThAQFjZ1747846131.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n<p>Repaired using a graft. (myringoplasty) <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: Eroded <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> and <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n<p>Graft placed on <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">incus</span> or remaining malleus. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: Absence of <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> and incus.</p>\n<p>Graft placed directly on <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> head (myringostapediopexy or <span class=\"customMeta\" data-dictid=\"e03b2f95ab1692777184437bf8f3c5\">columella</span> tympanoplasty).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: Only the <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> of the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> is present. It is exposed to the external ear.</p>\n<p>A <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> is placed between <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> and round windows, allowing sound to act directly on the <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> and the <span class=\"customMeta\" data-dictid=\"ae3483b8c91692777197c75b7af9a9\">round window</span> is shielded. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fenestration operation: Creation of a new window on the <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> semicircular canal, covering it with a <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> when the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> is fixed but the <span class=\"customMeta\" data-dictid=\"ae3483b8c91692777197c75b7af9a9\">round window</span> is functional.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old boy was brought to the emergency department with complaints of melena that contains gastric mucosa and acute intermittent pain in the right iliac region. On surgical exploration, the following structure was found, what is the diagnosis?", "options": [{"label": "A", "text": "Meckel's diverticulum", "correct": true}, {"label": "B", "text": "Appendicular lump", "correct": false}, {"label": "C", "text": "Carcinoid", "correct": false}, {"label": "D", "text": "Obstructed bowel loops", "correct": false}], "correct_answer": "A. Meckel's diverticulum", "question_images": ["https://image.prepladder.com/content/0Fs38ypib0HpzqMZeIa91741111424.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital true <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> of the small intestine, resulting from the incomplete <span class=\"customMeta\" data-dictid=\"e5922b669a169277719487f8bbabd3\">obliteration</span> of the <span class=\"customMeta\" data-dictid=\"4df1564f3c1692777202da97b54e7e\">vitelline</span> duct.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rule of 2’s</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2% population, 2 <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> from the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> valve, 2 inches in length, 2 types of <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> tissue (gastric, pancreatic), 2 years most common presentation, 2:1 male predominance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Painless <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (melena), intestinal obstruction, diverticulitis, volvulus, intussusception.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Meckel’s scan (Tc-99m <span class=\"customMeta\" data-dictid=\"1771fe713b169277719506679fa243\">pertechnetate</span> scan for <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> mucosa).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (diverticulectomy or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> resection) if symptomatic.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not related to disease progression?", "options": [{"label": "A", "text": "Duration", "correct": true}, {"label": "B", "text": "Depth", "correct": false}, {"label": "C", "text": "Site", "correct": false}, {"label": "D", "text": "Stage of Cancer", "correct": false}], "correct_answer": "A. Duration", "question_images": ["https://image.prepladder.com/content/oZEgru0yYh1xXnXke3qR1741106706.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect on Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Depth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deeper invasion into muscle, cartilage, or bone increases severity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-risk sites (face, scalp, ears) have more aggressive behavior</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Later stages indicate increased tumor burden and invasion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slow growth means duration does not directly impact aggressiveness</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fetal anaemia is monitored by?", "options": [{"label": "A", "text": "MCA-PSV", "correct": true}, {"label": "B", "text": "Maternal blood", "correct": false}, {"label": "C", "text": "Fetal blood", "correct": false}, {"label": "D", "text": "Amniocentesis", "correct": false}], "correct_answer": "A. MCA-PSV", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/h3RPoBASLU2BtwxonBBk1741106737.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was presented to the OPD with complaints of greenish black matter in the nose with merciful smelling. What is the diagnosis?", "options": [{"label": "A", "text": "Allergic rhinitis", "correct": false}, {"label": "B", "text": "Atrophic rhinitis", "correct": true}, {"label": "C", "text": "Rhinitis caseosa", "correct": false}, {"label": "D", "text": "Rhinitis sicca", "correct": false}], "correct_answer": "B. Atrophic rhinitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Heredity</li>\n<li>Endocrine disturbance</li>\n<li>Racial factors</li>\n<li>Nutritional deficiency</li>\n<li><strong>Infective: <span class=\"customMeta\" data-dictid=\"50f3c6e8dd16927771902c55d555b8\">Klebsiella</span> ozaenae </strong></li>\n<li>Autoimmune</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n<p><strong>And Examination findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primarily affects females, starts around puberty</li>\n<li>Foul-smelling <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> discharge; patients are usually unaware of it themselves and have <span class=\"customMeta\" data-dictid=\"cc8a35010816927771819ba9cf19d8\">anosmia</span> <strong>(merciful anosmia).</strong></li>\n<li>Paradoxical <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> despite enlarged <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> chambers.</li>\n<li>Epistaxis from <span class=\"customMeta\" data-dictid=\"62b976e2941692777185c4b2eb180b\">crust</span> removal.</li>\n<li>Pale <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> mucosa, <span class=\"customMeta\" data-dictid=\"ae1132b13e1692777182aec918eee0\">atrophied</span> turbinates, potential septal perforation, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> dermatitis, <span class=\"customMeta\" data-dictid=\"8b3b29ae5516927771987d1b16beb1\">saddle</span> nose deformity.</li>\n<li>Possible extension to <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">pharynx</span> and <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> leading to <span class=\"customMeta\" data-dictid=\"65b19c9ce61692777182e7b765acf0\">atrophic pharyngitis</span> and laryngitis.</li>\n<li>Eustachian tube <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> cause hearing impairment.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the lymphatic structure from the histology section given below?", "options": [{"label": "A", "text": "Tonsil", "correct": false}, {"label": "B", "text": "Lymph node", "correct": false}, {"label": "C", "text": "Spleen", "correct": false}, {"label": "D", "text": "Thymus", "correct": true}], "correct_answer": "D. Thymus", "question_images": ["https://image.prepladder.com/content/91QlKfIL3bNM9kvYoSyO1741031704.png"], "explanation_images": ["https://image.prepladder.com/content/7aRs4SramQn5zoYtkOlU1741031801.png", "https://image.prepladder.com/content/18vgyfESyYDIakRoWoU61741031834.png", "https://image.prepladder.com/content/kZLkp3LGmPqu2MoLjyt21741031874.png", "https://image.prepladder.com/content/H3YVOsf6qq62A9CWVMEx1741031907.png", "https://image.prepladder.com/content/qGpc2Ik7btZpaug239qp1741089865.png", "https://image.prepladder.com/content/M0tw8pTTBJUnHn4agJZN1741031986.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A TB patient with HIV begins ART and experiences deterioration in health after 2 months. What is the likely cause?", "options": [{"label": "A", "text": "Development of drug resistance to TB drugs", "correct": false}, {"label": "B", "text": "Drug-drug interactions between TB and ART medications", "correct": false}, {"label": "C", "text": "Immunological changes in the body", "correct": true}, {"label": "D", "text": "Development of drug resistance to ART", "correct": false}], "correct_answer": "C. Immunological changes in the body", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which anti-epileptic drug is commonly associated with gum hypertrophy and dizziness as side effects?", "options": [{"label": "A", "text": "Carbamazepine", "correct": false}, {"label": "B", "text": "Phenytoin", "correct": true}, {"label": "C", "text": "Levetiracetam", "correct": false}, {"label": "D", "text": "Topiramate", "correct": false}], "correct_answer": "B. Phenytoin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with penicillin allergy presents with fever, burning micturition, and hearing problems accompanied by dizziness. Which drug is the most appropriate for the management?", "options": [{"label": "A", "text": "Azithromycin", "correct": false}, {"label": "B", "text": "Amikacin", "correct": false}, {"label": "C", "text": "Ciprofloxacin", "correct": true}, {"label": "D", "text": "Ampicillin-Clavulanic acid", "correct": false}], "correct_answer": "C. Ciprofloxacin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ciprofloxacin</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacokinetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Good oral absorption</li>\n<li>Bioavailability ~70%,Moderate <span class=\"customMeta\" data-dictid=\"082d1526db1692777188311b6eef04\">half-life</span> (~4-5 hours)</li>\n<li>Widely distributed in tissues and body fluids</li>\n<li>Renal excretion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections</li>\n<li>Prostatitis</li>\n<li>Pseudomonas aeruginosa (DOC)</li>\n<li><strong>Anthrax (Bacillus anthracis) (DOC)</strong></li>\n<li>Gastrointestinal infections (e.g., traveller's diarrhoea)</li>\n<li>Bone and joint infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gastrointestinal disturbances (nausea, diarrhoea).</li>\n<li>CNS effects (headache, dizziness).</li>\n<li>Tendonitis and <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> rupture.</li>\n<li>Photosensitivity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pregnancy</li>\n<li>Children (due to potential for <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> damage)</li>\n<li>Myasthenia gravis (can exacerbate muscle weakness)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is pressure epiphysis", "options": [{"label": "A", "text": "Head of Humerus", "correct": true}, {"label": "B", "text": "Elbow joint", "correct": false}, {"label": "C", "text": "Wrist joint", "correct": false}, {"label": "D", "text": "Sternum", "correct": false}], "correct_answer": "A. Head of Humerus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 29-year-old woman presents with abdominal pain, vaginal bleeding, and a history of amenorrhea for 6 weeks. Transvaginal ultrasound does not show an intrauterine gestational sac or features suggestive of ectopic pregnancy. Her serum β-hCG is 1,200 IU/L, which is below the discriminatory zone. What is the next step in management?", "options": [{"label": "A", "text": "Laparoscopy", "correct": false}, {"label": "B", "text": "Methotrexate therapy", "correct": false}, {"label": "C", "text": "Repeat β-hCG after 48 hours", "correct": true}, {"label": "D", "text": "Dilatation and curettage", "correct": false}], "correct_answer": "C. Repeat β-hCG after 48 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male presents with a history of vestibular schwannoma and psammoma bodies in the brain. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Meningioma", "correct": true}, {"label": "B", "text": "GBM (Glioblastoma Multiforme)", "correct": false}, {"label": "C", "text": "Pilocytic astrocytoma", "correct": false}, {"label": "D", "text": "Oligodendroglioma", "correct": false}], "correct_answer": "A. Meningioma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following image shows", "options": [{"label": "A", "text": "Open Neural tube defect", "correct": true}, {"label": "B", "text": "Meningocele", "correct": false}, {"label": "C", "text": "Spina bifida", "correct": false}, {"label": "D", "text": "Myelomeningocele", "correct": false}], "correct_answer": "A. Open Neural tube defect", "question_images": ["https://image.prepladder.com/content/xUQQKhVgV0echRR2vqDf1741106166.png"], "explanation_images": ["https://image.prepladder.com/content/7AIt0XOqKaezO5RN6UFd1741106101.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:604px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of <span class=\"customMeta\" data-dictid=\"78d32c50611692777199c6c6b9b525\">Spina</span> Bifida</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spina Bifida Occulta </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spine is abnormal, but the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord is unaffected.</li>\n<li>Overlying skin is usually normal.</li>\n<li>May have a small dimple, <span class=\"customMeta\" data-dictid=\"121d2a043516927772012d5faa616f\">tuft</span> of hair, or <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> over the skin indicating the defect.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meningocele </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Protrusion of a <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> of <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> through the vertebral defect.</li>\n<li>Contains only <strong>clear fluid</strong>, <strong>no <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> components</strong>.</li>\n<li><strong>Transillumination is positive</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myelomeningocele</strong><strong> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sac protrudes through the <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> and contains <strong>neural components</strong> herniating from the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Scientists administered norepinephrine to guinea pigs, resulting in an increase in systolic and diastolic blood pressure and a decrease in heart rate. What mechanism explains this response?", "options": [{"label": "A", "text": "Beta-1 receptor blockade", "correct": false}, {"label": "B", "text": "Alpha-1 receptor blockade", "correct": false}, {"label": "C", "text": "Baroreceptor stimulation", "correct": true}, {"label": "D", "text": "Baroreceptor inhibition", "correct": false}], "correct_answer": "C. Baroreceptor stimulation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Baroreceptors in <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> and aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> detect BP changes</li>\n<li>Increased BP <span class=\"customMeta\" data-dictid=\"ad337177ee1692777199de941a0cda\">stretches</span> receptors, sending signals to <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> via <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> and <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> nerves</li>\n<li>Medulla inhibits <span class=\"customMeta\" data-dictid=\"52abfe100916927772011ad20f3fda\">vasoconstrictor</span> center and stimulates <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> center</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Actions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vasodilation of blood vessels</li>\n<li>Decreased heart rate and <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> strength</li>\n<li>Reduced BP due to lower <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> resistance and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Maintains BP stability during activities like standing</li>\n<li>Fastest acting</li>\n<li>Tends to reset within 1-2 days for long-term regulation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person with the H/o long-term sexual relationship presented with painful ulcers on his genitals with tender lymphadenopathy. What is the diagnosis?", "options": [{"label": "A", "text": "Gonorrhoea", "correct": false}, {"label": "B", "text": "Chlamydia", "correct": false}, {"label": "C", "text": "LGV", "correct": false}, {"label": "D", "text": "Chancroid", "correct": true}], "correct_answer": "D. Chancroid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9iCuQE9Qj8H2ReO2Cq951741086520.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 49-year-old female from Nagaland presented with right-sided hearing loss and tinnitus. On examination, dull tympanic membrane with lymph nodes in the posterior triangle of the neck was seen. Which of the following is the management for the condition?", "options": [{"label": "A", "text": "Grommet insertion + Steroids", "correct": false}, {"label": "B", "text": "Grommet insertion", "correct": false}, {"label": "C", "text": "Steroids", "correct": false}, {"label": "D", "text": "Radiotherapy", "correct": true}], "correct_answer": "D. Radiotherapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A case of death of a married female within 3 years of marriage was reported. Inquest is done by?", "options": [{"label": "A", "text": "Judicial", "correct": false}, {"label": "B", "text": "Police", "correct": false}, {"label": "C", "text": "Coroner", "correct": false}, {"label": "D", "text": "Magistrate", "correct": true}], "correct_answer": "D. Magistrate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PI2pc0xvnk4xzs47PNkN1747840509.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Police Inquest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magistrate Inquest</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conducted by</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Police officer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Magistrate (DM, SDM, Judicial, or Executive Magistrate)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Involvement of witnesses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires signatures of panchas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Does not require witness signatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Witness statements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Admissible in court</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not admissible in court</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Can order arrest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No, but can arrest in cognizable offenses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can issue arrest warrants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exhumation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cannot order exhumation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can order <span class=\"customMeta\" data-dictid=\"9ede3648ef1692777187540bde750b\">exhumation</span> of a body</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autopsy orders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sends bodies for <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> indiscriminately</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Orders <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> only when necessary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Forensic analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cannot order chemical analysis of viscera</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can order chemical analysis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old child was brought with bow legs and on x-ray of wrist following were the findings. What is the diagnosis?", "options": [{"label": "A", "text": "Rickets", "correct": true}, {"label": "B", "text": "Scurvy", "correct": false}, {"label": "C", "text": "Hypophosphatemia", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "A. Rickets", "question_images": ["https://image.prepladder.com/content/ksKq0CUKsCVSvOnb1UvF1741087161.png"], "explanation_images": ["https://image.prepladder.com/content/MaeIdjipQgcgxAZyLGfV1741060320.png", "https://image.prepladder.com/content/s0fCIVY3wfk6V83OBIM21741060343.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with grade 4 hemorrhoids underwent surgery, identify the instrument.", "options": [{"label": "A", "text": "Haemorrhoids resection kit", "correct": false}, {"label": "B", "text": "Stapler kit", "correct": false}, {"label": "C", "text": "Haemorrhoids band kit", "correct": true}, {"label": "D", "text": "CO2 laser", "correct": false}], "correct_answer": "C. Haemorrhoids band kit", "question_images": ["https://image.prepladder.com/content/jHrsvAfCw6t7A1xkydIE1741111486.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade of Hemorrhoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 1</strong> (No prolapse)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lifestyle modification, fiber, sitz bath, <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> agents</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 2</strong> (Prolapse, <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> reduction)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rubber band ligation, sclerotherapy, <span class=\"customMeta\" data-dictid=\"82df9c600116927771907b7977a3b4\">infrared</span> coagulation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 3</strong> (Prolapse, manual reduction needed)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rubber band ligation, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> if persistent symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 4</strong> (Irreducible prolapse)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical options: <span class=\"customMeta\" data-dictid=\"688498a587169277718835ead0f24e\">Hemorrhoidectomy</span> (excision or stapler), laser hemorrhoidoplasty</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the deficiency in the image shown below?", "options": [{"label": "A", "text": "Copper Deficiency", "correct": false}, {"label": "B", "text": "Zinc Deficiency", "correct": true}, {"label": "C", "text": "Vitamin C Deficiency", "correct": false}, {"label": "D", "text": "Vitamin D Deficiency", "correct": false}], "correct_answer": "B. Zinc Deficiency", "question_images": ["https://image.prepladder.com/content/rQ4lVL0jxWzoiewXJbmn1741064180.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:500px\">\n<tbody>\n<tr>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Diarrhea.</li>\n<li>Mood changes.</li>\n<li>Anorexia.</li>\n<li>Neurological disturbances.</li>\n<li>Hypogonadism</li>\n</ul>\n<br/>\n\t\t\t </td>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Growth retardation.</li>\n<li>Alopecia (hair loss).</li>\n<li>Weight loss.</li>\n<li>Recurrent infections.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old woman comes to the clinic for a routine follow-up. She has a history of mild hypertension, which is well-controlled with medication. She reports no symptoms such as palpitations, dizziness, or chest pain. An ECG of the patient is given below. What is the most likely diagnosis based on the ECG findings?", "options": [{"label": "A", "text": "Second-Degree AV Block", "correct": false}, {"label": "B", "text": "First-Degree AV Block", "correct": true}, {"label": "C", "text": "Third-Degree AV Block", "correct": false}, {"label": "D", "text": "Bundle Branch Block", "correct": false}], "correct_answer": "B. First-Degree AV Block", "question_images": ["https://image.prepladder.com/content/E4Q3HxOFLM41zAEFMq8Q1741080778.png"], "explanation_images": ["https://image.prepladder.com/content/YbLxBsoZEJ6tIfPuZ5do1741080790.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>First Degree AV Block</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>First-degree <span class=\"customMeta\" data-dictid=\"78a0565f7316927771827e4aca866c\">AV block</span> is characterized by a prolonged PR interval (&gt;0.20 seconds) without <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> from <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> to ventricles.</li>\n<li>The delay typically occurs in the AV node, but may also involve the atria, His bundle, or Purkinje fibers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Commonly attributed to increased <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> tone in younger patients.</li>\n<li>In older patients, often due to fibrotic changes in the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> system.</li>\n<li>Other causes include <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> heart disease, myocardial infarction, <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> abnormalities, inflammation, infections, certain drugs, <span class=\"customMeta\" data-dictid=\"3107ad472c16927771900477b8dae0\">infiltrative</span> diseases, <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> diseases, and <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> degenerative diseases.</li>\n<li>Lymes disease, Chagas disease, Diphtheria, <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> arthritis, Scleroderma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually asymptomatic; patients are often unaware of the condition until discovered on an ECG.</li>\n<li>In cases where the PR interval exceeds 0.30 seconds, symptoms may resemble \"pacemaker syndrome,\" including dyspnea, malaise, lightheadedness, and chest pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is confirmed by a PR interval greater than 0.20 seconds on an ECG.</li>\n<li>PR interval can be marked (&gt;0.30 seconds) in some cases, and P waves may appear within preceding T waves.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Generally, no treatment is required; routine observation is sufficient.</li>\n<li>Pacemaker placement may be considered for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> patients with PR interval &gt;0.30 seconds or those with coexisting heart disease.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"2f4652078816927771814621857a81\">antiarrhythmic</span> medications are indicated, and surveillance with routine ECGs is recommended to monitor for worsening.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the population norm for an ASHA worker?", "options": [{"label": "A", "text": "700-1000", "correct": false}, {"label": "B", "text": "1000-1500", "correct": false}, {"label": "C", "text": "1000-2500", "correct": true}, {"label": "D", "text": "2000-2500", "correct": false}], "correct_answer": "C. 1000-2500", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child diagnosed with von Willebrand disease requires an understanding of the role of von Willebrand factor (vWF). What does von Willebrand factor primarily combine with?", "options": [{"label": "A", "text": "Glycoprotein Ib", "correct": true}, {"label": "B", "text": "Platelet factor 3", "correct": false}, {"label": "C", "text": "ADP", "correct": false}, {"label": "D", "text": "Prothrombin", "correct": false}], "correct_answer": "A. Glycoprotein Ib", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/E2CVJFlUdQPCJd1CXITs1741061179.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with gum bleeding, petechiae, poor wound healing, and other related symptoms. Which of the following vitamin deficiencies is most likely responsible for this presentation?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin B6", "correct": false}, {"label": "C", "text": "Vitamin B3", "correct": false}, {"label": "D", "text": "Vitamin C", "correct": true}], "correct_answer": "D. Vitamin C", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vitamin C <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> (Scurvy)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor dietary <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> (malnutrition, alcoholism, elderly, infants on cow's milk)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding gums, petechiae, bruising, corkscrew hairs, poor wound healing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subperiosteal hemorrhage, joint pain, anemia, weakness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical features, low <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"964b8993a1169277720279c9c96cd1\">vitamin C</span> levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vitamin C supplementation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presents with hirsutism, delayed periods, obesity. USG findings are given below. What is the likely diagnosis?", "options": [{"label": "A", "text": "PCOD", "correct": true}, {"label": "B", "text": "POI", "correct": false}, {"label": "C", "text": "OHSS", "correct": false}, {"label": "D", "text": "Thecal luteal cyst", "correct": false}], "correct_answer": "A. PCOD", "question_images": ["https://image.prepladder.com/content/1QEoR0tg65ZKBI11rUJP1741060448.png"], "explanation_images": ["https://image.prepladder.com/content/3yDy9AtuxKkuKzw1PSiF1741060538.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:653px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recommended Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical <span class=\"customMeta\" data-dictid=\"67593c3b001692777189ea37898103\">Hyperandrogenism</span> (or)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated total or free testosterone, or calculated indices (FAI, BioT). DHEAS and ANSD can be considered.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Hyperandrogenism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Modified Ferriman–Gallwey score <strong>≥4 to ≥8</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oligo-Anovulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oligo-amenorrhea (<strong>cycles &gt;35 days apart or &lt;8 menses/year</strong>).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Polycystic Ovarian <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">Morphology</span> (On USG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>≥20 follicles per ovary</strong> (in either ovary) or <strong>≥10 cm³ ovarian volume</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The ureter is safe in which type of hysterectomy?", "options": [{"label": "A", "text": "Open laparotomy", "correct": false}, {"label": "B", "text": "Laparoscopy", "correct": false}, {"label": "C", "text": "Robotic", "correct": false}, {"label": "D", "text": "Vaginal", "correct": true}], "correct_answer": "D. Vaginal", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hysterectomy Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ureteric Injury Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reasons</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Open laparotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct ureteric handling, risk during ligation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk due to <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> and <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> injuries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Robotic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate to high</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> but better visualization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaginal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lowest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal ureteric dissection, lower risk of injury</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which findings are suggestive of tubal pregnancy?", "options": [{"label": "A", "text": "Ovarian mass with single layer of endometrium", "correct": false}, {"label": "B", "text": "Adnexal mass with empty uterus", "correct": false}, {"label": "C", "text": "Trilayer endometrium without adnexal mass", "correct": false}, {"label": "D", "text": "Adnexal mass with empty uterus and fluid in pelvis", "correct": true}], "correct_answer": "D. Adnexal mass with empty uterus and fluid in pelvis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for the given image?", "options": [{"label": "A", "text": "Genital TB", "correct": true}, {"label": "B", "text": "Normal fallopian tube", "correct": false}, {"label": "C", "text": "Hydrosalphinx", "correct": false}, {"label": "D", "text": "Endometrosis", "correct": false}], "correct_answer": "A. Genital TB", "question_images": ["https://image.prepladder.com/content/4PuTLmQTzsznG9R96STP1741106856.png"], "explanation_images": ["https://image.prepladder.com/content/tXlKG5E0MCgZe3AYhU701741106868.png", "https://image.prepladder.com/content/wvDHm9Dc5LQrhmfci6T61741106915.png", "https://image.prepladder.com/content/P9sNna9we0FtyzkA2Jc91741106964.png", "https://image.prepladder.com/content/P0QwdPvpEDCSu9aLXZG01741107025.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man is found unconscious after a fall from a ladder. In the emergency department, his eyes do not open even in response to pain; he is making incomprehensible sounds, and he exhibits abnormal flexion in response to painful stimuli. What is his Glasgow Coma Scale (GCS) score?", "options": [{"label": "A", "text": "5", "correct": false}, {"label": "B", "text": "6", "correct": true}, {"label": "C", "text": "7", "correct": false}, {"label": "D", "text": "8", "correct": false}], "correct_answer": "B. 6", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:426px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Head Injury Severity: Clinical Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minor head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 15 with no LOC (loss of consciousness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 14 or 15 with LOC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 9 - 13</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 3 - 8</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:297px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pupils Unreactive to Light</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pupil Reactivity Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both Pupils</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neither Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "This instrument is contraindicated for?", "options": [{"label": "A", "text": "Caesarean section", "correct": false}, {"label": "B", "text": "Obstructed labor", "correct": true}, {"label": "C", "text": "After coming head of breech", "correct": false}, {"label": "D", "text": "Occipital posterior position", "correct": false}], "correct_answer": "B. Obstructed labor", "question_images": ["https://image.prepladder.com/content/HD5i4V1SP7PxfJnVGmA31741059498.png"], "explanation_images": ["https://image.prepladder.com/content/iJXUe6hW36jrfNGhfXHm1741059640.png", "https://image.prepladder.com/content/tOo9VeBFlwIv5mWGUAmd1741059624.png", "https://image.prepladder.com/content/cszrCEBwSfXLNkQh80SE1741059611.png", "https://image.prepladder.com/content/nSEXxFEEtwaYvwzSvaGs1741059596.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Instrument</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Piper <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> </strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"209\" src=\"https://image.prepladder.com/content/iJXUe6hW36jrfNGhfXHm1741059640.png\" width=\"209\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asymmetrical blades (one solid, one fenestrated)</li>\n<li>Specifically for the after-coming head in <span class=\"customMeta\" data-dictid=\"6946dd732d1692777183e8fbb62785\">breech</span> deliveries.</li>\n<li>Allows application when access to the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head is limited.</li>\n<li>Designed for quick delivery of <strong>head-in <span class=\"customMeta\" data-dictid=\"6946dd732d1692777183e8fbb62785\">breech</span> births</strong></li>\n<li>It has distinct <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> curve, allows for application to the <strong>aftercoming head in <span class=\"customMeta\" data-dictid=\"6946dd732d1692777183e8fbb62785\">breech</span> delivery.</strong><strong> (Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simpson forceps</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"239\" src=\"https://image.prepladder.com/content/tOo9VeBFlwIv5mWGUAmd1741059624.png\" width=\"132\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long, curved blades.</li>\n<li>Sliding lock mechanism.</li>\n<li>Versatile - used for <strong>outlet and low-cavity applications.</strong></li>\n<li>Accommodates various <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head sizes.</li>\n<li>One of the most commonly used forceps.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wrigley's forceps</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"210\" src=\"https://image.prepladder.com/content/cszrCEBwSfXLNkQh80SE1741059611.png\" width=\"208\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Short, slightly curved blades.</li>\n<li>Fixed English-style lock.</li>\n<li>Designed for <strong>low or outlet <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> deliveries.</strong></li>\n<li>It is easier to manoeuvre when the <strong>fetal head is very low or visible.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kielland forceps</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"218\" src=\"https://image.prepladder.com/content/nSEXxFEEtwaYvwzSvaGs1741059596.png\" width=\"164\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long, almost straight blades</li>\n<li>Adjustable pivot.</li>\n<li>Designed for <strong>rotation of the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head</strong>.</li>\n<li>Useful for<strong> <span class=\"customMeta\" data-dictid=\"d4214cf5bc1692777194bd76243b92\">occiput</span> <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> positions. </strong><strong>(Option D)</strong></li>\n<li>Can accommodate <span class=\"customMeta\" data-dictid=\"e67797478a16927771821d950ff605\">asynclitism</span> (tilted <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the classical triad of acute cholangitis?", "options": [{"label": "A", "text": "Pain, jaundice, fever", "correct": true}, {"label": "B", "text": "Pain, jaundice, shock", "correct": false}, {"label": "C", "text": "Fever, jaundice, ↑WBC", "correct": false}, {"label": "D", "text": "Pain, ↑WBC, ↑Bilirubin", "correct": false}], "correct_answer": "A. Pain, jaundice, fever", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Cholangitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Often due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in the <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree, leading to bacterial infection by organisms like Klebsiella, E. coli, Enterobacter, Pseudomonas, and <span class=\"customMeta\" data-dictid=\"e58661c5961692777184ecb7121396\">Citrobacter</span> species.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Charcot's <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> - pain, jaundice, fever</strong></li>\n<li>Additional <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"b2332a96a2169277718756eb10e3e7\">epigastrium</span> and right <span class=\"customMeta\" data-dictid=\"c8bf2605091692777189746f65e812\">hypochondrium</span> is common.</li>\n<li>Severe Form: <strong>Reynolds pentad</strong> - <strong>persistent pain, fever, jaundice, shock, and altered mental status</strong></li>\n<li>Indicates <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> obstructive <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> cholangitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lab Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"57176262ed169277720233ee0ceb2a\">white blood cell</span> count, bilirubin, and <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> levels.</li>\n<li>Chronic cases may show <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> or hypertrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Recurrent <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">Pyogenic</span> Cholangitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>More common in East Asian populations, caused by <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> stones and infections</li>\n<li>Risk factors include <span class=\"customMeta\" data-dictid=\"c0433f52ad1692777194c2ffb6fc63\">parasitic</span> infections like <span class=\"customMeta\" data-dictid=\"1d97210e3416927771844d6a6b6242\">Clonorchis</span> sinensis and <span class=\"customMeta\" data-dictid=\"d4d6dc03c61692777182e9a842faf7\">Ascaris</span> lumbricoides.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When is a blood sample taken to diagnose neonatal hypothyroidism?", "options": [{"label": "A", "text": "Immediately from the umbilical cord", "correct": false}, {"label": "B", "text": "24 hours after delivery", "correct": false}, {"label": "C", "text": "23-48 hours after delivery", "correct": false}, {"label": "D", "text": "72 hours after delivery", "correct": true}], "correct_answer": "D. 72 hours after delivery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with telecanthus, hypertelorism, antimongoloid slant, and cardiac defects. What is the most likely chromosomal abnormality?", "options": [{"label": "A", "text": "Translocation", "correct": false}, {"label": "B", "text": "Inversion", "correct": false}, {"label": "C", "text": "Microdeletion", "correct": true}, {"label": "D", "text": "Trisomy", "correct": false}], "correct_answer": "C. Microdeletion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VkrJWduH3NVV2RJ4QFjo1741106028.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Microdeletion on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 22q11.2.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Developmental Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal development of the third and fourth pharyngeal pouches during embryogenesis.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:478px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Facial Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypertelorism (widely spaced eyes).</li>\n<li>Antimongoloid <span class=\"customMeta\" data-dictid=\"bc8b45183516927771983a212ad17a\">slant</span> of eyes.</li>\n<li>Low-set ears.</li>\n<li>Micrognathia (small jaw).</li>\n<li>Short philtrum.</li>\n<li>Bifid uvula.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypocalcaemic <span class=\"customMeta\" data-dictid=\"3d62cb9e271692777200980467ea01\">tetany</span> (due to hypoparathyroidism).</li>\n<li>Aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> anomalies.</li>\n<li>Thymic <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> or aplasia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T Cell Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present in 20–30% of patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ranges from mild <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> to severe <span class=\"customMeta\" data-dictid=\"141d29cc7f16927771890a8e0860e6\">immunodeficiency</span> requiring <span class=\"customMeta\" data-dictid=\"fbd2788fff16927772009c0137de78\">thymus</span> or HSCT.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with electric burns and stable vital signs, red-colored urine is observed. What is the most likely finding in the patient's serology?", "options": [{"label": "A", "text": "RBCs in urine", "correct": false}, {"label": "B", "text": "Increased creatinine levels", "correct": false}, {"label": "C", "text": "Decreased hemoglobin levels", "correct": false}, {"label": "D", "text": "Increased potassium levels", "correct": true}], "correct_answer": "D. Increased potassium levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:463px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathologic Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cloudy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nephrotic syndrome</li>\n<li>Phosphaturia</li>\n<li>Pyuria</li>\n<li>Chyluria</li>\n<li>Lipiduria</li>\n<li>Hyperoxaluria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cola coloured </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute Glomerulonephritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brown</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bile pigments</li>\n<li>Myoglobin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brownish-black</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bile pigments</li>\n<li>Melanin</li>\n<li>Methemoglobin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Green or Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pseudomonas UTI</li>\n<li>Biliverdin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orange</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bile pigments</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Red</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hematuria</li>\n<li>Hemoglobinuria</li>\n<li>Myoglobinuria <strong>(Rhabdomyolysis)</strong></li>\n<li>Porphyria</li>\n<li>Beetroot ingestion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Concentrated urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Black </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alkaptonuria</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the culture media used for tuberculosis?", "options": [{"label": "A", "text": "LJ medium", "correct": true}, {"label": "B", "text": "MacConkey medium", "correct": false}, {"label": "C", "text": "Blood agar", "correct": false}, {"label": "D", "text": "Chocolate agar", "correct": false}], "correct_answer": "A. LJ medium", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AH9qHhFJaoRVlfXkIUiK1741104996.png", "https://image.prepladder.com/content/0Lay65WXYwbjnZcV6npx1741105527.png", "https://image.prepladder.com/content/8iiuJtgYOLrszGlK1jgk1741105590.png", "https://image.prepladder.com/content/4KQKy8o8wRnbGu3GKQyq1741105154.png", "https://image.prepladder.com/content/gWHRBfabEW8lcdv4yTYu1741105135.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enriched Media</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Base medium enriched with 5-10% <span class=\"customMeta\" data-dictid=\"2a29598e9c169277718512eee3da8b\">defibrinated</span> sheep blood, used to grow moderately <span class=\"customMeta\" data-dictid=\"7723db033f16927772024ba220f823\">fastidious</span> bacteria and observe <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> reactions.</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/AH9qHhFJaoRVlfXkIUiK1741104996.png\" width=\"3971\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chocolate agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This is an enriched medium made by heating blood agar, which lyses red blood cells and releases nutrients such as haemoglobin and NAD. It supports the growth of <span class=\"customMeta\" data-dictid=\"7723db033f16927772024ba220f823\">fastidious</span> bacteria such as <span class=\"customMeta\" data-dictid=\"e8810d5c6b169277718827849b05a3\">Haemophilus</span> and <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> species.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/0Lay65WXYwbjnZcV6npx1741105527.png\" width=\"3994\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brain-heart <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> (BHI) broth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This is an enriched medium containing nutrients from brains and beef hearts, along with peptones, glucose, sodium chloride, and buffers. It supports the growth of non-fastidious and moderately <span class=\"customMeta\" data-dictid=\"7723db033f16927772024ba220f823\">fastidious</span> microorganisms.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/8iiuJtgYOLrszGlK1jgk1741105590.png\" width=\"1999\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>serum slope</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An enriched medium with high <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> content, prepared with eggs. Primarily used for the recovery and identification of <span class=\"customMeta\" data-dictid=\"5c14de20c01692777185f63bede46f\">Corynebacterium</span> diphtheriae from nose and throat specimens.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2350\" src=\"https://image.prepladder.com/content/4KQKy8o8wRnbGu3GKQyq1741105154.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Lowenstein-Jensen medium:</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Used specifically for cultivating <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> species, this enriched, selective medium contains glycerol, mineral salts, aspargine, malachite green, and hen’s eggs.</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/gWHRBfabEW8lcdv4yTYu1741105135.png\" width=\"3230\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman, a few weeks after delivery, complains of bloody discharge from nipple and fever. On examination, diffuse lump under areola. What is the diagnosis?", "options": [{"label": "A", "text": "Galactocele", "correct": false}, {"label": "B", "text": "Lactational mastitis", "correct": true}, {"label": "C", "text": "Mondor disease", "correct": false}, {"label": "D", "text": "Fibrocystic disease", "correct": false}], "correct_answer": "B. Lactational mastitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lactational Mastitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacterial infection due to milk <span class=\"customMeta\" data-dictid=\"ea73ce564216927771989ea1aa2c3d\">stasis</span> (commonly <em>Staphylococcus aureus</em>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breastfeeding, <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> trauma (cracks), poor latch, prolonged engorgement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, malaise, <strong>painful swollen breast</strong>, erythema, <strong>bloody or <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tender <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> mass</strong>, warmth, <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> over the affected breast</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breast <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> (if untreated)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequent breastfeeding, warm compress, analgesics, <strong>antibiotics (dicloxacillin, cephalexin)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which deficiency is most likely in a patient with delayed wound healing and alopecia?", "options": [{"label": "A", "text": "Zinc", "correct": true}, {"label": "B", "text": "Copper", "correct": false}, {"label": "C", "text": "Calcium", "correct": false}, {"label": "D", "text": "Vitamin D", "correct": false}], "correct_answer": "A. Zinc", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zinc</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Component of metalloenzymes</li>\n<li>Involved in protein, DNA, and <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> synthesis</li>\n<li>Necessary for <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> hormone receptors</li>\n<li>Essential for <span class=\"customMeta\" data-dictid=\"a3b0e644a6169277719912525dffae\">spermatogenesis</span> and <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> growth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features of <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">Zinc</span> Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diarrhea</li>\n<li><strong>Alopecia</strong></li>\n<li>Muscle wasting</li>\n<li>Depression</li>\n<li>Irritability</li>\n<li>Rash</li>\n<li><strong>Delayed wound healing</strong></li>\n<li>Scaly dermatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Level of <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">Zinc</span> Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> level &lt;12 μmol/L (70 μg/dL)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the level of lymph nodes indicated in the marked region of the neck in the given anatomical image.", "options": [{"label": "A", "text": "Level II", "correct": true}, {"label": "B", "text": "Level Ia", "correct": false}, {"label": "C", "text": "Level Ib", "correct": false}, {"label": "D", "text": "Level IV", "correct": false}], "correct_answer": "A. Level II", "question_images": ["https://image.prepladder.com/content/PFjXNKJtuJ4SSVXMTYA41741106358.png"], "explanation_images": ["https://image.prepladder.com/content/zJaV0kTQqZeUXQ8pMkvV1741106507.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Submental &amp; submandibular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Divided into <span class=\"customMeta\" data-dictid=\"45d7632a0216927771898df908d43b\">Ia</span> (midline) &amp; Ib (lateral)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> nodes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jugulodigastric region (common in <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> CA)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mid-jugular region</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> &amp; cricoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> nodes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> &amp; clavicle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior triangle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spinal <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fracture:", "options": [{"label": "A", "text": "Depressed fracture", "correct": true}, {"label": "B", "text": "Linear fracture", "correct": false}, {"label": "C", "text": "Hinge fracture", "correct": false}, {"label": "D", "text": "Gutter fracture", "correct": false}], "correct_answer": "A. Depressed fracture", "question_images": ["https://image.prepladder.com/content/HjvaXUB3kYek38vYxw4U1741086932.png"], "explanation_images": ["https://image.prepladder.com/content/YiFLBqku6FTOjzax3wJq1741060573.png", "https://image.prepladder.com/content/onK1hGFQSfueiFaddICX1741060592.png", "https://image.prepladder.com/content/Zlr8iFHchhsdA7JXq4FH1741060608.png", "https://image.prepladder.com/content/Ke0VUG38SDJD8QRwV91X1741060664.png", "https://image.prepladder.com/content/itnjgJUSiq39izfu0uhF1741060690.png", "https://image.prepladder.com/content/NurZERQYVxov9C5mZmNY1741060738.png", "https://image.prepladder.com/content/Dy62gEKyrvLmbgNeB8nA1741060990.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Depressed Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Comminuted Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gutter Fracture</strong></p>\n<p style=\"text-align: center;\"><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Occurs when a fragment of the skull is pushed inward towards the brain.</li>\n<li style=\"text-align: center;\">Caused by blows from heavy objects with a small surface (e.g., hammers, bricks).</li>\n<li style=\"text-align: center;\">The shape of the depressed area may resemble the object that caused the injury.</li>\n</ul>\n<p style=\"text-align: center;\"><u>Variants:</u></p>\n<ul>\n<li style=\"text-align: center;\"><u>Elevated Fracture</u>: One end of the fractured fragment is raised above the skull, while the other is pushed inward. Caused by sharp objects like an axe.</li>\n<li style=\"text-align: center;\"><u>Pond Fracture</u>: Seen in infants, this smooth depression occurs without a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line, resembling <strong>a dent in a ping-pong ball.</strong> Caused by <span class=\"customMeta\" data-dictid=\"9427862c811692777194034ade4877\">obstetrics</span> <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> blade.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Involves multiple intersecting <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> lines, breaking the bone into several fragments.</li>\n<li style=\"text-align: center;\">Caused by high-impact trauma (e.g., vehicular accidents, crushing injuries).</li>\n<li style=\"text-align: center;\">It may occur alongside other fractures (e.g., fissured or depressed fractures).</li>\n<li style=\"text-align: center;\">Spider web-like patterns on an <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> are characteristic of <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> fractures.</li>\n<li style=\"text-align: center;\">In severe cases, bone fragments may penetrate the brain or become displaced.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">A <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> or channel is formed in the skull bone, often due to <strong>an <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> bullet wound. </strong></li>\n<li style=\"text-align: center;\">Frequently associated with <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> and depressed fractures of the inner skull table.</li>\n<li style=\"text-align: center;\">Bone fragments can cause injury to the <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> or brain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"186\" src=\"https://image.prepladder.com/content/YiFLBqku6FTOjzax3wJq1741060573.png\" width=\"235\"/></p>\n<p style=\"text-align: center;\"><strong>Depressed fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"282\" src=\"https://image.prepladder.com/content/onK1hGFQSfueiFaddICX1741060592.png\" width=\"142\"/></p>\n<p style=\"text-align: center;\"><strong>Comminuted fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"212\" src=\"https://image.prepladder.com/content/Zlr8iFHchhsdA7JXq4FH1741060608.png\" width=\"212\"/></p>\n<p style=\"text-align: center;\"><strong>Gutter fracture</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ring Fracture</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Motorcyclist <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Hinge Fracture)</strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Encircles the <strong>foramen magnum</strong> at the skull base.</li>\n<li style=\"text-align: center;\">Runs from the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica to the <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridges and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fossa.</li>\n<li style=\"text-align: center;\">It can extend to the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> and roof of the nose.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Transverse <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> at the skull base, <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> it and creating a <strong>\"hinge\" - nodding face sign</strong><strong>.</strong></li>\n<li style=\"text-align: center;\">It extends from one <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridge across the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica to the other <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridge.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Caused by:</p>\n<ul>\n<li style=\"text-align: center;\">Falls landing on feet/buttocks (force transmitted through the spine).</li>\n<li style=\"text-align: center;\">Heavy blows to the top of the skull/ vertex.</li>\n<li style=\"text-align: center;\">Twisting of the head on the spine.</li>\n<li style=\"text-align: center;\">Blows to the <span class=\"customMeta\" data-dictid=\"d4214cf5bc1692777194bd76243b92\">occiput</span> or chin.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Often caused by <strong>side impacts</strong>.</p>\n<p style=\"text-align: center;\"><br/>\n\t\t\t </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"261\" src=\"https://image.prepladder.com/content/Ke0VUG38SDJD8QRwV91X1741060664.png\" width=\"225\"/></p>\n<p style=\"text-align: center;\"><strong>Ring fracture</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"341\" src=\"https://image.prepladder.com/content/itnjgJUSiq39izfu0uhF1741060690.png\" width=\"337\"/></p>\n<p style=\"text-align: center;\"><strong>Hinge fracture</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fissured <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Linear Fracture)</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diastatic <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Sutural Fracture) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">The most common skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> accounts for about 70% of cases.</li>\n<li style=\"text-align: center;\">Linear cracks may involve the <span class=\"customMeta\" data-dictid=\"47effe8b551692777201331142edf5\">vertex</span> or skull base. It can affect the full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of the bone or just the inner/outer layers.</li>\n<li style=\"text-align: center;\">The <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line is <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> and fine, sometimes hard to detect on X-rays. It runs <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the compressive force.</li>\n<li style=\"text-align: center;\">No depression of bone fragments.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Involves the separation of <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> sutures.</li>\n<li style=\"text-align: center;\">More common in children.</li>\n<li style=\"text-align: center;\">Often occurs with other skull fractures, especially fissured fractures.</li>\n<li style=\"text-align: center;\">Commonly seen at the <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">sagittal</span> suture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><u>Causes:</u></p>\n<ul>\n<li style=\"text-align: center;\">Impact against broad surfaces (e.g., falls or road traffic accidents)</li>\n<li style=\"text-align: center;\">Falls on <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> or buttocks, transmitting force upwards.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><u>Causes:</u></p>\n<ul>\n<li style=\"text-align: center;\">Blunt trauma to the head.</li>\n<li style=\"text-align: center;\"><strong>Increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure leads to <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> separation.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"156\" src=\"https://image.prepladder.com/content/NurZERQYVxov9C5mZmNY1741060738.png\" width=\"367\"/></p>\n<p style=\"text-align: center;\"><strong>Narrow <span class=\"customMeta\" data-dictid=\"b2af124a931692777203c9f8031b77\">fissure</span> skull fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"342\" src=\"https://image.prepladder.com/content/Dy62gEKyrvLmbgNeB8nA1741060990.png\" width=\"328\"/></p>\n<p style=\"text-align: center;\"><strong>Diastatic Fracture</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with fused carpal bones comes to your clinic. What is the gene associated with hand-feet syndrome?", "options": [{"label": "A", "text": "HOXA13", "correct": true}, {"label": "B", "text": "BCL6", "correct": false}, {"label": "C", "text": "FGFR", "correct": false}, {"label": "D", "text": "COl11", "correct": false}], "correct_answer": "A. HOXA13", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly female undergoing chemotherapy for breast cancer is experiencing significant hair loss. What is the most likely cause of her condition?", "options": [{"label": "A", "text": "Telogen Effluvium", "correct": false}, {"label": "B", "text": "Trichotillomania", "correct": false}, {"label": "C", "text": "Anagen Effluvium", "correct": true}, {"label": "D", "text": "Alopecia Areata", "correct": false}], "correct_answer": "C. Anagen Effluvium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following enzymes is dependent on Vitamin C for its activity?", "options": [{"label": "A", "text": "Lysyl dehydrogenase", "correct": false}, {"label": "B", "text": "Lysyl oxidase", "correct": false}, {"label": "C", "text": "Prolyl hydroxylase", "correct": true}, {"label": "D", "text": "Hydroxyprolyl kinase", "correct": false}], "correct_answer": "C. Prolyl hydroxylase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vitamin C Dependency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prolyl hydroxylase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hydroxylates <span class=\"customMeta\" data-dictid=\"e17970718c16927771967aa6347980\">proline</span> residues in <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> for stability.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lysyl hydroxylase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hydroxylates <span class=\"customMeta\" data-dictid=\"6413333d09169277719125b8a2a652\">lysine</span> residues in <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> for cross-linking.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lysyl oxidase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cross-links <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> via <span class=\"customMeta\" data-dictid=\"126202981a1692777181f2970b8c7f\">aldehyde</span> formation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No</strong> (Requires copper)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hydroxyprolyl kinase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phosphorylates hydroxyproline.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which therapy is given for cervical cancer?", "options": [{"label": "A", "text": "Immunotherapy", "correct": false}, {"label": "B", "text": "Hormonal therapy", "correct": false}, {"label": "C", "text": "Targeted therapy", "correct": false}, {"label": "D", "text": "Platinum-based therapy", "correct": true}], "correct_answer": "D. Platinum-based therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:782px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiotherapy (Brachytherapy, Teletherapy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemoradiation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IA1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Conization or extra fascial <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> (if <span class=\"customMeta\" data-dictid=\"51b378d6031692777184a20aa31718\">childbirth</span> is completed)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Intracavitary <span class=\"customMeta\" data-dictid=\"61c2938b191692777183fbbe51a17c\">brachytherapy</span> alone (not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>NIL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IA2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> or radical <span class=\"customMeta\" data-dictid=\"bfdf455449169277720023fbcbb064\">trachelectomy</span> with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> lymphadenectomy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IB1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> or radical <span class=\"customMeta\" data-dictid=\"bfdf455449169277720023fbcbb064\">trachelectomy</span> with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> lymphadenectomy.</p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>NIL</p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chemoradiation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IB2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Radical hysterectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IB3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chemoradiation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IIA1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> or chemoradiation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IIA2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chemoradiation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IIB-IVA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chemoradiation and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"b26b12affb16927771872ba42c137b\">exenteration</span> for central recurrences after radiotherapy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>External beam radiation therapy (40 to 50 Gy) for 5 weeks.</p>\n<p>Brachytherapy (post ext. Beam radiation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Concurrent chemotherapy, with <strong>cisplatin. (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IVB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Palliative; <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> radiation to manage symptoms.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pelvic radiation (symptom control)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Systemic chemotherapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person got stabbed in his anterior thigh and died. His body was brought for postmortem. What type of injury is this?", "options": [{"label": "A", "text": "Incised wound", "correct": false}, {"label": "B", "text": "Penetrating wound", "correct": true}, {"label": "C", "text": "Puncture wound", "correct": false}, {"label": "D", "text": "Blunt force injury", "correct": false}], "correct_answer": "B. Penetrating wound", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ui6VqqeIGKGNNO2KuZzp1741019708.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stab wound/Punctured wound </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These are inflicted by <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> with long, narrow instruments having pointed (sometimes blunt) ends into the depth of the body, which is deeper than its length and width.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weapons used </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Knife (most common)</li>\n<li>Pieces of glass (broken glass bottle)</li>\n<li>Scissors</li>\n<li>Screwdrivers</li>\n<li>Pens</li>\n<li>Ice picks</li>\n<li>Forks</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of stab wounds </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Puncture wound: </strong><strong>(Option C)</strong>\n<ul>\n<li>Soft tissues are involved</li>\n</ul>\n</li>\n<li><strong>Penetrating wound: </strong>\n<ul>\n<li>Enters a <span class=\"customMeta\" data-dictid=\"1e856760501692777183f2469a5056\">body cavity</span> or a viscus</li>\n</ul>\n</li>\n<li><strong>Perforating wound: </strong>\n<ul>\n<li>Through-and-through <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> wounds</li>\n<li>The weapon enters the body from one side and <span class=\"customMeta\" data-dictid=\"89f5610ffd1692777184b03f1f88cc\">comes</span> out the other</li>\n<li>The wound of entry is larger than the exit</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance of the wound dimensions </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Length </strong>is slightly <strong>less than the <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">width</span> </strong>of the weapon due to the stretching of the skin.</li>\n<li><strong>Breadth </strong>is<strong> more than the <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> </strong>of weapon due to gaping.</li>\n<li><strong>Depth</strong>, the <strong>greatest dimension </strong>of the wound, corresponds to the <strong>length</strong> of the weapon's blade, which has completely entered the body without perforation.</li>\n<li><strong>Margins </strong>or edges of the wound are <strong>clean cut </strong>with usually no <span class=\"customMeta\" data-dictid=\"2ff3cc6c8a16927771802154170e4f\">abrasion</span> or bruising.\n\t\t\t\t<ul>\n<li>Margins by a pointed or <span class=\"customMeta\" data-dictid=\"a3a8e127bb1692777184393fdcbf10\">conical</span> weapon have <span class=\"customMeta\" data-dictid=\"55a1f34a051692777191fefd6dfafa\">lacerated</span> edges</li>\n<li>If the hilt guard of the weapon strikes the skin, a regular, sharp, and well-defined patterned <span class=\"customMeta\" data-dictid=\"2ff3cc6c8a16927771802154170e4f\">abrasion</span> or bruising is formed</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the National Deworming Day?", "options": [{"label": "A", "text": "10th February", "correct": true}, {"label": "B", "text": "10th August", "correct": false}, {"label": "C", "text": "10th March", "correct": false}, {"label": "D", "text": "11th January", "correct": false}], "correct_answer": "A. 10th February", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/99mTd95BGu1Ro04FBgVj1741064031.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Following a fight between 2 groups, a boy was brought with severe pain in the chest, distended neck veins, dyspnea, and a BP of 80/50 mmHg. X-ray shows the following findings: What is the diagnosis?", "options": [{"label": "A", "text": "Tension pneumothorax", "correct": true}, {"label": "B", "text": "Primary Spontaneous Pneumothorax", "correct": false}, {"label": "C", "text": "Traumatic Pneumothorax", "correct": false}, {"label": "D", "text": "Bilateral Pneumothorax", "correct": false}], "correct_answer": "A. Tension pneumothorax", "question_images": ["https://image.prepladder.com/content/WjV4qIzZwOHcUtgAZN7Y1741111598.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tension Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma, mechanical ventilation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe dyspnea, hypotension, JVD, <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> deviation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mediastinal shift away from affected side, hyperlucency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ruptured <span class=\"customMeta\" data-dictid=\"6136118183169277719961922f8790\">subpleural</span> blebs (tall, thin males)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden dyspnea, pleuritic pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperlucency without <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Traumatic Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blunt/penetrating trauma, rib fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dyspnea, pain, absent breath sounds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperlucency, no <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift unless tension develops</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilateral Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, seen in severe trauma, barotrauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Respiratory distress, hypoxia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral hyperlucency</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following enzymes is typically elevated in prostate cancer?", "options": [{"label": "A", "text": "Acid phosphatase", "correct": true}, {"label": "B", "text": "Alkaline phosphatase", "correct": false}, {"label": "C", "text": "Lactate dehydrogenase", "correct": false}, {"label": "D", "text": "Alpha-fetoprotein", "correct": false}], "correct_answer": "A. Acid phosphatase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with lower symmetric flaccidity and no cord reflex, suggesting which condition?", "options": [{"label": "A", "text": "Guillain-Barré syndrome", "correct": true}, {"label": "B", "text": "Multiple sclerosis", "correct": false}, {"label": "C", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "D", "text": "Spinal cord injury", "correct": false}], "correct_answer": "A. Guillain-Barré syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Guillain-Barré syndrome (GBS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Motor Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Progressive <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> paralysis</strong> <strong>(distal to proximal)</strong></li>\n<li><strong>Areflexia</strong></li>\n<li>Weakness in legs causing rubbery legs and <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> to stand</li>\n<li>Truncal paralysis, quadriplegia, neck floppiness</li>\n<li>Bilateral 7th nerve palsy</li>\n<li>Bulbar palsy\n\t\t\t\t<ul>\n<li>Difficulty in handling secretions leading to <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> pneumonia</li>\n<li>A leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> involvement.</li>\n</ul>\n</li>\n<li>Diaphragmatic paralysis\n\t\t\t\t<ul>\n<li>Ventilatory support is required in 30% of cases.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"c32b3a9fac16927771831530888fdf\">carbon dioxide</span> levels.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sensory Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Glove-and-stocking distribution paresthesias</li>\n<li>Proprioception loss\n\t\t\t\t<ul>\n<li>Difficulty in climbing stairs</li>\n<li>Pain in the neck/arm/shoulder is similar to over-exercised muscle</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Sensory manifestations can occur before or along with motor manifestations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Autonomic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"3704fc52401692777186c42775c9fb\">dysregulation</span> (e.g., <span class=\"customMeta\" data-dictid=\"32742bce4316927771941ff62a9db7\">orthostatic</span> hypotension, bladder/bowel sparing/transient involvement)</li>\n<li>Wide fluctuations of blood pressure, arrhythmias, postural hypotension</li>\n<li>Reduced heart rate and blood pressure, <span class=\"customMeta\" data-dictid=\"fec88fc386169277719326fdef547f\">neurogenic</span> shock.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A total of 2000 patients were assessed for HIV. 200 were diagnosed positive. A new ELISA screening test was tested on the same group. It showed 260 as positive out of which only 130 had the disease. What is the specificity of the test?", "options": [{"label": "A", "text": "96%", "correct": true}, {"label": "B", "text": "80%", "correct": false}, {"label": "C", "text": "72%", "correct": false}, {"label": "D", "text": "68%", "correct": false}], "correct_answer": "A. 96%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old man was admitted with a murmur and blood culture positive for Gram-positive cocci. Choose the common agent causing prosthetic valve infective endocarditis.", "options": [{"label": "A", "text": "Streptococcus viridans", "correct": false}, {"label": "B", "text": "Staphylococcus epidermidis", "correct": true}, {"label": "C", "text": "Staphylococcus aureus", "correct": false}, {"label": "D", "text": "Enterococci", "correct": false}], "correct_answer": "B. Staphylococcus epidermidis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old woman presents to the emergency department 6 hours after ingesting a large quantity of paracetamol tablets. What is the most likely progression of paracetamol poisoning in this case?", "options": [{"label": "A", "text": "Increase in liver enzymes within 24 hours", "correct": true}, {"label": "B", "text": "Liver failure within 24 hours", "correct": false}, {"label": "C", "text": "Paracetamol achieves peak concentration within 4 hours", "correct": false}, {"label": "D", "text": "Recovery within 72 hours", "correct": false}], "correct_answer": "A. Increase in liver enzymes within 24 hours", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolism of Acetaminophen</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acetaminophen is mainly metabolized via <strong>phase II</strong> reactions into harmless<strong> sulfate</strong> and <strong>glucuronide</strong> metabolites.</li>\n<li>A small portion undergoes<strong> phase I </strong>metabolism by<strong> CYP2E1</strong>, forming the <span class=\"customMeta\" data-dictid=\"aad52f4a541692777188bfd2c5830b\">hepatotoxic</span> <span class=\"customMeta\" data-dictid=\"fceb6bf8d01692777192b8b179f554\">metabolite</span> <strong>N-acetyl-p-benzoquinone-imine (NAPQI)</strong>.</li>\n</ul>\n<p><strong>Detoxification of NAPQI</strong></p>\n<ul>\n<li>NAPQI is neutralized by binding to glutathione, forming water-soluble mercapturic acid, which is excreted via the kidneys.</li>\n</ul>\n<p><strong>Glutathione Depletion</strong></p>\n<ul>\n<li>When excessive NAPQI is produced, or <span class=\"customMeta\" data-dictid=\"f945849e691692777188ad7ce5b5e2\">glutathione</span> is depleted, NAPQI binds to <span class=\"customMeta\" data-dictid=\"d92a2c1a2f1692777188848354f32b\">hepatocyte</span> macromolecules, forming acetaminophen-protein adducts, causing <span class=\"customMeta\" data-dictid=\"d92a2c1a2f1692777188848354f32b\">hepatocyte</span> necrosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic alcohol use (induces CYP2E1, depletes glutathione).</li>\n<li>Starvation.</li>\n<li>Prior use of mixed-function oxidase-inducing drugs (e.g.,<strong> phenobarbital</strong>, <strong>INH</strong>).</li>\n<li><strong>Hepatitis C</strong> infection increases the risk of liver injury in overdose.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Symptoms (4-12 hrs)</strong>:</p>\n<ul>\n<li>Nausea, vomiting, diarrhea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, shock.</li>\n</ul>\n<p><strong>Delayed Symptoms (24-48 hrs)</strong>:</p>\n<ul>\n<li>Hepatic injury becomes apparent.</li>\n<li>Coagulopathy and encephalopathy.</li>\n<li>Maximal damage seen 3–5 days post-ingestion with <span class=\"customMeta\" data-dictid=\"c011dc417616927771816fef085ce1\">aminotransferase</span> levels &gt;10,000 IU/L.</li>\n<li>Renal failure and myocardial injury may occur.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stages of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"95b7c54ee116927771809963c4ee14\">acetaminophen</span> poisoning</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Time Post-Ingestion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>0–24 hours</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nausea, vomiting, and anorexia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>24–72 hours</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain; elevated liver enzymes (AST, ALT), and sometimes increased <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> and INR if <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> is severe.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>72–96 hours</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vomiting, signs of liver failure; peak levels of AST, ALT, bilirubin, and INR. Possible <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure and pancreatitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&gt; 5 days</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recovery of liver function or <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to multiple organ failure.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are the changes seen in irreversible cell injury", "options": [{"label": "A", "text": "Bleb formation", "correct": false}, {"label": "B", "text": "Amorphous density of mitochondria", "correct": true}, {"label": "C", "text": "Clumping of chromatin", "correct": false}, {"label": "D", "text": "Cellular Swelling", "correct": false}], "correct_answer": "B. Amorphous density of mitochondria", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate presents with a growing skin lesion, as shown in the image provided. The mother reports that the lesion has been increasing in size daily. What is the appropriate management?", "options": [{"label": "A", "text": "Observation", "correct": true}, {"label": "B", "text": "Excision and Laser Therapy", "correct": false}, {"label": "C", "text": "Immediate Biopsy due to Malignancy Risk", "correct": false}, {"label": "D", "text": "Cryotherapy", "correct": false}], "correct_answer": "A. Observation", "question_images": ["https://image.prepladder.com/content/EaA7GeCQQK4ZSKO2TL5I1741088795.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32 y/o pregnant woman presents for her routine antenatal check-up at 28 weeks gestation. She has a history of obesity but no previous history of diabetes. Her fasting plasma glucose level is 104 mg/dL, and her 2-hour plasma glucose level after a 75g Oral Glucose Tolerance Test (OGTT) is 167 mg/dL. Based on these findings, what is the most appropriate next step?", "options": [{"label": "A", "text": "Start lifestyle modifications and repeat OGTT at 32 weeks gestation.", "correct": false}, {"label": "B", "text": "Diagnose her with pre-existing diabetes and initiate insulin therapy.", "correct": false}, {"label": "C", "text": "Diagnose her with GDM and initiate dietary modifications with close monitoring of blood glucose levels.", "correct": true}, {"label": "D", "text": "Monitor her closely without intervention since her glucose levels are borderline.", "correct": false}], "correct_answer": "C. Diagnose her with GDM and initiate dietary modifications with close monitoring of blood glucose levels.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gestational Diabetes </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pre-existing Diabetes</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing </strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>During pregnancy</p>\n</td>\n<td colspan=\"2\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present before conception</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fasting <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> glucose</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>92 mg/dL</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>126 mg/dL (on two occasions)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-hour <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>180 mg/dL</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥200 mg/dL (with <span class=\"customMeta\" data-dictid=\"36a802ceb516927771893371227fb8\">hyperglycemic</span> symptoms)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-hour <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>153 mg/dL</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥200 mg/dL (during an <span class=\"customMeta\" data-dictid=\"1132c78e2716927771943d6ef17c70\">OGTT</span> in <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> individuals)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HbA1c</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥5.7-6.4%</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥6.5%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resolves after delivery.</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires <span class=\"customMeta\" data-dictid=\"901bf573f216927771905f0abedca2\">intensive</span> management before and during pregnancy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient shows flat affect. What does it indicate?", "options": [{"label": "A", "text": "Positive symptom", "correct": false}, {"label": "B", "text": "Negative symptom", "correct": true}, {"label": "C", "text": "Affect symptom", "correct": false}, {"label": "D", "text": "Cognitive symptom", "correct": false}], "correct_answer": "B. Negative symptom", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the use of Shakir's tape?", "options": [{"label": "A", "text": "Intersectoral coordination", "correct": false}, {"label": "B", "text": "Equitable distribution", "correct": false}, {"label": "C", "text": "Appropriate technology", "correct": true}, {"label": "D", "text": "Community participation", "correct": false}], "correct_answer": "C. Appropriate technology", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:400px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Red</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;11.5 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe Malnutrition</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>11.5-12.5 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Borderline Malnutrition</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Green</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;12.5 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is deficient in the mucopolysaccharidosis associated with Natowicz disease?", "options": [{"label": "A", "text": "Dermatan sulfate", "correct": false}, {"label": "B", "text": "Heparan sulfate", "correct": false}, {"label": "C", "text": "Keratan sulfate", "correct": false}, {"label": "D", "text": "Hyaluronic acid", "correct": true}], "correct_answer": "D. Hyaluronic acid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Accumulated GAG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS I (Hurler/Scheie)<br/>\n\t\t\t(Option A ruled out)<br/>\n\t\t\t(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>α-L-iduronidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatan sulfate, Heparan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS II (Hunter)<br/>\n\t\t\t(Option A ruled out)<br/>\n\t\t\t(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iduronate-2-sulfatase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatan sulfate, Heparan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS III (Sanfilippo)<br/>\n\t\t\t(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heparan N-sulfatase, etc.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heparan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS IV (Morquio)<br/>\n\t\t\t(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Galactosamine-6-sulfatase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Keratan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS VI (Maroteaux-Lamy)<br/>\n\t\t\t(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arylsulfatase B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS VII (Sly)<br/>\n\t\t\t(Option A ruled out)<br/>\n\t\t\t(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>β-Glucuronidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatan sulfate, Heparan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS IX (Natowicz)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyaluronidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyaluronan</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure?", "options": [{"label": "A", "text": "Retrograde pyelogram", "correct": false}, {"label": "B", "text": "Combined Retrograde Pyelogram and Ureteroscopy", "correct": false}, {"label": "C", "text": "Intravenous Pyelogram", "correct": true}, {"label": "D", "text": "Antegrade pyelography", "correct": false}], "correct_answer": "C. Intravenous Pyelogram", "question_images": ["https://image.prepladder.com/content/RLJF5y2jpRv0a8KGdEcp1741111710.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">Pyelogram</span> (IVP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV contrast injection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspected <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> obstruction, nephrolithiasis, tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast seen in kidneys, ureters, and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> on sequential films</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retrograde <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">Pyelogram</span> (RGP) </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> via <span class=\"customMeta\" data-dictid=\"3ee67fc1971692777185b21b950a61\">cystoscopy</span> into ureters</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspected ureteral obstruction, non-visualization on IVP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast opacifies the <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> without nephrogram</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antegrade <span class=\"customMeta\" data-dictid=\"aabbf4882c169277719601141cd424\">Pyelography</span> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> percutaneously into the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pelvis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction, post-surgical assessment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast fills <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and ureters from above</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Combined RGP &amp; <span class=\"customMeta\" data-dictid=\"aba89fa6131692777201043967a365\">Ureteroscopy</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ureteroscope inserted via <span class=\"customMeta\" data-dictid=\"3ee67fc1971692777185b21b950a61\">cystoscopy</span> + contrast study</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ureteric stones, strictures, or tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> along with contrast study</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked structure?", "options": [{"label": "A", "text": "Cystic artery", "correct": false}, {"label": "B", "text": "Right Hepatic artery", "correct": true}, {"label": "C", "text": "Hepatic duct", "correct": false}, {"label": "D", "text": "Cystic duct", "correct": false}], "correct_answer": "B. Right Hepatic artery", "question_images": ["https://image.prepladder.com/content/7vGJC3a2fSKtuZfJdDB81741105464.png"], "explanation_images": ["https://image.prepladder.com/content/l3G1WweZ7qBkY3roLwtP1741105597.png", "https://image.prepladder.com/content/rh4ubsFoW9av32ruf1Rr1741105663.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proper <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">Hepatic</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (branch of Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">Hepatic</span> Artery)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs behind the common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> and ascends toward the right <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> of the liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Branches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (to gallbladder), <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">Segmental</span> branches to liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the right <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> of the liver and gallbladder</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Injury during <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> can lead to <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> or <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> ischemia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A firefighter was admitted with fever, cough, culture shown in the image reveals gram-negative, oxidase-positive bacilli. Colonies transilluminating while passing under UV light. Choose the correct agent.", "options": [{"label": "A", "text": "Klebsiella", "correct": false}, {"label": "B", "text": "Staphylococcus aureus", "correct": false}, {"label": "C", "text": "Pseudomonas aeruginosa", "correct": true}, {"label": "D", "text": "Serratia", "correct": false}], "correct_answer": "C. Pseudomonas aeruginosa", "question_images": ["https://image.prepladder.com/content/avNa5GAFKOdpy5FyIOwx1741084441.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:692px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Specific Features for <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sample Collection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collect specimens such as sputum, urine, wound swabs, blood, ear discharge, eye discharge, or <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specimens vary based on the site of infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram stain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gram-negative rods</strong>; <span class=\"customMeta\" data-dictid=\"27cf09e9d316927771928763e99e0d\">motile</span> with flagella.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth on common laboratory media:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produces beta-hemolytic gray, moist colonies.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MacConkey agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produces pale, non-lactose fermenting colonies, <strong>Fluorescence under UV light.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nutrient agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produces large, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> colonies with a <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> sheen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peptone water</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Forms uniform <span class=\"customMeta\" data-dictid=\"e895ca709f1692777201b92e4f9aee\">turbidity</span> with surface pellicle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cetrimide Agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Selective medium that inhibits other <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">Gram-negative</span> bacteria; specifically selected for <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa; <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> production (e.g., pyocyanin).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>King’s medium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>used to increase <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> production by pseudomonas</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"8\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical Tests</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Various biochemical tests to identify specific <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> properties:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oxidase test </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positive</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Catalase test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ICUT Test:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indole test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Citrate test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urease test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Triple sugar test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shows <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"bc8b45183516927771983a212ad17a\">slant</span> with no gas and <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> sulfide.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PCR (Polymerase Chain Reaction), <span class=\"customMeta\" data-dictid=\"748392c25a1692777197c7f442ba28\">16S rRNA</span> sequencing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides specific and sensitive <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa DNA.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antimicrobial <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">Susceptibility</span> Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disk <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> method, Minimum <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">Inhibitory</span> Concentration (MIC) testing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Determines the <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> of <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa to various antibiotics.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Histopathological examination showed follicular cells with pink eosinophilic cytoplasm. It is seen in?", "options": [{"label": "A", "text": "Papillary CA", "correct": false}, {"label": "B", "text": "Follicular CA", "correct": true}, {"label": "C", "text": "Medullary CA", "correct": false}, {"label": "D", "text": "Anaplastic CA", "correct": false}], "correct_answer": "B. Follicular CA", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The toughness of bacterial cell walls is due to:", "options": [{"label": "A", "text": "Teichoic acid", "correct": false}, {"label": "B", "text": "Peptidoglycan", "correct": true}, {"label": "C", "text": "Lipopolysaccharides", "correct": false}, {"label": "D", "text": "Outer membrane", "correct": false}], "correct_answer": "B. Peptidoglycan", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gram-positive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gram-negative</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thick layer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peptidoglycan layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin layer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100 layer thick</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thickness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1–2-layer thickness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-5 %</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lipid content</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Peptidoglycans+++</strong></li>\n<li>Lipoproteins</li>\n<li><strong>Teichoic acid</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lipopolysaccharide</strong></li>\n<li>Lipoproteins</li>\n<li>Peptidoglycan+</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Outer membrane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Present</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Periplasmic space + Porins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Teichoic acid (used for</strong></p>\n<p><strong>attachment)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pentapeptide cross bridge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NAM-NAG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Leading questions can be asked in?", "options": [{"label": "A", "text": "Cross-examination", "correct": true}, {"label": "B", "text": "Re-examination", "correct": false}, {"label": "C", "text": "Anytime", "correct": false}, {"label": "D", "text": "Examination in chief", "correct": false}], "correct_answer": "A. Cross-examination", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examination-in-Chief (Direct Examination)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cross-Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Re-Examination</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Conducted By</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Party who calls the witness (e.g., public prosecutor)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Opposing party (typically defense)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Party who called the witness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Present all relevant facts</li>\n<li>Provide expert interpretation if applicable</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Challenge witness's credibility</li>\n<li>Elicit favorable facts</li>\n<li>Test accuracy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Clarify issues raised during cross-examination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Leading Questions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not allowed unless the witness is declared hostile <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Allowed (<strong>Sec. 146 BSA</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not allowed <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nature of Questions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Open-ended questions to elicit narrative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Can include leading questions to control the narrative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Generally clarifying questions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Time Limit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Typically structured and may have time constraints</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>No set time limit; may last for hours or even days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Generally limited to <span class=\"customMeta\" data-dictid=\"68c95b7b5a169277718451643a0b35\">clarification</span> purposes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Judicial Oversight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Judge may intervene to ensure questions are relevant and not leading</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Court can disallow indecent or scandalous questions (Sec. 154, BSA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Judge monitors to ensure focus remains on clarification</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman diagnosed with schizophrenia had been compliant with her prescribed olanzapine for several months. However, she discontinued the treatment. Which of the following is the most likely reason for her discontinuation?", "options": [{"label": "A", "text": "Weight gain", "correct": true}, {"label": "B", "text": "Acute dystonia", "correct": false}, {"label": "C", "text": "Akathisia", "correct": false}, {"label": "D", "text": "Tardive dyskinesia", "correct": false}], "correct_answer": "A. Weight gain", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First Generation Antipsychotics</strong></p>\n<p><strong>(Typical)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Second Generation Antipsychotics</strong></p>\n<p><strong>(Atypical)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Second Generation Antipsychotics</strong></p>\n<p><strong>(Atypical)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>D2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial D2 Agonists</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>D2/5-HT2A Antagonists</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Haloperidol</li>\n<li>Fluphenazine</li>\n<li>Perphenazine</li>\n<li>Chlorpromazine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aripiprazole</li>\n<li>Brexpiprazole</li>\n<li>Cariprazine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Risperidone</strong></li>\n<li>Olanzapine</li>\n<li>Quetiapine</li>\n<li>Ziprasidone</li>\n<li>Paliperidone</li>\n<li>Lurasidone</li>\n<li>Clozapine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extrapyramidal Side Effects (EPS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common with<strong> first-generation antipsychotics</strong>, including symptoms like\n\t\t\t\t<ul>\n<li><strong>Acute <span class=\"customMeta\" data-dictid=\"61747121f116927771862fad303b93\">dystonia</span> </strong>- Earliest, can occur within minutes of the <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> <strong> (Option B)</strong></li>\n<li><strong>Parkinson's</strong> - Occurs within days to weeks</li>\n<li><strong>Akathisia </strong>- Occurs within days to weeks<strong> (Option C)</strong></li>\n</ul>\n</li>\n<li>Alternatives for management include dose reduction, antiparkinson medications, or switching to medications with lower EPS risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tardive <span class=\"customMeta\" data-dictid=\"aa971a0b1c169277718621174b6657\">Dyskinesia</span> (TD)</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Affects 20-30% of patients on long-term <strong>first-generation antipsychotics</strong>, with higher risk in the elderly and those with cognitive or mood disorders.</li>\n<li>Prevention strategies include using the <strong>lowest effective doses </strong>and <strong>switching to other medications like Clozapine.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sedation</strong> &amp; <strong>Postural hypotension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Especially with low-potency antipsychotics.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Long-term antipsychotic</strong> use can elevate <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> levels, affecting sexual function and potentially leading to osteoporosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "OCPs are not protective for?", "options": [{"label": "A", "text": "Breast Ca", "correct": true}, {"label": "B", "text": "Colorectal Ca", "correct": false}, {"label": "C", "text": "Endometrial Ca", "correct": false}, {"label": "D", "text": "Ovarian Ca", "correct": false}], "correct_answer": "A. Breast Ca", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cancer Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect of <span class=\"customMeta\" data-dictid=\"606de5c78a1692777184fda50c9271\">COC</span> Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endometrial Cancer </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by <strong>≥30%</strong>, with greater protection in long-term users. The effect persists for years after discontinuation.</li>\n<li>More pronounced reduction seen in smokers, <span class=\"customMeta\" data-dictid=\"43663fecf11692777194c870d1d548\">obese</span> women, and those with low physical activity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ovarian Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by <strong>30–50%</strong>, with greater protection in long-term users. The effect persists for 10–15 years after stopping, even with short-term use (≥6 months).</li>\n<li>Protection extends to BRCA1/BRCA2 <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> carriers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colorectal Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by <strong>15–20%</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breast Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>COC use increases risk by <strong>25%</strong>, especially in <span class=\"customMeta\" data-dictid=\"341daa40bb169277719303fbd1ce1a\">nulliparous</span> women who start before age 24 and use it for &gt;4 years.</li>\n<li>If breast cancer develops, it is usually <strong>well-differentiated with a good prognosis</strong>.</li>\n<li>The increased risk disappears after 10 years of stopping.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cervical Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"606de5c78a1692777184fda50c9271\">COC</span> use increases risk, particularly of <strong>adenocarcinoma </strong>of the cervix.</li>\n<li>Women using COCs for ≥5 years have a higher risk, with risk increasing with longer duration.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A renal biopsy image is shown. Identify the cells marked in the histological section.", "options": [{"label": "A", "text": "Macula densa", "correct": false}, {"label": "B", "text": "Juxtaglomerular (JG) cells", "correct": false}, {"label": "C", "text": "Lacis cells", "correct": true}, {"label": "D", "text": "Podocytes", "correct": false}], "correct_answer": "C. Lacis cells", "question_images": ["https://image.prepladder.com/content/VAp0zr3E4pe4q0F0NaAJ1741086630.png"], "explanation_images": ["https://image.prepladder.com/content/VbQgTrifBe28I5KQmqqs1741086821.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Macula densa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">tubule</span> near <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> arteriole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Senses sodium concentration &amp; regulates <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> secretion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Juxtaglomerular (JG) cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Afferent arteriole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secrete <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> in response to low BP</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lacis cells (Extraglomerular mesangial cells)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> &amp; <span class=\"customMeta\" data-dictid=\"8833ce72c71692777187014d5585e7\">efferent</span> arterioles</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facilitate communication between <span class=\"customMeta\" data-dictid=\"948746a830169277719140f9f93879\">macula</span> densa and JG cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Podocytes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visceral layer of Bowman's capsule</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Filtration barrier in glomerulus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female who delivered a healthy term baby one week ago is now presenting to the OBG clinic with complaints of fishy-smelling pale brownish vaginal discharge. What is the nature of this discharge?", "options": [{"label": "A", "text": "Lochia Rubra", "correct": false}, {"label": "B", "text": "Lochia Serosa", "correct": true}, {"label": "C", "text": "Lochia Alba", "correct": false}, {"label": "D", "text": "Leukorrhea", "correct": false}], "correct_answer": "B. Lochia Serosa", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Lochia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lochia Rubra -red</strong></p>\n<p><strong>(</strong><strong>Option A</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in 1-4 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood</li>\n<li>Shreds of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> membranes and decidua</li>\n<li>Vernix caseosa</li>\n<li>Lanugo and meconium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lochia Serosa-yellowish or</strong></p>\n<p><strong>pink or pale brownish </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-9 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> but more leukocytes</li>\n<li>Wound exudate</li>\n<li>Mucus from the cervix</li>\n<li>Microorganisms (anaerobic <span class=\"customMeta\" data-dictid=\"8876d7c56816927771999e61073f60\">streptococci</span> and staphylococci)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lochia Alba-pale white</strong></p>\n<p><strong>(</strong><strong>Option C</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-15 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Decidual cells</li>\n<li>Leukocytes</li>\n<li>Mucus</li>\n<li>Cholesterin crystals, <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> and <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> epithelial cells</li>\n<li>Microorganisms.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the type of cartilage present in the histology section given below?", "options": [{"label": "A", "text": "Hyaline cartilage", "correct": true}, {"label": "B", "text": "Elastic cartilage", "correct": false}, {"label": "C", "text": "Articular cartilage", "correct": false}, {"label": "D", "text": "Fibrocartilage", "correct": false}], "correct_answer": "A. Hyaline cartilage", "question_images": ["https://image.prepladder.com/content/QKaYTbd98MRTjQLSPP7W1741087425.png"], "explanation_images": ["https://image.prepladder.com/content/DYdC8lSYjPO5ESEHmw7U1741087574.png", "https://image.prepladder.com/content/2BWo2bWkYTeJ0uYCIvC21741087557.png", "https://image.prepladder.com/content/pJCZfHC4qVZ5ZRzL7zqs1741087608.png", "https://image.prepladder.com/content/0WtN4PifsLB7SnD5jTTm1741087643.png", "https://image.prepladder.com/content/4QB0aNpvhxaMhjmzzbAQ1741087674.png", "https://image.prepladder.com/content/fPg1UTf1EDDoHx7vg79o1741087694.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:810px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hyaline <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">Cartilage</span> (Most Common) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Elastic <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">Cartilage</span> (Yellow cartilage) (Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fibrocartilage (Option D) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Matrix appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogeneous, basophilic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contains <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> fiber network</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Numerous <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> bundles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chondrocyte arrangement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Groups (cell nests/isogenous groups)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to hyaline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single rows or <span class=\"customMeta\" data-dictid=\"e2c83bc4de1692777190e11dbe140f\">isogenous</span> groups</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perichondrium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (except in <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Main fiber type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type II collagen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elastic fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I (primarily) and <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">Type II</span> collagen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Main functions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Structural support, forms <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surfaces</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides flexibility and resilience</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resists <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> and shearing, shock absorption</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Costal cartilage, <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> rings, <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Auricle, epiglottis, <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> tube</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intervertebral discs, menisci</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the key difference between Cisplatin and Carboplatin?", "options": [{"label": "A", "text": "Cisplatin is less neurotoxic than Carboplatin", "correct": false}, {"label": "B", "text": "Cisplatin causes fewer gastric issues compared to Carboplatin", "correct": false}, {"label": "C", "text": "Carboplatin is more neurotoxic than Cisplatin", "correct": false}, {"label": "D", "text": "Cisplatin has more nephrotoxic side effects compared to Carboplatin", "correct": true}], "correct_answer": "D. Cisplatin has more nephrotoxic side effects compared to Carboplatin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male experiences headache, nausea, and shortness of breath while trekking. The physician prescribes a drug to alleviate his symptoms. The drug administered primarily acts on which part of the nephron?", "options": [{"label": "A", "text": "Proximal convoluted tubule (PCT)", "correct": true}, {"label": "B", "text": "Loop of Henle", "correct": false}, {"label": "C", "text": "Distal convoluted tubule (DCT)", "correct": false}, {"label": "D", "text": "Collecting duct (CD)", "correct": false}], "correct_answer": "A. Proximal convoluted tubule (PCT)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AJk0aNkS8zd671lJp5yC1741042325.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23 year old male epileptic patient presented with pain in right shoulder region. Examination revealed that right upper limb was abducted and externally rotated and the movements could not be performed. Which of the following is most likely diagnosed", "options": [{"label": "A", "text": "Intrathoracic dislocation of shoulder", "correct": false}, {"label": "B", "text": "Luxation erecta", "correct": false}, {"label": "C", "text": "Subglenoid dislocation of shoulder", "correct": true}, {"label": "D", "text": "Posterior dislocation of shoulder", "correct": false}], "correct_answer": "C. Subglenoid dislocation of shoulder", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7wuleQW1cI23q8AoCGN51741061599.png", "https://image.prepladder.com/content/dKhnOSi1yaaYe2yRYrlJ1741061627.png", "https://image.prepladder.com/content/GDsfaMPluB1b8oprVNYC1741061642.png", "https://image.prepladder.com/content/QENfYtfbCfpBoGn519mn1741061669.png", "https://image.prepladder.com/content/Vt43htE4UrDtgcHN6FpD1741061695.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:663px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior dislocation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior dislocation</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior dislocation</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not very common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fall on an outstretched hand with an abducted and externally rotated shoulder.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs during <strong>seizures or convulsions</strong>.</p>\n<ul>\n<li>A fall onto a <strong>flexed, adducted arm</strong>.</li>\n<li>A direct impact to the <strong>anterior aspect of the shoulder</strong>.</li>\n<li>A fall onto an <strong>outstretched hand</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also called <strong>luxatio erecta.</strong></li>\n<li>Result from a severe hyper-abduction force.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and movement restriction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Duga’s test, Hamilton ruler test and Regimental <span class=\"customMeta\" data-dictid=\"3fb38cd2a416927771822103bd8bcd\">badge</span> test.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Callaway’s test and Regimental <span class=\"customMeta\" data-dictid=\"3fb38cd2a416927771822103bd8bcd\">badge</span> test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bryant’s test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arm Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abduction and external rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adduction and internal rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arm locked in hyperabduction with the hand positioned above the head.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The humeral head is displaced anteriorly and inferiorly, often under the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process <strong>(\"subcoracoid\" position).</strong></li>\n<li><strong>\"Hill-Sachs lesion\" </strong>(compression <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> on the <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">posterolateral</span> aspect of the humeral head).</li>\n<li><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"242\" src=\"https://image.prepladder.com/content/7wuleQW1cI23q8AoCGN51741061599.png\" width=\"187\"/></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The humeral head is displaced posteriorly, appearing closer to the scapula.</li>\n<li><strong>‘Light bulb sign</strong>’(humeral head appears rounded due to internal rotation).</li>\n<li><strong>‘Rim sign’</strong> (widening of the <span class=\"customMeta\" data-dictid=\"138e482a341692777188df645a942c\">glenohumeral</span> joint space).</li>\n<li><strong>‘Reverse Hill-Sachs lesion’</strong> (compression <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> on the <span class=\"customMeta\" data-dictid=\"f90b38d04f16927771818db430bf86\">anteromedial</span> humeral head).</li>\n<li><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"167\" src=\"https://image.prepladder.com/content/dKhnOSi1yaaYe2yRYrlJ1741061627.png\" width=\"192\"/></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The humeral head is displaced inferiorly below the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> cavity.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"252\" src=\"https://image.prepladder.com/content/GDsfaMPluB1b8oprVNYC1741061642.png\" width=\"187\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction techniques:</p>\n<ul>\n<li><strong>Kocher's method </strong>(Most commonly used)</li>\n<li>Hippocrates method</li>\n<li>Stimson’s technique</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction and immobility, followed by active exercises.</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Closed reduction</li>\n<li>Open reduction if soft tissue injuries are present</li>\n<li>Re-examination after reduction to avoid <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> injuries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early:</strong>\n<ul>\n<li>Neurovascular injuries</li>\n<li>Rotator <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> tear</li>\n</ul>\n</li>\n<li><strong>Delayed:</strong>\n<ul>\n<li>Recurrence</li>\n<li>Stiffness</li>\n<li>Unreduced dislocation</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrence</li>\n<li>Unreduced dislocation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurovascular injuries</li>\n<li>Recurrence</li>\n<li>Unreduced dislocation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Shoulder <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Subglenoid</strong>: The humeral head lies below the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> fossa.</li>\n<li><strong>Subclavicular</strong>: The humeral head is displaced beneath the clavicle.</li>\n<li><strong>Intrathoracic</strong>: The humeral head dislocates into the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> cavity, which is rare.</li>\n<li><strong>Subcoracoid</strong>: The humeral head lies below the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"595\" src=\"https://image.prepladder.com/content/QENfYtfbCfpBoGn519mn1741061669.png\" width=\"593\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of the <span class=\"customMeta\" data-dictid=\"70d60276a81692777185b5f6f71fa9\">deltoid</span> <span class=\"customMeta\" data-dictid=\"21f826cc7316927771858a31dad57d\">contour</span> (loss of shoulder roundness)</li>\n<li>The shoulder is <strong>extended, abducted and externally rotated</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Duga’s test</strong> is the inability to touch the opposite shoulder.</li>\n<li><strong>Hamilton ruler</strong> test is where the gap between the ruler and the arm is lost.</li>\n<li><strong>Callaway’s test</strong> is increased girth of the <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> on the dislocated side.</li>\n<li><strong>Bryant’s Test</strong> is where the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> axillary fold is displaced downward on the affected side.</li>\n<li><strong>Regiment batch sign</strong> is loss of sensation due to axillary nerve damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X-ray reveals that the humeral head is displaced anteriorly and inferiorly, often under the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process <strong>(\"subcoracoid\" position)</strong></li>\n<li>An MRI is necessary to assess soft-tissue injuries and identify Bankart and Hill-Sachs lesions, which are complications of shoulder dislocations and increase the risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> due to joint instability.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"581\" src=\"https://image.prepladder.com/content/Vt43htE4UrDtgcHN6FpD1741061695.png\" width=\"457\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Kocher's method </strong>(Most common method) is the reduction by <strong>traction, external rotation, adduction, and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> rotation.</strong></li>\n<li>In <strong>Hippocrates' method, </strong>the surgeon pulls the semi-abducted arm firmly while using his foot in the <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> as a fulcrum to reduce the dislocation.<strong> </strong></li>\n<li><strong>Stimson’s technique</strong> is the reduction by applying weight for traction, using the body as counter traction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26 year old female was brought to ER post fire incidence. Her face and lower limbs were spared. Calculate the area of burn.", "options": [{"label": "A", "text": "5-10%", "correct": false}, {"label": "B", "text": "20-30%", "correct": false}, {"label": "C", "text": "10-15%", "correct": false}, {"label": "D", "text": "40-50%", "correct": true}], "correct_answer": "D. 40-50%", "question_images": ["https://image.prepladder.com/content/mggNti9SMWSMEA1pLy6G1741111356.png"], "explanation_images": ["https://image.prepladder.com/content/zwP5xDskgAhOfnkVFrak1741069571.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head &amp; neck</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Front of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Back of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18 x 2 = 36%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13.5 x 2 = 27%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perineum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs were not given for hypertension in pregnancy?", "options": [{"label": "A", "text": "Methyldopa", "correct": false}, {"label": "B", "text": "Enalapril", "correct": true}, {"label": "C", "text": "Labetalol", "correct": false}, {"label": "D", "text": "Nifedipine", "correct": false}], "correct_answer": "B. Enalapril", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Beta-blockers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Labetalol </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preferred. Generally safe and effective</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcium channel blockers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nifedipine </strong><strong>(Option D)</strong>,</p>\n<p>Amlodipine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Safe, less BP <span class=\"customMeta\" data-dictid=\"128186f064169277720116e786798a\">variability</span> compared to labetalol</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alpha-2 agonist</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methyl dopa</strong> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Safe but less effective in severe hypertension. It works by reducing <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> outflow and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance. However, it has <span class=\"customMeta\" data-dictid=\"dd4bbf3a1a16927771988e61c3d5e9\">sedative</span> effects and may cause fatigue or depression.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasodilators</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hydralazine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reserved for cases with cardiac/renal dysfunction</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:528px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ACE inhibitors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enalapril, </strong>Lisinopril</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with severe <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> malformations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Angiotensin-receptor blockers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Losartan, Valsartan</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not recommended at any point during pregnancy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman had a difficult labour. She complains of dribbling of urine 7 days after surgery. What is the diagnosis?", "options": [{"label": "A", "text": "VVF", "correct": true}, {"label": "B", "text": "UVF", "correct": false}, {"label": "C", "text": "Rectovaginal fistula", "correct": false}, {"label": "D", "text": "VUF", "correct": false}], "correct_answer": "A. VVF", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystoscopy with <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It involves inserting a <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> solution (methylene blue) to <strong>confirm the diagnosis.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI or CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> modalities may be used to assess complex cases or to plan <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> repair, providing detailed <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> information.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">pyelogram</span> (IVP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>(IVP)</strong> is a <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> test that is not typically used as a primary method to diagnose vesico-vaginal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> (VVF).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conservative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Genitourinary fistulas may spontaneously close during continuous <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> using an <span class=\"customMeta\" data-dictid=\"3d7fbfbd7f1692777190bde80be811\">indwelling</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> catheter.</li>\n<li>In 10 per cent of cases, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> fistulas close spontaneously after 2 to 8 weeks of <span class=\"customMeta\" data-dictid=\"041fb2c22116927772007921f33a1e\">transurethral</span> catheterization, especially if the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> is small.</li>\n</ul>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transvaginal Repair:</p>\n<ul>\n<li>This approach involves accessing the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> through the <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> wall.</li>\n<li>It is suitable for smaller fistulas and those located in favourable positions that allow for direct access and closure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transabdominal Repair:</p>\n<ul>\n<li>Larger or more complex fistulas may require an <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> approach.</li>\n<li>This can be done via <span class=\"customMeta\" data-dictid=\"a422b7cfac1692777191bf0a3499e4\">laparotomy</span> (open surgery) or <span class=\"customMeta\" data-dictid=\"6aea253fe3169277719122813f8e25\">laparoscopy</span> (minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> surgery).</li>\n<li>Laparoscopy is preferred when feasible as it offers faster recovery and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> complications.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with respiratory difficulty and a history of chronic smoking. Pulmonary function testing shows a decrease in FEV1%. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Chronic Obstructive Pulmonary Disease (COPD)", "correct": true}, {"label": "B", "text": "Pulmonary Fibrosis", "correct": false}, {"label": "C", "text": "Interstitial Lung Disease", "correct": false}, {"label": "D", "text": "Asthma", "correct": false}], "correct_answer": "A. Chronic Obstructive Pulmonary Disease (COPD)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby is born with microcephaly, intracerebral calcification and chorioretinitis. Which teratogenic infections is the mother suffering from?", "options": [{"label": "A", "text": "Toxoplasma", "correct": true}, {"label": "B", "text": "CMV", "correct": false}, {"label": "C", "text": "Varicella", "correct": false}, {"label": "D", "text": "Rubella", "correct": false}], "correct_answer": "A. Toxoplasma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uyQKW3oEA7rxMIMDpXXt1741087707.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:699px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> infection with <em>Toxoplasma gondii</em> during pregnancy is the primary cause</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection during the first trimester: severe outcomes, lower transmission rate (~17%)</p>\n<p>Infection during third trimester: milder outcomes, higher transmission rate (~65%)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CNS:</strong> Hydrocephalus, <strong>intracranial calcifications</strong>, seizures, developmental delays, <strong>microcephaly </strong>in severe brain damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular:</strong> <strong>Chorioretinitis</strong>, vision impairment, strabismus, photophobia, epiphora</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic:</strong> Hepatosplenomegaly, lymphadenopathy, prematurity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other:</strong> Jaundice, thrombocytopenia, rash, hearing loss</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:694px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fetal Ultrasound</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Performed every 2 weeks during <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> after diagnosis of <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PCR Analysis of <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">Amniotic</span> Fluid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for <span class=\"customMeta\" data-dictid=\"d554413593169277719693b8e38638\">prenatal</span> diagnosis of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serologic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent or rising titers in dye/IFA tests, positive IgM-ELISA.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Newborn Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General, ophthalmologic, and neurologic exams; head <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> for <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> calcifications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lumbar <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> with analysis for Toxoplasma-specific <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> and IgM, total IgG, cells, glucose, and protein.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxoplasma Isolation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isolation from placenta, infant’s leukocytes, and <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> using PCR</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:655px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyrimethamine and Sulfadiazine, along with <span class=\"customMeta\" data-dictid=\"699ed0930f1692777203617cf3f0c7\">Folinic Acid</span> (Calcium Leucovorin)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Synergistic action against <em>Toxoplasma gondii</em>. Standard treatment for <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> toxoplasmosis. <strong>Folinic Acid </strong>is administered to prevent <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> caused by pyrimethamine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spiramycin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used in pregnant women during the first <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> to prevent vertical transmission.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> counts twice weekly to detect <span class=\"customMeta\" data-dictid=\"3925bbe5df1692777193bd03c159a8\">neutropenia</span> and other hematologic effects.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Following image denote which side of placenta?", "options": [{"label": "A", "text": "Fetal", "correct": true}, {"label": "B", "text": "Maternal", "correct": false}, {"label": "C", "text": "Decidual surface", "correct": false}, {"label": "D", "text": "Basal plate", "correct": false}], "correct_answer": "A. Fetal", "question_images": ["https://image.prepladder.com/content/8u1UC4mdlBSXmpvNRywE1741105929.png"], "explanation_images": ["https://image.prepladder.com/content/4Ryn6sWHuyJtLydc0ZW11741059943.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maternal surface (Basal plate)</strong><br/>\n<strong>(Options B &amp; D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fetal surface (Chorionic plate)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adherent to the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall.</li>\n<li>It is rough, <span class=\"customMeta\" data-dictid=\"68d37494591692777186d7c7ce4531\">dull</span> and dark red in colour</li>\n<li>It is divided into cotyledons by decidual septum.</li>\n<li>It helps <span class=\"customMeta\" data-dictid=\"517e55e7781692777181b4d509dbdd\">anchor</span> the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> to the uterus.</li>\n<li>Contains <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> blood sinus.</li>\n<li>Receives blood from <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> arteries.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The<strong> <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> cord is attached to the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> surface.</strong></li>\n<li>It is smooth, shiny and bluish-purple.</li>\n<li>It is covered with amnion.</li>\n<li>Takes part in <span class=\"customMeta\" data-dictid=\"efdaffab1b169277718873fda1f11e\">gaseous</span> and nutritional exchange.</li>\n<li>Highly <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> with <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> capillaries.</li>\n<li>Facilitates nutritional exchange via chorionic villi.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For the diagnosis of typhus, an antigen of Proteus is used. What is this type of antigen called?", "options": [{"label": "A", "text": "Sequestered antigen", "correct": false}, {"label": "B", "text": "Super antigen", "correct": false}, {"label": "C", "text": "Iso antigen", "correct": false}, {"label": "D", "text": "Heterophile antigen", "correct": true}], "correct_answer": "D. Heterophile antigen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Agglutination Test Result</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Epidemic and <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> typhus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Mainly agglutinates with OX19; sometimes with OX2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Tick-borne Spotted Fever</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Antibodies to both OX19 and OX2 elevated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Scrub Typhus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Raised antibodies to OXK</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Rickettsial Pox, Q Fever, Ehrlichiosis, Bartonellosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Negative test</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the OPD with hearing loss. On examination: Rinne test- Positive in the left ear and negative in the right ear Weber's test - lateralization towards the left Bone conduction test - Reduced in the right ear and similar in the left ear. Interpret the findings.", "options": [{"label": "A", "text": "Sensorineural hearing loss in left ear", "correct": false}, {"label": "B", "text": "Sensorineural hearing loss in right ear", "correct": true}, {"label": "C", "text": "Conductive hearing loss in left ear", "correct": false}, {"label": "D", "text": "Conductive hearing loss in right ear.", "correct": false}], "correct_answer": "B. Sensorineural hearing loss in right ear", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:473px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conductive Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensorineural Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal Hearing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rinne</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative (BC &gt; AC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (AC &gt; BC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (AC &gt; BC)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weber</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateralises to worse ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateralises to better ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heard equally</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Bone Conduction</strong></p>\n<p><strong>(ABC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears as long as the examiner</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears for a shorter duration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears as long as the examiner</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schwabach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lengthened</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the duration of abstinence post vasectomy?", "options": [{"label": "A", "text": "3 months", "correct": true}, {"label": "B", "text": "7 months", "correct": false}, {"label": "C", "text": "8 months", "correct": false}, {"label": "D", "text": "5 months", "correct": false}], "correct_answer": "A. 3 months", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of fracture is caused by a hammer?", "options": [{"label": "A", "text": "Linear", "correct": false}, {"label": "B", "text": "Depressed", "correct": true}, {"label": "C", "text": "Hinge", "correct": false}, {"label": "D", "text": "Ring", "correct": false}], "correct_answer": "B. Depressed", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bZqZU4kPstHOAgba90XF1741020348.png", "https://image.prepladder.com/content/RyC56O6y7ZFNKTZNOpmc1741020371.png", "https://image.prepladder.com/content/AxrL1f5Jnge8uwJaKwEq1741020387.png", "https://image.prepladder.com/content/WNAZ3uG1DO9A5v71GkVm1741088606.png", "https://image.prepladder.com/content/1u8fzyTQMsjWOfqoQdTy1741020421.png", "https://image.prepladder.com/content/ueUoY1kWMFjsUp6qAVDH1741020451.png", "https://image.prepladder.com/content/KEE9YBQeaP5iIUt2Yb9N1741020471.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Depressed Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Comminuted Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gutter Fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs when a fragment of the skull is pushed inward towards the brain.</li>\n<li>Caused by blows from heavy objects with a small surface (e.g., hammers, bricks).</li>\n<li>The shape of the depressed area may resemble the object that caused the injury.</li>\n</ul>\n<p><u>Variants:</u></p>\n<ul>\n<li><u>Elevated Fracture</u>: One end of the fractured fragment is raised above the skull, while the other is pushed inward. Caused by sharp objects like an axe.</li>\n<li><u>Pond Fracture</u>: Seen in infants, this smooth depression occurs without a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line, resembling <strong>a dent in a ping-pong ball.</strong> Caused by <span class=\"customMeta\" data-dictid=\"9427862c811692777194034ade4877\">obstetrics</span> <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> blade.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves multiple intersecting <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> lines, breaking the bone into several fragments.</li>\n<li>Caused by high-impact trauma (e.g., vehicular accidents, crushing injuries).</li>\n<li>It may occur alongside other fractures (e.g., fissured or depressed fractures).</li>\n<li>Spider web-like patterns on an <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> are characteristic of <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> fractures.</li>\n<li>In severe cases, bone fragments may penetrate the brain or become displaced.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> or channel is formed in the skull bone, often due to <strong>an <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> bullet wound. </strong></li>\n<li>Frequently associated with <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> and depressed fractures of the inner skull table.</li>\n<li>Bone fragments can cause injury to the <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> or brain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"785\" src=\"https://image.prepladder.com/content/bZqZU4kPstHOAgba90XF1741020348.png\" width=\"140\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Depressed fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/RyC56O6y7ZFNKTZNOpmc1741020371.png\" width=\"509\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Comminuted fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/AxrL1f5Jnge8uwJaKwEq1741020387.png\" width=\"1600\"/></p>\n<p><strong>Gutter fracture</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ring Fracture</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motorcyclist <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Hinge Fracture)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Encircles the <strong>foramen magnum</strong> at the skull base.</li>\n<li>Runs from the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica to the <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridges and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fossa.</li>\n<li>It can extend to the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> and roof of the nose.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transverse <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> at the skull base, <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> it and creating a <strong>\"hinge\" - nodding face sign</strong><strong>.</strong></li>\n<li>It extends from one <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridge across the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica to the other <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridge.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by:</p>\n<ul>\n<li>Falls landing on feet/buttocks (force transmitted through the spine).</li>\n<li>Heavy blows to the top of the skull/ vertex.</li>\n<li>Twisting of the head on the spine.</li>\n<li>Blows to the <span class=\"customMeta\" data-dictid=\"d4214cf5bc1692777194bd76243b92\">occiput</span> or chin.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often caused by <strong>side impacts</strong>.</p>\n<br/>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1572\" src=\"https://image.prepladder.com/content/WNAZ3uG1DO9A5v71GkVm1741088606.png\" width=\"404\"/></p>\n<p><strong>Ring fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"550\" src=\"https://image.prepladder.com/content/1u8fzyTQMsjWOfqoQdTy1741020421.png\" width=\"393\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Hinge fracture</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fissured <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Linear Fracture)</strong></p>\n<p><strong>(Option A)</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diastatic <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Sutural Fracture) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The most common skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> accounts for about 70% of cases.</li>\n<li>Linear cracks may involve the <span class=\"customMeta\" data-dictid=\"47effe8b551692777201331142edf5\">vertex</span> or skull base. It can affect the full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of the bone or just the inner/outer layers.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line is <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> and fine, sometimes hard to detect on X-rays. It runs <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the compressive force.</li>\n<li>No depression of bone fragments.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves the separation of <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> sutures.</li>\n<li>More common in children.</li>\n<li>Often occurs with other skull fractures, especially fissured fractures.</li>\n<li>Commonly seen at the <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">sagittal</span> suture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><u>Causes:</u></p>\n<ul>\n<li>Impact against broad surfaces (e.g., falls or road traffic accidents)</li>\n<li>Falls on <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> or buttocks, transmitting force upwards.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><u>Causes:</u></p>\n<ul>\n<li>Blunt trauma to the head.</li>\n<li><strong>Increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure leads to <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> separation.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"326\" src=\"https://image.prepladder.com/content/ueUoY1kWMFjsUp6qAVDH1741020451.png\" width=\"537\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Narrow <span class=\"customMeta\" data-dictid=\"b2af124a931692777203c9f8031b77\">fissure</span> skull fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"329\" src=\"https://image.prepladder.com/content/KEE9YBQeaP5iIUt2Yb9N1741020471.png\" width=\"202\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Diastatic Fracture</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-week-old neonate was brought to the hospital with a complaint of non-bilious vomiting. While examining the baby, the physician noted a lump in the left epigastric region, which showed movement while feeding. What is the likely diagnosis of this child?", "options": [{"label": "A", "text": "Esophageal atresia", "correct": false}, {"label": "B", "text": "Duodenal atresia", "correct": false}, {"label": "C", "text": "IHPS", "correct": true}, {"label": "D", "text": "Intusussception", "correct": false}], "correct_answer": "C. IHPS", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/V5Z4QutDAmCnVSEbKT8n1741089057.png", "https://image.prepladder.com/content/7voN9YQ0ubZfI7FcThUp1741089109.png", "https://image.prepladder.com/content/O7t9dpSUzfzTcTbn5lFl1741089138.png", "https://image.prepladder.com/content/wjCPJEKSCNOJKxAgXGVM1741089175.png", "https://image.prepladder.com/content/jzsnOg242egnNtGPOkwi1741089201.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Risk Factors of <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> Hypertrophic Pyloric Stenosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>White race of northern European descent</li>\n<li>Male sex</li>\n<li>Familial History: Higher risk in offspring of mothers with CHPS (20% for sons, 10% for daughters)</li>\n<li>Twin Studies: Higher <span class=\"customMeta\" data-dictid=\"a5379e182d1692777184224652dcb1\">concordance</span> in <span class=\"customMeta\" data-dictid=\"e7afab7b981692777192aca13178fa\">monozygotic</span> twins suggests a genetic component</li>\n<li>Blood Groups: Infants with B and O blood groups.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Environmental Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Erythromycin Use: Especially if administered within the first two weeks of life</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> in infants whose mothers used macrolides during pregnancy or breastfeeding, particularly in females.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Associated Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Other <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> Defects Syndromes: Occasionally associated with <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">tracheoesophageal</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> and <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> or <span class=\"customMeta\" data-dictid=\"133b86a0a516927771809ea08682e8\">agenesis</span> of the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"59733f304e1692777191d9deb34f10\">labial</span> frenulum.</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> gastroenteritis, Apert syndrome, Zellweger syndrome, <span class=\"customMeta\" data-dictid=\"5e54fdc4d3169277720003f231621d\">trisomy</span> 18, Smith-Lemli-Opitz syndrome, and Cornelia <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> Lange syndrome.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:558px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic findings of Contrast studies in CHPS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>String Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A thin line of contrast material passes through the narrowed pyloric channel, indicating severe narrowing due to hypertrophied muscle.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"499\" src=\"https://image.prepladder.com/content/7voN9YQ0ubZfI7FcThUp1741089109.png\" width=\"610\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Shoulder Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A bulge of the hypertrophied pyloric muscle into the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"96976bc5fc1692777181dc8403015a\">antrum</span> gives the appearance of a “shoulder.”</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3692\" src=\"https://image.prepladder.com/content/O7t9dpSUzfzTcTbn5lFl1741089138.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Double <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">Tract</span> Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Parallel streaks of contrast material within the narrowed pyloric channel suggest the presence of a narrow passage for contrast flow.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"470\" src=\"https://image.prepladder.com/content/wjCPJEKSCNOJKxAgXGVM1741089175.png\" width=\"638\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mushroom sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bulging of the hypertrophic muscle into the 1st part of the duodenum.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"449\" src=\"https://image.prepladder.com/content/jzsnOg242egnNtGPOkwi1741089201.png\" width=\"474\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/F4I1GDij20fn65AhkXkq1744571219.mp3", "video": ""}, {"text": "Chronic malnutrition is best measured by?", "options": [{"label": "A", "text": "Height for age", "correct": true}, {"label": "B", "text": "Weight for age", "correct": false}, {"label": "C", "text": "Weight for height", "correct": false}, {"label": "D", "text": "Body mass index", "correct": false}], "correct_answer": "A. Height for age", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:662px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>WHO <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Malnutrition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderately underweight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight-for-age is between -2 and -3 SDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severely underweight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight-for-age is &lt; -3 SDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderately wasted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight-for-length/height is between -2 and -3 SDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severely wasted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight-for-length/height is &lt; -3 SDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Malnutrition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weight-for-length/height or BMI-for-age is between -2 and -3 SDs.</li>\n<li>Mid-upper arm <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> (MUAC) is between 11.5 cm and 12.5 cm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Malnutrition:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weight-for-length/height or BMI-for-age is less than -3SDs.</li>\n<li>MUAC is less than 11.5 cm.</li>\n<li>The presence of <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"a8c53e6875169277719588cd709854\">pitting</span> oedema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderately Stunted (Moderate </strong><strong>Chronic Malnutrition)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Length/height-for-age</strong> is between -2 and -3 SDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severely Stunted (Severe </strong><strong>Chronic Malnutrition</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Length/height-for-age </strong><strong>is &lt; -3 SDs. </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?", "options": [{"label": "A", "text": "Anhidrosis", "correct": false}, {"label": "B", "text": "Miosis", "correct": false}, {"label": "C", "text": "Ptosis", "correct": false}, {"label": "D", "text": "Exophthalmos", "correct": true}], "correct_answer": "D. Exophthalmos", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preganglionic </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postganglionic </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Brainstem <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> (tumours, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> diseases, demyelinating disorders)</li>\n<li>Spinal cord tumours</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pancoast tumour</li>\n<li>Carotid and Aortic aneurysms</li>\n<li>Neck lesions</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atherosclerosis of ICA (internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery))</li>\n<li>Nasopharyngeal tumours</li>\n<li>Cavernous <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> pathology</li>\n<li>Cluster headaches</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the defect in the given image:", "options": [{"label": "A", "text": "Open neural tube defect", "correct": true}, {"label": "B", "text": "Meningoencephalocele", "correct": false}, {"label": "C", "text": "Occult Spina bifida", "correct": false}, {"label": "D", "text": "Encephalocele", "correct": false}], "correct_answer": "A. Open neural tube defect", "question_images": ["https://image.prepladder.com/content/v0jD5lGGTQKHCZ9AG8fC1741088212.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Failure of proper <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube &amp; covering mesoderm/ectoderm; <strong>most common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> anomaly.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Primary NTDs have <span class=\"customMeta\" data-dictid=\"8dcd91eadf1692777193a72a442f37\">multifactorial</span> inheritance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Maternal risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Alcohol, radiation exposure, IDDM, valproate, carbamazepine, <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> and <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> deficiency.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types of NTDs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spina bifida occulta, meningocele, encephalocele, myelomeningocele, anencephaly,</strong> <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> syndrome, <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> sinus, tethered cord, syringomyelia, diastematomyelia, lipoma, iniencephaly.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spina bifida occulta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Midline <strong>defect of vertebral bodies without <span class=\"customMeta\" data-dictid=\"08b787c5a41692777196c0e16b3805\">protrusion</span> of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord or meninges</strong>; usually <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> and not of consequence.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Craniorachischisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Rare <span class=\"customMeta\" data-dictid=\"88900fc4c61692777191a66457050a\">malformation</span> with <strong>skull and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> bone defects</strong>; <strong>brain and nerves exposed</strong>; may have other defects like <span class=\"customMeta\" data-dictid=\"51aedf4b7a1692777189224a776ed8\">imperforate</span> anus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Meningocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Meninges herniate</strong> through vertebral arches or sacrum; <strong>spinal cord norma</strong>l. <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">Fluctuant</span> midline mass that may<strong> transilluminate.</strong> Surgery may be delayed in <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> cases with normal neuro findings and skin covering.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Myelomeningocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Most common in<strong> <span class=\"customMeta\" data-dictid=\"2d710fe8461692777191d18505790c\">lumbosacral</span> region</strong>; sac-like <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> structure with <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tissue; 80% develop <strong>hydrocephalus with <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">type II</span> Chiari malformation.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Anencephaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Large <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> of calvarium, meninges, and scalp; associated with <span class=\"customMeta\" data-dictid=\"552c5ff93a16927771977cf35eac28\">rudimentary</span> brain due to failure of <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of <span class=\"customMeta\" data-dictid=\"1f4bb4632d16927771975d96e35378\">rostral</span> neuropore.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Iniencephaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Retroflexion of head </strong>with <strong>occipital and upper spine defects,</strong> nearly absent neck; <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> can range from <span class=\"customMeta\" data-dictid=\"ca09d35fbc1692777180daa0f01405\">acrania</span> to minimal defect.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prenatal diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Detailed ultrasound, <strong>MSAFP</strong> (maternal <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> α-fetoprotein), <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid <span class=\"customMeta\" data-dictid=\"63b92227451692777180db3901b72f\">acetylcholinesterase</span> (<strong>AChE</strong>).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>0.4 mg <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> daily for <strong>all women of childbearing age</strong>; 4 mg daily for high-risk women (prior affected child).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Risk of recurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>3-4% after 1 affected child; 10% after 2 affected children.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Surgery for defect; VP <span class=\"customMeta\" data-dictid=\"950826ab361692777198366a25dfbf\">shunt</span> if <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">hydrocephalus</span> present. Open lesions should be closed within 24 hours. Antibiotics if infection is present.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of strenuous exercise skipped a meal and later consumed alcohol at a party. Alcohol inhibits which of the following biochemical processes, potentially leading to hypoglycemia?", "options": [{"label": "A", "text": "Gluconeogenesis", "correct": true}, {"label": "B", "text": "Glycogenolysis", "correct": false}, {"label": "C", "text": "Hexose Monophosphate (HMP) Shunt", "correct": false}, {"label": "D", "text": "Ketone Body Formation", "correct": false}], "correct_answer": "A. Gluconeogenesis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:472px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect of Alcohol</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑ <span class=\"customMeta\" data-dictid=\"70e624dfd41692777193efc364d5b4\">NADH</span> inhibits gluconeogenesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓ <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> production → Hypoglycemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness, dizziness, confusion, seizures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fasting, exercise, malnutrition, chronic alcoholism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV dextrose, <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> in alcoholics</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient admitted with fever and nuchal rigidity. CSF analysis shows decreased glucose and increased protein and neutrophils. Choose the correct treatment", "options": [{"label": "A", "text": "Ampicillin", "correct": false}, {"label": "B", "text": "Ceftriaxone", "correct": true}, {"label": "C", "text": "Penicillin", "correct": false}, {"label": "D", "text": "Vancomycin", "correct": false}], "correct_answer": "B. Ceftriaxone", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2s4Zs3oMYzbbCojGMWhv1741086633.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Bacterial <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">Meningitis</span> in Adults and Prevention</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Streptococcus pneumoniae and <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitides</strong> are the primary causes.<strong> <span class=\"customMeta\" data-dictid=\"0df89fd47716927771914ac591d3a9\">Listeria</span> monocytogenes</strong> is a significant risk in adults over 50, especially in those with diabetes, alcoholism, or weakened immune systems.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiological Process</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/2s4Zs3oMYzbbCojGMWhv1741086633.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classic <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">Triad</span> of Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fever</strong></li>\n<li>Headache</li>\n<li><strong>Nuchal <span class=\"customMeta\" data-dictid=\"9ab07bba3016927771976de44bf865\">rigidity</span> (stiff neck)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Opening pressure: Elevated</li>\n<li><strong>Predominant cell type: <span class=\"customMeta\" data-dictid=\"0d0b0bf80b1692777196a0d5a44e03\">Polymorphonuclear</span> neutrophils (PMNs)</strong></li>\n<li><strong>Protein: Elevated</strong></li>\n<li><strong>Glucose: Decreased</strong></li>\n<li>Gross appearance: Turbid</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immediate Management: </strong>\n<ul>\n<li>Start with <strong>intravenous <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics</strong> to cover pathogens.</li>\n<li><strong>First-line <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> of choice: Ceftriaxone</strong></li>\n<li>Treatment is then adjusted based on the identified organism and its susceptibility</li>\n</ul>\n</li>\n<li><strong>Adjunctive Therapy:</strong> <strong>Dexamethasone</strong> may be given to reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and prevent complications, particularly if administered early.</li>\n<li><strong>Supportive Care:</strong> Manage complications like raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure and seizures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vaccines for H. influenzae type b, N. meningitidis, and S. pneumoniae. No vaccine currently exists for group B meningococcal infections.</li>\n<li><strong>Chemoprophylaxis</strong>: Close contacts of individuals with meningococcal <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> should receive <strong>prophylactic antibiotics </strong>like rifampicin, ciprofloxacin, <span class=\"customMeta\" data-dictid=\"765229d44a1692777182fb0343abf4\">azithromycin</span> or ceftriaxone to reduce the risk of secondary infections.\n\t\t\t\t<ul>\n<li><strong>Rifampicin - 600 mg 12 hourly for 2 days</strong></li>\n<li><strong>Ciprofloxacin - 500 mg single dose</strong></li>\n<li><strong>Azithromycin 500 mg single dose</strong></li>\n<li><strong>Ceftriaxone - 250 mg <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">Intramuscular</span> single dose</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the schedule of the OPV vaccine?", "options": [{"label": "A", "text": "6th week, 10th week and 14th week", "correct": true}, {"label": "B", "text": "6th week, 10th week &amp;amp; 9th month", "correct": false}, {"label": "C", "text": "6th week, 14th week &amp;amp; 9th month", "correct": false}, {"label": "D", "text": "6 to 12 weeks", "correct": false}], "correct_answer": "A. 6th week, 10th week and 14th week", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>IPV (salk type)</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>OPV (sabin type)</strong></p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Type of vaccine</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Killed formalised virus</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Live attenuated virus</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Mode of administration</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>S/C or IM (0.5 mL)</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Oral (2 drops)</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Type of immunity</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Only humoral</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Humoral and intestinal</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Prevention of</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Paralysis</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Paralysis + Intestinal re-infection</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Control of epidemics</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Not useful</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Effective</p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Storage &amp; transport</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less stringent conditions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires sub-zero temperatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shelf life</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Longer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VAPP (Vaccine Associated <span class=\"customMeta\" data-dictid=\"14bba9af561692777194c8cadacf13\">Paralytic</span> Polio)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Zero incidences</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 per 1 million vaccines</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient sample positive for Infectious Hepatitis B. Choose the correct marker for thiscondition.", "options": [{"label": "A", "text": "HBe Ag", "correct": false}, {"label": "B", "text": "HBsAg + HBe", "correct": true}, {"label": "C", "text": "HBcAg", "correct": false}, {"label": "D", "text": "HBs + Anti Hbe", "correct": false}], "correct_answer": "B. HBsAg + HBe", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:714px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>HBsAg</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>HBeAg</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBc </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBs </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBe </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Interpretation </strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection</strong></p>\n<p style=\"text-align: center;\">Highly infectious</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Chronic <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection, highly infectious</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Chronic <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection, low infectivity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Recovery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Window period</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Post-vaccination</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Dehydration is more severe in infants compared to adults. Which of the following is a true statement about infants?", "options": [{"label": "A", "text": "Extracellular fluid (ECF) is more than intracellular fluid (ICF)", "correct": false}, {"label": "B", "text": "Intracellular fluid (ICF) is more than extracellular fluid (ECF)", "correct": false}, {"label": "C", "text": "Total body water in infants is more than in adults", "correct": true}, {"label": "D", "text": "Extracellular fluid equals intracellular fluid", "correct": false}], "correct_answer": "C. Total body water in infants is more than in adults", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old child with mid-arm circumference of 105mm, upon providing therapeutic food, eagerly completed all of it. This patient is considered under?", "options": [{"label": "A", "text": "Uncomplicated SAM", "correct": true}, {"label": "B", "text": "Complicated SAM", "correct": false}, {"label": "C", "text": "Acute malnutrition", "correct": false}, {"label": "D", "text": "Normal nutrition", "correct": false}], "correct_answer": "A. Uncomplicated SAM", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uMNYfeg8L6lpJBtvCrPF1741087829.png", "https://image.prepladder.com/content/HY17D3N3QkKZWO5w5jzS1741087864.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:697px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria for SAM</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"250\" src=\"https://image.prepladder.com/content/uMNYfeg8L6lpJBtvCrPF1741087829.png\" width=\"734\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Assessment for Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Check for the following complications:</p>\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (+++)</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"d4a253810c1692777181f708ba3dc6\">appetite</span> (fails <span class=\"customMeta\" data-dictid=\"d4a253810c1692777181f708ba3dc6\">appetite</span> test)</li>\n<li>Medical complications</li>\n<li>Presence of one or more danger signs (as per IMNCI guidelines)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on the presence or absence of complications:</p>\n<ul>\n<li>If <strong>NO </strong>complications <strong>→ Uncomplicated SAM → </strong>Supervised home management</li>\n<li>If <strong>YES</strong> (complications present)<strong> → Complicated SAM → </strong>Inpatient management in a healthcare facility</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child presents with a refractive error of -2D in the right eye and +1D in the left eye. Fundus examination reveals normal visual acuity and retinal findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myopia", "correct": false}, {"label": "B", "text": "Hyperopia", "correct": false}, {"label": "C", "text": "Anisometropia", "correct": true}, {"label": "D", "text": "Amblyopia", "correct": false}], "correct_answer": "C. Anisometropia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with fluctuating muscle weakness, especially affecting her speech and swallowing. Repetitive nerve stimulation shows a decremental response. Her blood tests are negative for acetylcholine receptor (AChR) antibodies. Which of the following antibodies is most likely responsible for her symptoms?", "options": [{"label": "A", "text": "Anti-dsDNA antibodies", "correct": false}, {"label": "B", "text": "Anti-MuSK antibodies", "correct": true}, {"label": "C", "text": "Anti-TPO antibodies", "correct": false}, {"label": "D", "text": "Anti-Ro antibodies", "correct": false}], "correct_answer": "B. Anti-MuSK antibodies", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autoantibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Target</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AChR antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acetylcholine receptors (AChR) on the <span class=\"customMeta\" data-dictid=\"978bd0e89f1692777196add72e1254\">postsynaptic</span> membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks signal transmission, leading to muscle weakness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MuSK antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle-specific <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> (MuSK)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impairs AChR clustering and maintenance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found in AChR-negative patients; associated with <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> muscle weakness (speech, swallowing, chewing issues)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male was admitted with respiratory distress. CT showed a nasal polyp with fluid collection in the sinus. Drainage of which of the following is obstructed?", "options": [{"label": "A", "text": "Ethmoidal sinus", "correct": false}, {"label": "B", "text": "Sphenoidal sinus", "correct": false}, {"label": "C", "text": "Frontal sinus", "correct": false}, {"label": "D", "text": "Maxillary sinus", "correct": true}], "correct_answer": "D. Maxillary sinus", "question_images": ["https://image.prepladder.com/content/kkgY4xOUtJ6RmAMm7njV1741062143.png"], "explanation_images": ["https://image.prepladder.com/content/vVU8T4Ryapl4y0hP03kt1741062195.png", "https://image.prepladder.com/content/4poixIXw2H01XmjvYJY51741062221.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which adverse effect of Bleomycin is exacerbated by radiation exposure?", "options": [{"label": "A", "text": "Pulmonary toxicity", "correct": true}, {"label": "B", "text": "Gastric toxicity", "correct": false}, {"label": "C", "text": "Neural toxicity", "correct": false}, {"label": "D", "text": "Hepatotoxicity", "correct": false}], "correct_answer": "A. Pulmonary toxicity", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KsoOUlfO9sXQuxpFedwl1741037206.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the timing at which the triphenyl tetrazolium chloride can elicit findings post MI", "options": [{"label": "A", "text": "1 hour", "correct": false}, {"label": "B", "text": "30 minutes", "correct": false}, {"label": "C", "text": "3 hours", "correct": true}, {"label": "D", "text": "Immediately", "correct": false}], "correct_answer": "C. 3 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A disease with mitochondrial inheritance is inherited from which family member?", "options": [{"label": "A", "text": "Mother", "correct": true}, {"label": "B", "text": "Grandmother (paternal)", "correct": false}, {"label": "C", "text": "Father", "correct": false}, {"label": "D", "text": "Both mother and father", "correct": false}], "correct_answer": "A. Mother", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Maternal inheritance:</strong> All children of an affected female inherit the disease.</li>\n<li><strong>Homoplasmy:</strong> Presence of <span class=\"customMeta\" data-dictid=\"be003ab8e21692777193372f7699ef\">mtDNA</span> which is either <strong>all <span class=\"customMeta\" data-dictid=\"8cae1d992c169277720269fdff79fc\">wild type</span> or all mutated</strong>.</li>\n<li><strong>Heteroplasmy:</strong> Presence of <strong>both <span class=\"customMeta\" data-dictid=\"8cae1d992c169277720269fdff79fc\">wild type</span> (normal) and mutated</strong> <span class=\"customMeta\" data-dictid=\"be003ab8e21692777193372f7699ef\">mtDNA</span> in the same individual.</li>\n<li><strong>Threshold effect: </strong>Minimum percentage of mutated <span class=\"customMeta\" data-dictid=\"be003ab8e21692777193372f7699ef\">mtDNA</span> required for disease manifestation. In the presence of heteroplasmy, the threshold effect leads to <span class=\"customMeta\" data-dictid=\"128186f064169277720116e786798a\">variability</span> in clinical expression across different tissues and <span class=\"customMeta\" data-dictid=\"be003ab8e21692777193372f7699ef\">mtDNA</span> mutations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples (Mnemonic: KLMNOP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li><strong>Kearns-Sayre syndrome- </strong>Pigmentary retinopathy, cerebellar ataxia, heart block</li>\n<li><strong>Leber's <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuropathy- </strong>Subacute painless <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> visual failure</li>\n<li><strong>MELAS-</strong> Mitochondrial Encephalomyopathy, <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">Lactic</span> acidosis, Stroke-like episodes</li>\n<li><strong>MERRF- </strong>Myoclonic epilepsy, Seizures, Ataxia</li>\n<li><strong>NARP-</strong> Neuropathy, Ataxia, <span class=\"customMeta\" data-dictid=\"4f1a033cae1692777197a3a6937a0c\">Retinitis</span> pigmentosa</li>\n<li><strong>CPEO-</strong> Chronic progressive external ophthalmoplegia, <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> Ptosis</li>\n<li><strong>Pearson syndrome- </strong>Sideroblastic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> of childhood, pancytopenia, pancreatic involvement</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a forensic examination, a skull bone was brought by police whose cephalic index came out to be 85. Skull bone belongs to which race?", "options": [{"label": "A", "text": "Negroes", "correct": false}, {"label": "B", "text": "Aryan", "correct": false}, {"label": "C", "text": "European", "correct": false}, {"label": "D", "text": "Mongoloids", "correct": true}], "correct_answer": "D. Mongoloids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skull Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cephalic Index (CI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Population</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dolichocephalic</strong></p>\n<p>(Long-headed)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>70-74.99</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pure Aryans, Aborigines, African (Negroid) <strong>(Options A, B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mesaticephalic</strong></p>\n<p>(Medium-headed)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>75-79.99</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>European (Caucasoid), Chinese, Indians. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brachycephalic</strong></p>\n<p>(Short-headed)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>80-84.99</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>East Asian (Mongoloid)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presented with tingling sensation of lateral 3 digits with loss of sensation of base of thumb on the dorsal aspect of the hand. Which is the nerve involved?", "options": [{"label": "A", "text": "Radial nerve", "correct": true}, {"label": "B", "text": "Ulnar nerve", "correct": false}, {"label": "C", "text": "Median nerve", "correct": false}, {"label": "D", "text": "AIN", "correct": false}], "correct_answer": "A. Radial nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WGDmDmDI9h41NAgLhi8A1741087312.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Region</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Area Supplied</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventral (Palmar) Aspect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 3½ fingers + <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> palm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Median nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palmar surface of thumb, index, middle, and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> half of <span class=\"customMeta\" data-dictid=\"3095f536db1692777197c4502be897\">ring finger</span> + palm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial 1½ fingers + <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> palm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulnar nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palmar surface of <span class=\"customMeta\" data-dictid=\"05bd79dc1d1692777191acf30a7886\">little finger</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> half of <span class=\"customMeta\" data-dictid=\"3095f536db1692777197c4502be897\">ring finger</span> + palm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thenar <span class=\"customMeta\" data-dictid=\"c7cd7c82631692777187abb016ed2e\">eminence</span> (skin)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Median nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over the base of thumb (root of thumb, <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> side)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypothenar eminence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulnar nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over the base of little finger</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dorsal Aspect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 3½ fingertips (nail beds)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Median nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"27cd397275169277719513776c38c8\">phalanges</span> of thumb, index, middle, and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> ring finger</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial 2½ fingers + hand dorsum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulnar nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal aspect of little finger, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> half of ring finger, and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> hand</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 1½ <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> + web space</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radial nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsum of hand near base of thumb, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> hand, and 1st web space</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Root (base) of thumb </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radial nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal aspect of thumb base and adjacent <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of hand</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o asthmatic patient is scheduled for a minor surgical procedure. Which induction agent and muscle relaxant combination is safest for this patient?", "options": [{"label": "A", "text": "Propofol and Succinylcholine", "correct": false}, {"label": "B", "text": "Ketamine and d-tubocurarine", "correct": false}, {"label": "C", "text": "Ketamine and Vecuronium", "correct": true}, {"label": "D", "text": "Thiopental and Rocuronium", "correct": false}], "correct_answer": "C. Ketamine and Vecuronium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child presented with multiple burn injuries involving the entire head, neck &amp;amp; upper limb. What is the percentage of burn?", "options": [{"label": "A", "text": "25-30%", "correct": true}, {"label": "B", "text": "40-44%", "correct": false}, {"label": "C", "text": "18-20%", "correct": false}, {"label": "D", "text": "5-10%", "correct": false}], "correct_answer": "A. 25-30%", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head &amp; neck</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>18%</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Front of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Back of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18 x 2 = 36%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13.5 x 2 = 27%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>18%</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perineum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which segment of the nephron has the lowest osmolality under the influence of antidiuretic hormone (ADH)?", "options": [{"label": "A", "text": "Early distal tubule", "correct": true}, {"label": "B", "text": "Descending limb of the loop of Henle", "correct": false}, {"label": "C", "text": "Collecting duct", "correct": false}, {"label": "D", "text": "Late distal tubule", "correct": false}], "correct_answer": "A. Early distal tubule", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient with HIV presenting with bouts of cough and fever. Which medium is appropriate for diagnosis?", "options": [{"label": "A", "text": "Tinsdale media", "correct": false}, {"label": "B", "text": "Lowenstein-Jensen (LJ) medium", "correct": true}, {"label": "C", "text": "MacConkey agar", "correct": false}, {"label": "D", "text": "Loeffler serum slope (LSS)", "correct": false}], "correct_answer": "B. Lowenstein-Jensen (LJ) medium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:712px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sputum <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial screening for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> TB.</li>\n<li>Samples are stained using the Ziehl-Neelsen method or Auramine-O <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB) under a microscope.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Quick and inexpensive. Can provide results within a few hours.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Low sensitivity, especially in cases of <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB or in patients with HIV.</li>\n<li>Cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> and non-tuberculous <span class=\"customMeta\" data-dictid=\"46f768d2e41692777193d69cbc7eec\">mycobacteria</span> (NTM).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Confirm the diagnosis of TB and assess drug susceptibility.</li>\n<li><strong>Solid Media:</strong> <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">Sputum</span> is inoculated onto solid culture media like <strong>Löwenstein-Jensen</strong><strong> </strong>or Middlebrook agar.</li>\n<li><strong>Liquid Media: </strong>Automated systems like <strong>BACTEC or MGIT</strong> are used to detect growth faster.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The gold standard for TB diagnosis.</li>\n<li>Allows for drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Time-consuming; results can take weeks.</li>\n<li>Requires specialized laboratory facilities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Xpert MTB/RIF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Detects <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> and <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</li>\n<li><strong>Method</strong>:\n\t\t\t\t<ul>\n<li>A cartridge-based system that performs <span class=\"customMeta\" data-dictid=\"6483f3ef3116927771935d328a8ab2\">nucleic acid</span> <span class=\"customMeta\" data-dictid=\"13e14b31b21692777181520d7c651c\">amplification</span> (NAAT).</li>\n<li>Sputum or other specimens are processed directly in the cartridge.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid results (within 2 hours).</li>\n<li>High sensitivity and specificity.</li>\n<li>Simultaneously detects <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More expensive than <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> microscopy.</li>\n<li>Does not provide full drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LAMP (Loop-Mediated Isothermal Amplification)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Detects DNA of <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> tuberculosis.</li>\n<li><strong>Method</strong>:\n\t\t\t\t<ul>\n<li>Amplifies DNA at a constant temperature without the need for <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> cycling.</li>\n<li>Sputum or other specimens are used.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid results (within 1-2 hours).</li>\n<li>High <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> and sensitivity.</li>\n<li>Can be performed at the point of care.</li>\n<li>Used for patients with <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> with CD4+ counts of less than 100 cells/μL irrespective of signs and symptoms of TB.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less widely available than PCR-based tests.</li>\n<li>Cannot detect <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> directly.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TrueNat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Point-of-care test for TB detection.</li>\n<li><strong>Method</strong>:\n\t\t\t\t<ul>\n<li>Uses a micro-PCR technology to amplify DNA.</li>\n<li>Results are available within 60 minutes.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Portable and easy to use in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> health facilities.</li>\n<li>Provides results quickly, facilitating immediate treatment decisions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Line <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">Probe</span> <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">Assay</span> (LPA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Detects TB and <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> (rifampicin and isoniazid).</li>\n<li><strong>Method</strong>:\n\t\t\t\t<ul>\n<li>Sputum samples are processed, and DNA is extracted.</li>\n<li>Amplified DNA is hybridized to specific probes on a <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> strip.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid results (within 1-2 days).</li>\n<li>Can detect multiple mutations associated with drug resistance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires a laboratory <span class=\"customMeta\" data-dictid=\"3a6d14db861692777198565f57828c\">setup</span> and trained personnel.</li>\n<li>Not suitable for all strains of TB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RFLP</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>IS6110 <span class=\"customMeta\" data-dictid=\"3668babc2b169277719777e6f04c66\">restriction fragment</span> length <span class=\"customMeta\" data-dictid=\"15d98152c61692777196a0f2fb42a0\">polymorphism</span> (RFLP)</strong> analysis is widely used for molecular epidemiological studies of tuberculosis.</li>\n<li>Restriction enzymes Nru I, EcoN I, Pst I, and Pvu II were used to analyze IS6110 fingerprints in <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> strains H37Rv (virulent) and H37Ra (avirulent).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with the palsy of the face as shown. Which of the following is most likely involved?", "options": [{"label": "A", "text": "7th nerve palsy", "correct": true}, {"label": "B", "text": "3rd nerve palsy", "correct": false}, {"label": "C", "text": "Erb’s palsy", "correct": false}, {"label": "D", "text": "Orbicularis oculi palsy", "correct": false}], "correct_answer": "A. 7th nerve palsy", "question_images": ["https://image.prepladder.com/content/dRzXZc28bPnpGYlZWnWa1741028210.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common cause of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy</li>\n<li>Characterized by idiopathic, <strong>LMN <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis</strong> of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> onset</li>\n<li><strong>Most commonly the <span class=\"customMeta\" data-dictid=\"4c41e52057169277719199abf55761\">Labyrinthine</span> segment</strong> of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve is involved.</li>\n<li><strong>Males and females are equally affected. </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic: Most common cause</strong></li>\n<li>Viral Infection: <strong>HSV</strong> &gt;&gt; <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">Herpes</span> zoster</li>\n<li>Vascular Ischemia</li>\n<li>Hereditary: Positive family history in 6-8%</li>\n<li>Autoimmune</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in diabetics (due to angiopathy) and pregnant women (due to fluid retention).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden onset of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> with inability to close the eye (Bell's phenomenon), <span class=\"customMeta\" data-dictid=\"0bead1317716927771827dc3e80706\">asymmetry</span> of the face, epiphora, drooping mouth, and dribbling of saliva.</li>\n<li>Associated symptoms may include ear pain, noise <span class=\"customMeta\" data-dictid=\"7794e5fd7a1692777190ee626ede62\">intolerance</span> (stapedial paralysis), or loss of taste (chorda tympani involvement).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is made by excluding other causes of <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>General: Reassurance, pain relief, eye protection and physiotherapy</li>\n<li>Medical: <strong>Prednisolone</strong> 60 mg per day for 5 days then <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by 10 mg per day (for a total treatment time of 10 days) and 50 mg per day (in two divided doses) for 10 days, <strong>Acyclovir (Adult doses)</strong></li>\n<li>Surgical: Nerve decompression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>85%-90% of patients fully recover </strong></li>\n<li>Incomplete resolution are mainly seen in recurrent/late recovery cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug is preferred for management of diabetes in a patient with cardiac and renal failure?", "options": [{"label": "A", "text": "SGLT2 inhibitors", "correct": true}, {"label": "B", "text": "Pioglitazone", "correct": false}, {"label": "C", "text": "Metformin", "correct": false}, {"label": "D", "text": "Sulfonylureas", "correct": false}], "correct_answer": "A. SGLT2 inhibitors", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Infections (vaginal thrush, balanoposthitis, Fournier’s gangrene) : Favour the growth of microbes in the lower urinary tract by providing an environment of excessive glucose.</li><li>↳ Infections (vaginal thrush, balanoposthitis, Fournier’s gangrene)</li><li>↳ Euglycemic ketoacidosis is due to inhibiting glucose reabsorption and the body’s preference for ketone bodies as an energy source after excess glucose excretion.</li><li>↳ Euglycemic ketoacidosis</li><li>↳ Osteoporosis: Rarely due to loss of calcium ions upon inhibition of the SGLT-2 receptors.</li><li>↳ Osteoporosis:</li><li>↳ Pioglitazone (Option B) is incorrect because pioglitazone (a thiazolidinedione, TZD) causes fluid retention , worsening heart failure .</li><li>↳ Pioglitazone (Option B)</li><li>↳ pioglitazone (a thiazolidinedione, TZD)</li><li>↳ fluid retention</li><li>↳ heart failure</li><li>↳ Metformin (Option C) is incorrect because although it is the first-line drug for type 2 diabetes , it is contraindicated in severe renal failure (eGFR &lt;30 mL/min/1.73m²) due to the risk of lactic acidosis .</li><li>↳ Metformin (Option C)</li><li>↳ first-line drug for type 2 diabetes</li><li>↳ contraindicated in severe renal failure (eGFR &lt;30 mL/min/1.73m²)</li><li>↳ risk of lactic acidosis</li><li>↳ Sulfonylureas (Option D) is incorrect because sulfonylureas (e.g., glibenclamide, glipizide) increase hypoglycemia risk , especially in renal impairment due to reduced clearance.</li><li>↳ Sulfonylureas (Option D)</li><li>↳ sulfonylureas (e.g., glibenclamide, glipizide)</li><li>↳ hypoglycemia risk</li><li>↳ renal impairment</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Edematous villi with chromosome XY was found. What will be the diagnosis?", "options": [{"label": "A", "text": "Complete mole", "correct": true}, {"label": "B", "text": "Partial mole", "correct": false}, {"label": "C", "text": "Cyst", "correct": false}, {"label": "D", "text": "Ectopic pregnancy", "correct": false}], "correct_answer": "A. Complete mole", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial Mole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete Mole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Karyotype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually 69, XXY or 69, XXX <strong>(triploid)</strong> <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually <strong>46, XX or 46, XY (diploid)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 paternal sets + 1 <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> set</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All paternal (empty egg + <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> duplication)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fetal tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It may be present but abnormal.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>β-hCG levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated, but lower than the complete mole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of persistent GTD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-10%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of choriocarcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-4%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-3%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Theca <span class=\"customMeta\" data-dictid=\"cb86764f631692777191898edd4296\">lutein</span> cysts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HPE findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Focal <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> </strong>(some <span class=\"customMeta\" data-dictid=\"bbea63556f1692777202e8abdd66a4\">villi</span> are normal, others are edematous)</li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> blood vessels in some villi.</li>\n<li>Focal trophoblastic hyperplasia</li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> tissue (may include <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> red blood cells or embryonic/fetal parts).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diffuse <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> and hydropic swelling.</strong></li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> blood vessels in villi</li>\n<li>Marked <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> trophoblastic <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (both <span class=\"customMeta\" data-dictid=\"03a334f35e1692777185356e060797\">cytotrophoblast</span> and syncytiotrophoblast).</li>\n<li>No <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> tissue is present.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drug dosages is incorrect for the treatment of leprosy in adults?", "options": [{"label": "A", "text": "Dapsone 100 mg", "correct": false}, {"label": "B", "text": "Clofazimine 50 mg", "correct": false}, {"label": "C", "text": "Clofazimine 300 mg", "correct": false}, {"label": "D", "text": "Rifampicin 450 mg", "correct": true}], "correct_answer": "D. Rifampicin 450 mg", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paucibacillary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multibacillary</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-5 lesions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;5 lesions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥1 nerve involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Slit skin smear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dapsone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clofazimine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rifampicin</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paucibacillary (PB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adult</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300 mg once a month &amp; 50 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>600 mg once a month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Child </strong></p>\n<p><strong>(9-14 yrs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>50 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>150 mg once a month &amp; 50 mg <em>alternate day</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>450 mg once a month</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multibacillary (MB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adult</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300 mg once a month &amp; 50 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>600 mg once a month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Child </strong></p>\n<p><strong>(9-14 yrs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>50 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>150 mg once a month &amp; 50 mg<em> <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> day</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>450 mg once a month</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug-resistant <span class=\"customMeta\" data-dictid=\"f200a5b7181692777191c4f24b2a3e\">leprosy</span> Regimen</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intensive Phase</strong> (6 months)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continuation Phase </strong>(18 months)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rifampicin-resistant cases:</strong></p>\n<p>2 second line + 1 first line (Clofazimine)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ofloxacin + <span class=\"customMeta\" data-dictid=\"3d49c44f24169277719259eb6f9a14\">Minocycline</span> + Clofazimine</p>\n<p><strong>(or)</strong></p>\n<p>Ofloxacin + <span class=\"customMeta\" data-dictid=\"00c4a4fe9b1692777184136ffde6c9\">Clarithromycin</span> + Clofazimine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ofloxacin + <span class=\"customMeta\" data-dictid=\"3d49c44f24169277719259eb6f9a14\">Minocycline</span> + Clofazimine</p>\n<p><strong>(or)</strong></p>\n<p>Ofloxacin + Clofazimine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rifampicin &amp; <span class=\"customMeta\" data-dictid=\"d78dc549171692777194a4af6724c2\">ofloxacin</span> resistant cases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clarithromycin + <span class=\"customMeta\" data-dictid=\"3d49c44f24169277719259eb6f9a14\">Minocycline</span> + Clofazimine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(Clarithromycin or Minocycline) + Clofazimine</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is not reversed with the administration of atropine?", "options": [{"label": "A", "text": "Bradycardia", "correct": false}, {"label": "B", "text": "Muscle weakness due to neuromuscular blockade", "correct": true}, {"label": "C", "text": "Excessive salivation", "correct": false}, {"label": "D", "text": "Bronchoconstriction", "correct": false}], "correct_answer": "B. Muscle weakness due to neuromuscular blockade", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Atropine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anticholinergic drug (Muscarinic <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist)</li>\n<li>Competitive <span class=\"customMeta\" data-dictid=\"2e432a4f3c1692777181e8e244ca0e\">antagonist</span> at <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Competitive <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of <span class=\"customMeta\" data-dictid=\"28ec2061691692777196c06b1c0fd4\">postganglionic</span> <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors</li>\n<li><strong>Blocks all subtypes of <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors (M₁, M₂, M₃)</strong></li>\n<li>Direct <span class=\"customMeta\" data-dictid=\"19f2818be81692777201fa125ef03b\">vagolytic</span> action leading to <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> inhibition</li>\n<li>Allows preexisting <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> to predominate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacological Actions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Overall <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> <span class=\"customMeta\" data-dictid=\"bec9bb02501692777199b0f75e340e\">stimulant</span> action</li>\n<li>Stimulates <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> centers (vagal, respiratory, vasomotor)</li>\n<li>Depresses <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> <span class=\"customMeta\" data-dictid=\"8265e091151692777187f264d73f3b\">excitation</span> (antimotion <span class=\"customMeta\" data-dictid=\"73c1caf8d11692777198b1248373d3\">sickness</span> property)</li>\n<li>Suppresses <span class=\"customMeta\" data-dictid=\"bb6d2476421692777200c2af1ac0c8\">tremor</span> and <span class=\"customMeta\" data-dictid=\"9ab07bba3016927771976de44bf865\">rigidity</span> in parkinsonism</li>\n<li>High doses: <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> excitation, restlessness, hallucinations, delirium</li>\n<li>Very high doses: <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> depression and coma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. CVS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heart:</p>\n<ul>\n<li><strong>Tachycardia </strong>(primary effect) - blocks <strong>M₂</strong> receptors on SA node<strong> </strong><strong>(Option A Ruled Out)</strong></li>\n<li>Initial <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> may occur with IM/SC injection</li>\n<li>Abbreviates <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> period of <span class=\"customMeta\" data-dictid=\"c270267d20169277718081ecee6362\">A-V</span> node</li>\n<li>Facilitates <span class=\"customMeta\" data-dictid=\"c270267d20169277718081ecee6362\">A-V</span> conduction</li>\n<li>Shortens P-R interval</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>Blood Pressure:</p>\n<ul>\n<li>No consistent/marked effect on BP</li>\n<li>Tachycardia and <span class=\"customMeta\" data-dictid=\"bd99ec780c16927772018a45db80c2\">vasomotor</span> center <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> tend to raise BP</li>\n<li>Histamine release and direct <span class=\"customMeta\" data-dictid=\"8827b8fae316927772019c9b7b884f\">vasodilator</span> action (at high doses) tend to lower BP</li>\n<li>Blocks <span class=\"customMeta\" data-dictid=\"000545992916927772017bc4c83041\">vasodepressor</span> action of <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">cholinergic</span> agonists</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Eye</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mydriasis (pupil dilation)</li>\n<li>Cycloplegia (paralysis of accommodation)</li>\n<li>Abolition of light reflex</li>\n<li>Effects last 7-10 days with <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> application</li>\n<li>May increase <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> tension, especially in narrow angle glaucoma</li>\n<li>Has mild local <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> action on cornea</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4. Smooth Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Relaxes all visceral smooth muscles with <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> (M₃ blockade)</li>\n<li>Reduces tone and <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> of GI contractions</li>\n<li>Slows passage of chyme; may cause constipation</li>\n<li>Causes <strong>bronchodilation</strong>, reduces <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> resistance <strong> </strong><strong>(Option D Ruled Out)</strong></li>\n<li>Relaxes <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> and <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> bladder</li>\n<li>Relaxation of <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> (less marked)</li>\n<li>Minimal effect on uterus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5. <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">Glandular</span> Secretions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Markedly <strong>decreases </strong>sweat, <strong>salivary</strong>, <span class=\"customMeta\" data-dictid=\"869f194fb11692777200fc402d40af\">tracheobronchial</span> and <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> secretions (<strong>M₃ </strong>blockade) <strong> </strong><strong>(Option C Ruled Out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6. Body Temperature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Higher doses can cause rise in body temperature</li>\n<li>Due to <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of <span class=\"customMeta\" data-dictid=\"8fab5233721692777199fc0bcd1210\">sweating</span> and <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of temperature regulating center</li>\n<li>Children are highly <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> to <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> fever</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relative Sensitivity of Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreasing order of sensitivity:</p>\n<p>Saliva, sweat, bronchial <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> &gt; eye, bronchial muscle, heart &gt; smooth muscle of intestine, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> &gt; <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> glands and smooth muscle</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate treatment for severe acne?", "options": [{"label": "A", "text": "Topical Tretinoin", "correct": false}, {"label": "B", "text": "Isotretinoin", "correct": true}, {"label": "C", "text": "Steroids", "correct": false}, {"label": "D", "text": "Antibiotics", "correct": false}], "correct_answer": "B. Isotretinoin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:518px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Acne Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Mild Acne</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Over-the-counter <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> treatments (benzoyl peroxide, salicylic acid)</li>\n<li>Topical retinoids (adapalene) <strong> (Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Moderate Acne</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Topical antibiotics (clindamycin, erythromycin)</li>\n<li>Oral antibiotics (doxycycline, minocycline)</li>\n<li>Topical retinoids <strong> (Option A ruled out)</strong></li>\n<li>Hormonal therapy (for females)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Severe Acne</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"e6a88ded8b1692777190caead269e4\">isotretinoin</span> (Most effective) <strong> (Option B)</strong></li>\n<li>Oral antibiotics</li>\n<li>Topical retinoids</li>\n<li>Hormonal therapy (for females)</li>\n<li>Intralesional corticosteroids (for <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> acne)<strong> </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with loss of sensation on the posterior surface of the ear along with a lesion. Which structure is most likely involved?", "options": [{"label": "A", "text": "Greater Auricular Nerve", "correct": true}, {"label": "B", "text": "Internal Jugular Vein", "correct": false}, {"label": "C", "text": "External Jugular Vein", "correct": false}, {"label": "D", "text": "External Carotid Artery", "correct": false}], "correct_answer": "A. Greater Auricular Nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A PLHIV came with multiple dog bites with a punctured wound. Choose the correctmanagement:", "options": [{"label": "A", "text": "Local wound cleaning", "correct": false}, {"label": "B", "text": "Vaccine", "correct": false}, {"label": "C", "text": "Local Treatment + RIG", "correct": false}, {"label": "D", "text": "Local Treatment + RIG + Vaccine", "correct": true}], "correct_answer": "D. Local Treatment + RIG + Vaccine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Exposure Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Touching or <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> animals</li>\n<li>Licking of intact skin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ensure proper hygiene</li>\n<li>No treatment required</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nibbling on uncovered skin</li>\n<li>Minor <span class=\"customMeta\" data-dictid=\"5ca3a9c7051692777198d5bd67dd6c\">scratches</span> or abrasions without bleeding</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate wound <span class=\"customMeta\" data-dictid=\"c846a3af9016927772026af6f9b6db\">washing</span> with soap and water</li>\n</ul>\n<p><strong>Rabies vaccination:</strong></p>\n<ul>\n<li>Unvaccinated: Days 0, 3, 7, and 14</li>\n<li>Previously vaccinated: <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">Booster</span> doses on Days 0 and 3</li>\n<li>No <span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\">Rabies</span> <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">Immunoglobulin</span> (RIG) required</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Bites or <span class=\"customMeta\" data-dictid=\"5ca3a9c7051692777198d5bd67dd6c\">scratches</span> with bleeding</strong></li>\n<li>Licks on broken skin</li>\n<li>Exposure to <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes (mouth, eyes, nose)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immediate wound <span class=\"customMeta\" data-dictid=\"c846a3af9016927772026af6f9b6db\">washing</span> with soap and water, <span class=\"customMeta\" data-dictid=\"919f290c4f1692777203469825e662\">flush</span> for at least 15 minutes.</strong></li>\n<li><strong>Suture: </strong>Do not <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> the wound immediately, as it may spread the virus, instead delay it for 24 to 48 hours.</li>\n<li><strong>Rabies vaccination</strong><strong>:</strong>\n<ul>\n<li><strong>Unvaccinated: </strong>Full <span class=\"customMeta\" data-dictid=\"624ee3cb8d1692777195f4dce9b626\">PEP</span> series on Days 0, 3, 7, and 14</li>\n<li><strong>Previously vaccinated:</strong> <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">Booster</span> doses on Days 0 and 3</li>\n</ul>\n</li>\n<li><strong>Rabies <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">Immunoglobulin</span> (RIG):</strong>\n<ul>\n<li><strong>Equine <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> or ERIG</strong></li>\n<li><strong>Human <span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\">rabies</span> <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">Immunoglobulin</span> or HRIG </strong>\n<ul>\n<li>Preferred (free from the danger of sensitisation, <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> and <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> viruses)</li>\n<li>Dose: – 40 IU / kg IM</li>\n<li>Started on Day 0 along with <span class=\"customMeta\" data-dictid=\"f23be6aa561692777201ca2e1aaa27\">vaccination</span> (can be given up to 7 days).</li>\n<li>70% is given around the wound and, the rest is given distant from the wound.</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n<p>Required for unvaccinated individuals</p>\n<p>Not needed for previously vaccinated individuals</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely cause of lower right abdominal pain and rebound tenderness in a patient with Meckel's diverticulum?", "options": [{"label": "A", "text": "Perforation", "correct": false}, {"label": "B", "text": "Intestinal obstruction", "correct": false}, {"label": "C", "text": "Appendicitis", "correct": true}, {"label": "D", "text": "Cholecystitis", "correct": false}], "correct_answer": "C. Appendicitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An image of the mascot is shown below. Identify the related national health.", "options": [{"label": "A", "text": "National Leprosy eradication programme", "correct": true}, {"label": "B", "text": "National Tuberculosis Elimination Programme", "correct": false}, {"label": "C", "text": "National Anti-Malaria Programme", "correct": false}, {"label": "D", "text": "National Polio Surveillance Program", "correct": false}], "correct_answer": "A. National Leprosy eradication programme", "question_images": ["https://image.prepladder.com/content/nH0jHws3RlqTyzFjOjF11741109603.png"], "explanation_images": ["https://image.prepladder.com/content/uOxfxsMhOKubBlKkd0YT1741109650.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:548px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Level of Prevention</strong></p>\n<ul>\n<li>Health Education</li>\n<li>SPARSH program uses a cartoon girl known as Sapna who is in a village <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> awareness on Leprosy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Level of Prevention</strong></p>\n<ul>\n<li>Early diagnosis and treatment</li>\n<li>ASHA does detection</li>\n<li>ASHA gets cash incentives</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tertiary Prevention</strong></p>\n<ul>\n<li>Treatment of <span class=\"customMeta\" data-dictid=\"d4c88fcae71692777186aa1c32423a\">drug-resistant</span> leprosy</li>\n<li>Disability limitation and rehabilitation</li>\n<li>Reconstructive surgeries for deformities</li>\n<li>Crutches to walk</li>\n<li>Microcellular rubber footwear</li>\n<li>Self-care kits</li>\n</ul>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/uOxfxsMhOKubBlKkd0YT1741109650.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:324px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dose of <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> as <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> (single dose):</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 15 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>600 mg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-14 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>450 mg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-9 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300 mg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Children &lt;20 kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-15 mg/kg</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with features of short stature, muscle weakness, and learning disability. Chromosome analysis reveals a deletion on the short arm of chromosome 15p on the paternal side. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Angelman syndrome", "correct": false}, {"label": "B", "text": "Prader-Willi syndrome", "correct": true}, {"label": "C", "text": "Cri du chat syndrome", "correct": false}, {"label": "D", "text": "Rett syndrome", "correct": false}], "correct_answer": "B. Prader-Willi syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Spread of prostate cancer to lumbar vertebra is via?", "options": [{"label": "A", "text": "Arterial spread", "correct": false}, {"label": "B", "text": "Local spread", "correct": false}, {"label": "C", "text": "Lymphatic spread", "correct": false}, {"label": "D", "text": "Venous spread", "correct": true}], "correct_answer": "D. Venous spread", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Route</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism &amp; Common Sites</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct extension into the <strong>seminal vesicles, bladder, or rectum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obturator, internal &amp; external <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> nodes</strong> are commonly involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematogenous spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Via <strong>Batson’s <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> → <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> vertebrae, pelvis, femur, ribs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, usually occurs <strong>late</strong> in disease progression</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following changes occurs during muscle contraction while exercising?", "options": [{"label": "A", "text": "M length increase", "correct": false}, {"label": "B", "text": "A length decrease", "correct": false}, {"label": "C", "text": "I length decrease", "correct": true}, {"label": "D", "text": "M length increase and I decrease", "correct": false}], "correct_answer": "C. I length decrease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JycTELSNfpPgLWRewaIm1741085943.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are protected by OCPs except?", "options": [{"label": "A", "text": "Carcinoma breast", "correct": true}, {"label": "B", "text": "Carcinoma endometrium", "correct": false}, {"label": "C", "text": "Colonic cancer", "correct": false}, {"label": "D", "text": "Ovarian cancer", "correct": false}], "correct_answer": "A. Carcinoma breast", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adverse Effects of Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pills (OCPs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications of Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pills (OCPs)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiovascular Effects (due to <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> content)</strong></p>\n<ul>\n<li>Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (MI)</li>\n<li>Cerebral <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> - Stroke</li>\n<li>Risk increases with age &gt;35 and cigarette smoking.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Carcinogenesis</strong></p>\n<ul>\n<li>Increased risk of <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> cancer</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Metabolic Effects (due to <span class=\"customMeta\" data-dictid=\"183d374ac91692777196c63c850299\">progesterone</span> content)</strong></p>\n<ul>\n<li>Elevated blood pressure</li>\n<li>Altered <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> levels</li>\n<li>Interference with blood clotting</li>\n<li>Interference with carbohydrate metabolism</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Thromboembolic Events</strong></p>\n<ul>\n<li>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> (DVT)</li>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (PE)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Others</strong></p>\n<ul>\n<li>Lactation: <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">Reduced</span> quantity and quality of breast milk</li>\n<li>Weight gain</li>\n<li>Migraine</li>\n<li>Breast tenderness</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Contraindications:</strong></p>\n<ul>\n<li>Cancer of the breast and genitals</li>\n<li>Liver disease</li>\n<li>Previous or present history of thromboembolism</li>\n<li>Cardiac abnormalities</li>\n<li>Congenital hyperlipidaemia</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Relative Contraindications (requiring medical surveillance):</strong></p>\n<ul>\n<li>Age over 40 years</li>\n<li>Smoking and age over 35 years</li>\n<li>Mild hypertension</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease</li>\n<li>Migraine</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old person presented with an ulcer on the medial canthus. The ulcer has rolled-out, beaded margins. Histopathology shows nesting cells with peripheral palisading patterns. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Squamous Cell Carcinoma (SCC)", "correct": false}, {"label": "B", "text": "Nevus", "correct": false}, {"label": "C", "text": "Basal Cell Carcinoma (BCC)", "correct": true}, {"label": "D", "text": "Melanoma", "correct": false}], "correct_answer": "C. Basal Cell Carcinoma (BCC)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After how long is a patient advised to use alternative contraception following a vasectomy?", "options": [{"label": "A", "text": "1 month", "correct": false}, {"label": "B", "text": "2 months", "correct": false}, {"label": "C", "text": "3 months", "correct": true}, {"label": "D", "text": "6 months", "correct": false}], "correct_answer": "C. 3 months", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman with forceps delivery 24 hours ago presents with pain in the perineum. Her BP is 80/60 and on examination, there is a swelling with bluish discolouration. Which of the following steps are advised not to do?", "options": [{"label": "A", "text": "Repair the wound in the ward", "correct": true}, {"label": "B", "text": "Give Blood Transfusion", "correct": false}, {"label": "C", "text": "Shift patient to OT", "correct": false}, {"label": "D", "text": "Inform senior about her", "correct": false}], "correct_answer": "A. Repair the wound in the ward", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male presents with left leg swelling and pain for 5 days and has a positive D-dimer test. Duplex ultrasonography confirms an extensive DVT involving the left popliteal and femoral veins. Which of the following is the most appropriate initial management strategy?", "options": [{"label": "A", "text": "Unfractionated heparin followed by warfarin", "correct": false}, {"label": "B", "text": "LMWH followed by oral anticoagulant", "correct": true}, {"label": "C", "text": "Catheter-directed thrombolysis", "correct": false}, {"label": "D", "text": "IVC filter placement", "correct": false}], "correct_answer": "B. LMWH followed by oral anticoagulant", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> with Duplex scanning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive; detects <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> by impaired <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and inability to <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> veins.</p>\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"91b98150ea169277718629280d911c\">echogenic</span> material completely <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> of vein</li>\n<li>Absence of compressibility</li>\n<li>Absence of blood flow</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venogram </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Accurate for detecting and locating <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> and differentiating <span class=\"customMeta\" data-dictid=\"3cd09dcb0e1692777194e41a18d184\">occlusive</span> and non-occlusive <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> but less commonly used due to invasiveness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impedance Plethysmography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures changes in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> volume and flow using a cuff. Less useful for calf <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> and previous thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrin and <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">Fibrinogen</span> Assays</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> products, including D-dimer.</p>\n<p>D-dimer has a high negative predictive value.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radioactive <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">Fibrinogen</span> Study</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses <span class=\"customMeta\" data-dictid=\"7cd1a840a2169277719756692d362d\">radiolabeled</span> <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">fibrinogen</span> to detect thrombus. Less commonly used.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRVI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive; Useful for <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> veins and IVC.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcutaneous LMWH: Rapidly anticoagulate confirmed <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> cases.</li>\n<li>Intravenous Unfractionated Heparin: For patients with significant <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment.</li>\n<li>Fondaparinux or Bivalirudin: Alternatives for those with <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">heparin</span> sensitivity or heparin-induced thrombocytopenia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transition to Oral Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duration: At least 3 months or longer based on risk factors or recurrence.</li>\n<li>Novel anticoagulants (NOACs): Rivaroxaban, <span class=\"customMeta\" data-dictid=\"bd0e99d93a169277718152523f2534\">Apixaban</span> (factor Xa inhibitors), Dabigatran (direct <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> inhibitor).</li>\n<li>Vitamin K Antagonists: <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">Warfarin</span> (alternative to NOACs).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Heparin: <span class=\"customMeta\" data-dictid=\"0f61fd74c41692777180190320f12e\">Activated partial <span class=\"customMeta\" data-dictid=\"9b51982d06169277720063c9420fbb\">thromboplastin</span> time</span> (APTT).</li>\n<li>Warfarin: INR maintained between 2.0 to 3.0.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For Patients with contraindications to Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temporary <span class=\"customMeta\" data-dictid=\"b1fef54dba1692777190ee3669e3e0\">IVC</span> Filter:</strong> Consider if <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk prevents <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> or to prevent <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism. It does not treat the existing <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> and is associated with long-term complications. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endovascular Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thrombus removal, lysis, and stenting.</li>\n<li>Beneficial in selected patients, especially those with <span class=\"customMeta\" data-dictid=\"dae3263b2716927771896cfc9f45c8\">iliofemoral</span> thrombosis, to reduce risk of chronic post-thrombotic syndrome.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following health programmes supports DANIDA?", "options": [{"label": "A", "text": "TB", "correct": false}, {"label": "B", "text": "Blindness", "correct": true}, {"label": "C", "text": "Malaria", "correct": false}, {"label": "D", "text": "HIV", "correct": false}], "correct_answer": "B. Blindness", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vEmUAF8RSjdRqIvv4yz21741075539.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:595px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Agencies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Headquarters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Services in India</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>United States Agency for International Development (USAID)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><em>Washington</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malaria eradication</li>\n<li>Medical and <span class=\"customMeta\" data-dictid=\"6f686e0c91169277719346f95361c8\">nursing</span> education</li>\n<li>Health education</li>\n<li>Water supply and sanitation</li>\n<li>Nutrition and Family Planning</li>\n<li>Control of <span class=\"customMeta\" data-dictid=\"6f6ef8bf7c1692777184dfdf8cf45d\">Communicable</span> Diseases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Swedish International Development Agency (SIDA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><em>Sweden</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assisting the National TB Control Program</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Danish International Development Agency (DANIDA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><em>Denmark</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assisting the National <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">Blindness</span> Control Programme.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a long-standing history of diabetes presents with cataracts. Which of the following metabolic products is primarily responsible for cataract formation in this condition?", "options": [{"label": "A", "text": "Mannitol", "correct": false}, {"label": "B", "text": "Galactitol", "correct": false}, {"label": "C", "text": "Sorbitol", "correct": true}, {"label": "D", "text": "Fructose", "correct": false}], "correct_answer": "C. Sorbitol", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ys19euRMGOTRwz9l6vlj1741021676.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A married female died in unnatural condition within 3 years of marriage. Her father filed a report to police and inquiry will be done under which section?", "options": [{"label": "A", "text": "194 BNSS/174 CrPC", "correct": false}, {"label": "B", "text": "196 BNSS/176 CrPC", "correct": true}, {"label": "C", "text": "116 BNS &amp;amp; 194 BNSS", "correct": false}, {"label": "D", "text": "106 BNS &amp;amp; 194 BNSS", "correct": false}], "correct_answer": "B. 196 BNSS/176 CrPC", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Police Inquest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magistrate Inquest</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conducted by</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Police officer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Magistrate (DM, SDM, Judicial, or Executive Magistrate)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Involvement of witnesses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires signatures of panchas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Does not require witness signatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Witness statements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Admissible in court</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not admissible in court</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Can order arrest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No, but can arrest in cognizable offenses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can issue arrest warrants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exhumation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cannot order exhumation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can order <span class=\"customMeta\" data-dictid=\"9ede3648ef1692777187540bde750b\">exhumation</span> of a body</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autopsy orders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sends bodies for <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> indiscriminately</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Orders <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> only when necessary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Forensic analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cannot order chemical analysis of viscera</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can order chemical analysis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 9-month-old child was admitted to ICU with a history of recurrent sinusitis and otitis media by Staphylococcus aureus. Blood test shows decreased serum IgA, IgG, IgM, IgE, and plasma B cells. What is the diagnosis?", "options": [{"label": "A", "text": "Ataxia telangiectasia", "correct": false}, {"label": "B", "text": "Chronic granulomatosis disease", "correct": false}, {"label": "C", "text": "Bruton syndrome", "correct": true}, {"label": "D", "text": "DiGeorge syndrome", "correct": false}], "correct_answer": "C. Bruton syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A group of students consumed fried rice in a restaurant. Six hours later, they start vomiting. What is the etiological agent?", "options": [{"label": "A", "text": "Bacillus cereus", "correct": true}, {"label": "B", "text": "Clostridium botulinum", "correct": false}, {"label": "C", "text": "Escherichia coli", "correct": false}, {"label": "D", "text": "Shigella dysentriae", "correct": false}], "correct_answer": "A. Bacillus cereus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Food Poisoning</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li><strong>Two distinct forms: diarrhoeal and emetic</strong>.</li>\n<li><strong>Diarrhoeal form:</strong> <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">Linked</span> to contaminated meat, poultry, vegetables, and pasta; symptoms appear 8-16 hours post-ingestion.</li>\n<li>Symptoms: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain, diarrhoea (vomiting less common, fever rare)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li><strong>Emetic form</strong><strong>:</strong> Associated with cooked rice, especially <strong>fried rice</strong>; <strong>nausea and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> within 1-6 hours. </strong></li>\n<li>Some cases may include diarrhoea</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Other Infections</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li><strong>Opportunistic infections:</strong> <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">Ocular</span> infections, meningitis, septicemia, endocarditis, osteomyelitis</li>\n</ul>\n<ul>\n<li>More common in <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> individuals, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> drug users, neonates, and post-surgical patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:646px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Food Poisoning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Culture of implicated food essential.</li>\n<li>&gt;10<sup>5</sup> B. cereus cells per <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> confirms the diagnosis.</li>\n<li>Quantitative <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> cultures with at least 10<sup>5</sup> cells per <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> support diagnosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Culture Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Aerobic growth at 37°C on sheep blood agar.</li>\n<li>β-hemolytic colonies with frosted glass appearance.</li>\n<li>Motile, lecithinase positive, fermenting salicin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Selective Media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>MYPA aids in isolating B. cereus from faeces and other sources</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Spore-forming, <span class=\"customMeta\" data-dictid=\"c72cd5f69316927771883c73649d86\">Gram-positive</span> bacilli.</li>\n<li>Motile</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Under IDSP, which diseases are included under sentinel surveillance?", "options": [{"label": "A", "text": "HIV + HBV", "correct": true}, {"label": "B", "text": "HIV + TB", "correct": false}, {"label": "C", "text": "Malaria + Dengue", "correct": false}, {"label": "D", "text": "Measles + Diphtheria", "correct": false}], "correct_answer": "A. HIV + HBV", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During spermatogenesis, which of the following hormones inhibits Follicle-Stimulating Hormone (FSH) secretion?", "options": [{"label": "A", "text": "Testosterone", "correct": false}, {"label": "B", "text": "Inhibin", "correct": true}, {"label": "C", "text": "Luteinizing Hormone (LH)", "correct": false}, {"label": "D", "text": "Androgen", "correct": false}], "correct_answer": "B. Inhibin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a class of 100 students, 80% students were immunised with measles, 12 were affected. What is the secondary attack rate?", "options": [{"label": "A", "text": "60%", "correct": true}, {"label": "B", "text": "80%", "correct": false}, {"label": "C", "text": "70%", "correct": false}, {"label": "D", "text": "50%", "correct": false}], "correct_answer": "A. 60%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young female has episodes of binge eating followed by self-induced vomiting. Which of the following acid- base disturbace is she likely to have?", "options": [{"label": "A", "text": "Respiratory acidosis", "correct": false}, {"label": "B", "text": "Respiratory alkalosis", "correct": false}, {"label": "C", "text": "Metabolic acidosis", "correct": false}, {"label": "D", "text": "Metabolic alkalosis", "correct": true}], "correct_answer": "D. Metabolic alkalosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kvgXPbwHX6BSIqD70Hex1741030324.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Binge Eating Episodes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Recurring episodes of <span class=\"customMeta\" data-dictid=\"45c64c16b516927771832de6bd0523\">binge</span> eating, occurring at least weekly for the last 3 months.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Compensatory Behaviors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Purging behaviors (self-induced vomiting, <span class=\"customMeta\" data-dictid=\"452c3c115d169277719186b3353c18\">laxative</span> abuse, diuretics), excessive exercise.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>BMI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Often normal or slightly <span class=\"customMeta\" data-dictid=\"e01b899fb61692777194fb4270ce6f\">overweight</span> (compared to <span class=\"customMeta\" data-dictid=\"8deb4a7e2b1692777181c91be40ed9\">anorexia</span> nervosa).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Physical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Parotid <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> (may see increased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> amylase)</li>\n<li style=\"text-align: center;\">Enamel <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> (from vomiting)</li>\n<li style=\"text-align: center;\">Mallory-Weiss syndrome (esophageal tears)</li>\n</ul>\n<p style=\"text-align: center;\">These signs appear due to repeated purging.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Electrolyte Disturbances</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Commonly <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> and hypochloremia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Metabolic Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\"><strong>Metabolic alkalosis</strong> due to vomiting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Physical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Dorsal hand calluses from <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (Russell sign).</li>\n</ul>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"251\" src=\"https://image.prepladder.com/content/kvgXPbwHX6BSIqD70Hex1741030324.png\" width=\"296\"/></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old unvaccinated child presents with fever, rash, and Bitot spots. What is the appropriate line of management?", "options": [{"label": "A", "text": "Measles Vaccine + Vitamin A Supplementation", "correct": false}, {"label": "B", "text": "Only Measles Vaccine", "correct": false}, {"label": "C", "text": "Only Vitamin A Supplementation", "correct": true}, {"label": "D", "text": "Supportive Care", "correct": false}], "correct_answer": "C. Only Vitamin A Supplementation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FX1w2vvuC1ioCwcEPxwE1741089321.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:703px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Measles</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ssRNA paramyxovirus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>10 days from exposure to onset of fever and 14 days to the appearance of rash</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Source of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Person with measles</li>\n<li>Infective material</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Period of communicability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>4 days before and 4 days after the appearance of rash</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prodromal stage</strong>:</p>\n<ul>\n<li>Fever</li>\n<li>Cough</li>\n<li>Coryza with sneezing</li>\n<li>Conjunctivitis with lacrimation</li>\n<li><strong>Koplik’s spots-</strong><em> </em>grayish-white spots on the <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">buccal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (<strong>Pathognomonic</strong> feature)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Eruptive stage</strong>:</p>\n<ul>\n<li>Dusky red macular/maculopapular rash, which starts behind the ears and progresses to the face, neck and then to trunks and limbs.</li>\n<li>In the absence of complications, the lesions and fever disappear after 3-4 days.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Post <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> stage:</strong></p>\n<ul>\n<li>After the <span class=\"customMeta\" data-dictid=\"8d4614c31316927771874f34d090a9\">eruptive</span> stage, it leads to weight loss, weakness, fatigue, diarrhea.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isolation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>7 days from the onset of rash</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Difference between <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> and <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Both rashes are maculopapular</li>\n<li>The <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> is more <span class=\"customMeta\" data-dictid=\"8793eea96e169277718446e2ea701a\">confluent</span> and botchy, whereas the <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> is <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> or non-confluent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinically diagnosed based on <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> and koplik’s spots</li>\n<li>Gold standard: PCR</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No specific treatment</li>\n<li>Symptomatic management only</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with rheumatoid arthritis is taking indomethacin and an ACE inhibitor for hypertension. What potential side effect is likely to be seen?", "options": [{"label": "A", "text": "Hyperkalemia", "correct": true}, {"label": "B", "text": "Hypercalcemia", "correct": false}, {"label": "C", "text": "Hypernatremia", "correct": false}, {"label": "D", "text": "Hyperphosphatemia", "correct": false}], "correct_answer": "A. Hyperkalemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug Interaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Implication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors + <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> Supplements/K-sparing diuretics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk of <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> by <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors combined with potassium-retaining agents.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monitoring <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels is crucial to avoid hyperkalemia, which can cause serious <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> issues such as arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors + NSAIDs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NSAIDs can reduce the anti-hypertensive effects of <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors and decrease <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> blood flow, increasing the risk of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure (ARF) or oliguria.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Use caution when combining NSAIDs with <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors, and closely monitor <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, particularly in high-risk patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors + Lithium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ACE inhibitors can increase the <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of lithium, potentially leading to <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> toxicity.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monitor <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> levels carefully when starting or adjusting <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors in patients taking lithium, and adjust the <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">dosage</span> as needed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors + Antacids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"cf91922bb816927771839a51f2d1e6\">bioavailability</span> of <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors due to binding with antacids.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Administer <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors at least two hours before or after antacids to maintain their efficacy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors + Diuretics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diuretics enhance the <span class=\"customMeta\" data-dictid=\"bf6247405e16927771891b6a068d36\">hypotensive</span> effects of <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors by depleting sodium and raising <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> levels.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In patients already on diuretics, start <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors at a low dose to minimise the risk of excessive <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> reduction initially.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male presents to the emergency department with a strong urge to urinate but is unable to do so. He has a history of perineal trauma. On examination, blood is noted at the external urethral meatus. Which structure is most likely injured?", "options": [{"label": "A", "text": "Bulbar urethra", "correct": true}, {"label": "B", "text": "Posterior urethral valve", "correct": false}, {"label": "C", "text": "Intraperitoneal Bladder rupture", "correct": false}, {"label": "D", "text": "Membranous urethra", "correct": false}], "correct_answer": "A. Bulbar urethra", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urethral Segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (Anterior)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Straddle injuries, <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> trauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood at meatus, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention, <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> hematoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (Posterior)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pelvic fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-riding prostate, inability to pass urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraperitoneal <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Rupture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blunt <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> trauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peritonitis, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> ascites</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Urethral Valve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital anomaly</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent UTIs, voiding difficulty</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old met with a bike accident and presented with the following finding. What is the diagnosis?", "options": [{"label": "A", "text": "Anterior hip dislocation", "correct": true}, {"label": "B", "text": "Posterior hip dislocation", "correct": false}, {"label": "C", "text": "Superior hip dislocation", "correct": false}, {"label": "D", "text": "Both a and b", "correct": false}], "correct_answer": "A. Anterior hip dislocation", "question_images": ["https://image.prepladder.com/content/33ECoaZhkud2FQ6XdDK91741087423.png"], "explanation_images": ["https://image.prepladder.com/content/NPQCcxl5hsgf8CLUAAOZ1741087485.png", "https://image.prepladder.com/content/33ECoaZhkud2FQ6XdDK91741087423.png", "https://image.prepladder.com/content/PAfjIQCWLjvM8sCHv51z1741059939.png", "https://image.prepladder.com/content/YdT8KH1yLO0TmyRgGSH71741059974.png", "https://image.prepladder.com/content/JXtWOXe0wpraZRzwbvFD1741060016.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:722px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"1954a47dd6169277720351aed9c4c0\">fracture-dislocation</span> of hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Mechanism of injury:</strong><br/>\n\t\t\t </p>\n<p>Caused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>Femoral head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Femoral head displaced from the acetabulum.</li>\n<li>The thigh is internally rotated, the <span class=\"customMeta\" data-dictid=\"0404f7b31816927771912f2b470952\">lesser trochanter</span> is not seen, and Shenton’s line is broken.</li>\n<li>May require a <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> for associated fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening </strong><strong>of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"705\" src=\"https://image.prepladder.com/content/NPQCcxl5hsgf8CLUAAOZ1741087485.png\" width=\"732\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p style=\";\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"627\" src=\"https://image.prepladder.com/content/33ECoaZhkud2FQ6XdDK91741087423.png\" width=\"1889\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"402\" src=\"https://image.prepladder.com/content/PAfjIQCWLjvM8sCHv51z1741059939.png\" width=\"276\"/>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"386\" src=\"https://image.prepladder.com/content/YdT8KH1yLO0TmyRgGSH71741059974.png\" width=\"237\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"378\" src=\"https://image.prepladder.com/content/JXtWOXe0wpraZRzwbvFD1741060016.png\" width=\"302\"/>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A forensic expert received a summons from the district court to record his evidence in a criminal case, but two days prior, he already received a summons for a civil case in the same district court for the same date. What should the doctor do?", "options": [{"label": "A", "text": "Inform both courts and wait.", "correct": false}, {"label": "B", "text": "Attend the court for which the summons came first.", "correct": false}, {"label": "C", "text": "Attend the court for the criminal case.", "correct": true}, {"label": "D", "text": "Do not attend either court.", "correct": false}], "correct_answer": "C. Attend the court for the criminal case.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the afferent limb of the corneal reflex?", "options": [{"label": "A", "text": "Optic nerve", "correct": false}, {"label": "B", "text": "Facial nerve", "correct": false}, {"label": "C", "text": "Trigeminal nerve", "correct": true}, {"label": "D", "text": "Trochlear nerve", "correct": false}], "correct_answer": "C. Trigeminal nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Afferent Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Efferent Nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Accommodation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>II (Optic nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>III (Oculomotor nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Corneal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₁ (Ophthalmic, <span class=\"customMeta\" data-dictid=\"cdd6d30ff216927771933bc53be84b\">nasociliary</span> branch)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bilateral VII (Facial nerve, <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> branch - orbicularis oculi)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cough</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve, also <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">phrenic</span> and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerves)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gag</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IX (Glossopharyngeal nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Jaw Jerk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₃ (Mandibular branch, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> from masseter)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₃ (Mandibular branch, motor to masseter)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lacrimation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₁ (Ophthalmic branch) (loss of <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> does not preclude emotional tears)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>VII (Facial nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pupillary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>II (Optic nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>III (Oculomotor nerve)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is correct regarding indirect ophthalmoscopy?", "options": [{"label": "A", "text": "The image is erect and real.", "correct": false}, {"label": "B", "text": "The condenser lens needs to be kept close to the eye.", "correct": false}, {"label": "C", "text": "It provides 15x magnification.", "correct": false}, {"label": "D", "text": "It provides 3-5x magnification.", "correct": true}], "correct_answer": "D. It provides 3-5x magnification.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xaFsHF03IYHMQsLkoT8s1741023721.png", "https://image.prepladder.com/content/y5lmzjZP1vA2Qbty0MYk1741023727.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Direct Ophthalmoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indirect Ophthalmoscopy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image of <span class=\"customMeta\" data-dictid=\"415c59955f16927771947b9c105bbf\">ophthalmoscope</span> </strong></p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/xaFsHF03IYHMQsLkoT8s1741023721.png\" width=\"629\"/></td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1480\" src=\"https://image.prepladder.com/content/y5lmzjZP1vA2Qbty0MYk1741023727.png\" width=\"1600\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Erect, virtual</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Real, inverted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>About 15x (more in myopes, less in hypermetropes)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>About 2.5x with a +20D lens, smaller with stronger lenses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Field of View</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited, detailed central <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> examination</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Larger field of view</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Routine <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Essential for assessing <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> lesions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prerequisites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Semi-darkroom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Darkroom, dilated pupils, <span class=\"customMeta\" data-dictid=\"00ab88c6091692777185ea2685fa40\">convex</span> lens (+20D), <span class=\"customMeta\" data-dictid=\"eadd1d717a16927771833964224058\">binocular</span> ophthalmoscope</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient’s laboratory results were positive for malarial antigen, and the Widal test findings were as follows: O ag &amp;gt;1:300, H ag &amp;gt;1:20, A &amp;gt;1:20, B &amp;gt;1:20. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Recent infection by Salmonella spp", "correct": true}, {"label": "B", "text": "Patient has taken TAB vaccine", "correct": false}, {"label": "C", "text": "Past infection", "correct": false}, {"label": "D", "text": "Reconvalescence", "correct": false}], "correct_answer": "A. Recent infection by Salmonella spp", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:564px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Widal Test Result</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Suggestive of</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rise of TO and TH antibody</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enteric fever due to S. Typhi</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rise of TO and AH antibody</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enteric fever due to S. Paratyphi A</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rise of TO and BH antibody</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enteric fever due to S. Paratyphi B</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rise of only TO antibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recent infection due to S. Typhi or S. Paratyphi A or B</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rise of only TH antibody</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Convalescent stage / <span class=\"customMeta\" data-dictid=\"c57ee8d25f1692777181b1645ee4ef\">Anamnestic</span> response</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rise of all TH, AH, BH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-TAB <span class=\"customMeta\" data-dictid=\"f23be6aa561692777201ca2e1aaa27\">vaccination</span> antibodies (Option B)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man with a psychiatric disorder has become very aggressive. He speaks very rapidly and sleeps very little. He exhibits hyperactive behavior after discontinuing his prescribed medication. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Depression", "correct": false}, {"label": "B", "text": "Bipolar disorder - manic episode", "correct": true}, {"label": "C", "text": "Schizophrenia", "correct": false}, {"label": "D", "text": "Substance- induced mood disorder", "correct": false}], "correct_answer": "B. Bipolar disorder - manic episode", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bipolar I Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bipolar II Disorder</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by at least<strong> 1 episode of mania</strong> and<strong> 1 episode of depression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by at least <strong>1 episode of hypomania</strong> and<strong> 1 episode of depression</strong><strong> (Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M=F</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>F&gt;M</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mean age of onset is 30yrs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mean age of onset is slightly higher</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:264px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic criteria for Mania</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>M</strong>ood Changes: Elation/ irritability</li>\n</ul>\n<p>+ ≥3 of the following symptoms (4 if <span class=\"customMeta\" data-dictid=\"31383b73d01692777190c6880a580b\">irritable</span> mood) for at least <strong>1 week</strong>:</p>\n<ul>\n<li><strong>D</strong>istractibility.</li>\n<li><strong>I</strong>mpulsivity/ high-risk activities</li>\n</ul>\n<ul>\n<li><strong>G</strong>randiosity/ Inflated Self-Esteem</li>\n<li><strong>F</strong>light of Ideas (Racing and expansive thoughts)</li>\n<li><strong>A</strong>ctivity increased (Hyperactivity)</li>\n<li><strong>S</strong>leep deficit (decreased need for sleep)</li>\n<li><strong>T</strong>alkativeness/ Pressured speech</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presents with a painful red granular lesion on the vulva accompanied by bilateral lymphadenopathy. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Chancroid", "correct": true}, {"label": "B", "text": "Neisseria Gonorrhoeae Infection", "correct": false}, {"label": "C", "text": "Granuloma Inguinale", "correct": false}, {"label": "D", "text": "Lymphogranuloma Venereum", "correct": false}], "correct_answer": "A. Chancroid", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Chancroid</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Causative organism</strong></td>\n<td><em>Haemophilus ducreyi</em></td>\n</tr>\n<tr>\n<td><strong>Incubation period</strong></td>\n<td>3–10 days</td>\n</tr>\n<tr>\n<td><strong>Ulcer</strong></td>\n<td><strong>Painful</strong>, non-indurated, soft <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> borders and <strong>granular base</strong></td>\n</tr>\n<tr>\n<td><strong>Number of ulcers</strong></td>\n<td>Often <strong>multiple</strong></td>\n</tr>\n<tr>\n<td><strong>Lymphadenopathy</strong></td>\n<td><strong>Painful</strong>, <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> or bilateral, may <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> <strong>buboes</strong> (fluctuant <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes)</td>\n</tr>\n<tr>\n<td><strong>Base of ulcer</strong></td>\n<td>Necrotic, purulent, bleeds on contact</td>\n</tr>\n<tr>\n<td><strong>Tenderness</strong></td>\n<td>Marked</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A villager was assaulted by 4-5 people &amp;amp; brought to hospital in serious condition. His dying declaration was being taken in hospital. What is correct regarding this process?", "options": [{"label": "A", "text": "Magistrate can record the statement", "correct": true}, {"label": "B", "text": "Doctor can record the statement", "correct": false}, {"label": "C", "text": "Leading questions can be asked", "correct": false}, {"label": "D", "text": "Oath is compulsory before recording the statement", "correct": false}], "correct_answer": "A. Magistrate can record the statement", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:733px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Dying Declaration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Dying Deposition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Recorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Anyone—Magistrate/doctor/village headman/police/any member of the public</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Always recorded by a Magistrate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Oath </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not required</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Must be taken</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Accused or his counsel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not present</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Always present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Cross-examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not done</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Done</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Legal value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Comparatively less</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Much more</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Admissibility if declarant survives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not admitted, but has corroborative value</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Fully admitted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Nature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Merely recording of statement</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Complete court procedure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Type of evidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Documentary</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Status in India</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Followed</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not followed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Leading Qs </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not Permitted</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Permitted</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a history of dysphagia, which is more pronounced for liquids than solids. Which radiological sign is most likely to be seen?", "options": [{"label": "A", "text": "Rat-tail sign", "correct": true}, {"label": "B", "text": "Filling defect", "correct": false}, {"label": "C", "text": "Corkscrew esophagus", "correct": false}, {"label": "D", "text": "Apple-core lesion", "correct": false}], "correct_answer": "A. Rat-tail sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/R6MgHinwvVI8otCHzJqs1741088479.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rat-tail sign</strong> (Correct Answer)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Achalasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smooth tapering of the <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> at the LES</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Filling defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal tumors, strictures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irregular <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"55052c0f0616927771829c99eec183\">barium</span> column</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corkscrew esophagus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> (DES)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple non-peristaltic contractions creating a \"corkscrew\" pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Apple-core lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal or <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Constricted <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> edges, resembling an apple core</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common causative organism of prosthetic heart valve endocarditis?", "options": [{"label": "A", "text": "S. viridans", "correct": false}, {"label": "B", "text": "S. aureus", "correct": false}, {"label": "C", "text": "S. epidermidis", "correct": true}, {"label": "D", "text": "Staphylococcus", "correct": false}], "correct_answer": "C. S. epidermidis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a routine pediatric check-up, a mother brings her 5 month old baby to the clinic. The pediatrician observes that the baby actively looks at his mother’s face and seems to respond with interest as she talks to him, showing recognition and engagement. When is this milestone normally achieved?", "options": [{"label": "A", "text": "2 months", "correct": false}, {"label": "B", "text": "3 months", "correct": true}, {"label": "C", "text": "6 months", "correct": false}, {"label": "D", "text": "9 months", "correct": false}], "correct_answer": "B. 3 months", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Developmental Milestones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gross Motor Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fine Motor Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Social Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Language Milestones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 month</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alerts to sounds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Social smile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neck holding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recognises mother, anticipates feed <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cooing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Laugh Loud</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rolls over</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bidextrous reach</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sits in <span class=\"customMeta\" data-dictid=\"83962896b5169277720032c8e8bd50\">tripod</span> position</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unidextrous reach</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recognize strangers, stranger anxiety</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monosyllables</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sits without support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stands with support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immature pincer grasp</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Waves bye bye</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bisyllables</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Creeps well, stands without support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mature pincer grasp</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comes when called, plays simple ball game</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 to 2 words with meaning</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Walks alone , creeps upstairs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imitates scribbling, tower of 2 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jargon speech</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs, explores drawers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scribbles, tower of 3 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copies parents in task</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8 to 10 words vocabulary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Walks up and downstairs (2 <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> per step), jumps</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tower of 6 blocks, vertical and <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> stroke</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asks for food, drink, toilet, pulls people to show toys</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 to 3 word sentences</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rides tricycle, <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> going upstairs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tower of 9 blocks, copies circle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shares toys, knows full name and gender</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asks questions, tells name and gender</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hops on one foot, <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> going downstairs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copies cross, bridge with blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Plays cooperatively in a group, goes to toilet alone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Says song or poem, tells stories</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copies triangle, gate with blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps in household tasks, dresses and undresses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asks meaning of words</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 160 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "In a follow-up case of prostate cancer, what do we need to check?", "options": [{"label": "A", "text": "Alkaline phosphatase", "correct": false}, {"label": "B", "text": "PSA", "correct": true}, {"label": "C", "text": "Testosterone", "correct": false}, {"label": "D", "text": "Acid phosphatase", "correct": false}], "correct_answer": "B. PSA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance in <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">Prostate</span> Cancer Follow-Up</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PSA (Prostate-Specific Antigen)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most important marker; rising levels indicate <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> or metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaline <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">Phosphatase</span> (ALP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marker for <strong>bone metastases</strong>, but not routinely used for follow-up</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acid <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">Phosphatase</span> (PAP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Older marker, now largely replaced by PSA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Testosterone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Checked in hormone-sensitive cases on ADT to confirm <strong>castrate levels</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person's father had colon cancer. He had bloody stool. So,he just came for a check-up. Before he had not undergone any screening. He was recommended to do a colonoscopy for screening. Screening is which level of prevention?", "options": [{"label": "A", "text": "Primordial", "correct": false}, {"label": "B", "text": "Primary", "correct": false}, {"label": "C", "text": "Secondary", "correct": true}, {"label": "D", "text": "Tertiary", "correct": false}], "correct_answer": "C. Secondary", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Levels of prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primordial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prevention of establishment of risk factors.</li>\n<li>It aims to discourage people from adopting harmful habits.</li>\n<li>Avoiding smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Primary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Health promotion and specific protection.</li>\n<li>Prevention of onset of disease in a high-risk group/individual.</li>\n<li>It aims to protect the health of those who are at risk.</li>\n<li>Reduces the <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of the disease.</li>\n<li>Quit smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Secondary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Disease <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> can be prevented at an early stage (Disease is reversible).</li>\n<li>It aims to reduce the <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of the disease by early identification and prompt treatment of diseases, and it also prevents complications.</li>\n<li>Screening for diabetes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Tertiary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prevention or limitation of <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> and disability in a diseased patient who has developed complications due to the disease and the disease has become irreversible.</li>\n<li>It aims to minimize a patient's suffering and maximize potential years of useful life.</li>\n<li>Disability limitation and rehabilitation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Quaternary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prevention of the risk of overmedicalization of a patient or population.</li>\n<li>Aims to prevent prescription of unnecessary medications and <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> medical interventions.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient scheduled for elective hip surgery is currently taking aspirin, enalapril, a multivitamin, and metoprolol. The surgery is planned in 5 days. What is the appropriate perioperative management for this patient?", "options": [{"label": "A", "text": "Stop enalapril", "correct": true}, {"label": "B", "text": "Stop aspirin to minimize perioperative bleeding risk", "correct": false}, {"label": "C", "text": "Stop metoprolol to increase cardiac output", "correct": false}, {"label": "D", "text": "Increase aspirin dosage for additional analgesic benefit", "correct": false}], "correct_answer": "A. Stop enalapril", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medication discontinuation before surgery </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continued or stopped preoperatively </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antithyroid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antiepileptic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antidepressants</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspirin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta Blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smoking</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stop at least 6-8 weeks prior</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Steroid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anticonvulsants</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continued</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monoamine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">Oxidase</span> Inhibitors (MAOIs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Discontinue 2-3 weeks before surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pill</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Discontinue at least 6 weeks before</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Herbal Supplements</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Discontinue at least 2 weeks before surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors (Enalapril)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stop 24 hours before surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Angiotensin II <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Blockers (ARBs) (Telmisartan)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stop 24 hours before surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcium Channel Blockers (Amlodipine)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continue</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with Hollman miller's sign in the CT image given below?", "options": [{"label": "A", "text": "Juvenile nasopharyngeal angiofibroma", "correct": true}, {"label": "B", "text": "Maxillary sinusitis", "correct": false}, {"label": "C", "text": "Nasal polyp", "correct": false}, {"label": "D", "text": "Rhinosporidiosis", "correct": false}], "correct_answer": "A. Juvenile nasopharyngeal angiofibroma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations of <span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\">Juvenile</span> <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contrast-Enhanced CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Investigation of choice</strong>; shows tumor size, location, and bony involvement.</li>\n<li>Pathognomonic sign: Holman-Miller sign (bowing of maxillary wall).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluates soft tissue and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension, differentiates between <span class=\"customMeta\" data-dictid=\"a479c9f4081692777187a3308ccd27\">extradural</span> and <span class=\"customMeta\" data-dictid=\"ebcba023d81692777190e9eef5bcc2\">intradural</span> spread.<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Digital <span class=\"customMeta\" data-dictid=\"408be3f8d81692777199619278702d\">Subtraction</span> <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">Angiography</span> (DSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visualizes tumor vascularity, identifies <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> vessels and aids in <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">preoperative</span> <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> to reduce <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> blood loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasopharyngoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides a direct view of the tumor, but <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is generally avoided due to high <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> caused by <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube obstruction; establishes <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> and monitors post-treatment hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biopsy is<strong> contraindicated</strong> due to risk of profuse bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify A and B in the image of the mosquito larvae given", "options": [{"label": "A", "text": "A-Culex, B-Aedes", "correct": false}, {"label": "B", "text": "A-Anopheles, B-Culex", "correct": true}, {"label": "C", "text": "A-Culex, B-Anopheles", "correct": false}, {"label": "D", "text": "A-Anopheles, B-Mansonia", "correct": false}], "correct_answer": "B. A-Anopheles, B-Culex", "question_images": ["https://image.prepladder.com/content/z7GBU2ILTvDOHSPtnk6q1747855857.png"], "explanation_images": ["https://image.prepladder.com/content/AFbAOBQnLGAshrmbvTnS1741104759.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:765px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anopheles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aedes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mansonoides</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Larvae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>No <span class=\"customMeta\" data-dictid=\"9d59eae3ce16927771982e99e0035f\">siphon</span> tube</strong></li>\n<li>Rests <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to water surface</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Longer <span class=\"customMeta\" data-dictid=\"9d59eae3ce16927771982e99e0035f\">siphon</span> tubes</li>\n<li>Rests at an angle to water surface</li>\n</ul>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Shorter <span class=\"customMeta\" data-dictid=\"9d59eae3ce16927771982e99e0035f\">siphon</span> tubes</li>\n<li>Rests at an angle to water surface</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eggs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lays singly</li>\n<li><strong>Boat shaped</strong></li>\n<li><strong>Lateral floats</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lays in clusters (100-250 in a single cluster)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lays singly</li>\n<li><strong>Cigar shaped</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lays in clusters</li>\n<li><strong>Star-shaped</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Habitat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exophilic: outside house</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exophilic: day</p>\n<p>Endophilic: night</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endophilic: inside house</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exophilic</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn male presents with urinary retention, lethargy and a distended bladder. Antenatal ultrasound showed a \"keyhole sign\" with a thickened bladder wall. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypospadias", "correct": false}, {"label": "B", "text": "Vesicoureteral reflux", "correct": false}, {"label": "C", "text": "Posterior urethral valves", "correct": true}, {"label": "D", "text": "Neurogenic bladder", "correct": false}], "correct_answer": "C. Posterior urethral valves", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Posterior urethral valves </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in male infants from membranous folds in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> urethra.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> from oligohydramnios.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I: <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> urethral folds</p>\n<p>Type II: Membranes at <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> neck</p>\n<p>Type III: Round <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> at verumontanum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital, unclear embryological origin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> pressure → hypertrophy, <span class=\"customMeta\" data-dictid=\"639b2545551692777201eeadb06d68\">vesicoureteric</span> reflux, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tools</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound, <span class=\"customMeta\" data-dictid=\"1fbf40a1d316927772018a8e73e615\">VCUG</span> (voiding cystourethrogram) and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> scintigraphy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antenatal Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound: Dilated <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> (\"keyhole sign\"), thickened walls.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postnatal Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary retention, infections, lethargy, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antenatal: Vesicostomy, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> ablation</li>\n<li>Postnatal: Stabilization, <span class=\"customMeta\" data-dictid=\"8a8a7309fc169277718529cb457969\">cystoscopic</span> ablation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depends on severity; long-term care needed for CKD, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> dysfunction, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> UTIs.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the nodal ministry of disaster management?", "options": [{"label": "A", "text": "Ministry of Health and Family Welfare", "correct": false}, {"label": "B", "text": "Ministry of Home Affairs", "correct": true}, {"label": "C", "text": "Ministry of Human Resource and Development", "correct": false}, {"label": "D", "text": "Ministry of Education", "correct": false}], "correct_answer": "B. Ministry of Home Affairs", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disaster Management Act (2005):</strong></p>\n<ul>\n<li>Established the National Disaster Management Authority (NDMA) and State Disaster Management Authorities (SDMAs).</li>\n<li>Provides a legal framework for disaster management in India.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>National Disaster Management Authority (NDMA):</strong></p>\n<ul>\n<li>Prepares national-level disaster management plans and oversees their execution.</li>\n<li>Key agency for disaster management <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> in India.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>National Institute of Disaster Management:</strong></p>\n<ul>\n<li>Located in New Delhi, it focuses on capacity building, training, and research.</li>\n<li>Aims to strengthen national disaster response capabilities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Role of State Governments:</strong></p>\n<ul>\n<li>Direct responsibility for executing relief efforts post-disaster.</li>\n<li>Supported by the Union government through the Calamity Relief Fund (3:1 contribution ratio).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ministry of Home Affairs (MHA): (Option B)</strong></p>\n<ul>\n<li>Nodal ministry for overall <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> of disaster management.</li>\n<li>Chaired by the Prime Minister, it oversees disaster response at the national level.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>National Crisis Management Committee (NCMC) and Cabinet Committee on Security (CCS):</strong></p>\n<ul>\n<li>Involved in high-level decision-making for disaster management in India.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emergency Medical Relief Wing:</strong></p>\n<ul>\n<li>Operates under the Ministry of Health and Family Welfare, coordinates health-related activities during disasters.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old woman laborer presented with visible, soft, and fluctuating swelling in front of the knee, over the patella and some discomfort or difficulty with knee movement, MRI findings are given below. What is the diagnosis?", "options": [{"label": "A", "text": "Housemaid's knee", "correct": true}, {"label": "B", "text": "Subdermal abscess", "correct": false}, {"label": "C", "text": "Gout", "correct": false}, {"label": "D", "text": "Rheumatoid arthritis", "correct": false}], "correct_answer": "A. Housemaid's knee", "question_images": ["https://image.prepladder.com/content/kSgdyCTvx5ybPDKqxOwf1741086749.png"], "explanation_images": ["https://image.prepladder.com/content/HJo7OcylK66RdhynYjTj1741086180.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A girl presents with microcephaly and a high-pitched cry. Which of the following is the most likely chromosomal abnormality?", "options": [{"label": "A", "text": "Deletion", "correct": true}, {"label": "B", "text": "Isochromosome", "correct": false}, {"label": "C", "text": "Trisomy", "correct": false}, {"label": "D", "text": "Mosaicism", "correct": false}], "correct_answer": "A. Deletion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old woman presents with irregular periods, acne &amp;amp; excessive hair growth. What is the first line management?", "options": [{"label": "A", "text": "Metformin", "correct": false}, {"label": "B", "text": "Lifestyle modifications", "correct": true}, {"label": "C", "text": "OCPs", "correct": false}, {"label": "D", "text": "Clomiphene citrate", "correct": false}], "correct_answer": "B. Lifestyle modifications", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benefits</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>OCPs (First-line for <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> regulation &amp; hirsutism)</strong><strong> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Estrogen increases SHBG, reducing free testosterone; <span class=\"customMeta\" data-dictid=\"5a7ee002c71692777196c96d5ada60\">Progestogen</span> suppresses LH &amp; <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> production</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regulates cycles, reduces <span class=\"customMeta\" data-dictid=\"8b61bc6e361692777180695ac33e91\">acne</span> &amp; hirsutism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-androgenic OCPs (Preferred)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cyproterone <span class=\"customMeta\" data-dictid=\"47765053a81692777180738f50cd4e\">acetate</span> or Drospirenone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best for <span class=\"customMeta\" data-dictid=\"b1cab43c3216927771897f8f15cbbd\">hirsutism</span> &amp; acne</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spironolactone + OCPs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> receptors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces <span class=\"customMeta\" data-dictid=\"b1cab43c3216927771897f8f15cbbd\">hirsutism</span> &amp; acne</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eflornithine Cream (Topical)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits hair growth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> hirsutism</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:704px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benefits</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Letrozole (Preferred Over Clomiphene Citrate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aromatase inhibitor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No anti-estrogenic effects on <span class=\"customMeta\" data-dictid=\"2f1603da6716927771878d0cbdd372\">endometrium</span> &amp; <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> → higher pregnancy rates, monofollicular stimulation, no ovarian <span class=\"customMeta\" data-dictid=\"97cdd1c214169277718992e2918f2c\">hyperstimulation</span> syndrome (OHSS)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Drowsiness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clomiphene <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">Citrate</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Selective <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> modulator</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Induces <span class=\"customMeta\" data-dictid=\"264a9eb50d1692777194427a13247b\">ovulation</span> in 80%, conception in 40-45%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti-estrogenic effects on <span class=\"customMeta\" data-dictid=\"2f1603da6716927771878d0cbdd372\">endometrium</span> &amp; <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> lower fertility, OHSS in &lt;1%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tamoxifen (Resistant Cases)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Estrogen <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> modulator</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used when Clomiphene fails (80-160 mg for 5 days)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>–</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dexamethasone (Adjunct)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lowers <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> androgens</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Improves <span class=\"customMeta\" data-dictid=\"264a9eb50d1692777194427a13247b\">ovulation</span> outcomes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>–</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benefits and side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metformin</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Improves <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity, reduces <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> production, lowers <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benefits: Increases <span class=\"customMeta\" data-dictid=\"264a9eb50d1692777194427a13247b\">ovulation</span> (70-80%), conception (30-40%).<br/>\n\t\t\t </p>\n<p>S/E: GI disturbances, <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis, avoid in liver/kidney disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N-acetylcysteine (NAC) + Micronutrients</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lowers homocysteine, improves <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> resistance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alternative to Metformin in some cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acarbose (Alternative to Metformin)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delays <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> absorption</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used if Metformin is contraindicated</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has a history of a flying foreign body injury to the eye. Hemochromatosis is subsequently diagnosed. Which of the following substances is most likely involved in the deposition?", "options": [{"label": "A", "text": "Iron", "correct": true}, {"label": "B", "text": "Aluminum", "correct": false}, {"label": "C", "text": "Wood", "correct": false}, {"label": "D", "text": "Glass", "correct": false}], "correct_answer": "A. Iron", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:660px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraocular Foreign Bodies (IOFBs)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An IOFB can lodge in any part of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> segments, causing mechanical damage, infection, or toxic effects on <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> structures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inert: </strong>Glass, wood, plastic, rubber, gold, silver, platinum</p>\n<p><strong>Reactive: </strong>Organic and <span class=\"customMeta\" data-dictid=\"fae9d02cdc1692777190a3151d6fef\">Inorganic</span> (iron causing siderosis, <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> causing chalcosis).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>History.</li>\n<li>Examination (wound examination, foreign body location, associated signs such as lid <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> and <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> segment damage should be noted).</li>\n<li><strong>CT (investigation of choice) </strong>with <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> and <span class=\"customMeta\" data-dictid=\"dad5b2152216927771851a3d10cd41\">coronal</span> cuts detects and localizes a <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> IOFB.</li>\n<li>MRI is contraindicated (metallic IOFB).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Magnetic removal (metallic IOFB)</li>\n<li>Forceps removal through <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> <span class=\"customMeta\" data-dictid=\"2d0756b0d11692777195ef3bcd110d\">plana</span> vitrectomy</li>\n<li>Prophylaxis against infection (topical/systemic antibiotics)<strong> </strong></li>\n<li>Conservative and supportive management (topical corticosteroids, analgesics, etc).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In paracetamol poisoning, N-acetylcysteine is administered as an antidote. How does it act to prevent toxicity?", "options": [{"label": "A", "text": "Inhibits the toxin", "correct": false}, {"label": "B", "text": "Removes the toxin", "correct": false}, {"label": "C", "text": "Restores glutathione levels", "correct": true}, {"label": "D", "text": "Neutralizes liver enzymes", "correct": false}], "correct_answer": "C. Restores glutathione levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"fcdd3383341692777194cf2cd4e400\">Paracetamol</span> poisoning</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gastric Lavage</strong></li>\n<li>Administer <span class=\"customMeta\" data-dictid=\"5dd23480451692777180e299cc38bc\">activated charcoal</span> or <span class=\"customMeta\" data-dictid=\"8cbc9195731692777184663e492746\">cholestyramine</span> (effective within 30 minutes of ingestion)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N-acetylcysteine (NAC) Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initiate within <strong>8 hours</strong> of ingestion; may be partially effective up to <strong>24–36 hours</strong> post-overdose.</li>\n<li><strong>Administration</strong>:</li>\n</ul>\n<ul>\n<li>IV: 140 mg/kg <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose over 1 hour, followed by 70 mg/kg every 4 hours for 15–20 doses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>NAC acts as a <span class=\"customMeta\" data-dictid=\"1a1b98a5d7169277719914104ae697\">sulfhydryl</span> donor, replenishing glutathione.</li>\n<li>Neutralizes toxic metabolites and prevents binding to cell proteins, reducing the severity of <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> necrosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Liver Transplantation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Considered in cases of <strong>hepatic failure</strong> (jaundice, coagulopathy, confusion).</li>\n<li><strong>King's College Criteria</strong> is used to predict the need for a liver transplant in patients with paracetamol-induced <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> liver failure :</li>\n</ul>\n<ul>\n<li>Arterial blood pH &lt; 7.30</li>\n</ul>\n<p>Or all of the following:</p>\n<ul>\n<li>Prothrombin time (PT) &gt; 100 seconds (INR &gt; 6.5)</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> &gt; 300 μmol/L</li>\n<li>Grade III or IV <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> encephalopathy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the emergency department with confusion. On examination, he opens his eyes to pain, shows abnormal flexion to pain, and is disoriented in speech. What is his Glasgow Coma Scale (GCS) score?", "options": [{"label": "A", "text": "11", "correct": false}, {"label": "B", "text": "12", "correct": false}, {"label": "C", "text": "10", "correct": false}, {"label": "D", "text": "9", "correct": true}], "correct_answer": "D. 9", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:441px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Response Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient's Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexion withdrawal from pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total <span class=\"customMeta\" data-dictid=\"e37b435fd416927771886af66a9675\">GCS</span> Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 + 4 + 3</strong> = <strong>9</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:406px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To voice</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oriented</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localizes pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flexion (abnormal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extension (abnormal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presents to the outpatient department with a swelling on his wrist. He reports fluctuation in size , mild numbness in the hand , and occasional pain . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Lipoma", "correct": false}, {"label": "B", "text": "Ganglion cyst", "correct": false}, {"label": "C", "text": "Dermoid cyst", "correct": true}, {"label": "D", "text": "Hematoma", "correct": false}], "correct_answer": "C. Dermoid cyst", "question_images": ["https://image.prepladder.com/content/gqjIclGrXM8GneTDx6Nq1741106569.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<th><strong>Condition</strong></th>\n<th><strong>Characteristics</strong></th>\n<th><strong>Pain</strong></th>\n<th><strong>Fluctuation in Size</strong></th>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Numbness</strong></p>\n</td>\n</tr>\n<tr>\n<td><strong>Lipoma</strong></td>\n<td>Soft, mobile, <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> fat mass</td>\n<td>No</td>\n<td>No</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n</tr>\n<tr>\n<td><strong>Ganglion cyst</strong></td>\n<td>Fluid-filled, over joint or <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> sheath, translucent</td>\n<td>Occasional</td>\n<td>Yes</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td><strong>Dermoid cyst</strong></td>\n<td>Congenital, contains ectodermal elements (hair/sebum)</td>\n<td>Rare</td>\n<td>Rare</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n</tr>\n<tr>\n<td><strong>Hematoma</strong></td>\n<td>Post-trauma, discoloured, self-resolving</td>\n<td>Yes (initially)</td>\n<td>No</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 9-month-old baby was admitted in the ICU with history of recurrent sinusitis and otitis media by staph aureus. Laboratory examination showed decreased serum IgA, IgG, IgM, IgE, and plasma B cells. Which of the following is the condition is described here?", "options": [{"label": "A", "text": "Ataxia telangiectasia", "correct": false}, {"label": "B", "text": "Chronic granulomatosis disease", "correct": false}, {"label": "C", "text": "Bruton syndrome", "correct": true}, {"label": "D", "text": "Di George syndrome", "correct": false}], "correct_answer": "C. Bruton syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn child is brought to the emergency department with respiratory difficulty. The doctor evaluated, and the child was found to have a posterolateral defect, as shown in the x-ray given. What is the diagnosis?", "options": [{"label": "A", "text": "Bochdalek hernia", "correct": true}, {"label": "B", "text": "Morgagni hernia", "correct": false}, {"label": "C", "text": "Hiatal hernia", "correct": false}, {"label": "D", "text": "Traumatic diaphragmatic hernia", "correct": false}], "correct_answer": "A. Bochdalek hernia", "question_images": ["https://image.prepladder.com/content/jSkknhPwrwYaa7hAhffh1741087237.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child presents with epiphora, and probing reveals a soft block at 7 mm. What is the best treatment option for this condition?", "options": [{"label": "A", "text": "Endonasal Dacryocystorhinostomy (DCR)", "correct": false}, {"label": "B", "text": "Conjunctival Dacryocystorhinostomy (DCR)", "correct": true}, {"label": "C", "text": "External Dacryocystorhinostomy (DCR)", "correct": false}, {"label": "D", "text": "Dacryocystectomy", "correct": false}], "correct_answer": "B. Conjunctival Dacryocystorhinostomy (DCR)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ylqEyp78Mczp5esU8UGZ1741088366.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a child presenting with diarrhoea, the following finding is noted. What is the likely micronutrient deficiency?", "options": [{"label": "A", "text": "Zinc", "correct": true}, {"label": "B", "text": "Copper", "correct": false}, {"label": "C", "text": "Vitamin A", "correct": false}, {"label": "D", "text": "Vitamin C", "correct": false}], "correct_answer": "A. Zinc", "question_images": ["https://image.prepladder.com/content/08O2Y8BouWdFAwm1OKHY1741087950.png"], "explanation_images": ["https://image.prepladder.com/content/RznW20SIAbUvx3cyrUdu1741088010.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following describes the chloride ion exchange in red blood cells, where bicarbonate ions are exchanged for chloride ions to maintain electrical neutrality?", "options": [{"label": "A", "text": "Haldane effect", "correct": false}, {"label": "B", "text": "Root effect", "correct": false}, {"label": "C", "text": "Bohr effect", "correct": false}, {"label": "D", "text": "Chloride shift", "correct": true}], "correct_answer": "D. Chloride shift", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chloride shift</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reverse <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> shift</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tissues</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lungs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Process</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CO₂ enters RBCs, forming H₂CO₃ → H⁺ + HCO₃⁻. HCO₃⁻ exits in exchange for Cl⁻</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CO₂ exits RBCs. HCO₃⁻ re-enters RBCs in exchange for Cl⁻</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect on RBCs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chloride influx causes water influx, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> RBCs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chloride efflux balances HCO₃⁻ re-entry, CO₂ is released</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impact on haematocrit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"2e114d4cdc169277718882a0a01076\">hematocrit</span> due to <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> swelling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily facilitates CO₂ release, indirectly affecting hematocrit</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a neck mass and laboratory findings of increased T4 and decreased TSH. The patient has a history of I-131 ablation therapy. Which of the following is a likely side effect of the treatment?", "options": [{"label": "A", "text": "Acute Thyroiditis", "correct": false}, {"label": "B", "text": "Hypothyroidism", "correct": false}, {"label": "C", "text": "Hyperthyroidism", "correct": true}, {"label": "D", "text": "Thyroid Storm", "correct": false}], "correct_answer": "C. Hyperthyroidism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypothyroidism (Correct Answer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Destruction of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> tissue → <strong>↓ T4, ↑ TSH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most patients post-I-131 therapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Thyroiditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiation-induced <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> → temporary <strong>thyroid pain, swelling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early post-treatment phase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperthyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thyrotoxic phase</strong> due to sudden hormone release from damaged cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, transient</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thyroid Storm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Massive release of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormones <strong>(life-threatening)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very rare, usually in untreated Graves'</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient undergoing general anesthesia develops left lung collapse following intubation. On auscultation, breath sounds are heard only on the right side. What is the most likely cause of this condition?", "options": [{"label": "A", "text": "Right endobronchial intubation", "correct": true}, {"label": "B", "text": "Mucus secretions obstructing the endotracheal tube", "correct": false}, {"label": "C", "text": "Pneumothorax on the left side due to positive pressure ventilation", "correct": false}, {"label": "D", "text": "Bronchospasm", "correct": false}], "correct_answer": "A. Right endobronchial intubation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which gene mutation is most commonly associated with Burkitt's lymphoma?", "options": [{"label": "A", "text": "C-myc", "correct": true}, {"label": "B", "text": "P-21", "correct": false}, {"label": "C", "text": "Rb", "correct": false}, {"label": "D", "text": "p53", "correct": false}], "correct_answer": "A. C-myc", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child was brought to the casualty with complaints of vomiting and loose stools with a history of laxative use. On examination, arrhythmia is present. What will be the abnormality present?", "options": [{"label": "A", "text": "Hyponatremia", "correct": false}, {"label": "B", "text": "Hypocalcemia", "correct": false}, {"label": "C", "text": "Hypokalemia", "correct": true}, {"label": "D", "text": "Hyperkalemia", "correct": false}], "correct_answer": "C. Hypokalemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications for IV <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> Supplementation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Symptomatic patients</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> (&lt;2.5 mEq/L)</li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> abnormalities</li>\n<li>Unable to tolerate oral feeds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">Chloride</span> Supplementation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dosage:</strong> 0.5-1 mEq/kg per dose</li>\n<li><strong>Administration:</strong> IV <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> over 1-2 hours</li>\n<li><strong>Infusion Rate:</strong> Do not exceed 1 mEq/kg per hour</li>\n<li><strong>Potassium Concentration:</strong>\n<ul>\n<li>Maximum of 60 mEq/L for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> lines</li>\n<li>Maximum of 80 mEq/L for central lines</li>\n</ul>\n</li>\n<li>Avoid using glucose-containing fluids to prevent insulin-mediated <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> shift.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> Supplementation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dosage:</strong> 2-4 mEq/kg per day, divided into 3-4 doses</li>\n<li><strong>Common Preparations:</strong>\n<ul>\n<li>Potassium <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> (10%; 20 mEq/15 mL)</li>\n<li>Potassium <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> (especially for <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis)</li>\n</ul>\n</li>\n<li><strong>Administration Tip:</strong> Liquid preparations can be bitter; <span class=\"customMeta\" data-dictid=\"e63a499e5716927771860681cef17d\">dilute</span> with juice or water to improve taste.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following factors causes a rightward shift in the oxygen-hemoglobin dissociation curve?", "options": [{"label": "A", "text": "Increase in CO₂", "correct": true}, {"label": "B", "text": "Increase in O₂", "correct": false}, {"label": "C", "text": "Decrease in CO₂", "correct": false}, {"label": "D", "text": "Decrease in temperature", "correct": false}], "correct_answer": "A. Increase in CO₂", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NAGQk0B2wtbH5rgNp2oY1741087175.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Bohr Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:top\">\n<p>A shift of the oxygen-hemoglobin <span class=\"customMeta\" data-dictid=\"18fb34ab321692777186e9bc95a726\">dissociation</span> curve to the right in response to increases in blood CO2 and H+ levels has a significant effect by enhancing the release of O2 from the blood in the tissues and enhancing <span class=\"customMeta\" data-dictid=\"db3aca8a9a16927771948a3ff7512d\">oxygenation</span> of the blood in the lungs</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:top\">\n<ul>\n<li>Increase in CO<sub>2</sub>: CO<sub>2</sub> diffuses from tissues into the blood, forming <span class=\"customMeta\" data-dictid=\"95585a69c21692777183b817f72e70\">carbonic acid</span> (H₂CO₃), dissociating into H+ and HCO<sub>3</sub>-. This increase in H+ lowers blood pH.</li>\n<li>Decrease in pH: Lower pH shifts the oxygen-haemoglobin <span class=\"customMeta\" data-dictid=\"18fb34ab321692777186e9bc95a726\">dissociation</span> curve to the right, causing haemoglobin to release O2 more readily.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Effects in Tissues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Higher CO2 and lower pH cause haemoglobin to release O2, delivering more O2 to metabolically active tissues.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Effects in Lungs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:top\">\n<p>Expelling CO2 in the lungs decreases blood CO2 levels and increases pH, shifting the <span class=\"customMeta\" data-dictid=\"18fb34ab321692777186e9bc95a726\">dissociation</span> curve to the left and allowing haemoglobin to bind O2 more readily for transport.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #cccccc; border-top:1px solid #cccccc; vertical-align:top\">\n<p><strong>Factors Influencing the Bohr Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #cccccc; border-left:1px solid #cccccc; border-right:1px solid #000000; border-top:1px solid #cccccc; vertical-align:top\">\n<ul>\n<li>Increased CO2 concentration</li>\n<li>Increased blood temperature</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"5eb010f3041692777182726fdec300\">2,3-bisphosphoglycerate</span> (BPG) concentration: BPG binds to haemoglobin, reducing its <span class=\"customMeta\" data-dictid=\"227269f3ec1692777180d76a7898dd\">affinity</span> for O2 and promoting O2 release.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the hormonal check for pregnancy at home?", "options": [{"label": "A", "text": "Beta-HCG", "correct": true}, {"label": "B", "text": "Estrogen", "correct": false}, {"label": "C", "text": "Progesterone", "correct": false}, {"label": "D", "text": "HPL", "correct": false}], "correct_answer": "A. Beta-HCG", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ENDOCRINE CHANGES IN PREGNANCY</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>INCREASE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DECREASE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>UNCHANGED</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prolactin</li>\n<li>Growth Hormone</li>\n<li>ACTH</li>\n<li>Cortisol</li>\n<li>Aldosterone</li>\n<li>Testosterone</li>\n<li>Calcitriol</li>\n<li>Thyroid-binding <span class=\"customMeta\" data-dictid=\"1a8bcc07ca16927771882f63452d6e\">globulin</span> (TBG)</li>\n<li>Total T4</li>\n<li>Total T3</li>\n<li>hCG</li>\n<li>Human <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">Placental</span> <span class=\"customMeta\" data-dictid=\"e4f0a280e61692777191be9d18ee25\">Lactogen</span> (hPL)</li>\n<li>Insulin</li>\n<li>PTH</li>\n<li>Calcitonin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>FSH</li>\n<li>LH</li>\n<li>DHEAS (Dehydro <span class=\"customMeta\" data-dictid=\"a4072435d916927771872434d3eeb1\">epiandrosterone</span> sulfate)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Free T3</li>\n<li>Free T4</li>\n<li>Vasopressin (ADH)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Spot the image.", "options": [{"label": "A", "text": "Balloon Tamponade", "correct": true}, {"label": "B", "text": "Umbrella pack", "correct": false}, {"label": "C", "text": "Parachute pack", "correct": false}, {"label": "D", "text": "Cervical ablation", "correct": false}], "correct_answer": "A. Balloon Tamponade", "question_images": ["https://image.prepladder.com/content/vqAISbNCov4KwaWpEUGH1741098073.png"], "explanation_images": ["https://image.prepladder.com/content/1CXiQ0UWTXnWyYI5BwON1741098254.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the American Heart Association (AHA), what is the 6th link added to the chain of survival?", "options": [{"label": "A", "text": "Rapid defibrillation", "correct": false}, {"label": "B", "text": "Recovery and rehabilitation", "correct": true}, {"label": "C", "text": "High-quality CPR", "correct": false}, {"label": "D", "text": "Advanced airway management", "correct": false}], "correct_answer": "B. Recovery and rehabilitation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wFhZiURrLA5C7kVNdZS01741085790.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male undergoes an open appendectomy for acute appendicitis. The choice of incision was McBurney's incision. Postoperatively, after a few days, he presents with pain and bulging in the right lower quadrant, which is diagnosed as an indirect inguinal hernia. Which nerve injury during the appendectomy is most likely responsible for this complication?", "options": [{"label": "A", "text": "Ilioinguinal nerve", "correct": true}, {"label": "B", "text": "Femoral nerve", "correct": false}, {"label": "C", "text": "Genitofemoral nerve", "correct": false}, {"label": "D", "text": "Pudendal nerve", "correct": false}], "correct_answer": "A. Ilioinguinal nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Wound infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <strong>MC <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> complication</strong> involves infection at the <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> site.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. Intraabdominal abscess</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> within the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cavity, typically due to infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. Ileus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary cessation of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> function, leading to <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension and discomfort.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> leading to embolism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formation of blood clots in the veins, which can travel to the lungs or other parts of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5. <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> pyaemia (Pylephlebitis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection and <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of the <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, a rare but serious complication.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6. <span class=\"customMeta\" data-dictid=\"396cb274df16927771803e151a1109\">Adhesive</span> intestinal obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formation of <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue causing <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction; <strong>MC late complication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7. Fecal fistula</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leakage from the <span class=\"customMeta\" data-dictid=\"23c46c5fc916927771813b486e3774\">appendiceal</span> stump.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8. Nerve injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Injury to the <span class=\"customMeta\" data-dictid=\"108e66d0571692777189ff4a5e8740\">Ilioinguinal</span> nerve and <span class=\"customMeta\" data-dictid=\"240b25374316927771890d8646eda8\">iliohypogastric</span> nerve</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with diffuse severely contaminated peritonitis underwent laparotomy and was left open after surgery. Which of the following might help?", "options": [{"label": "A", "text": "VAC", "correct": true}, {"label": "B", "text": "Normal saline soaked gauze", "correct": false}, {"label": "C", "text": "Prefer closure after laparotomy", "correct": false}, {"label": "D", "text": "Antibiotic soaked gauze", "correct": false}], "correct_answer": "A. VAC", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Option</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effectiveness in Open Abdomen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Considerations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VAC Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Highly effective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces infection, removes fluids, aids healing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">Saline</span> Soaked Gauze</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporary benefit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keeps wound moist but does not actively remove exudates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">Closure</span> After Laparotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not preferred in contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome &amp; infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotic-Soaked Gauze</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited benefit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Does not provide <span class=\"customMeta\" data-dictid=\"befa0a72121692777193663f2ca836\">negative pressure</span> drainage</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The development of cataracts in patients with Diabetes Mellitus is primarily due to the accumulation of which of the following substances in the lens?", "options": [{"label": "A", "text": "Sorbitol", "correct": true}, {"label": "B", "text": "Dulcitol", "correct": false}, {"label": "C", "text": "Mannitol", "correct": false}, {"label": "D", "text": "Galactitol", "correct": false}], "correct_answer": "A. Sorbitol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve will be involved in the following finding on rest?", "options": [{"label": "A", "text": "Ulnar", "correct": true}, {"label": "B", "text": "Median", "correct": false}, {"label": "C", "text": "Musculocutaneous", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "A. Ulnar", "question_images": ["https://image.prepladder.com/content/fVELYacsj2fd8tinw56l1741092176.png"], "explanation_images": ["https://image.prepladder.com/content/XOAlT145EZ8iI9vzQxnu1741059038.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Clawing:</strong> <span class=\"customMeta\" data-dictid=\"2ad2fb4cc8169277718925a677620c\">Hyperextension</span> of the <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joints and <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints.</li>\n<li>Clawing is seen in 2 <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> fingers only.</li>\n<li>Seen in <strong>pure <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve injury</strong>.</li>\n<li>Also known as the true <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete <span class=\"customMeta\" data-dictid=\"c2193cdaa816927771843863690961\">claw</span> hand:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clawing of all 4 fingers.</li>\n<li>Seen in combined<strong> <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> + <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> </strong>nerve palsy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tardy <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Slow-onset (over years) <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve palsy.</li>\n<li>Seen with <span class=\"customMeta\" data-dictid=\"5a7668926a1692777185299ac4cf5a\">cubitus</span> <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> seen in <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other deformities:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wasting of <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">hypothenar</span> muscles &amp; <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> muscles of the hand.</li>\n<li>Hollow inter-metacarpal spaces in hand.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Static procedure (removal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Zancolli Lasso procedure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dynamic procedures (tendon transfer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Modified Bunnel technique</li>\n<li>Brand’s operation</li>\n<li>Fowler’s operation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old female presents with complaints of a yellowish-green, foul-smelling vaginal discharge. She reports painful urination and pain during intercourse &amp;amp; no itching. On speculum examination, her vulva and vaginal walls appear inflamed. What is the causative agent?", "options": [{"label": "A", "text": "Trichomonas vaginalis", "correct": true}, {"label": "B", "text": "Candida albicans", "correct": false}, {"label": "C", "text": "Gardnerella vaginalis", "correct": false}, {"label": "D", "text": "Neisseria gonorrhoeae", "correct": false}], "correct_answer": "A. Trichomonas vaginalis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The cover-uncover test is performed to diagnose various eye conditions. Which of the following is not detected by this test?", "options": [{"label": "A", "text": "Latent Squint", "correct": false}, {"label": "B", "text": "Manifest Squint", "correct": false}, {"label": "C", "text": "Lateral Nystagmus", "correct": false}, {"label": "D", "text": "Amblyopia", "correct": true}], "correct_answer": "D. Amblyopia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xid5Y49PckvPBSIgjrej1741088211.png", "https://image.prepladder.com/content/FNLz61QtW6J0TjCyYz3O1741088228.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Identifies latent deviations or tropias.</li><li>↳ latent deviations or tropias.</li><li>↳ Procedure: Cover one eye and then observe the covered eye when the cover is removed. If the eye reverts to fixation, it indicates a phoria or intermittent tropia . If the eye remains deviated, it suggests a tropia with fixation preference for the fellow eye.</li><li>↳ Procedure:</li><li>↳ Cover one eye and then observe the covered eye when the cover is removed. If the eye reverts to fixation, it indicates a phoria or intermittent tropia . If the eye remains deviated, it suggests a tropia with fixation preference for the fellow eye.</li><li>↳ Cover one eye and then observe the covered eye when the cover is removed.</li><li>↳ If the eye reverts to fixation, it indicates a phoria or intermittent tropia .</li><li>↳ phoria or intermittent tropia</li><li>↳ If the eye remains deviated, it suggests a tropia with fixation preference for the fellow eye.</li><li>↳ tropia with fixation preference for the fellow eye.</li><li>↳ Alternate Cover Test: Detects phorias by dissociating the visual axes.</li><li>↳ Alternate Cover Test:</li><li>↳ Alternate covering each eye to maximize visual axis dissociation. Care must be taken to permit time for each eye to reside behind the cover (the cover must not be “fanned” before the eyes). Use prisms to quantify phorias or tropias. If measurements are unclear, estimate the midpoint between defined movements.</li><li>↳ Alternate covering each eye to maximize visual axis dissociation.</li><li>↳ Care must be taken to permit time for each eye to reside behind the cover (the cover must not be “fanned” before the eyes).</li><li>↳ Use prisms to quantify phorias or tropias. If measurements are unclear, estimate the midpoint between defined movements.</li><li>↳ Lateral Nystagmus (Option C): Nystagmus is involuntary, rhythmic eye movements. The cover-uncover test might exacerbate nystagmus, though it is not the primary test for detecting it.</li><li>↳ Lateral Nystagmus (Option C):</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vaccine is contraindicated in pregnancy?", "options": [{"label": "A", "text": "Influenza", "correct": false}, {"label": "B", "text": "Varicella", "correct": true}, {"label": "C", "text": "Rabies", "correct": false}, {"label": "D", "text": "TDaP", "correct": false}], "correct_answer": "B. Varicella", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is positive for HBsAg and anti-HBc IgM. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute hepatitis", "correct": true}, {"label": "B", "text": "Chronic hepatitis", "correct": false}, {"label": "C", "text": "Recovery phase", "correct": false}, {"label": "D", "text": "Vaccination", "correct": false}], "correct_answer": "A. Acute hepatitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:714px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>HBsAg</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>HBeAg</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBc </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBs </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBe </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Interpretation </strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">- </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection</strong></p>\n<p style=\"text-align: center;\">Highly infectious</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chronic <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection</strong>, highly infectious</p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Chronic <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection, low infectivity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Recovery </strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Window period</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Post-vaccination</strong></p>\n<p style=\"text-align: center;\"><strong>(Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient undergoing surgery is administered succinylcholine for muscle relaxation. Shortly after administration, he develops hyperthermia, muscle rigidity, tremors, and tachycardia. What is the most appropriate treatment for this condition?", "options": [{"label": "A", "text": "Neostigmine", "correct": false}, {"label": "B", "text": "Dantrolene sodium", "correct": true}, {"label": "C", "text": "Atropine", "correct": false}, {"label": "D", "text": "Midazolam", "correct": false}], "correct_answer": "B. Dantrolene sodium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 y/o male suddenly experiences an intense headache, described as the worst headache of his life, followed by vomiting and photophobia. O/E he has neck stiffness and a dilated pupil on the right side. A CT scan reveals bleeding in the subarachnoid space. Which of the following is the most common cause of this condition?", "options": [{"label": "A", "text": "Hypertension", "correct": false}, {"label": "B", "text": "Intracranial aneurysm", "correct": true}, {"label": "C", "text": "Arteriovenous malformation (AVM)", "correct": false}, {"label": "D", "text": "Brain tumour", "correct": false}], "correct_answer": "B. Intracranial aneurysm", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following methods is used to measure fetal anemia?", "options": [{"label": "A", "text": "Umbilical artery Doppler", "correct": false}, {"label": "B", "text": "Cord blood sampling", "correct": false}, {"label": "C", "text": "Chorionic villus sampling", "correct": false}, {"label": "D", "text": "Peak systolic velocity in the fetal middle cerebral artery (MCA)", "correct": true}], "correct_answer": "D. Peak systolic velocity in the fetal middle cerebral artery (MCA)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Utility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Invasiveness</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MCA-PSV <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> (Correct Answer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gold standard for <strong>non-invasive</strong> <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> anemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Umbilical <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> Doppler</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <strong>placental insufficiency</strong> (not <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> anemia)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cord blood <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> (PUBS - <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">Percutaneous</span> <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">Umbilical</span> Blood Sampling)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Directly measures <strong>fetal <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> and hematocrit</strong> but has high risk of complications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invasive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chorionic <span class=\"customMeta\" data-dictid=\"b0bb7d5b6716927772028625a93e1e\">villus</span> <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> (CVS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for <strong>genetic testing</strong> in the first trimester, not <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> anemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Invasive</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate was born to a controlled gestational diabetes mother. At the time of birth, he was fine but 4 days later, he developed dyspnea with Spo2 80% at room air. What is the initial management?", "options": [{"label": "A", "text": "Give 21% to 30% O2", "correct": false}, {"label": "B", "text": "Give 100% O2", "correct": true}, {"label": "C", "text": "Give 50% O2", "correct": false}, {"label": "D", "text": "Observation", "correct": false}], "correct_answer": "B. Give 100% O2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old patient presents with absolute constipation and abdominal distension. And the X-ray abdomen is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Caecal Volvulus", "correct": false}, {"label": "B", "text": "Sigmoid Volvulus", "correct": true}, {"label": "C", "text": "Intestinal Obstruction", "correct": false}, {"label": "D", "text": "Small Bowel Volvulus", "correct": false}], "correct_answer": "B. Sigmoid Volvulus", "question_images": ["https://image.prepladder.com/content/DSpTmQBW5S2JhnoneQBq1741057455.png"], "explanation_images": ["https://image.prepladder.com/content/OFB2juCfEkwFX2tZXqkq1741057520.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:573px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sigmoid Volvulus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic constipation, long redundant <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coffee bean sign on X-ray, bird’s <span class=\"customMeta\" data-dictid=\"273ed4fdf916927771827f19d7abc5\">beak</span> sign on contrast enema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abdominal distension, pain, absolute constipation, vomiting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic <span class=\"customMeta\" data-dictid=\"dfd87633931692777186f47063d1c2\">detorsion</span> (if no gangrene), surgery for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A corneal wisp test was performed, and the corneal reflex was elicited. Which of the following nerves is responsible for the afferent limb of this reflex?", "options": [{"label": "A", "text": "Facial Nerve", "correct": false}, {"label": "B", "text": "Trigeminal Nerve", "correct": true}, {"label": "C", "text": "Oculomotor Nerve", "correct": false}, {"label": "D", "text": "Abducens Nerve", "correct": false}], "correct_answer": "B. Trigeminal Nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Afferent Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Efferent Nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Accommodation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>II (Optic nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>III (Oculomotor nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Corneal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₁ (Ophthalmic, <span class=\"customMeta\" data-dictid=\"cdd6d30ff216927771933bc53be84b\">nasociliary</span> branch)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bilateral VII (Facial nerve, <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> branch - orbicularis oculi)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cough</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve, also <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">phrenic</span> and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerves)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gag</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IX (Glossopharyngeal nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Jaw Jerk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₃ (Mandibular branch, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> from masseter)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₃ (Mandibular branch, motor to masseter)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lacrimation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₁ (Ophthalmic branch) (loss of <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> does not preclude emotional tears)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>VII (Facial nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pupillary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>II (Optic nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>III (Oculomotor nerve)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer presents with fever and subconjunctival hemorrhage. The microscopic agglutination test turns to be positive. What is the diagnosis?", "options": [{"label": "A", "text": "Brucella", "correct": false}, {"label": "B", "text": "Leptospira", "correct": true}, {"label": "C", "text": "E coli", "correct": false}, {"label": "D", "text": "Staph aureus", "correct": false}], "correct_answer": "B. Leptospira", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1hfmsMr1jo6VdBvrGORq1741092435.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leptospira interrogans (bacteria)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Zoonotic disease</li>\n<li><strong>Indirect: </strong>Contact with water, moist soil, or surfaces contaminated with animal urine.</li>\n<li><strong>Direct: </strong>Contact with <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> or <span class=\"customMeta\" data-dictid=\"720552f298169277719434da81c0ef\">parturition</span> products from infected animals.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis Phases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Septicemic Phase: </strong>Entry through <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> or skin, dissemination via <span class=\"customMeta\" data-dictid=\"a813884d6016927771838d2d1f9d1d\">bloodstream</span> to organs.</li>\n<li><strong>Immune Phase:</strong> Antibodies develop, spirochetes disappear from blood; antigen-antibody complexes form, and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"d9e023242c16927771840efda08ae3\">colonization</span> occurs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Syndromes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Mild <span class=\"customMeta\" data-dictid=\"034b17cc011692777181338eb131f6\">Anicteric</span> Illness: </strong>Seen in 90% of cases, flu-like symptoms with <strong>fever</strong>, headache, <strong>conjunctival suffusion</strong>, nausea, vomiting, and myalgia.</li>\n<li><strong>Weil’s Disease:</strong> Severe icteric illness in 10% of cases; rapid progression, fatality rate of 5-15%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture Media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ellinghausen-McCullough-Johnson-Harris (EMJH) </strong>medium is commonly used for culturing <span class=\"customMeta\" data-dictid=\"6ca28c6bc31692777191173bb04186\">Leptospira</span> species showing <strong>Dinger’s ring.</strong></li>\n</ul>\n<p><strong></strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/1hfmsMr1jo6VdBvrGORq1741092435.png\" width=\"787\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li>It is a semi-solid or liquid medium that supports the slow-growing leptospires, often requiring <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> for weeks.</li>\n<li><strong>Specimen Sources:</strong> Blood, urine, or <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF) samples are often used, depending on the stage of infection.</li>\n<li>Other culture media are <strong>Korthoff and Fletcher.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Microscopic <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">Agglutination</span> Test (MAT)</strong><strong>: </strong>Considered the<strong> gold standard for <span class=\"customMeta\" data-dictid=\"6ca28c6bc31692777191173bb04186\">Leptospira</span> detection</strong>, <span class=\"customMeta\" data-dictid=\"4a466821d51692777191eed0c276f5\">MAT</span> measures antibodies in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> samples.</li>\n<li>The <strong>Modified Faine’s Criteria</strong> used to aid in the diagnosis of leptospirosis, especially in <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> areas.This scoring system combines <strong>clinical, epidemiological and laboratory data </strong>to increase <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> accuracy.</li>\n<li><strong>PCR (Polymerase Chain Reaction): </strong>Provides a faster diagnosis by detecting <span class=\"customMeta\" data-dictid=\"6ca28c6bc31692777191173bb04186\">leptospira</span> DNA in blood or urine, especially effective in the early stage.</li>\n<li><strong>ELISA</strong>: Used for <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> and is helpful for confirming infection in the later stages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotics</strong>: Early <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy is crucial and often involves:</p>\n<ul>\n<li><strong>Doxycycline</strong>: Typically used for mild cases and prophylaxis.</li>\n<li><strong>Penicillin or Ampicillin: </strong>Preferred for severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby presents with the clinical features shown in the image, including characteristic perioral and perianal rash along with a history of diarrhea. Which of the following is the most likely deficiency responsible for this condition?", "options": [{"label": "A", "text": "Zinc Deficiency", "correct": true}, {"label": "B", "text": "Niacin Deficiency", "correct": false}, {"label": "C", "text": "Selenium Deficiency", "correct": false}, {"label": "D", "text": "Magnesium Deficiency", "correct": false}], "correct_answer": "A. Zinc Deficiency", "question_images": ["https://image.prepladder.com/content/WIdfU4lhyCPE8giN92XV1747645788.png"], "explanation_images": ["https://image.prepladder.com/content/YLA12nZCwzsPVV4Gaemo1747645519.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zinc Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital (SLC39A4 mutation) or <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> (malnutrition, chronic diarrhea)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Skin Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perioral, perianal, and <span class=\"customMeta\" data-dictid=\"b01b22718a169277718096920a80e7\">acral</span> <span class=\"customMeta\" data-dictid=\"fedc53b3161692777186553c8f8d7d\">dermatitis</span> with erythematous, <span class=\"customMeta\" data-dictid=\"a37fd1603c1692777198f87a4a51dc\">scaly</span> plaques</p>\n<p style=\";\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2333\" src=\"https://image.prepladder.com/content/YLA12nZCwzsPVV4Gaemo1747645519.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth retardation, diarrhea, alopecia, immune dysfunction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Zinc supplementation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with recurrent Staphylococcus infections. Laboratory examination shows very low levels of immunoglobulins (G, A, M, E), and a low quantity of B cells. There is a normal reaction to environmental antigens on the skin. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bruton's agammaglobulinemia", "correct": true}, {"label": "B", "text": "DiGeorge syndrome", "correct": false}, {"label": "C", "text": "Hyper IgM syndrome", "correct": false}, {"label": "D", "text": "Common variable immunodeficiency", "correct": false}], "correct_answer": "A. Bruton's agammaglobulinemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of pneumonia develops pleural effusion. What is the expected finding in the pleural analysis for parapneumonic effusion?", "options": [{"label": "A", "text": "Pleural protein/plasma protein ratio less than 0.5", "correct": false}, {"label": "B", "text": "Pleural LDH less than 2/3rd of plasma LDH", "correct": false}, {"label": "C", "text": "Pleural pH less than 7.2", "correct": true}, {"label": "D", "text": "Pleural LDH less than 0.6 of plasma LDH", "correct": false}], "correct_answer": "C. Pleural pH less than 7.2", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:710px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parapneumonic effusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition: </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">parapneumonic</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> is a pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> that occurs in association with bacterial pneumonia, lung abscess, or bronchiectasis.</li>\n<li>These effusions develop in about 40-60% of patients with bacterial pneumonia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types:</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Parapneumonic effusions can be categorized into three stages: simple (uncomplicated), complicated, and empyema.\n\t\t\t\t<ul>\n<li><strong>Simple <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">parapneumonic</span> effusions</strong>, the pleural fluid is <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> and can resolve with <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy alone.</li>\n<li><strong>Complicated <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">parapneumonic</span> effusions</strong> contain bacteria and require <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> in addition to antibiotics.</li>\n<li><strong>Empyema</strong> represents the most advanced stage where frank <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> is present in the pleural space.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simple <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">Parapneumonic</span> Effusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appearance: Serous</li>\n<li>PMN++, <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> fluid (negative bacterial culture)</li>\n<li>pH &gt;7.3, <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &lt;500 U/L, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &gt;80 mg/dL</li>\n<li>Fluid-glucose: serum-glucose &gt;0.5</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complicated <span class=\"customMeta\" data-dictid=\"9c1ee188b6169277719419aefc81d2\">Parapneumonic</span> Effusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appearance: Turbid</li>\n<li>PMN++, bacterial culture may be + or -</li>\n<li><strong>pH &lt;7.1,</strong> <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt;1000 U/L, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt;40 mg/dL</li>\n<li>Fluid-glucose: serum-glucose &lt;0.5</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Empyema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Appearance: Pus</li>\n<li>PMN++, bacterial culture positive or negative</li>\n<li>pH &lt;7.1, <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt;1000 U/L, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt;40 mg/dL</li>\n<li>Fluid-glucose: serum-glucose &lt;0.5</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management: </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Drain with antibiotics; small-bore drains (10-14 gauge) are often preferable. Consider thoracoscopic <span class=\"customMeta\" data-dictid=\"980a3fc15c1692777185d2c3e2e17f\">decortication</span> if these fail.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "KAT G mutation associated with:", "options": [{"label": "A", "text": "Isoniazid", "correct": true}, {"label": "B", "text": "Rifampicin", "correct": false}, {"label": "C", "text": "Levofloxacin", "correct": false}, {"label": "D", "text": "Ethambutol", "correct": false}], "correct_answer": "A. Isoniazid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0lvXK8DWvPLkFDYEuIJN1741086720.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mechanisms of <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> Resistance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KatG gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>INH</strong> is a prodrug, converted to the active <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> by catalase-peroxidase produced by the <span class=\"customMeta\" data-dictid=\"0ed7b29b0216927771900d7c5f7eb0\">Kat</span> G gene. The mutated <span class=\"customMeta\" data-dictid=\"553253f1ce1692777183d395babc1b\">catalase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> does not <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the active drug</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KasA gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Component of <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> mycolic acid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>InhA gene overexpression </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes <span class=\"customMeta\" data-dictid=\"9a6a6e737e1692777185f1b77971e2\">cross-resistance</span> to <span class=\"customMeta\" data-dictid=\"765ad61235169277718731b19650f4\">Ethionamide</span> (second-line drug)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which antihypertensive drug is contraindicated in pregnancy?", "options": [{"label": "A", "text": "Methyldopa", "correct": false}, {"label": "B", "text": "Enalapril", "correct": true}, {"label": "C", "text": "Labetalol", "correct": false}, {"label": "D", "text": "Nifedipine", "correct": false}], "correct_answer": "B. Enalapril", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:659px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adverse Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypotension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decrease in blood pressure, especially upon <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> of therapy or with <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">dosage</span> increases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> secretion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cough</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent dry cough, possibly due to <span class=\"customMeta\" data-dictid=\"3c5739595d16927771839e61a5855c\">bradykinin</span> buildup in the lungs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Angioedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to increased <span class=\"customMeta\" data-dictid=\"3c5739595d16927771839e61a5855c\">bradykinin</span> levels, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of deeper layers of skin, particularly around the eyes and lips, can be life-threatening.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rashes/Urticaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin reactions like rashes or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> occur in a small percentage of users.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dysgeusia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reversible taste changes are more common with captopril.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rare Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Granulocytopenia (low white blood cells) and <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> (excess protein in urine) are more concerning in patients with <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible in patients with <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> due to decreased <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> filtration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fetal Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ACE inhibitors are contraindicated during pregnancy due to potential harm to the fetus, including <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage due to <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> renin-angiotensin system.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient diagnosed with Cryptococcal meningitis. What is the treatment?", "options": [{"label": "A", "text": "Flucytosine", "correct": false}, {"label": "B", "text": "Fluconazole", "correct": false}, {"label": "C", "text": "L.Amp", "correct": false}, {"label": "D", "text": "Flucytosine + L.Amp", "correct": true}], "correct_answer": "D. Flucytosine + L.Amp", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cryptococcus neoformans </strong>(most common)</li>\n<li>Candida</li>\n<li>Histoplasma</li>\n<li>Blastomyces</li>\n<li>Coccidioides</li>\n<li>Sporothrix</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immunocompromised patients</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headache</li>\n<li>Altered mental status, lethargy</li>\n<li>Fever</li>\n<li>Neck stiffness</li>\n<li>Nausea and vomiting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lumbar Puncture:</strong> Low <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and high protein levels. <span class=\"customMeta\" data-dictid=\"3c1935637a1692777202a9c50cc6f5\">White cell count</span> can be normal or higher than 20 microL and have a <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> predominance.</li>\n<li>India ink <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> shows <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells.</li>\n<li>CSF <span class=\"customMeta\" data-dictid=\"3e4873f1941692777187410ddeb16a\">ELISA</span> for CRAG (Cryptococcal Antigen).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>LAMB</strong> (Liposomal Amphotericin-B) and <strong>5-Fluorocytosine</strong> (Flucytosine) for 2 weeks</li>\n<li><strong>Fluconazole </strong>is given subsequently for 8-10 weeks.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of cartilage?", "options": [{"label": "A", "text": "Hyaline cartilage", "correct": true}, {"label": "B", "text": "Elastic cartilage", "correct": false}, {"label": "C", "text": "Fibro cartilage", "correct": false}, {"label": "D", "text": "Calcified cartilage", "correct": false}], "correct_answer": "A. Hyaline cartilage", "question_images": ["https://image.prepladder.com/content/gQ6gvhMAV2WHHkM4uapQ1741105781.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old female presents with irregular menstrual cycles, acne, and excessive hair growth. An ultrasound reveals multiple ovarian cysts. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Polycystic Ovary Syndrome (PCOS)", "correct": true}, {"label": "B", "text": "Endometriosis", "correct": false}, {"label": "C", "text": "Hypothyroidism", "correct": false}, {"label": "D", "text": "Ovarian hyperstimulation syndrome (OHSS)", "correct": false}], "correct_answer": "A. Polycystic Ovary Syndrome (PCOS)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most likely abnormality in a patient of recurrent vomiting with pH 7.5, pCO2 48mm Hg, and HCO3- 33?", "options": [{"label": "A", "text": "Metabolic acidosis", "correct": false}, {"label": "B", "text": "Metabolic alkalosis", "correct": true}, {"label": "C", "text": "Respiratory acidosis", "correct": false}, {"label": "D", "text": "Respiratory alkalosis", "correct": false}], "correct_answer": "B. Metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Alkalosis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Metabolic <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> is characterized by an <strong>increase in arterial pH</strong>, <strong>elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> [HCO3−], and increased PaCO2</strong> due to <strong>compensatory hypoventilation.</strong></li>\n<li>Often presents with <strong>hypochloremia </strong>and <strong>hypokalemia</strong>.</li>\n<li>Occurs as a mixed disorder with <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> or <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> or alkalosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Exogenous <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">Bicarbonate</span> Loads</strong>\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b802ae0373169277718153c4d4fbaf\">alkali</span> administration</li>\n<li>Milk-alkali syndrome</li>\n</ul>\n</li>\n<li><strong>Effective ECFV <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">Contraction</span> (Normotension, K+ Deficiency, Secondary Hyperreninemic Hyperaldosteronism)</strong>\n<ul>\n<li>Gastrointestinal Origin: Vomiting, <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> aspiration, <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> chloridorrhea, gastrocystoplasty, <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> adenoma</li>\n<li>Renal Origin: <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">Diuretic</span> use (thiazides, loop diuretics), posthypercapnic state, hypercalcemia/hypoparathyroidism, recovery from acidosis, non-resorbable anions (e.g., penicillin), Mg²⁺ deficiency, K⁺ depletion, Bartter's syndrome, Gitelman's syndrome</li>\n</ul>\n</li>\n<li><strong>ECFV Expansion, Hypertension, K+ Deficiency, and <span class=\"customMeta\" data-dictid=\"35933061bb1692777192630f88863d\">Mineralocorticoid</span> Excess</strong>\n<ul>\n<li>High Renin: <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis, accelerated hypertension, renin-secreting tumor, <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> therapy</li>\n<li>Low Renin: Primary <span class=\"customMeta\" data-dictid=\"881ff8b2a21692777181fdd87352f8\">aldosteronism</span> (adenoma, hyperplasia, carcinoma), <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> defects (11β-hydroxylase, 17α-hydroxylase deficiency), Cushing’s syndrome, substances like licorice, carbenoxolone</li>\n<li>Genetic <span class=\"customMeta\" data-dictid=\"276be2047116927771989f7bf5ed02\">Sodium Channel</span> <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">Mutation</span> (Liddle's Syndrome)</li>\n<li>Gain-of-function <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule, causing ECFV expansion, hypertension, K⁺ deficiency, and hypo-reninemic-hypoaldosteronism</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurological: Mental confusion, obtundation, potential seizures</li>\n<li>Peripheral Nervous System: Paresthesias, muscle cramps, <span class=\"customMeta\" data-dictid=\"3d62cb9e271692777200980467ea01\">tetany</span> (similar to <span class=\"customMeta\" data-dictid=\"59f10ee7c31692777189a8544bb404\">hypocalcemia</span> effects)</li>\n<li>Cardiovascular: Aggravation of arrhythmias, particularly in <span class=\"customMeta\" data-dictid=\"6a75d857ea1692777185f9245b02b8\">COPD</span> patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electrolyte Imbalances:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Potassium (K⁺): Hypokalemia, especially in cases involving secondary <span class=\"customMeta\" data-dictid=\"982551b8f81692777189e20f09de85\">hyperaldosteronism</span> or <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> use.</li>\n<li>Chloride (Cl⁻): Hypochloremia, frequently accompanying alkalosis, especially in cases of <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> or <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> use.</li>\n<li>Calcium (Ca²⁺): Symptoms may <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> <span class=\"customMeta\" data-dictid=\"59f10ee7c31692777189a8544bb404\">hypocalcemia</span> despite normal levels.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which factor is most useful for distinguishing Acute Kidney Injury (AKI) from Chronic Kidney Disease (CKD)?", "options": [{"label": "A", "text": "Creatinine levels", "correct": false}, {"label": "B", "text": "Albumin levels", "correct": true}, {"label": "C", "text": "Urinary output", "correct": false}, {"label": "D", "text": "Blood urea nitrogen (BUN)", "correct": false}], "correct_answer": "B. Albumin levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease is defined as the presence of an <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> structure or function persisting for more than 3 months.</li>\n<li>This includes 1 or more of the following:\n\t\t\t\t<ul>\n<li>GFR less than 60 mL/min</li>\n<li><strong>Albuminuria </strong>(ie, <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> ≥30 mg/24 hours or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> albumin-to-creatinine ratio [ACR] ≥30 mg/g)</li>\n<li>Abnormalities in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> sediment, <span class=\"customMeta\" data-dictid=\"ebf8f256f3169277718992ac1b2330\">histology</span> or <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> suggestive of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> disorders</li>\n<li>History of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> transplantation.</li>\n</ul>\n</li>\n<li>Evaluation for the <span class=\"customMeta\" data-dictid=\"4711a65634169277718737b781005d\">etiology</span> of <span class=\"customMeta\" data-dictid=\"e6dc8586b11692777184b083672593\">CKD</span> should be guided by a patient’s clinical history, physical examination, and <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> by 0.3 mg/dL or more (26.5 μmol/L or more) within 48 hours.</li>\n<li>Increase in <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> to 1.5 times or more than the <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> of the prior 7 days.</li>\n<li>Urine volume less than 0.5 mL/kg/h for at least 6 hours.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure given in the image below", "options": [{"label": "A", "text": "Buccopharyngeal fascia", "correct": true}, {"label": "B", "text": "Prevertebral fascia", "correct": false}, {"label": "C", "text": "Pharyngobasilar fascia", "correct": false}, {"label": "D", "text": "Alar fascia", "correct": false}], "correct_answer": "A. Buccopharyngeal fascia", "question_images": ["https://image.prepladder.com/content/NuyPAK8WJt3XFzSAuuTw1741087227.png"], "explanation_images": ["https://image.prepladder.com/content/LgryenCQv761t9dxV5et1741063734.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A total of 60 patients were diagnosed with COVID-19. Out of which,12 cases of deaths were reported. Calculate the Case fatality rate?", "options": [{"label": "A", "text": "20%", "correct": true}, {"label": "B", "text": "30%", "correct": false}, {"label": "C", "text": "40%", "correct": false}, {"label": "D", "text": "10%", "correct": false}], "correct_answer": "A. 20%", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FsaQjUTOszdRgzc4z94r1741062054.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:596px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Virulence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The degree of severity or harmfulness of a disease, measuring the proportion of severe or fatal cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infectivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The ability of a <span class=\"customMeta\" data-dictid=\"ed4634701d16927771942c4408495f\">pathogen</span> to establish an infection and spread among a population.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The ability of a <span class=\"customMeta\" data-dictid=\"03aede3b101692777192c7f7a5e99c\">microorganism</span> to cause disease determines whether an infection will manifest as an illness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmissibility</strong></p>\n<p>(Communicability)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The ability of a disease to be transmitted from one host to another indicates how easily it spreads. This is measured by the secondary attack rate.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with unilateral throbbing pain, photophobia, nausea, and vomiting. The symptoms improve after taking sumatriptan. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Migraine", "correct": true}, {"label": "B", "text": "Tension headache", "correct": false}, {"label": "C", "text": "Cluster headache", "correct": false}, {"label": "D", "text": "Sinus headache", "correct": false}], "correct_answer": "A. Migraine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features of Migraine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Premonitory (Prodromal) Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neck discomfort</li>\n<li>Cognitive <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> (brain “fog”)</li>\n<li>Mood changes</li>\n<li>Fatigue</li>\n<li>Yawning/sleepiness</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"01cdc9604816927772010d5f2b7e82\">urination</span> and thirst</li>\n<li>Food cravings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aura</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurologic disturbances (e.g., visual disturbances like scintillating scotoma)</li>\n<li>Due to Cerebral vasoconstriction. Therefore prevention is by Vasodilators.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Headache Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pain</li>\n<li>Nausea/vomiting</li>\n<li>Sensory sensitivities:\n\t\t\t\t<ul>\n<li>Photophobia (sensitivity to light)</li>\n<li>Phonophobia (sensitivity to sound)</li>\n<li>Osmophobia (sensitivity to smells)</li>\n<li>Allodynia (pain from non-painful stimuli)</li>\n<li>Vertigo</li>\n</ul>\n</li>\n<li>Due to cerebral vasodilation. So treatment is Vasoconstrictors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postdrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tiredness</li>\n<li>Weariness</li>\n<li>Impaired concentration</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:583px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Simplified <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Criteria for <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">Migraine</span> by International Headache Society </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Repeated attacks of headache lasting 4–72h in patients with a normal physical examination, no other reasonable cause for the headache, and:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>At least 2 of the following features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Plus at least 1 of the following features:</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Unilateral pain</strong></li>\n<li><strong>Throbbing pain</strong></li>\n<li>Aggravation by movement</li>\n<li>Moderate or severe intensity</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Nausea/vomiting</strong></li>\n<li><strong>Photophobia and phonophobia</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which electrolyte abnormality will lead to cardiac arrhythmia in patients with severe vomiting?", "options": [{"label": "A", "text": "Hypokalemia", "correct": true}, {"label": "B", "text": "Hyponatremia", "correct": false}, {"label": "C", "text": "Hyperkalemia", "correct": false}, {"label": "D", "text": "Hypocalcemia", "correct": false}], "correct_answer": "A. Hypokalemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-month-old child has a respiratory rate of 56/min with no chest indrawing and no danger signs. As per IMNCI what is the most appropriate diagnosis?", "options": [{"label": "A", "text": "Pneumonia", "correct": true}, {"label": "B", "text": "Cold and cough", "correct": false}, {"label": "C", "text": "Severe Pneumonia", "correct": false}, {"label": "D", "text": "Allergy", "correct": false}], "correct_answer": "A. Pneumonia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Ask</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Look</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Able to drink or breastfeed?</li>\n<li>Does the child <span class=\"customMeta\" data-dictid=\"e66d63de4e16927772027ffae57751\">vomit</span> everything?</li>\n<li>H/O convulsions during this illness?</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Lethargic or unconscious?</li>\n<li>Currently convulsing?</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>If any danger signs are present, the child needs URGENT attention.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Severe <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">Pneumonia</span> or Very Severe Disease (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Any general danger sign</li>\n</ul>\n<p style=\"text-align: center;\">OR</p>\n<ul>\n<li>Oxygen <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> &lt;90%</li>\n<li>Stridor in calm child</li>\n<li>Central cyanosis</li>\n<li>Convulsions</li>\n<li>AVPU = V, P, or U</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Start oxygen therapy if <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> &lt; 90%.</li>\n<li>Administer <span class=\"customMeta\" data-dictid=\"670fd69d0f1692777182f40b22be72\">Benzyl</span> <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">Penicillin</span> &amp; Gentamicin.</li>\n<li>Give <span class=\"customMeta\" data-dictid=\"80d3ceeba61692777186f4f5da691f\">diazepam</span> if convulsing.</li>\n<li>Prevent low blood sugar.</li>\n<li>Treat <span class=\"customMeta\" data-dictid=\"c804829f4416927772026f34ff3e31\">wheeze</span> if present.</li>\n<li>Urgent referral or admission.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pneumonia </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Chest indrawing in calm child</li>\n</ul>\n<p style=\"text-align: center;\">OR</p>\n<ul>\n<li><strong>Fast breathing</strong></li>\n</ul>\n<p style=\"text-align: center;\">AND</p>\n<ul>\n<li><strong>No signs of severe pneumonia</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Administer <span class=\"customMeta\" data-dictid=\"d1e73ea72b1692777181fe0162bd92\">Amoxicillin</span> <span class=\"customMeta\" data-dictid=\"cbb3e1bab11692777186c622a68d44\">Dispersible</span> Tablet.</li>\n<li>Give Vitamin A.</li>\n<li>Treat <span class=\"customMeta\" data-dictid=\"c804829f4416927772026f34ff3e31\">wheeze</span> if present.</li>\n<li>Follow up in 5 days</li>\n<li>Advise on immediate return signs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>No Pneumonia: <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">Cough</span> or Cold</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>No signs of <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> or very severe disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Treat <span class=\"customMeta\" data-dictid=\"c804829f4416927772026f34ff3e31\">wheeze</span> if present - <span class=\"customMeta\" data-dictid=\"479585b1c81692777198b4f752d734\">salbutamol</span> for 5 days</li>\n<li>Advise on immediate return signs.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman with a history of type 2 diabetes presents for a routine follow-up. Her serum creatinine and potassium levels are normal, but she has microalbuminuria and an HbA1c of 8%. Her blood pressure and pulse are within normal limits, and she is currently on metformin for diabetes management. What should be the next step in her management?", "options": [{"label": "A", "text": "Begin a thiazide diuretic", "correct": false}, {"label": "B", "text": "Start insulin therapy", "correct": false}, {"label": "C", "text": "Stop Metformin and start a different OHA", "correct": false}, {"label": "D", "text": "Start an ACE inhibitor", "correct": true}], "correct_answer": "D. Start an ACE inhibitor", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> nephropathy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">Hypoglycemic</span> agents (OHAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>SGLT2 inhibitors </strong>lower the risk of <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> events and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure; they are also recently approved for HFpEF.</li>\n<li>For HbA1C &lt; 9.5%, OHAs can be used</li>\n<li><strong>Metformin</strong> is <strong>withheld</strong> if <strong>eGFR is &lt; 30 mL/min/1.73 m2 </strong><strong>(Option C)</strong>, and drugs safe in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure can be used like\n\t\t\t\t<ul>\n<li>Glipizide</li>\n<li>Linagliptin</li>\n<li>Repaglinide</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insulin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>80% of the calculated dose is started if <strong>HbA1C &gt; 9.5% </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antihypertensives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In the presence of microalbuminuria, ACEi and ARBs have shown evidence to slow the <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> if started in early stages.</li>\n<li>In hypertension, for BP &gt; 130/90, ACEi or ARBs are preferred</li>\n<li>If BP is still not under control, <strong>Calcium channel <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> (CCB)</strong> can be added</li>\n<li><strong>Thiazide diuretic</strong> - in the presence of oedema <strong>(Option A)</strong></li>\n<li>If eGFR &lt;30 ml/min, then the <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> used - <strong>Metolazone.</strong></li>\n<li>ACEi/ARB <span class=\"customMeta\" data-dictid=\"89f5610ffd1692777184b03f1f88cc\">comes</span> with a <span class=\"customMeta\" data-dictid=\"79506a117416927771988bbe7a8302\">side effect</span> of hyperkalemia; hence, regular monitoring of <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> is necessary.</li>\n<li>In the presence of <strong>hyperkalemia</strong>, ACEi/ARB is replaced by CCB</li>\n<li><strong>Alpha <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> (Prazosin) </strong>- <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> in ESRD.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>K Binding resins</strong> (Bind to <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> in the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> and promote its excretion)</p>\n<ul>\n<li>Sodium <span class=\"customMeta\" data-dictid=\"8904ca22bf1692777196567c8fff23\">polystyrene</span> sulfonate</li>\n<li>Patiromer</li>\n<li>Sodium zirconate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal Transplant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>If eGFR is &lt; 20 mL/min/1.73</strong><strong>m2</strong><strong>.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a study based in Delhi, doctors followed 100 people who did exercise for a year and later they checked who all had developed coronary heart disease. Which type of study is this?", "options": [{"label": "A", "text": "Case Control Study", "correct": false}, {"label": "B", "text": "Prospective Study", "correct": false}, {"label": "C", "text": "Cross Sectional Study", "correct": false}, {"label": "D", "text": "Cohort study", "correct": true}], "correct_answer": "D. Cohort study", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A doctor asked the patient what her age is and she told him that she is married to an older man, and she has 2 kids of 15 and 18 years, and she is 39 years old. What is the disorder present?", "options": [{"label": "A", "text": "Derailment", "correct": false}, {"label": "B", "text": "Circumstantial speech", "correct": true}, {"label": "C", "text": "Flight of ideas", "correct": false}, {"label": "D", "text": "Tangentiality", "correct": false}], "correct_answer": "B. Circumstantial speech", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with high blood pressure accompanied by a decrease in heart rate. What is the most likely physiological mechanism responsible for this response?", "options": [{"label": "A", "text": "Stimulation of baroreceptors", "correct": true}, {"label": "B", "text": "Inhibition of baroreceptors", "correct": false}, {"label": "C", "text": "Bezold-Jarisch reflex (J reflex)", "correct": false}, {"label": "D", "text": "Stimulation of chemoreceptors", "correct": false}], "correct_answer": "A. Stimulation of baroreceptors", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Baroreceptors in the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> and the aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> detect BP changes</li>\n<li>Increased BP <span class=\"customMeta\" data-dictid=\"ad337177ee1692777199de941a0cda\">stretches</span> receptors, sending signals to <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> via <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> and <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> nerves</li>\n<li>Medulla inhibits <span class=\"customMeta\" data-dictid=\"52abfe100916927772011ad20f3fda\">vasoconstrictor</span> center and stimulates <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> center</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Actions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vasodilation of blood vessels</li>\n<li>Decreased heart rate and <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> strength</li>\n<li>Reduced BP due to lower <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> resistance and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Maintains BP stability during activities like standing</li>\n<li>Fastest acting</li>\n<li>Tends to reset within 1-2 days for long-term regulation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the context of mitral stenosis, which clinical feature is typically observed?", "options": [{"label": "A", "text": "Loud S1", "correct": true}, {"label": "B", "text": "Absent S1", "correct": false}, {"label": "C", "text": "S3 gallop", "correct": false}, {"label": "D", "text": "Muffled heart sounds", "correct": false}], "correct_answer": "A. Loud S1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral Stenosis: Clinical Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rheumatic fever (predominant cause)</li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disorders</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> with <span class=\"customMeta\" data-dictid=\"4c3d2d86ec1692777191af6eda4772\">leaflet</span> involvement</li>\n<li>SLE, RA</li>\n<li>Myxoma</li>\n<li>Large <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> vegetations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Normal <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> area: 4-6 cm²</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> when area &lt; 2 cm²</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> when area &lt; 1.5 cm²</li>\n<li>Elevated LA pressure required to maintain normal <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output</li>\n<li>Development of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output during exertion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Exertional dyspnea</li>\n<li>Orthopnea</li>\n<li>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> dyspnea</li>\n<li>Hemoptysis</li>\n<li>Right-sided <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> symptoms in advanced cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Loud S1</strong></li>\n<li>Opening snap after A2</li>\n<li>Mid-diastolic rumbling <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> with <span class=\"customMeta\" data-dictid=\"46f491f18c1692777196fb409699bc\">presystolic</span> accentuation\n\t\t\t\t<ul>\n<li>Best heard at apex</li>\n<li>With bell of stethoscope</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> position</li>\n</ul>\n</li>\n<li>Signs of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension\n\t\t\t\t<ul>\n<li>Loud P2</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> heave</li>\n</ul>\n</li>\n<li>Irregular pulse (if <span class=\"customMeta\" data-dictid=\"e6a04221a41692777182825f0f08da\">atrial fibrillation</span> present)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ECG\n\t\t\t\t<ul>\n<li>Left atrial enlargement</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> in advanced cases</li>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> may be present</li>\n</ul>\n</li>\n<li>Chest X-ray\n\t\t\t\t<ul>\n<li>Straightening of upper <span class=\"customMeta\" data-dictid=\"9a065f288c1692777191f5b93fa49b\">left heart</span> border</li>\n<li>Double density sign</li>\n<li>Kerley B lines</li>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> congestion</li>\n</ul>\n</li>\n<li>Echocardiogram\n\t\t\t\t<ul>\n<li>Valve area measurement</li>\n<li>Transvalvular gradient</li>\n<li>Assessment of <span class=\"customMeta\" data-dictid=\"4c3d2d86ec1692777191af6eda4772\">leaflet</span> <span class=\"customMeta\" data-dictid=\"650eb29fb9169277719270ea0fbea5\">mobility</span> and calcification</li>\n<li>Evaluation of associated lesions</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What stage of embryonic development is shown in the following image?", "options": [{"label": "A", "text": "Morula", "correct": false}, {"label": "B", "text": "Ova", "correct": false}, {"label": "C", "text": "Blastocyst", "correct": true}, {"label": "D", "text": "Gastrula", "correct": false}], "correct_answer": "C. Blastocyst", "question_images": ["https://image.prepladder.com/content/BM0GF6GxIX5H6Xvl3sH31741106646.png"], "explanation_images": ["https://image.prepladder.com/content/77SZbev0YK6h0yWBWOFz1741106688.png", "https://image.prepladder.com/content/l3c1NLnfDTf6YK2uVIU01741106772.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DAY</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>EVENT</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fertilization: The <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> fertilizes the egg in the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube, forming a <span class=\"customMeta\" data-dictid=\"0052ecdccc1692777202bad37cc0f1\">zygote</span> (single <span class=\"customMeta\" data-dictid=\"52d06e3e001692777186400050f388\">diploid</span> cell)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two cell stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Four cell stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twelve cell stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morula Formation:</strong> The <span class=\"customMeta\" data-dictid=\"0052ecdccc1692777202bad37cc0f1\">zygote</span> becomes a solid ball of <strong>16-32 cells.</strong><strong> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blastocyst Formation:</strong> The <span class=\"customMeta\" data-dictid=\"b02677c64d1692777192214107ce39\">morula</span> continues to divide and develops a blastocoel, trophoblast, and inner cell mass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 6&amp;7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Implantation begins: </strong>Blastocyst attaches to the endometrial lining of the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> and <span class=\"customMeta\" data-dictid=\"b307523a5616927772006c03caff44\">trophoblast</span> begins to invade the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall to start implantation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 14–21</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gastrulation begins: </strong>The <span class=\"customMeta\" data-dictid=\"c53ef2f424169277719061a7a3fc0f\">inner cell mass</span> differentiates into three <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> layers (ectoderm, mesoderm, and endoderm), forming the<strong> gastrula.</strong><strong> (Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the emergency department with complaints of blurred vision, dizziness, and severe headache after ingesting an unknown quantity of homemade alcohol earlier in the day. On examination, he is disoriented. Laboratory tests reveal severe metabolic acidosis with a high anion gap. Which metabolite is primarily responsible for the toxicity in this case?", "options": [{"label": "A", "text": "Methanol", "correct": false}, {"label": "B", "text": "Formic acid", "correct": true}, {"label": "C", "text": "Formaldehyde", "correct": false}, {"label": "D", "text": "Acetic acid", "correct": false}], "correct_answer": "B. Formic acid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Adulteration in Country liquor.</strong></li>\n<li>Solvent in industrial processes.</li>\n<li>Antifreeze.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Methanol ö <span class=\"customMeta\" data-dictid=\"59e3af5975169277720384661ff5bf\">Formaldehyde</span> (oxidation by alcohol dehydrogenase).</li>\n<li>Formaldehyde ö <span class=\"customMeta\" data-dictid=\"46ef53b3061692777203313130b967\">Formic acid</span> (oxidation by <span class=\"customMeta\" data-dictid=\"126202981a1692777181f2970b8c7f\">aldehyde</span> dehydrogenase).</li>\n<li>Formic Acid ö Inhibition of Cytochrome c Oxidase ö Cellular Hypoxia and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">Metabolic</span> Acidosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features of Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CNS: <strong>Headache</strong>, dizziness, confusion, ataxia, seizures</li>\n<li>Ocular: <strong>Blurred (</strong>\"snowfield\" vision).</li>\n<li>Gastrointestinal: <strong>Nausea, vomiting</strong>,<strong> fruity breath</strong> and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Metabolic: <strong>Severe <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis, elevated <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mnemonic: <strong>SHAFE</strong></p>\n<ul>\n<li><strong>S</strong>odium Bicarbonate to correct <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis</li>\n<li><strong>H</strong>emodialysis to remove <span class=\"customMeta\" data-dictid=\"c578fa95fe16927771927ea57020f0\">methanol</span> and its metabolites</li>\n<li><strong>A</strong>ntidote:<strong> F</strong>omepizole or <strong>E</strong>thanol to <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> ADH</li>\n<li><strong>F</strong>olinic acid or <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> to enhance <span class=\"customMeta\" data-dictid=\"8723cfd7d21692777203cc8312c239\">formate</span> metabolism.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During laparoscopic surgery, where shouldn't the trocar be inserted?", "options": [{"label": "A", "text": "Superior epigastric artery", "correct": false}, {"label": "B", "text": "Inferior epigastric artery", "correct": false}, {"label": "C", "text": "Abdominal aorta", "correct": false}, {"label": "D", "text": "Both A and B", "correct": true}], "correct_answer": "D. Both A and B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trocar Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>At Risk Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Precautions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Umbilical (Primary)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insert at <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> alba</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supraumbilical (Upper Trocar)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior Epigastric Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Avoid midline <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infraumbilical/Midclavicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior Epigastric Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insert <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palmar’s Point (LUQ Trocar)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal risk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used in difficult access cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the jugular venous pressure (JVP) waveform, the \"a\" wave corresponds to:", "options": [{"label": "A", "text": "Right Atrial contraction", "correct": true}, {"label": "B", "text": "Tricuspid valve bulging into Right atria", "correct": false}, {"label": "C", "text": "Right Atrial relaxation", "correct": false}, {"label": "D", "text": "Right atrial filling", "correct": false}], "correct_answer": "A. Right Atrial contraction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jfXFwVgw4dcJ2e0oF6Ku1741087032.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>a wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by atrial systole.</li>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> results in a temporary halt in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> inflow.</li>\n<li>Some blood flows back into the veins, causing a rise in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>c wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Arises from the increase in atrial pressure during isovolumetric <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> contraction.</li>\n<li>Pressure is transmitted through the closed and bulging <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>x descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ventricular <span class=\"customMeta\" data-dictid=\"13941ea4ec1692777199fc8cfd1a7a\">systole</span> pulls the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> down</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>v wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Corresponds to the rise in atrial pressure as blood fills the atria.</li>\n<li>Occurs during <span class=\"customMeta\" data-dictid=\"11d448b6c4169277718635a922383c\">diastole</span> while the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> is still closed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>y descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Opening of <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> causing <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> of right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> into ventricle</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "75% of iatrogenic ureteric injuries are due to gynaecological procedures. Which hysterectomy route has the least risk of ureteric injury?", "options": [{"label": "A", "text": "Laparoscopic", "correct": false}, {"label": "B", "text": "Abdominal", "correct": false}, {"label": "C", "text": "Vaginal", "correct": true}, {"label": "D", "text": "Robotic", "correct": false}], "correct_answer": "C. Vaginal", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaginal <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abdominal <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small uterus, minimal <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pathology, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> organ descent.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> masses, adhesions, oophorectomy, cancer staging, complex cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recovery Time</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Faster recovery and shorter hospital stay.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Longer recovery, longer hospital stay, increased <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postoperative Pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain and risk of wound infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Operating Time</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shorter operating time compared to the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> approach.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Longer operating time than <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> or <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> approaches.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Injury Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lower <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> injury risk.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> injury. <strong>(Option B)</strong></p>\n<p><strong>Lower <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> injury risk.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complexity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires less technical expertise.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires higher technical expertise, especially in complex cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Access to Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited access to <span class=\"customMeta\" data-dictid=\"a45b36c1c716927771840ee63f1cba\">concurrent</span> procedures.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Greater access to <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> organs, ovaries, and upper <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> for cancer <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> or additional surgeries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suitability for Larger Uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not ideal for large <span class=\"customMeta\" data-dictid=\"7ed30519d816927772013f317e9a66\">uteri</span> or complex conditions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preferred for large <span class=\"customMeta\" data-dictid=\"7ed30519d816927772013f317e9a66\">uteri</span> or complex conditions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cancer Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preferred for non-cancer cases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caution with <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> power <span class=\"customMeta\" data-dictid=\"1550c9b88416927771923c01e78d72\">morcellation</span> in potential cancer cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risks of Infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower risk of infection.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> fever and wound infection.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old male patient with a history of hypertension presents to the emergency department in acute distress. He is diaphoretic, tachycardic, and complains of severe chest pain. His ECG is given below. Given the patient's condition, what is the most appropriate immediate management for this patient?", "options": [{"label": "A", "text": "Amiodarone", "correct": false}, {"label": "B", "text": "Radiofrequency catheter ablation", "correct": false}, {"label": "C", "text": "Digoxin", "correct": false}, {"label": "D", "text": "Synchronized cardioversion", "correct": true}], "correct_answer": "D. Synchronized cardioversion", "question_images": ["https://image.prepladder.com/content/hYmLOPcvfcclQnAcQqSB1741079515.png"], "explanation_images": ["https://image.prepladder.com/content/Hy7EyWWEFFmCLrDJeEI61741079510.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:683px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Atrial Flutter</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> is characterized by a large re-entry circuit, usually within the right atrium, encircling the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"2889a63cdd1692777181f9102ed608\">annulus</span> originating from the cavotricuspid isthmus.</li>\n</ul>\n<ul>\n<li>The atrial rate is approximately <strong>300 beats per minute</strong>.</li>\n<li>It is typically associated with 2:1, 3:1, or 4:1 AV block, resulting in <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> rates of 150, 100, or 75 beats per minute.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> shows<strong> saw-tooth <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves</strong>, often <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as <strong>\"F-waves.\"</strong></li>\n<li>With a 2:1 AV block, <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves may be buried in QRS complexes and T waves, making them difficult to identify.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ewingdo\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ECG_Atrial_Flutter_294_bpm.jpg\" data-tags=\"\" height=\"2506\" src=\"https://image.prepladder.com/content/Hy7EyWWEFFmCLrDJeEI61741079510.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atrial <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> should be suspected in narrow-complex <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> at a rate of 150 beats per minute.</li>\n<li>Carotid <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> pressure or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"d3f6a49b7416927771802124ccddf0\">adenosine</span> may help reveal <span class=\"customMeta\" data-dictid=\"5f95d4da09169277720316a3947e42\">flutter</span> waves by temporarily increasing the degree of AV block.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Rhythm Control:</strong></p>\n<ul>\n<li><strong>Acute Management:</strong>\n<ul>\n<li>Hemodynamically <strong>Unstable</strong> Patients: Synchronized cardioversion.</li>\n<li><strong>Stable </strong>Patients:\n\t\t\t\t\t<ul>\n<li>Electrical <span class=\"customMeta\" data-dictid=\"f6c133a4ba1692777183c42bc77b81\">cardioversion</span> (if no <span class=\"customMeta\" data-dictid=\"18fe4e325016927771905dfc04519d\">intracardiac</span> thrombus).</li>\n<li>Pharmacological cardioversion:\n\t\t\t\t\t\t<ul>\n<li>Antiarrhythmic drugs:\n\t\t\t\t\t\t\t<ul>\n<li>Amiodarone</li>\n<li>Class IA: Procainamide, Quinidine, Disopyramide</li>\n<li>Class IC: Flecainide, Propafenone</li>\n</ul>\n</li>\n<li>Calcium Channel Blockers: Verapamil, Diltiazem</li>\n<li>Beta-Blockers: Metoprolol, Carvedilol, Esmolol</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</li>\n<li><strong>Long-Term Management:</strong>\n<ul>\n<li>Radiofrequency <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> of the cavotricuspid isthmus.</li>\n</ul>\n</li>\n</ul>\n<p><strong>2. Rate Control:</strong></p>\n<ul>\n<li>First-Line Agents:\n\t\t\t\t<ul>\n<li>Calcium Channel Blockers (e.g., Verapamil, Diltiazem)</li>\n<li>Beta-Blockers (e.g., Metoprolol, Carvedilol, Esmolol)</li>\n<li>Digoxin (use cautiously due to toxicity).</li>\n</ul>\n</li>\n<li>Goal: Heart rate &lt; 110 beats per minute.</li>\n</ul>\n<p><strong>3. Anticoagulation:</strong></p>\n<ul>\n<li>Assess stroke risk using the CHADS2-VASC score:</li>\n<li>Anticoagulation Recommendations:\n\t\t\t\t<ul>\n<li>2 or more points: Strong recommendation for anticoagulation.</li>\n<li>1 point: Consider either <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> or full anticoagulation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lady presents to the hospital after having a fight with her husband. She reports that she is unable to speak However, all neurological and physical examinations are normal, and she does not seem concerned about her health status, What is the most likely diagnosis?", "options": [{"label": "A", "text": "Malingering", "correct": false}, {"label": "B", "text": "La belle indifférence", "correct": true}, {"label": "C", "text": "Adaptation", "correct": false}, {"label": "D", "text": "Somatic symptom", "correct": false}], "correct_answer": "B. La belle indifférence", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was presented to the OPD with a sudden onset of shortness of breath. Identify the condition with the radiological image given below.", "options": [{"label": "A", "text": "Epiglottitis", "correct": false}, {"label": "B", "text": "Laryngotracheobronchitis", "correct": true}, {"label": "C", "text": "Bronchitis", "correct": false}, {"label": "D", "text": "Laryngomalacia", "correct": false}], "correct_answer": "B. Laryngotracheobronchitis", "question_images": ["https://image.prepladder.com/content/pXP0cG2CsnwVDGv6TPNg1741063322.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with eyelid crusting and a thready sensation between the cornea and lids. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Chronic Blepharitis", "correct": true}, {"label": "B", "text": "Dry Eye Syndrome", "correct": false}, {"label": "C", "text": "Meibomian Gland Dysfunction", "correct": false}, {"label": "D", "text": "Conjunctivitis", "correct": false}], "correct_answer": "A. Chronic Blepharitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic infection of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of the lid margin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Synonyms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> blepharitis</li>\n<li>Staphylococcal blepharitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Organisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Most commonly <span class=\"customMeta\" data-dictid=\"0520f732541692777199acffcfd9ba\">Staphylococci</span> (coagulase positive)</strong></li>\n<li>Rarely Streptococci, <span class=\"customMeta\" data-dictid=\"77ba04808316927771963f119df5a5\">Propionibacterium</span> acnes, and Moraxella</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic irritation</li>\n<li>Itching</li>\n<li>Mild lacrimation</li>\n<li>Gluing of cilia</li>\n<li>Mild photophobia</li>\n<li>Yellow crusts at the root of cilia</li>\n<li>Small ulcers that bleed easily when crusts are removed</li>\n<li>Red, thickened lid margins with dilated blood vessels</li>\n<li>Mild <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> <span class=\"customMeta\" data-dictid=\"6ce77d5f5e1692777185cf7f8a67cd\">conjunctivitis</span> and conjunctival hyperemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lid Hygiene:\n\t\t\t\t<ul>\n<li>Warm compresses</li>\n<li>Cotton buds dipped in <span class=\"customMeta\" data-dictid=\"e63a499e5716927771860681cef17d\">dilute</span> baby shampoo or 3% sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> solution</li>\n<li>Avoid touching</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Antibiotics</li>\n<li>Topical Steroids</li>\n<li>Ocular Lubricants</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While evaluating a 3-year-old with short stature, height is measured at 90cm and the lower segment is 45 cm. What is the likely diagnosis?", "options": [{"label": "A", "text": "Achondroplasia", "correct": false}, {"label": "B", "text": "Congenital hypothyroidism", "correct": false}, {"label": "C", "text": "Rickets", "correct": false}, {"label": "D", "text": "Spondyloepiphyseal dysplasia", "correct": true}], "correct_answer": "D. Spondyloepiphyseal dysplasia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:717px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Proportionate <span class=\"customMeta\" data-dictid=\"89170298ec1692777198eac32ce789\">Short Stature</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conditions Causing <span class=\"customMeta\" data-dictid=\"89170298ec1692777198eac32ce789\">Short Stature</span> with US &gt; LS </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conditions Causing <span class=\"customMeta\" data-dictid=\"89170298ec1692777198eac32ce789\">Short Stature</span> with US &lt; LS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Growth hormone deficiency</li>\n<li>Genetic syndromes: Noonan syndrome, Prader-Willi syndrome, 3M syndrome</li>\n<li>Environmental pollutants: Lead, calcium, hexachlorobenzene, polychlorinated biphenyl</li>\n<li>Family history</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Achondroplasia <strong>(Option A)</strong></li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">hypothyroidism</span> <strong>(Option B)</strong></li>\n<li>Turner syndrome</li>\n<li>Diastrophic dysplasia</li>\n<li>Rickets <strong>(Option C)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Spondyliepiphyseal <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> (Option D)</strong></li>\n<li>Morquio syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with proptosis that increases when bending down. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Orbital Varices", "correct": true}, {"label": "B", "text": "Thyroid Eye Disease", "correct": false}, {"label": "C", "text": "Cavernous Sinus Thrombosis", "correct": false}, {"label": "D", "text": "Orbital Cellulitis", "correct": false}], "correct_answer": "A. Orbital Varices", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orbital Varices</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dilated <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> channels in the orbit (part of the spectrum of developmental <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> anomalies)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most cases are <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> and the most frequent site is upper nasal.</p>\n<p>Slowly progressive <strong>intermittent proptosis</strong> which worsens with head position changes, bending forward, or Valsalva maneuver.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May involve one large vessel or multiple ectatic veins with fibrotic walls.</p>\n<p>Thrombosed lumens can contain phleboliths from calcified thrombi.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT</strong> - serpiginous, dense structures that enlarge with Valsalva, <strong>enhances with contrast</strong> administration.</p>\n<p><strong>MRI</strong> - T1 images show low <span class=\"customMeta\" data-dictid=\"ad45f1e11716927771901f3d9b18eb\">isointense</span> signal, T2 shows dark signal <span class=\"customMeta\" data-dictid=\"3ea4fc34801692777202b98af71861\">void</span> from flowing blood. <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">Enhancement</span> with <span class=\"customMeta\" data-dictid=\"e3767003061692777187b931c6a08f\">Gadolinium</span> is marked, except in areas of thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No treatment</strong> needed for mild symptoms;</p>\n<p><strong>Surgical or embolization</strong> options for severe cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Good</strong> unless large lesions <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve, risking vision loss.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with micrognathia and low-set ears. These clinical features are commonly associated with which type of genetic abnormality?", "options": [{"label": "A", "text": "Deletion", "correct": true}, {"label": "B", "text": "Translocation", "correct": false}, {"label": "C", "text": "Amplification", "correct": false}, {"label": "D", "text": "Inversion", "correct": false}], "correct_answer": "A. Deletion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The CSF findings in bacterial meningitis would include which of the following?", "options": [{"label": "A", "text": "Elevated protein and decreased glucose", "correct": true}, {"label": "B", "text": "Normal white blood cell count", "correct": false}, {"label": "C", "text": "Decreased protein and elevated glucose", "correct": false}, {"label": "D", "text": "Elevated WBC count with normal glucose", "correct": false}], "correct_answer": "A. Elevated protein and decreased glucose", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:698px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predominant Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gross Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bacterial Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Polymorphonuclear Neutrophils (PMNs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elevated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreased</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Turbid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fungal/Tubercular Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Straw-colored (TB meningitis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Viral Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or Slightly Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or</p>\n<p>Turbid</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with right-sided field defects in both eyes, but central vision remains unaffected. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Homonymous Hemianopia with Macular Sparing", "correct": true}, {"label": "B", "text": "Heteronymous Hemianopia with Central Sparing", "correct": false}, {"label": "C", "text": "Optic Chiasm Lesion", "correct": false}, {"label": "D", "text": "Optic Tract Lesion", "correct": false}], "correct_answer": "A. Homonymous Hemianopia with Macular Sparing", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ezkdRPntaZnPng2qGzrl1741022029.png", "https://image.prepladder.com/content/BYHZfQtacQwkn2VXPDdp1741022053.png", "https://image.prepladder.com/content/UF4vrJZmRQkYMPTdGZmT1741022071.png", "https://image.prepladder.com/content/snK6ikphebHvnxAfv8aH1741022091.png", "https://image.prepladder.com/content/T9Z2jm7cfZ7El3O9QB1n1741022123.png", "https://image.prepladder.com/content/LhQAZiJP8btuZrL6RVno1741022283.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">Pathway</span> Lesions and Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibers Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Field Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> + <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"763\" src=\"https://image.prepladder.com/content/BYHZfQtacQwkn2VXPDdp1741022053.png\" width=\"184\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Anopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Chiasma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1574\" src=\"https://image.prepladder.com/content/UF4vrJZmRQkYMPTdGZmT1741022071.png\" width=\"1600\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Bitemporal Hemianopia</strong></p>\n<p><strong>(Heteronymous Hemianopia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Optic Tract</strong></li>\n<li><strong>Lateral <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">Geniculate</span> Body (LGB Lesion)</strong></li>\n<li><strong>Optic Radiation</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/snK6ikphebHvnxAfv8aH1741022091.png\" width=\"1600\"/></p>\n<p><strong>Homonymous Hemianopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">Cortex</span> without the involvement of tip</strong></p>\n<p><strong>(Post. Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers except <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> representation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/T9Z2jm7cfZ7El3O9QB1n1741022123.png\" width=\"1600\"/></p>\n<p><strong>Homonymous <span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\">Hemianopia</span> with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">Macular</span> Sparing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tip of Visual Cortex</strong></p>\n<p><strong>(Middle Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Macular Representation of <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">Ipsilateral</span> <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> and <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/LhQAZiJP8btuZrL6RVno1741022283.png\" width=\"1599\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Macular <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">Homonymous</span> Hemianopia</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of throat infection presents with a water hammer pulse. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Rheumatic fever with aortic regurgitation", "correct": true}, {"label": "B", "text": "Infective endocarditis", "correct": false}, {"label": "C", "text": "Mitral stenosis", "correct": false}, {"label": "D", "text": "Aortic stenosis", "correct": false}], "correct_answer": "A. Rheumatic fever with aortic regurgitation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conditions Associated</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Water-Hammer (Collapsing) Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Aortic regurgitation</strong></li>\n<li>Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus</li>\n<li>Hyperdynamic <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> (e.g., fever, anemia)</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> and aortic regurgitation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Parvus et Tardus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aortic stenosis</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus <span class=\"customMeta\" data-dictid=\"e506039a4916927771831191786c58\">Bisferiens</span> (Collapsing + Slow Rising)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aortic regurgitation</li>\n<li>Hypertrophic obstructive cardiomyopathy</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> and aortic regurgitation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Alternans</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> failure</li>\n<li>Dilated cardiomyopathy</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease</li>\n<li>Hypertrophic obstructive cardiomyopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dicrotic Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe sepsis</li>\n<li>Shock (especially <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock)</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output states</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jerky Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe aortic stenosis</li>\n<li>Hyperdynamic circulation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Paradoxus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cardiac tamponade</li>\n<li>Constrictive pericarditis</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> or COPD</li>\n<li>Airway obstruction</li>\n<li>Superior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bounding Pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aortic regurgitation</li>\n<li>Hyperthyroidism</li>\n<li>Paget's disease</li>\n<li>Fever (hyperdynamic circulation)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Bigeminus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ventricular <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> beats</li>\n<li>Severe arrhythmias</li>\n<li>Myocardial infarction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsus Tardus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aortic stenosis</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the formula for sensitivity?", "options": [{"label": "A", "text": "TP/(TP+FP)x100", "correct": false}, {"label": "B", "text": "TP/(TP+FN)x100", "correct": true}, {"label": "C", "text": "TN/(TN+FP)x100", "correct": false}, {"label": "D", "text": "TN/(TN+FN)x100", "correct": false}], "correct_answer": "B. TP/(TP+FN)x100", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TiAmZhcfs1e6ZtocIwuU1741064617.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the correct arrangement about the levels of health care?", "options": [{"label": "A", "text": "1- Medical colleges and hospitals are primary level, 2- CHC is secondary level, 3- Sub Centre and PHC are tertiary", "correct": false}, {"label": "B", "text": "1- Sub Centre and PHC are primary level, 2- CHC is secondary level, 3- Medical colleges and hospitals are tertiary", "correct": true}, {"label": "C", "text": "1- CHC is primary level, 2- Sub Centre and PHC are secondary level, 3- Medical colleges and hospitals are tertiary", "correct": false}, {"label": "D", "text": "1- PHC is primary level, 2- Sub Centre is secondary level, 3- Medical colleges and hospitals are tertiary", "correct": false}], "correct_answer": "B. 1- Sub Centre and PHC are primary level, 2- CHC is secondary level, 3- Medical colleges and hospitals are tertiary", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "MOA of botulinum toxin is", "options": [{"label": "A", "text": "Inhibits Elongation factor 2", "correct": false}, {"label": "B", "text": "Inhibits the release of GABA", "correct": false}, {"label": "C", "text": "Inhibits the release of Acetylcholine", "correct": true}, {"label": "D", "text": "Increases cAMP", "correct": false}], "correct_answer": "C. Inhibits the release of Acetylcholine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3yAHaQPZfdTNy5tPrnDp1741086418.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38 Y/o woman presents with complaints of heavy menstrual bleeding, pelvic discomfort, and frequent urination. On physical examination, her uterus is found to be irregularly enlarged. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Endometriosis", "correct": false}, {"label": "B", "text": "Ovarian cyst", "correct": false}, {"label": "C", "text": "Leiomyoma", "correct": true}, {"label": "D", "text": "Polycystic ovary syndrome (PCOS)", "correct": false}], "correct_answer": "C. Leiomyoma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 39-year-old patient with HIV and a CD4 count of 139 cells/μL presents with altered sensorium and impaired consciousness. CSF examination using an India ink preparation reveals a positive result. Which organism is most likely responsible?", "options": [{"label": "A", "text": "Cryptococcus neoformans", "correct": true}, {"label": "B", "text": "Aspergillus fumigatus", "correct": false}, {"label": "C", "text": "Histoplasma capsulatum", "correct": false}, {"label": "D", "text": "Candida albicans", "correct": false}], "correct_answer": "A. Cryptococcus neoformans", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/X6XPOLaMmG1g8DZkIoOH1741084613.png", "https://image.prepladder.com/content/fT8oxh5IZgYbBtBnpKwe1741084655.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:729px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features of <span class=\"customMeta\" data-dictid=\"e828e24db216927771854e0dd69280\">Cryptococcosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory System </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cryptococcus typically enters the body via <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> and can cause <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infection / <span class=\"customMeta\" data-dictid=\"5a679034841692777196d988b49eb5\">pneumonitis</span> - primary site of infection</li>\n<li>Patients may present with cough, pleuritic chest pain, and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress.</li>\n<li>Imaging shows a <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> nodule</li>\n<li>Dissemination of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infection leads to the involvement of other organs</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central Nervous System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meningitis:</strong> Characterized by severe headaches, fever, <strong>altered mental status</strong>, <strong>sensory and memory loss</strong>, <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve <span class=\"customMeta\" data-dictid=\"fec3fca4a316927771949da843f588\">paresis</span> and loss of vision</p>\n<p>It is the most serious type of <span class=\"customMeta\" data-dictid=\"6bd3522c4516927771855962983e97\">cryptococcal</span> infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cutaneous Cryptococcosis:</strong> Causes skin lesions, particularly in <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> patients.</p>\n<p>Associated with C.neoformans var neoformans (serotype D)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver, spleen, and bones maybe involved in <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> infections</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:761px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis </strong><strong>of Cryptococcosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>India ink</strong><strong>:</strong> <strong>Demonstrates the capsule</strong>, which appears as<strong> clear space surrounding the round <span class=\"customMeta\" data-dictid=\"38e3eb755216927771834bb7e72a61\">budding</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2803\" src=\"https://image.prepladder.com/content/X6XPOLaMmG1g8DZkIoOH1741084613.png\" width=\"4167\"/></p>\n<ul>\n<li><strong>Mucicarmine stain:</strong> It stains the carminophilic <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> of C. neoformans</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sabouraud <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> Agar</strong>, forming smooth, mucoid, cream-coloured colonies.</li>\n<li><strong>Niger seed <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> </strong>and <strong>bird seed agar</strong>: Demonstrates <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> production (brown colored colonies) due to <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> oxidase/laccase enzyme.</li>\n<li>The ability to grow at <strong>37°C</strong> and <strong>hydrolyse <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> </strong>differentiates C. neoformans from non-pathogenic cryptococci.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3864\" src=\"https://image.prepladder.com/content/fT8oxh5IZgYbBtBnpKwe1741084655.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antigen <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Demonstration of the capsular <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> by <strong>Precipitation </strong>and <strong>Latex agglutination</strong> <strong>test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial Treatment with <strong>liposomal <span class=\"customMeta\" data-dictid=\"2aca559df7169277718182de664e44\">Amphotericin B</span> </strong>and <strong>Flucytosine</strong></li>\n<li>Maintenance Therapy<strong> </strong>with <strong>Fluconazole</strong> for 6-12 months, depending on immune status.</li>\n</ul>\n<ul>\n<li>Monitoring: Regularly check <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> for fungal clearance, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, and electrolytes.</li>\n</ul>\n<ul>\n<li>Management of Underlying Conditions: Optimize ART to reduce <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked area in the image given.", "options": [{"label": "A", "text": "Morrison's pouch", "correct": false}, {"label": "B", "text": "Vesicouterine pouch", "correct": false}, {"label": "C", "text": "Pouch of Douglas", "correct": true}, {"label": "D", "text": "Ischioanal Fossa", "correct": false}], "correct_answer": "C. Pouch of Douglas", "question_images": ["https://image.prepladder.com/content/6PaS0cDdV811bSQUtvm51741089398.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a history of vomiting. Arterial blood gas analysis reveals the following: pH : 7.5 pCO₂ : 48 mm Hg HCO₃⁻ : 30 mm Hg What is the most likely acid-base abnormality?", "options": [{"label": "A", "text": "Metabolic alkalosis", "correct": true}, {"label": "B", "text": "Metabolic acidosis", "correct": false}, {"label": "C", "text": "Respiratory acidosis", "correct": false}, {"label": "D", "text": "Respiratory alkalosis", "correct": false}], "correct_answer": "A. Metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with a right transverse palmar crease, a cardiac defect, survival into childhood, and mild intellectual impairment. What is the chromosomal abnormality most likely associated with these findings?", "options": [{"label": "A", "text": "Tetralogy", "correct": false}, {"label": "B", "text": "Haploid", "correct": false}, {"label": "C", "text": "Monosomy", "correct": false}, {"label": "D", "text": "Mosaicism", "correct": true}], "correct_answer": "D. Mosaicism", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the fIPV dose schedule under the National Immunization Schedule?", "options": [{"label": "A", "text": "6 weeks, 10 weeks, 14 weeks", "correct": false}, {"label": "B", "text": "At birth, 6 weeks, 10 weeks, 14 weeks, 16-24 months, 5 years", "correct": false}, {"label": "C", "text": "6 weeks, 14 weeks, 9 months", "correct": true}, {"label": "D", "text": "6 weeks, 10 weeks, 12 weeks", "correct": false}], "correct_answer": "C. 6 weeks, 14 weeks, 9 months", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>IPV (salk type)</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>OPV (sabin type)</strong></p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Type of vaccine</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Killed formalised virus</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Live attenuated virus</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Mode of administration</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>S/C or IM (0.5 mL)</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Oral (2 drops)</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Type of immunity</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Only humoral</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Humoral and intestinal</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Prevention of</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Paralysis</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Paralysis + Intestinal re-infection</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Control of epidemics</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Not useful</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Effective</p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Storage &amp; transport</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less stringent conditions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires sub-zero temperatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shelf life</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Longer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VAPP (Vaccine Associated <span class=\"customMeta\" data-dictid=\"14bba9af561692777194c8cadacf13\">Paralytic</span> Polio)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Zero incidences</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 per 1 million vaccines</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old female visited the clinician with a solitary thyroid nodule and was advised for thyroid function tests where Tsh level is 27.3mU/L, T3 is 1.24 ng/ml, and T4 is 4.87 microgram/ml. Which of the following manifestations is true regarding the condition?", "options": [{"label": "A", "text": "Heat intolerance", "correct": false}, {"label": "B", "text": "Tachycardia", "correct": false}, {"label": "C", "text": "Diarrhea", "correct": false}, {"label": "D", "text": "Weight gain", "correct": true}], "correct_answer": "D. Weight gain", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:572px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hyperthyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> rate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> rate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight gain, puffiness, dry skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased appetite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased appetite</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bradycardia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachycardia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cold intolerance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heat intolerance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Constipation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diarrhea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Menorrhagia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amenorrhea, infertility</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiomegaly, <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiovascular complications such as atrial fibrillation, cardiomyopathy, and Congestive heart failure.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Altered mental status, coma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-month-old baby is brought by the mother with complaints of the left upper eyelid moving up and down during breastfeeding or thumb sucking, which disappears when the baby is not being fed. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Marcus Gunn Jaw-Winking Syndrome", "correct": true}, {"label": "B", "text": "Lagophthalmos", "correct": false}, {"label": "C", "text": "Myasthenia Gravis", "correct": false}, {"label": "D", "text": "3rd CN palsy", "correct": false}], "correct_answer": "A. Marcus Gunn Jaw-Winking Syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lYed476bmt0uk0xXWNvS1741088005.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is shown in the image below (circled)?", "options": [{"label": "A", "text": "Columella", "correct": false}, {"label": "B", "text": "Osteomeatal complex", "correct": true}, {"label": "C", "text": "Nasal valve", "correct": false}, {"label": "D", "text": "Crest of maxilla", "correct": false}], "correct_answer": "B. Osteomeatal complex", "question_images": ["https://image.prepladder.com/content/PmLeHcnGCTKIp53FWuuD1741087320.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate on examination has bilateral cataracts and, after investigations, is found to have a patent ductus arteriosus and salt &amp;amp; paper retinopathy. What is the most likely congenital infection?", "options": [{"label": "A", "text": "Rubella", "correct": true}, {"label": "B", "text": "CMV", "correct": false}, {"label": "C", "text": "Toxoplasma", "correct": false}, {"label": "D", "text": "Varicella", "correct": false}], "correct_answer": "A. Rubella", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yYlWqwJQ4qqZphA2OJ9A1741087376.png", "https://image.prepladder.com/content/KmEopIBujdsYAfsB7TOI1741087340.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Congenital Rubella</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rubella (German measles) is a mild disease in infants and children but can cause <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> syndrome (CRS) if contracted during pregnancy.</li>\n<li>The risk is highest in the first trimester, especially within the first 8 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Viremia is most intense from 10 to 17 days after infection.</li>\n<li>Viral shedding is from day 10 of infection up to 2 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of Defects by Gestational Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Highest in the first 12 weeks of <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> and decreases significantly thereafter, with defects being rare after 20 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features of <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hearing loss (most common)</li>\n<li>Vision problems (<strong>cataracts</strong>, glaucoma, <strong>salt and pepper</strong><strong> </strong><strong>retinopathy</strong>).\n\t\t\t\t<ul>\n<li>Cataracts are the most common <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> associated with <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> rubella.</li>\n</ul>\n</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"336\" src=\"https://image.prepladder.com/content/yYlWqwJQ4qqZphA2OJ9A1741087376.png\" width=\"687\"/></p>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/KmEopIBujdsYAfsB7TOI1741087340.png\" width=\"3846\"/>\n<ul>\n<li>Heart defects (<strong>patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus</strong> &gt; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> (right &gt; left) &gt; <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> septal defect)</li>\n<li><strong>Low birth weight</strong></li>\n<li>Neurological issues (microcephaly, intellectual disabilities, encephalitis, behavioural issues)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronicity and Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic presence of the virus can cause ongoing damage</li>\n<li>The risk of progressive <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> <span class=\"customMeta\" data-dictid=\"871ad2a8051692777194a3f7cd0309\">panencephalitis</span> (PRP) years later is a rare complication.</li>\n<li>Less common complications: Growth retardation, hepatitis, bone lesions.</li>\n<li>Risk of diabetes and <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> dysfunction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rubella <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> <span class=\"customMeta\" data-dictid=\"9660c7ea2116927771894b30a0f80b\">immunosorbent</span> <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">assay</span> (detects antibodies)</li>\n<li>Viral isolation (growing the virus from samples)</li>\n<li>Polymerase chain reaction (PCR) (detects <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> RNA)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"a4a589776216927771991b881f95b1\">specific treatment</span> for CRS; supportive care is key</li>\n<li>Early intervention for complications (e.g., hearing loss) is crucial</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Standard with <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> <span class=\"customMeta\" data-dictid=\"43ce88387a1692777196387ed2c267\">precaution</span> in hospitalized cases</li>\n<li>Rubella <span class=\"customMeta\" data-dictid=\"f23be6aa561692777201ca2e1aaa27\">vaccination</span> RA 27/3 live attenuated vaccine (MMR or <span class=\"customMeta\" data-dictid=\"dfad3b2dd41692777192eef4355bc3\">MMRV</span> with varicella) effectively prevents <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> and CRS</li>\n<li>MMR vaccine has a 95% <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> after one dose and 99% after two doses</li>\n<li>Vaccination side effects: fever, rash, joint pain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Considerations for Pregnant Women</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immunoglobulin </strong>may be considered if pregnancy is not terminated, though it does not guarantee prevention of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> infection</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vaccines is C/I in pregnancy?", "options": [{"label": "A", "text": "Influenza", "correct": false}, {"label": "B", "text": "Varicella", "correct": true}, {"label": "C", "text": "Rabies", "correct": false}, {"label": "D", "text": "TDaP", "correct": false}], "correct_answer": "B. Varicella", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Varicella <span class=\"customMeta\" data-dictid=\"03350c16f71692777202dbca70976e\">zoster</span> <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> (VZIG)</strong></p>\n\t\t\t \n\n\t\t\t<p>VZIG is given within 72 hours of exposure and is recommended for the prevention of <span class=\"customMeta\" data-dictid=\"d5b9e7187c16927771847488b5f135\">chickenpox</span> in exposed individuals like:</p>\n<ul>\n<li>HIV/AIDS or <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> persons</li>\n<li>Immunosuppressive therapy patients</li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> immunodeficiency</li>\n<li>Pregnant females, early neonates, <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> infants or low birth weights</li>\n<li>Given to neonates if their mothers get <span class=\"customMeta\" data-dictid=\"d5b9e7187c16927771847488b5f135\">chickenpox</span> 5 days before or 2 days after delivery.</li>\n</ul>\n<p>Dose: 12.5 units/kg with a maximum of 625 units, repeat the dose in 3 weeks if the high-risk patient remains exposed.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Live vaccine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5 ml <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> route.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schedule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Given in 2 doses, it is recommended for all.</p>\n<ul>\n<li>If given &lt; 13 years, the duration between two dosages should be 1-3 months</li>\n<li>For &gt;13 years, the duration between two doses is 4-6 weeks</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Combination</strong></p>\n<p><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chickenpox vaccine can be given as MMRV– <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> <span class=\"customMeta\" data-dictid=\"f61c340e77169277719339e74267c4\">mumps</span> <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> varicella.</p>\n<ul>\n<li>MMRV– administered to 9 months to 12 years of age</li>\n<li>Two doses schedule with an interval of 4 weeks</li>\n<li>However, it is preferred that the second dose be administered 6 weeks to 3 months after the first dose or at 4-6 years of age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post Exposure</strong></p>\n<p><strong>Prophylaxis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This can be done if there is known exposure to <span class=\"customMeta\" data-dictid=\"cf329b8cef169277720107b1efa15b\">varicella</span> virus; the vaccine should be given within 5 days of exposure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vaccine is contraindicated</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the CTG pattern?", "options": [{"label": "A", "text": "Early deceleration", "correct": true}, {"label": "B", "text": "Late decelarations", "correct": false}, {"label": "C", "text": "Variable", "correct": false}, {"label": "D", "text": "Normal", "correct": false}], "correct_answer": "A. Early deceleration", "question_images": ["https://image.prepladder.com/content/6wIT8gO4caxs7qfjMJ521741097152.png"], "explanation_images": ["https://image.prepladder.com/content/qdQPzBmr6o69eWN9c1fO1741097352.png", "https://image.prepladder.com/content/mBVx14iIg9oXC4QeP5Bx1741097388.png", "https://image.prepladder.com/content/EmkKzEYMOxfEQnDJHz7J1741097538.png", "https://image.prepladder.com/content/WB0XqrdHDBUNUb4cl8sB1741097782.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Decelerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual decline and recovery of FHR that coincide with the onset and recovery of the contraction. The nadir of the <span class=\"customMeta\" data-dictid=\"7be129d4bb1692777185fa5706fe88\">deceleration</span> occurs <strong>≥30 seconds</strong> after onset. The nadir of the <span class=\"customMeta\" data-dictid=\"7be129d4bb1692777185fa5706fe88\">deceleration</span> occurs <strong>≥30 seconds</strong> after onset.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fetal head compression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual decrease mirroring contractions.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1041\" src=\"https://image.prepladder.com/content/qdQPzBmr6o69eWN9c1fO1741097352.png\" width=\"1041\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late Decelerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual decline in FHR that begins <strong>at or after</strong> the contraction’s peak and recovers after the <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> ends. The nadir occurs <strong>≥30 seconds</strong> after onset.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fetal hypoxia, <span class=\"customMeta\" data-dictid=\"091c4fd1e61692777201ec50806bc4\">uteroplacental</span> insufficiency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Begin after <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> peak, uniform U-shaped.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1041\" src=\"https://image.prepladder.com/content/mBVx14iIg9oXC4QeP5Bx1741097388.png\" width=\"1041\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variable Decelerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abrupt FHR drop (≥15 bpm) with onset varying between contractions. Onset-to-nadir &lt;30 sec, duration ≥15 sec but &lt;2 min.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Umbilical cord compression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abrupt, irregular, \"V\" or \"W\" shapes.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4160\" src=\"https://image.prepladder.com/content/EmkKzEYMOxfEQnDJHz7J1741097538.png\" width=\"4160\"/></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following CVS changes are not seen in pregnancy?", "options": [{"label": "A", "text": "Soft Systolic murmur", "correct": false}, {"label": "B", "text": "Diastolic murmur", "correct": true}, {"label": "C", "text": "S3", "correct": false}, {"label": "D", "text": "Loud S1 splitting", "correct": false}], "correct_answer": "B. Diastolic murmur", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemodynamic changes during pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Change</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cardiac output (L/min)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases +40%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stroke volume (ml)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases +27%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heart rate (per minute)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases +17%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An unaffected or mid-pregnancy drop of <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">diastolic pressure</span> by 5-10 mm Hg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Venous pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases +100%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colloid <span class=\"customMeta\" data-dictid=\"5d369be246169277719451754ab37a\">oncotic</span> pressure (mmHg)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreases -14%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance (SVR)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreases -21%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance (PVR)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreases -34%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given instrument.", "options": [{"label": "A", "text": "Veress needle", "correct": true}, {"label": "B", "text": "Hasson's cannula", "correct": false}, {"label": "C", "text": "Jamshidi needle", "correct": false}, {"label": "D", "text": "3 mm Trocar", "correct": false}], "correct_answer": "A. Veress needle", "question_images": ["https://image.prepladder.com/content/C1gY2W6LEluDhcPuVqK81741108912.png"], "explanation_images": ["https://image.prepladder.com/content/ZHbblWdREHDVZXKlV4201741108932.png", "https://image.prepladder.com/content/mLgIqP5CtUHgpcAjsK4T1741069125.png", "https://image.prepladder.com/content/AhVvenpxAlOSG9Eyrxeg1741069144.png", "https://image.prepladder.com/content/aEOWFP9nAbqHWYIm3wMM1741108962.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:402px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Creates <span class=\"customMeta\" data-dictid=\"8c36ab9b0516927771962c88c4ada4\">pneumoperitoneum</span> for laparoscopy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spring-loaded <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> <span class=\"customMeta\" data-dictid=\"a1244e4821169277719985dd460729\">stylet</span> for safety</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insertion Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly at the umbilicus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alternative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hasson’s open technique</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Artificial creation of gas <span class=\"customMeta\" data-dictid=\"0bb08aec621692777190d80a74d35c\">insufflation</span> in the peritoneal <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> to facilitate <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Gas Used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carbon <span class=\"customMeta\" data-dictid=\"0bd01a042116927771868e3482910e\">dioxide</span> (CO₂) due to its rapid absorption, non-combustibility, and high <span class=\"customMeta\" data-dictid=\"a9295e67a41692777198dce0de3f34\">solubility</span> in blood.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Closed technique</strong>: Uses <span class=\"customMeta\" data-dictid=\"4726929e261692777201a665a56fa7\">Veress needle</span> for insufflation.</p>\n<p><strong>Open technique</strong>: Uses Hasson’s <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> without prior insufflation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insufflation Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-15 mmHg (optimal for maintaining <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> space while minimizing complications).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gas-related</strong>: Hypercapnia, acidosis, gas embolism.</p>\n<p><strong>Entry-related</strong>: <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> injury, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury, <span class=\"customMeta\" data-dictid=\"707b8e89cd1692777196474be04ff0\">preperitoneal</span> insufflation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention of Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Correct needle placement confirmation (aspiration test, <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> drop test).</p>\n<p>Slow controlled insufflation.</p>\n<p>Monitoring <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO₂ levels.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient reports difficulty switching between movements and experiences uncontrollable hand movements. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Dysdiadochokinesis", "correct": true}, {"label": "B", "text": "Intentional Tremor", "correct": false}, {"label": "C", "text": "Metamorphosis", "correct": false}, {"label": "D", "text": "Resting Tremor", "correct": false}], "correct_answer": "A. Dysdiadochokinesis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypotonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased muscle tone, often on the same side as the cerebellar lesion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ataxia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncoordinated movements, often leading to a \"drunken\" gait.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysdiadochokinesia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inability to perform rapid <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> movements, such as flipping the hands back and forth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysmetria (Past pointing)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Movements that overshoot or undershoot the intended target.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intention tremor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tremors occurring when moving toward a target</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysarthria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jumbled speech due to lack of <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> in the muscles involved in speech</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nystagmus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid, tremulous eye movements</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rebound Phenomenon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limb jerking back after resistance is suddenly removed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decomposition of movement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can't move multiple joints simultaneously.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> deficit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not typically present in cerebellar diseases.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked in the image given below.", "options": [{"label": "A", "text": "Buccopharyngeal fascia", "correct": false}, {"label": "B", "text": "Capsule", "correct": false}, {"label": "C", "text": "Superior constrictor muscle", "correct": false}, {"label": "D", "text": "Pharyngobasilar fascia", "correct": true}], "correct_answer": "D. Pharyngobasilar fascia", "question_images": ["https://image.prepladder.com/content/LB2zMYRgAaL92DPoB0s11741090319.png"], "explanation_images": ["https://image.prepladder.com/content/DFtNa1AR3JlLzkOLPChB1741024952.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:406px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structures forming the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">Tonsillar</span> bed</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscles forming the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> bed</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Superior <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">Constrictor</span> Muscle</li>\n<li>Styloglossus Muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures close to the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> bed (outside the superior <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle)</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Facial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (Tonsillar Branch): Major blood supply to the tonsils, at risk for haemorrhage during surgery.</li>\n<li>Paratonsillar Vein: <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of the tonsil, risk of <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> during tonsillectomy.</li>\n<li>Submandibular Salivary Gland</li>\n<li>Posterior Belly of <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">Digastric</span> Muscle</li>\n<li>Medial <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">Pterygoid</span> Muscle</li>\n<li>Mandible</li>\n<li>Glossopharyngeal Nerve: Provides <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the tonsils.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A post menopausal women presents with irregular bleeding, endometrium biopsy shows endometrial hyperplasia without atypia. What is the likely management?", "options": [{"label": "A", "text": "OCP", "correct": false}, {"label": "B", "text": "Estradiol", "correct": false}, {"label": "C", "text": "LNG-IUS", "correct": true}, {"label": "D", "text": "Danazol", "correct": false}], "correct_answer": "C. LNG-IUS", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2vO2xqkNHmzAI5bnktUI1741106930.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old woman with a history of chronic obstructive pulmonary disease (COPD) presents with increased breathlessness, cough, and sputum production over the last two days. She appears distressed and has a respiratory rate of 28 breaths per minute. Her oxygen saturation is 88% on room air. Which of the following management strategies is most appropriate for her immediate treatment?", "options": [{"label": "A", "text": "Initiate high-flow oxygen therapy to maintain oxygen saturation above 95%", "correct": false}, {"label": "B", "text": "Start nebulised bronchodilator therapy with salbutamol and ipratropium", "correct": true}, {"label": "C", "text": "Begin intravenous glucocorticoids immediately", "correct": false}, {"label": "D", "text": "Order a chest X-ray before any treatment is provided", "correct": false}], "correct_answer": "B. Start nebulised bronchodilator therapy with salbutamol and ipratropium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Arterial blood gases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess severity of hypoxaemia, hypercapnia, acidaemia; guide oxygen therapy and ventilation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Identify complications such as pneumonia, pneumothorax, or pleural effusion. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Oxygen Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Administer<strong> controlled oxygen at 24% or 28%</strong> to maintain PaO2 &gt; 8 kPa (60 mmHg) or SaO2 &gt; 90%. <strong>(Option A ruled out)</strong></li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> gas monitoring to adjust therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bronchodilators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Use nebulised short-acting β2-agonists (e.g., salbutamol, terbutaline) with anticholinergics (e.g., ipratropium).</li>\n<li>If oxygen sensitivity is a concern, use compressed air for nebulisation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Administer oral <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> (30 mg for 10 days) to reduce symptoms and improve lung function.Reduces frequency and severity of exacerbations.</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> for repeated courses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antibiotic Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Indicated for increased <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> purulence, volume, or breathlessness.</li>\n<li>Use simple regimens (aminopenicillin, tetracycline, macrolide); <span class=\"customMeta\" data-dictid=\"dd4d53634b1692777184851322327e\">co-amoxiclav</span> in areas with β-lactamase organisms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Non-Invasive <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (NIV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Safe for mild to moderate <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis; helps reduce <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> need and mortality.</li>\n<li>Not suitable for patients unable to protect their airway.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mechanical Ventilation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consider if there is a <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> cause, no prior <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, or if <span class=\"customMeta\" data-dictid=\"0e4135f3bc1692777193047657d8c5\">NIV</span> has failed/contraindicated.</li>\n<li>Decisions should involve the patient, family, and GP.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Additional Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diuretics for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> oedema.</li>\n<li>Limited evidence for <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> aminophylline; consider <span class=\"customMeta\" data-dictid=\"5280ec6ae91692777182aa6322ae68\">arrhythmia</span> risk.</li>\n<li>Doxapram may be used short-term for low <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rates.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presents to the OPD with a 3 cm breast lump in the upper medial quadrant . The lump has an uneven, bosselated surface , and the overlying skin is mildly ulcerated . Microscopic examination reveals the given findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Phyllodes tumor", "correct": true}, {"label": "B", "text": "Galactocele", "correct": false}, {"label": "C", "text": "Fibroadenoma", "correct": false}, {"label": "D", "text": "Paget's disease", "correct": false}], "correct_answer": "A. Phyllodes tumor", "question_images": ["https://image.prepladder.com/content/DOhXoukvwuwXNLuszAAc1741075420.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:344px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-50 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid, large <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> mass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surface</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uneven, bosselated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stromal overgrowth, leaf-like pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> / mastectomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male patient presented with localized pain, which is gradual in onset and worsened over time. X-ray showed the following finding. What is the diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": true}, {"label": "B", "text": "Ewing sarcoma", "correct": false}, {"label": "C", "text": "Chondrosarcoma", "correct": false}, {"label": "D", "text": "Gout", "correct": false}], "correct_answer": "A. Osteosarcoma", "question_images": ["https://image.prepladder.com/content/k1uA6n8wczOZOfLcBr761741058451.png"], "explanation_images": ["https://image.prepladder.com/content/BJCDTsXfCE7Lr7WDJXo91741058567.png", "https://image.prepladder.com/content/K1XAuTM1yB4RiZdTwFL81741058609.png", "https://image.prepladder.com/content/k1uA6n8wczOZOfLcBr761741058451.png", "https://image.prepladder.com/content/ADfGkyLin0Bi82sdfaXl1741058724.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following tests is most appropriate for diagnosing this condition?", "options": [{"label": "A", "text": "Nikolsky Test", "correct": false}, {"label": "B", "text": "Asboe-Hansen test", "correct": false}, {"label": "C", "text": "Grattage Test", "correct": true}, {"label": "D", "text": "Tzanck Smear", "correct": false}], "correct_answer": "C. Grattage Test", "question_images": ["https://image.prepladder.com/content/1q6owN5zmAbaGCK8y1rG1741088923.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came to the hospital with muscle weakness, diarrhea, and bradycardia. He was diagnosed with organophosphate poisoning for which atropine was administered. After atropine administration, which of the following changes are not seen?", "options": [{"label": "A", "text": "Bradycardia", "correct": false}, {"label": "B", "text": "Muscle weakness", "correct": true}, {"label": "C", "text": "Diaphoresis", "correct": false}, {"label": "D", "text": "Nasal discharge", "correct": false}], "correct_answer": "B. Muscle weakness", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iMu7d6R9pWHJD80lFcYo1741020944.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Muscarinic: </strong>Lethargy, Salivation, Diarrhea, Lacrimation, Urination, Miosis, Muscle weakness, Bronchorrhea, Bronchospasm, Bradycardia, Emesis (Mnemonic: DUMBBELLS)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nicotinic: </strong>Muscle weakness, Fasciculation, Areflexia, Muscle paralysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>CNS: </strong>Headache, Tremor, Confusion, Slurred speech, Coma, Convulsion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Laboratory Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>RBC/True Cholinesterase</strong> (specific)</li>\n<li><strong>Plasma/Pseudocholinesterase</strong> (Most common)\n\t\t\t\t<ul>\n<li>Falls rapidly with <span class=\"customMeta\" data-dictid=\"8e1f460230169277719463930573a7\">organophosphorus</span> poisoning</li>\n<li>Inexpensive, sensitive)</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Atropine test</strong>: If 2 mg of <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">Atropine</span> relieves symptoms, it confirms OP poisoning</li>\n<li><strong>P-nitro <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> test</strong> for confirmation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Resuscitative measures (Airway-Breathing-Circulation)</li>\n<li>Decontamination</li>\n<li>Gastric <span class=\"customMeta\" data-dictid=\"b625b3e881169277719169ef4e1af3\">lavage</span> with 1:5000 KMnO4</li>\n<li>Activated charcoal</li>\n<li><strong>Atropine sulfate</strong> (2-4 mg IV every 10-15 minutes until atropinization)</li>\n<li><strong>Signs of atropinization:</strong> Heart rate&gt;80 beats/min, pupils no longer pinpoint, clear chest on <span class=\"customMeta\" data-dictid=\"b2f0dbabe516927771821b0ec5ba85\">auscultation</span> with no wheeze, <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP&gt;80mmHg, Dry axillae</li>\n<li>Oximes (Pralidoxime) to decrease <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> and CNS symptoms\n\t\t\t\t<ul>\n<li>removes <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> group</li>\n<li>reduces <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> requirement</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause of Death</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Respiratory Muscle <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">Paralysis</span> (RMP)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Option</strong></th>\n<th><strong>Explanation</strong></th>\n<th><strong>Seen after atropine?</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Bradycardia</strong></td>\n<td>Reversed by <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> (muscarinic blockade)</td>\n<td>Not seen</td>\n</tr>\n<tr>\n<td>Muscle weakness</td>\n<td>Nicotinic effect; not reversed by atropine</td>\n<td>Seen</td>\n</tr>\n<tr>\n<td>Diaphoresis</td>\n<td>Muscarinic effect; reversed by atropine</td>\n<td>Seen before, improves</td>\n</tr>\n<tr>\n<td>Nasal discharge</td>\n<td>Muscarinic effect; reversed by atropine</td>\n<td>Seen before, improves</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a primary use of this imaging modality?", "options": [{"label": "A", "text": "Staging of esophageal cancer", "correct": true}, {"label": "B", "text": "Evaluation of gastroesophageal reflux disease (GERD)", "correct": false}, {"label": "C", "text": "Identifying the cause of dysphagia", "correct": false}, {"label": "D", "text": "Assessing cardiac and aortic pathology", "correct": false}], "correct_answer": "A. Staging of esophageal cancer", "question_images": ["https://image.prepladder.com/content/dX6ygIOTIo4YCuad18YV1741087794.png"], "explanation_images": ["https://image.prepladder.com/content/df3MKhXZiv3Sqfwa7TMC1741087906.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Application</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staging of <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> cancer</strong> (Correct Answer)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluates tumor depth and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pancreatic lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects and biopsies pancreatic cysts, tumors, or chronic pancreatitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subepithelial GI tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Differentiates between leiomyomas, GISTs, and <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biliary pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"92128a6d941692777184f9d2f7ef4d\">choledocholithiasis</span> and <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> strictures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rectal cancer staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Determines depth of invasion and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old male presents with sudden onset acute abdominal pain , constipation for 1 day , persistent hiccups , and occasional vomiting . An abdominal X-ray was performed. Identify the pathology.", "options": [{"label": "A", "text": "Sigmoid volvulus", "correct": true}, {"label": "B", "text": "Caecal volvulus", "correct": false}, {"label": "C", "text": "Intussusception", "correct": false}, {"label": "D", "text": "Dynamic obstruction", "correct": false}], "correct_answer": "A. Sigmoid volvulus", "question_images": ["https://image.prepladder.com/content/Yw1ZeYZhWd6f3QV3hMzU1741070969.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sigmoid Volvulus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caecal Volvulus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twisting of <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> on its mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Twisting of <span class=\"customMeta\" data-dictid=\"603036123f1692777183f87e582e3e\">caecum</span> &amp; <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> colon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Coffee bean\" or \"Omega loop\" sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>\"Comma\" or \"Kidney bean\" sign</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bowel Dilatation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sigmoid <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> massively distended</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dilated caecum, displaced medially</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic <span class=\"customMeta\" data-dictid=\"dfd87633931692777186f47063d1c2\">detorsion</span> or surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgery (right <span class=\"customMeta\" data-dictid=\"b8e6dbcc40169277718814cf80f864\">hemicolectomy</span> if gangrenous)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An unvaccinated 5-year-old child of a migrant worker family was brought to the causality with fever and a characteristic skin rash. Upon eye examination, Bitot’s spot was seen. What is the appropriate management?", "options": [{"label": "A", "text": "Isolate and give nutritional supply with vitamin A supplement", "correct": true}, {"label": "B", "text": "Give measles vaccine and vitamin A supplement", "correct": false}, {"label": "C", "text": "Institutional Isolation, nutritional management with vitamin A supplement", "correct": false}, {"label": "D", "text": "Only measles vaccine", "correct": false}], "correct_answer": "A. Isolate and give nutritional supply with vitamin A supplement", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/w2WRPFFlILWMUgcEhAwV1741087579.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measles (rubeola) is a highly <span class=\"customMeta\" data-dictid=\"6f6ef8bf7c1692777184dfdf8cf45d\">communicable</span> childhood <span class=\"customMeta\" data-dictid=\"4f279b047716927771872685599ba9\">exanthematous</span> illness caused by the <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> virus, an <strong>RNA virus</strong> from the <strong>Paramyxoviridae family.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contact with <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> aerosols (through the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or conjunctiva)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary viremia</strong> occurs, resulting in infection of the <span class=\"customMeta\" data-dictid=\"77c058b3b21692777197f5fd539d12\">reticuloendothelial</span> system, followed by<strong> secondary viremia,</strong> which results in <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8-12 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Period of infectivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>From 3 days before to 4 days after the <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> onset.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common in preschool children</li>\n<li><strong>Prodromal phase: </strong><strong>Fever </strong>(before rash), rhinorrhea, conjunctival <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and a <strong>dry hacking cough</strong>.</li>\n<li><strong>Koplik spots</strong>, <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> for measles, appear on the 2nd or<strong> </strong>3rd day of illness<strong> </strong>as grey-white, sand-like lesions with surrounding <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> on the <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">buccal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> opposite the lower second molars.</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"440\" src=\"https://image.prepladder.com/content/w2WRPFFlILWMUgcEhAwV1741087579.png\" width=\"434\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The erythematous <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> appears on the 4th day, starting behind the ears, along the hairline, and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cheeks, then <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> to the rest of the body over the next 2-3 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isolation</strong>.</p>\n<p><strong>Symptomatic and conservative</strong> (antipyretics, maintenance of hygiene, <strong>ensuring adequate fluid and <span class=\"customMeta\" data-dictid=\"39156a37b21692777183372a301aa8\">caloric</span> intake</strong>, and humidification).</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Under 6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>50,000 IU once daily on D1, D2, and 4 weeks later</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>6 to 12 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>100,000 IU once daily on D1, D2, and 4 weeks later</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Over 1 year</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>200,000 IU once daily on D1, D2, and 4 weeks later</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 1.5-month-old male infant presents to the outpatient department with vomiting after feeding and failure to thrive . On examination, a firm, olive-shaped mass is palpated in the upper abdomen . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Subacute Intestinal Obstruction", "correct": false}, {"label": "B", "text": "Pyloric Stenosis", "correct": true}, {"label": "C", "text": "GERD", "correct": false}, {"label": "D", "text": "Esophageal Atresia", "correct": false}], "correct_answer": "B. Pyloric Stenosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UIu3Uu2ja3gXkt5yywRZ1741075174.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:421px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age of Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-6 weeks of life</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Projectile, non-bilious vomiting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Exam</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Olive-shaped mass in epigastrium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound: Pyloric muscle hypertrophy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ramstedt's pyloromyotomy</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the usual method of collecting a sample of urine to detect UTI?", "options": [{"label": "A", "text": "Early morning sample", "correct": false}, {"label": "B", "text": "Midstream catch", "correct": true}, {"label": "C", "text": "Supra pubic catheter", "correct": false}, {"label": "D", "text": "Starting stream collection", "correct": false}], "correct_answer": "B. Midstream catch", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with vision problems and has a history of cataract surgery. OCT finding is shown below. What is the syndrome most likely associated with these findings?", "options": [{"label": "A", "text": "Posner-Schlossman Syndrome", "correct": false}, {"label": "B", "text": "Irvine-Gass Syndrome", "correct": true}, {"label": "C", "text": "Central Serous Retinopathy", "correct": false}, {"label": "D", "text": "Elschnig Pearls", "correct": false}], "correct_answer": "B. Irvine-Gass Syndrome", "question_images": ["https://image.prepladder.com/content/7Ot9ZQPwXx4E3MM2CYfI1741088058.png"], "explanation_images": ["https://image.prepladder.com/content/lYpGjzMJzJR40s8v8pOu1741088094.png", "https://image.prepladder.com/content/4p3RWJoZu7tHqhjxm0fU1741088112.png", "https://image.prepladder.com/content/ZxnuBLwUaqyv9hG1xAFB1741088166.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person came with the H/o thorn prick a week ago. A few days later, he developed ulcers along lymphatic drainage. Choose the correct organism.", "options": [{"label": "A", "text": "Coccidioides immitis", "correct": false}, {"label": "B", "text": "Aspergillus flavus", "correct": false}, {"label": "C", "text": "Sporothrix schenckii", "correct": true}, {"label": "D", "text": "Trichophyton rubrum", "correct": false}], "correct_answer": "C. Sporothrix schenckii", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lrLRxu6nru8RicCs2Zto1741085614.png", "https://image.prepladder.com/content/sO0vOtDKku1ax5i3sWFc1741085639.png", "https://image.prepladder.com/content/XfQqJpACv7qk4t48XpPJ1741085661.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sporotrichosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dimorphic <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> <span class=\"customMeta\" data-dictid=\"9163b9f3c51692777199fc6798ccf0\">Sporothrix</span> schenckii.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in <strong>gardeners</strong>, forest workers, and manual labourers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Route of Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minor trauma or<strong> thorn prick.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic infection affects cutaneous, subcutaneous, and <strong>lymphatic tissue.</strong></li>\n<li>Lesions <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> at sites of minor trauma or thorn pricks, starting as nodules.</li>\n<li>Nodules <strong>ulcerate </strong>and necrose; infection <strong>spreads through <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> channels.</strong></li>\n</ul>\n<p><strong></strong><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3650\" src=\"https://image.prepladder.com/content/lrLRxu6nru8RicCs2Zto1741085614.png\" width=\"4167\"/></p>\n<p> </p>\n<ul>\n<li><strong>Lymphocutaneous sporotrichosis: </strong>Secondary ulcers on <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes; lymphatics become hardened and cord-like.</li>\n<li><strong>Systemic dissemination: </strong>Can affect bones, joints, and meninges.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Specimens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aspiration from nodules and <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> material.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopy:</strong></p>\n<ul>\n<li>KOH mounts or histopathological sections stained by <span class=\"customMeta\" data-dictid=\"cb3712727816927771925665b0b1e0\">methenamine</span> silver <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> show <strong>asteroid bodies (Splendore hoeppli phenomenon)</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/sO0vOtDKku1ax5i3sWFc1741085639.png\" width=\"3238\"/></p>\n<ul>\n<li><strong>Yeast phase: Cigar-shaped cells. </strong><strong>(Option C)</strong></li>\n</ul>\n<p><strong>Culture:</strong> Thin <span class=\"customMeta\" data-dictid=\"55f411a4ea1692777198d8f2de73b0\">septate</span> hyphae with flower-like clusters of small conidia; <strong>pear-shaped <span class=\"customMeta\" data-dictid=\"774c1b33a916927771844f6c75dcff\">conidia</span> in rosette-like clusters</strong> in mycelial phase.</p>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2778\" src=\"https://image.prepladder.com/content/XfQqJpACv7qk4t48XpPJ1741085661.png\" width=\"4167\"/>\n<p><strong>Serological tests: </strong>Helpful for extracutaneous or <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medications:</p>\n<ul>\n<li>Itraconazole</li>\n<li>Terbinafine</li>\n<li>Amphotericin B: For <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> infection</li>\n</ul>\n<p>Cryotherapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with dilated tortuous veins of the leg presented to the OPD and is diagnosed with varicose vein of grade C4a. What is the best preferred treatment?", "options": [{"label": "A", "text": "Compression", "correct": false}, {"label": "B", "text": "Endothermal ablation", "correct": true}, {"label": "C", "text": "Non endothermal non tumescent ablation", "correct": false}, {"label": "D", "text": "Open surgery", "correct": false}], "correct_answer": "B. Endothermal ablation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CEAP Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preferred Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No visible/palpable signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No treatment needed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Telangiectasias or <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conservative (compression)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varicose veins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compression, ablation, or surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Edema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endothermal ablation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pigmentation/eczema</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endothermal ablation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lipodermatosclerosis or <span class=\"customMeta\" data-dictid=\"b04fb2c703169277718295309e32d6\">atrophie</span> blanche</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endothermal or open surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Healed <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endothermal <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">ablation</span> + <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> care</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Active <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multimodal therapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "It is shoulder dystocia when the anterior shoulder is delivered after what time of head delivery?", "options": [{"label": "A", "text": "15 sec", "correct": false}, {"label": "B", "text": "30 sec", "correct": false}, {"label": "C", "text": "45 sec", "correct": false}, {"label": "D", "text": "60 sec", "correct": true}], "correct_answer": "D. 60 sec", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Maternal Complications</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Neonatal Complications</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Soft tissue injuries</strong>: Lacerations of the bladder, urethra, vagina, anal sphincter, or rectum</li>\n<li><strong>Nerve injury</strong>: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> neuropathy</li>\n<li><strong>Postpartum hemorrhage</strong></li>\n<li><strong>Pelvic injury</strong>: Symphyseal separation</li>\n<li><strong>Uterine rupture</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fetal death</strong></li>\n<li><strong>Hypoxic-ischemic <span class=\"customMeta\" data-dictid=\"b37b211cbc169277718725f07b5473\">encephalopathy</span> (HIE)</strong></li>\n<li><strong>Fractures</strong>: <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">Clavicle</span> or humerus</li>\n<li><strong>Neurologic injuries</strong>:\n\t\t\t\t<ul>\n<li>Brachial <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> injury</li>\n<li>Diaphragmatic paralysis</li>\n<li>Facial nerve injury</li>\n<li>Horner syndrome (ptosis, miosis, anhidrosis)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a food adulteration disease?", "options": [{"label": "A", "text": "Lathyrism", "correct": false}, {"label": "B", "text": "Fluorosis", "correct": true}, {"label": "C", "text": "Dropsy", "correct": false}, {"label": "D", "text": "Aflatoxicosis", "correct": false}], "correct_answer": "B. Fluorosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9F9EdgiA8sU1d0BK9Zyt1741075856.png", "https://image.prepladder.com/content/HNkDU8Ud93iD8Hi3Rtt81741075875.png", "https://image.prepladder.com/content/sdIVLxVSZxUivTM4HL9f1741075899.png", "https://image.prepladder.com/content/XaZO5tEkiKVDzfkKjkgB1741075919.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:587px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluorine content in water</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Related symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.5mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dental caries</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"225\" src=\"https://image.prepladder.com/content/9F9EdgiA8sU1d0BK9Zyt1741075856.png\" width=\"281\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;1.5mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dental fluorosis</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"176\" src=\"https://image.prepladder.com/content/HNkDU8Ud93iD8Hi3Rtt81741075875.png\" width=\"317\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-6mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skeletal fluorosis</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"287\" src=\"https://image.prepladder.com/content/sdIVLxVSZxUivTM4HL9f1741075899.png\" width=\"216\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;10mg/L</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crippling fluorosis</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"253\" src=\"https://image.prepladder.com/content/XaZO5tEkiKVDzfkKjkgB1741075919.png\" width=\"291\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly man presents with an ulcerative lesion at the inner canthus of his eye with pearly margins. On microscopic examination, it shows a palisading arrangement of cells. Identify the lesion:", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": false}, {"label": "B", "text": "Basal cell carcinoma", "correct": true}, {"label": "C", "text": "Keratoacanthoma", "correct": false}, {"label": "D", "text": "Melanocytic melanoma", "correct": false}], "correct_answer": "B. Basal cell carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/M33byyPD710YLq93m0jo1741061580.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with a Graham-Steel murmur?", "options": [{"label": "A", "text": "Ventricular septal defect (VSD)", "correct": false}, {"label": "B", "text": "Hypertrophic obstructive cardiomyopathy (HOCM)", "correct": false}, {"label": "C", "text": "Pulmonary regurgitation", "correct": true}, {"label": "D", "text": "Aortic regurgitation", "correct": false}], "correct_answer": "C. Pulmonary regurgitation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Murmur Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-pitched <span class=\"customMeta\" data-dictid=\"6457553d6d1692777186a244ef269e\">diastolic murmur</span> with an opening snap, best heard at the apex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic Stenosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crescendo-decrescendo <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur, radiates to carotids, best heard at the right upper sternal border</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">Ductus</span> Arteriosus (PDA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous, machine-like murmur, best heard at the left <span class=\"customMeta\" data-dictid=\"71409dc88a1692777190aedbc558b6\">infraclavicular</span> area</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypertrophic <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">Cardiomyopathy</span> (HOCM) </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Harsh <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> with a crescendo-decrescendo pattern, best heard at the left sternal border, increases with Valsalva maneuver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitral <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (MR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Holosystolic murmur, best heard at the apex, radiates to the axilla</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aortic <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (AR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early diastolic decrescendo murmur, best heard at the left sternal border</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventricular Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (VSD) </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Harsh <span class=\"customMeta\" data-dictid=\"b1b77428461692777189ac124a6fa6\">holosystolic</span> murmur, best heard at the left lower sternal border (LLSB)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atrial Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (ASD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Systolic <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur, best heard at the left upper sternal border (LUSB), with fixed, widely split S2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tricuspid <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (TR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Holosystolic murmur, best heard at the left lower sternal border,<strong> increases with inspiration (Carvallo’s sign)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Murmur</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Cause &amp; Characteristics</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Graham-Steel <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">Murmur</span> (Pulmonary <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Hypertension)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4>Early diastolic decrescendo murmur, best heard at the left upper sternal border, caused by <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"9a02ac20c3169277719094af57128d\">incompetence</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension</h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Austin <span class=\"customMeta\" data-dictid=\"9f2591dc721692777202895079015f\">Flint Murmur</span> </strong></h4>\n<h4><strong>(Severe Aortic Regurgitation)</strong></h4>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4>Low-pitched, rumbling diastolic murmur, best heard at the apex, due to <span class=\"customMeta\" data-dictid=\"66c04c3ac01692777201f1d43f0964\">turbulent flow</span> in the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> compressing the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve</h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Mammary <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">Murmur</span> (Physiologic in Pregnancy)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4>Continuous hissing murmur, heard over the left second and third <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> spaces, caused by increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> through internal mammary vessels</h4>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the active management of the third stage of labor, which intervention is recommended to prevent postpartum hemorrhage primarily due to uterine atony?", "options": [{"label": "A", "text": "Immediate administration of 20 units of undiluted oxytocin intravenously", "correct": false}, {"label": "B", "text": "Oxytocin 10 units IM with crowning", "correct": false}, {"label": "C", "text": "Vigorous fundal massage combined with a uterotonic agent", "correct": true}, {"label": "D", "text": "Controlled cord traction with immediate removal of the placenta", "correct": false}], "correct_answer": "C. Vigorous fundal massage combined with a uterotonic agent", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uterine Massage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Always <span class=\"customMeta\" data-dictid=\"5aabcb1ee8169277719447f2dd6c2c\">palpate</span> the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> after <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> delivery.</li>\n<li>Vigorous <span class=\"customMeta\" data-dictid=\"651c76a8c91692777203be09fa3dd6\">fundal</span> massage, combined with a <span class=\"customMeta\" data-dictid=\"9c6928089d1692777201892110e175\">uterotonic</span> agent, is recommended to prevent PPH due to <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> atony.</li>\n<li>During immediate PPH, perform <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"c515f6a71d16927771919f574f1ee9\">massage</span> while evaluating for other <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> sources and administering <span class=\"customMeta\" data-dictid=\"9c6928089d1692777201892110e175\">uterotonic</span> agents.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oxytocin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recommended by WHO as a first-line <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> treatment for <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage.</li>\n<li>Administer 20 units of <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">oxytocin</span> in 1,000 mL of <span class=\"customMeta\" data-dictid=\"745d08a9151692777185b2d2527097\">crystalloid</span> solution intravenously at 10 mL/min for a dose of 200 mU/min.</li>\n<li>Never administer <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">oxytocin</span> as an undiluted <span class=\"customMeta\" data-dictid=\"8d138d554c16927771835be732558c\">bolus</span> due to risks of severe <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> or <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.<strong>(Option A)</strong></li>\n<li>Intravenous <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">oxytocin</span> is also a first-line treatment for <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> atony.</li>\n<li>Oxytocin 10 units can be given IM with the delivery of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> shoulder <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delayed Cord Clamping/Controlled Cord <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">Traction</span> (CCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>If <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> separation is evident, perform expression via <span class=\"customMeta\" data-dictid=\"651c76a8c91692777203be09fa3dd6\">fundal</span> pressure or controlled cord traction.</li>\n<li>If the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> is not separated, perform manual removal under general anaesthesia.</li>\n<li>Delivery of the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> by cord <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> before <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> separation especially in an atonic <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> may cause <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> inversion. <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A Tzanck smear prepared from a vesicle shows multinucleated giant cells. What is the diagnosis?", "options": [{"label": "A", "text": "HIV", "correct": false}, {"label": "B", "text": "HSV", "correct": true}, {"label": "C", "text": "HPV", "correct": false}, {"label": "D", "text": "EBV", "correct": false}], "correct_answer": "B. HSV", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6n95r1nbfJi6935v5xfT1741085759.png", "https://image.prepladder.com/content/MkJki5EaRLemxUYPaLXZ1741085781.png", "https://image.prepladder.com/content/DOskERgZc7KV4ofzoKjR1741085805.png", "https://image.prepladder.com/content/aCUrzcD9nLTBfI21U1cS1741086251.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Herpes Simplex Virus:</strong></p>\n<ul>\n<li><strong>Tzanck smear: <span class=\"customMeta\" data-dictid=\"aa085932ce1692777193be7e5198bf\">Multinucleated</span> giant cells</strong> with faceted <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> and homogeneously stained 'ground-glass' <span class=\"customMeta\" data-dictid=\"77399c6ee0169277718492fb8fd58f\">chromatin</span> (<strong>Tzanck cells</strong>).</li>\n<li>Formation of<strong> Lipschutz bodies (Cowdry type A).</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3168\" src=\"https://image.prepladder.com/content/6n95r1nbfJi6935v5xfT1741085759.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HHV 8 (human <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">herpes</span> virus type 8):</strong></p>\n<ul>\n<li><strong>Castleman disease: </strong>Onion skinning of lymphocytes and blood vessels, giving the appearance of <strong>“Lollipop follicles”</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3279\" src=\"https://image.prepladder.com/content/MkJki5EaRLemxUYPaLXZ1741085781.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of botulinum toxin?", "options": [{"label": "A", "text": "Inhibits acetylcholine release from the presynaptic terminal", "correct": true}, {"label": "B", "text": "Inhibits acetylcholine reuptake", "correct": false}, {"label": "C", "text": "Blocks the postsynaptic acetylcholine receptor", "correct": false}, {"label": "D", "text": "Inhibits acetylcholinesterase", "correct": false}], "correct_answer": "A. Inhibits acetylcholine release from the presynaptic terminal", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the management of a HIV positive patient with multiple dog bites ?", "options": [{"label": "A", "text": "Rabies vaccine + wound management", "correct": false}, {"label": "B", "text": "Immunoglobulin only", "correct": false}, {"label": "C", "text": "Wound management", "correct": false}, {"label": "D", "text": "Rabies vaccine + Immunoglobulin + Wound management", "correct": true}], "correct_answer": "D. Rabies vaccine + Immunoglobulin + Wound management", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exposure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Licks and touch on intact skin (skin integrity not broken)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Local wound management: soap, running water, <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> <span class=\"customMeta\" data-dictid=\"c24e790aa2169277720062b62227ae\">tincture</span> for 15-20 min.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abrasion, <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">laceration</span> (skin integrity broken)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Local wound management</li>\n<li>Immediate <span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\">Rabies</span> vaccination</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Class III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding, licks on mucosa/ broken skin, deep tissue injury, all wild animal or bat bite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Wound management (avoid suturing)</li>\n<li>Rabies vaccination</li>\n<li>Rabies immunoglobulin</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the investigation shown in the image?", "options": [{"label": "A", "text": "Intravenous Pyelogram (IVP)", "correct": true}, {"label": "B", "text": "Retrograde Pyelogram", "correct": false}, {"label": "C", "text": "Computed Tomography (CT) Urography", "correct": false}, {"label": "D", "text": "Magnetic Resonance Urography", "correct": false}], "correct_answer": "A. Intravenous Pyelogram (IVP)", "question_images": ["https://image.prepladder.com/content/AIiZVt4yOlBlFrDp4G1K1741088084.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:466px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">Pyelogram</span> (IVP)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X-ray with IV contrast</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urinary stones, hydronephrosis, <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> → <span class=\"customMeta\" data-dictid=\"b02f35d9471692777198bf98bee1f7\">serial</span> <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">X-rays</span> taken at intervals</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> defects, delayed excretion</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following amino acids primarily acts as a buffer in blood due to its ability to accept and donate protons at physiological pH?", "options": [{"label": "A", "text": "Histidine", "correct": true}, {"label": "B", "text": "Arginine", "correct": false}, {"label": "C", "text": "Tryptophan", "correct": false}, {"label": "D", "text": "Tyrosine", "correct": false}], "correct_answer": "A. Histidine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amino Acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Buffering Ability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reason</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histidine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strong buffer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imidazole group has pKa ~6.0, close to <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> pH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arginine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor buffer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Guanidinium group has pKa ~12.5, too high to act as a <span class=\"customMeta\" data-dictid=\"9d374d494a169277718337f2820f3a\">buffer</span> at pH 7.4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tryptophan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal buffering</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indole group is non-ionizable at <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> pH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tyrosine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal buffering</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phenol group has pKa ~10.1, too high to be effective</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A body brought for autopsy is cold and has developed rigor mortis in all 4 limbs and livor mortis at the back/fixed, but no signs of putrefaction. What will be the estimated time since death?", "options": [{"label": "A", "text": "12-24 hrs", "correct": true}, {"label": "B", "text": "6-12 hrs", "correct": false}, {"label": "C", "text": "24-48 hrs", "correct": false}, {"label": "D", "text": "36-48 hrs", "correct": false}], "correct_answer": "A. 12-24 hrs", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d4iyyvsvCUC1XeunFfc01741019957.png"], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Observation</strong></th>\n<th><strong>Interpretation</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Body cold to touch</strong></td>\n<td>Suggests death occurred <strong>more than 8–12 hours</strong> ago (body cools gradually)</td>\n</tr>\n<tr>\n<td><strong>Rigor mortis in all four limbs</strong></td>\n<td>Fully established <span class=\"customMeta\" data-dictid=\"1e5d9c18d816927771972634f9a13f\">rigor</span> occurs <strong>around 12 hours</strong> post-death and lasts up to 24 hrs</td>\n</tr>\n<tr>\n<td><strong>Livor mortis fixed at the back</strong></td>\n<td>Lividity becomes <strong>fixed after 6–12 hours</strong></td>\n</tr>\n<tr>\n<td><strong>No signs of putrefaction</strong></td>\n<td>Putrefaction usually begins <strong>after 24–36 hours</strong>, depending on environment</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Feature</strong></th>\n<th><strong>Details</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Other names</strong></td>\n<td>Cadaveric lividity, <span class=\"customMeta\" data-dictid=\"88bcb684bf169277719687b1e4d84b\">postmortem</span> staining, suggillations, vibices, \"darkening of death\"</td>\n</tr>\n<tr>\n<td><strong>Site</strong></td>\n<td>Superficial <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> (capillaries and venules)</td>\n</tr>\n<tr>\n<td><strong>Mechanism</strong></td>\n<td>Gravitational settling of deoxygenated blood → purple-blue skin discolouration in dependent areas</td>\n</tr>\n<tr>\n<td><strong>Onset</strong></td>\n<td>Begins in <strong>30 minutes – 1 hour</strong> after death</td>\n</tr>\n<tr>\n<td><strong>Fully developed by</strong></td>\n<td>~<strong>4 hours</strong></td>\n</tr>\n<tr>\n<td><strong>Fixation time</strong></td>\n<td>Becomes <strong>fixed in 6–12 hours</strong></td>\n</tr>\n<tr>\n<td><strong>Confirmation of fixation</strong></td>\n<td>Apply pressure → if colour does not blanch, it is fixed</td>\n</tr>\n<tr>\n<td><strong>Primary lividity</strong></td>\n<td>Max intensity seen by <strong>6–12 hours</strong></td>\n</tr>\n<tr>\n<td><strong>Secondary lividity</strong></td>\n<td>Lividity may shift if the body is moved within a few hours of death</td>\n</tr>\n<tr>\n<td><strong>Duration</strong></td>\n<td>Persists until <span class=\"customMeta\" data-dictid=\"cb6efad46e16927771961e21da0ce6\">putrefaction</span> begins</td>\n</tr>\n<tr>\n<td><strong>Image</strong></td>\n<td>\n<p style=\"\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"861\" src=\"https://image.prepladder.com/content/d4iyyvsvCUC1XeunFfc01741019957.png\" width=\"1600\"/></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Phase</strong></th>\n<th><strong>Description</strong></th>\n<th><strong>Timeframe</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Primary Relaxation</strong></td>\n<td>Muscles are flaccid; ATP levels are 100%. Sphincters relax, leading to the release of urine/feces.</td>\n<td>0–1 hour after death</td>\n</tr>\n<tr>\n<td><strong>Rigor Mortis Onset</strong></td>\n<td>Begins as ATP falls to 85%; actin-myosin <span class=\"customMeta\" data-dictid=\"2cf4952c63169277718543a0883583\">cross-linking</span> causes stiffening. Appears in smaller muscles first (eyelids, jaw), progresses to limbs.</td>\n<td>Begins 1–2 hrs; full by 12 hrs</td>\n</tr>\n<tr>\n<td><strong>Rigor Resolution</strong></td>\n<td>Due to proteolysis, <span class=\"customMeta\" data-dictid=\"9ab07bba3016927771976de44bf865\">rigidity</span> dissipates. <span class=\"customMeta\" data-dictid=\"1e5d9c18d816927771972634f9a13f\">Rigor</span> fades by <strong>24–36 hours</strong> depending on conditions.</td>\n<td>12–36 hours after death</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Position</strong></th>\n<th><strong>Lividity Location</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Supine</td>\n<td>Back of head, neck, trunk, and limbs (excluding pressure areas)</td>\n</tr>\n<tr>\n<td>Prone</td>\n<td>Chest, face, front of limbs</td>\n</tr>\n<tr>\n<td>Side</td>\n<td>Dependent side</td>\n</tr>\n<tr>\n<td>Head-down</td>\n<td>Face and neck blackened</td>\n</tr>\n<tr>\n<td>Vertical suspension</td>\n<td>Legs, hands, external <span class=\"customMeta\" data-dictid=\"a6a00bd30e169277718892b3a6076c\">genitalia</span> (glove and stocking pattern)</td>\n</tr>\n<tr>\n<td>Drowning</td>\n<td>Face, chest, hands, feet, calves</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hormone responsible?", "options": [{"label": "A", "text": "Oxytocin", "correct": true}, {"label": "B", "text": "TSH", "correct": false}, {"label": "C", "text": "GH", "correct": false}, {"label": "D", "text": "FSH", "correct": false}], "correct_answer": "A. Oxytocin", "question_images": ["https://image.prepladder.com/content/ay0XFxN54WDrMQbsIwnl1741106017.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male patient was brought to the emergency department following a road traffic accident.O/E, he had multiple injuries all over his body and was found to be in class III hemorrhagic shock. The percentage of blood loss would be between:", "options": [{"label": "A", "text": "5-15%", "correct": false}, {"label": "B", "text": "30-40%", "correct": true}, {"label": "C", "text": "&amp;gt;40%", "correct": false}, {"label": "D", "text": "15-30%", "correct": false}], "correct_answer": "B. 30-40%", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class I (Compensated Shock)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class II (Hypoxemia)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class IV (Refractory Shock)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Up to 15%<strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-30% <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-40%<strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 40%<strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compensatory mechanisms maintain <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalized vasoconstriction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decompensated shock.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Refractory shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heart Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;100/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100-120/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>120-140/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;140/min</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marked hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Profound hypotension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urine Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;30 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-30 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-15 ml/hour</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mental Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alert, normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anxious, mildly agitated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused, altered mental status</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comatose, lethargic</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents to the hospital with auditory hallucinations and inability to recognize his own family members. He reports his last alcohol intake was 48 hours ago. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Delirium tremens", "correct": true}, {"label": "B", "text": "Alcoholic hallucinosis", "correct": false}, {"label": "C", "text": "Alcohol-induced psychosis", "correct": false}, {"label": "D", "text": "Schizophrenia", "correct": false}], "correct_answer": "A. Delirium tremens", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:696px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset after last drink</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Mild anxiety</p>\n<p>• Tremulousness</p>\n<p>• Nausea</p>\n<p>• Headache</p>\n<p>• Palpitations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-12 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alcoholic <span class=\"customMeta\" data-dictid=\"f43e09e4621692777188050c41c06a\">hallucinosis</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Visual, auditory, or <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> hallucinations</p>\n<p>• Intact orientation</p>\n<p>• Normal vital signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Withdrawal seizures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> seizures</p>\n<p>• Usually brief and self-limited</p>\n<p>• Also known as rum fits</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>24-48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delirium tremens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Severe agitation</p>\n<p>• Confusion and disorientation</p>\n<p>• Hallucinations (often visual)</p>\n<p>• <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">Autonomic</span> <span class=\"customMeta\" data-dictid=\"2e780c7fd416927771895c61217c12\">hyperactivity</span> (tachycardia, hypertension, fever)</p>\n<p>• Profound sweating</p>\n<p>• Tremors</p>\n<p>• Insomnia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>48-96 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with fever, neck rigidity, headache, vomiting, and petechial rashes on the lower limbs. What is the most likely causative organism?", "options": [{"label": "A", "text": "Neisseria meningitidis", "correct": true}, {"label": "B", "text": "Clostridium perfringens", "correct": false}, {"label": "C", "text": "Cryptococcus neoformans", "correct": false}, {"label": "D", "text": "Clostridium difficile", "correct": false}], "correct_answer": "A. Neisseria meningitidis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:537px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cerebrospinal Fluid (CSF) Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Appearance</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cloudy or purulent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>White <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">Blood Cell Count</span> (WBC)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated (pleocytosis), typically &gt;1,000 cells/µL, with predominance of neutrophils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Protein</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Glucose</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gram Stain</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">gram-negative</span> diplococci</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Culture</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth of <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitidis on chocolate <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> or Thayer-Martin agar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Polymerase Chain Reaction (PCR)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detection of <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitidis DNA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Latex <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">Agglutination</span> Test</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive for <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitidis antigens</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Blood Tests</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Culture</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth of <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitidis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>White Blood Cell Count</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\">leukocytosis</span> with left shift</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female patient presents to the clinic for evaluation of her fertility status. She has been trying to conceive for over a year without success. Which of the following is the single best test for assessing her ovarian reserve?", "options": [{"label": "A", "text": "Follicle-stimulating hormone (FSH) on day 3", "correct": false}, {"label": "B", "text": "Estradiol on day 3", "correct": false}, {"label": "C", "text": "Anti-Müllerian hormone (AMH)", "correct": true}, {"label": "D", "text": "Serum inhibin levels on day 5", "correct": false}], "correct_answer": "C. Anti-Müllerian hormone (AMH)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Test Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-Müllerian Hormone (AMH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A hormone produced by ovarian antral follicles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood test reflecting the remaining quantity of eggs.</li>\n<li><strong>Not affected by the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle.</strong></li>\n<li><strong>The single best test for assessing her ovarian reserve</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antral <span class=\"customMeta\" data-dictid=\"b0c3f6b8901692777203d0446fe1f4\">Follicle</span> Count (AFC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ultrasound count of the small follicles (antral follicles) within the ovaries.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Direct visual assessment.</li>\n<li>Can vary with the cycle.</li>\n<li>Baseline assessment and monitoring.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Follicle-stimulating hormone (FSH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures the level of FSH, which stimulates the growth of ovarian follicles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood test done on day 3 of the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle.</li>\n<li>Initial screening of ovarian function.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Estradiol (E2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures the level of estradiol, an <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> produced by growing follicles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood test done on day 3 of the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle.</li>\n<li>High levels can mask high <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> levels, so they are used in conjunction with FSH.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inhibin B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures the level of <span class=\"customMeta\" data-dictid=\"310439225b1692777190ac31461dbd\">inhibin</span> B, which reflects the number of antral follicles.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood test on day 5 of the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clomiphene <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">Citrate</span> Challenge Test (CCCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> and <span class=\"customMeta\" data-dictid=\"d8cc09346f16927771878d48ba1ce8\">estradiol</span> before and after taking clomiphene citrate.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Two blood tests: day 3 and day 10.</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> levels on day 10 indicate lower reserve.</li>\n<li>Used for detailed functional assessment.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Histological section is given below. Identify the marked cell.", "options": [{"label": "A", "text": "Stellate cell", "correct": false}, {"label": "B", "text": "Basket cell", "correct": false}, {"label": "C", "text": "Purkinje cell", "correct": true}, {"label": "D", "text": "Granular cell", "correct": false}], "correct_answer": "C. Purkinje cell", "question_images": ["https://image.prepladder.com/content/e9wwGmut9KNn9sWJpRMi1741090058.png"], "explanation_images": ["https://image.prepladder.com/content/QF0JAJ2Ft17hKDEiEs401741090082.png", "https://image.prepladder.com/content/O9dvQEj0i3Q73W1NzmFE1741032851.png", "https://image.prepladder.com/content/LH8aeiiNhpPmp7Zt2jQG1741032868.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Layers of the cerebellar cortex</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular (plexiform) layer</strong></p>\n<p><strong>(Options A, B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purkinje cell layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granular layer</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It primarily contains numerous <span class=\"customMeta\" data-dictid=\"77f797c5e8169277718535480fa7fd\">dendritic</span> branches from Purkinje cells, with relatively few widely spaced nerve cells.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It consists of a single row of large flask-shaped cells, the <strong>Purkinje cells</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The inner <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> layer is made up of many closely packed small<strong> <span class=\"customMeta\" data-dictid=\"fd69fc99d41692777188cc051aafa5\">granule</span> cells</strong>, along with a few larger <strong>Golgi cells.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These nerve cells are of two types:</p>\n<p>(a) Basket cells</p>\n<p>(b) <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">Stellate</span> cells.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The axons of Purkinje cells are the only output from the <span class=\"customMeta\" data-dictid=\"8c584f1d6a16927771847eabd3ce01\">cerebellar cortex</span> and have an <strong>inhibitory</strong> effect on the <span class=\"customMeta\" data-dictid=\"892754df9f169277719002da27f662\">intracerebellar</span> nuclei.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Golgi cells are<strong> inhibitory</strong> while the <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> cells are <strong>excitatory.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common defect in a ventricular septal defect?", "options": [{"label": "A", "text": "Muscular defect", "correct": false}, {"label": "B", "text": "Membranous defect", "correct": true}, {"label": "C", "text": "Non-development of the perimembranous part of the septum", "correct": false}, {"label": "D", "text": "Incomplete fusion of the septum", "correct": false}], "correct_answer": "B. Membranous defect", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The given image is of an ulcer, identify the marked structure?", "options": [{"label": "A", "text": "Margin", "correct": false}, {"label": "B", "text": "Edge", "correct": true}, {"label": "C", "text": "Floor", "correct": false}, {"label": "D", "text": "Base", "correct": false}], "correct_answer": "B. Edge", "question_images": ["https://image.prepladder.com/content/3n8GoJsAETkxnp4HVJly1741111534.png"], "explanation_images": ["https://image.prepladder.com/content/PV1RL6iYEdLsFJET3bJi1741111552.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Part</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Margin </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Outer limit of the ulcer, usually blending into the surrounding skin/mucosa.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Edge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The border between the margin and the <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> floor, may be raised (malignant), undermined (tuberculous), or <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> (syphilitic).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Floor </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The exposed surface inside the ulcer, may contain slough, <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, or necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Base </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The structure beneath the ulcer, which can be soft tissue, bone, or a vessel.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A hypertensive patient’s lab results reveal hypernatremia, hypokalemia, and metabolic alkalosis. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Conn's Syndrome", "correct": true}, {"label": "B", "text": "Addison’s Disease", "correct": false}, {"label": "C", "text": "Diabetes Insipidus", "correct": false}, {"label": "D", "text": "Cushing's Disease", "correct": false}], "correct_answer": "A. Conn's Syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During starvation, which of the following hormones is primarily produced to maintain blood glucose levels?", "options": [{"label": "A", "text": "Glucagon", "correct": true}, {"label": "B", "text": "Insulin", "correct": false}, {"label": "C", "text": "Amylase", "correct": false}, {"label": "D", "text": "Somatostatin", "correct": false}], "correct_answer": "A. Glucagon", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hormone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect in Starvation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucagon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increases</strong> to stimulate <span class=\"customMeta\" data-dictid=\"724a9faafe1692777188ca8840ec5c\">gluconeogenesis</span> and glycogenolysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insulin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreases</strong> to reduce <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> by tissues.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cortisol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increases</strong> to promote protein <span class=\"customMeta\" data-dictid=\"67f82f0d211692777183f709777947\">catabolism</span> for gluconeogenesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epinephrine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increases</strong> to enhance <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">glycogen</span> <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> and lipolysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth Hormone (GH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increases</strong> to reduce <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"6aee31718c16927772019237286270\">utilization</span> and promote lipolysis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with CSOM was presented to the OPD with seizures. On examination and evaluation, homonymous hemianopia and epilepsy were present. Identify the condition with the CT scan given below?", "options": [{"label": "A", "text": "Temporal abscess", "correct": true}, {"label": "B", "text": "Cerebellar abscess", "correct": false}, {"label": "C", "text": "Extradural abscess", "correct": false}, {"label": "D", "text": "Meningitis", "correct": false}], "correct_answer": "A. Temporal abscess", "question_images": ["https://image.prepladder.com/content/jojksr3JpyU3ptperaiM1741063106.png"], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary mechanism behind tissue damage in long-standing diabetes?", "options": [{"label": "A", "text": "Insulin resistance", "correct": false}, {"label": "B", "text": "Sorbitol accumulation", "correct": false}, {"label": "C", "text": "Hyperglycemia", "correct": true}, {"label": "D", "text": "Decreased insulin secretion", "correct": false}], "correct_answer": "C. Hyperglycemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male with chronic stable angina presents with worsening chest pain during routine activities. His current medications include aspirin, clopidogrel, metoprolol, and atorvastatin, but his symptoms persist. ECG shows ST-segment depression in V5-V6, and coronary angiography reveals 80% stenosis of the left anterior descending (LAD) artery. What is the most appropriate intervention?", "options": [{"label": "A", "text": "Increase the dose of beta-blockers", "correct": false}, {"label": "B", "text": "Add ranolazine to medical therapy", "correct": false}, {"label": "C", "text": "Percutaneous coronary intervention (PCI) with drug-eluting stent (DES)", "correct": true}, {"label": "D", "text": "Refer for coronary artery bypass grafting (CABG)", "correct": false}], "correct_answer": "C. Percutaneous coronary intervention (PCI) with drug-eluting stent (DES)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medication Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Function/Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side Effects/</strong></p>\n<p style=\"text-align: center;\"><strong>Contraindication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nitrates</strong></p>\n<p>Sublingual <span class=\"customMeta\" data-dictid=\"7cfca041201692777193da668f40be\">nitroglycerin</span> (0.4 or 0.6 mg)</p>\n<p>Long-acting forms (oral, transdermal)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic venodilation</li>\n<li>Reduces LV <span class=\"customMeta\" data-dictid=\"437bfd6ffb1692777187b5a7a706d5\">end-diastolic volume</span> and pressure</li>\n<li>Releases <span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\">nitric</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> (NO) to relax <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> smooth muscle</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina relief</li>\n<li>Preemptive use before activities</li>\n<li>Improves exercise tolerance</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Tolerance</strong> development</li>\n<li>Headaches, dizziness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-Blocker</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduces heart rate, arterial pressure, and myocardial contractility</li>\n<li>Improves survival post-MI</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina relief</li>\n<li><strong>Reduces mortality </strong>and reinfarction rates</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Asthma</strong></li>\n<li>AV <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> disturbances</li>\n<li>Severe bradycardia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Channel Blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Coronary vasodilators</li>\n<li>Reduces myocardial oxygen demand and arterial pressure</li>\n<li>Dihydropyridines (e.g., amlodipine) and non-dihydropyridines (e.g., verapamil)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Angina treatment when <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> blockers are ineffective</li>\n<li>Variant angina</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bradyarrhythmias</li>\n<li>May aggravate LV failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiplatelet Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Aspirin</strong>: inhibits <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> activation</li>\n<li><strong>Clopidogrel 75mg</strong>: blocks <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> aggregation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> events in high-risk populations</li>\n<li>Stent placement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk of bleeding</li>\n<li>Gastrointestinal issues, allergies</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Percutaneous <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> Intervention (PCI) </strong><strong> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PCI involves balloon <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> and stenting for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> <span class=\"customMeta\" data-dictid=\"b72de43dd6169277718942f907b87c\">IHD</span> with suitable stenoses in epicardial <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> arteries.</p>\n<ul>\n<li><strong>Indications</strong>:\n\n\t\t\t\t<ul>\n<li>Symptom-limiting <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> despite <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> medical therapy.</li>\n<li>Evidence of <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> during stress tests.</li>\n</ul>\n</li>\n<li><strong>Post-PCI Management</strong>:\n\t\t\t\t<ul>\n<li><strong>Aspirin </strong>is administered indefinitely, and P2Y12 antagonists for 1-3 months.</li>\n<li>Current-generation<strong> drug-eluting stents</strong> reduce <span class=\"customMeta\" data-dictid=\"46b2c025701692777197ebd5938ea9\">restenosis</span> but require prolonged dual <span class=\"customMeta\" data-dictid=\"257da9409416927771815e64ee5df1\">antiplatelet</span> therapy (DAPT).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">Bypass</span> <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">Grafting</span> (CABG) </strong><strong> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves bypassing obstructive lesions using<strong> internal mammary arteries</strong>, <strong>radial arteries</strong>, or <strong>saphenous veins</strong>.</p>\n<ul>\n<li><strong>Indications</strong>:\n\n\t\t\t\t<ul>\n<li>Safe with low mortality in patients without serious comorbidities and normal LV function.</li>\n<li>Effective for patients with <strong>left main <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis</strong>, <strong>multivessel disease</strong>, or <strong>impaired LV function</strong>.</li>\n</ul>\n</li>\n<li><strong>Outcomes</strong>:\n\t\t\t\t<ul>\n<li>Angina relief in ~90% of patients after complete revascularization.</li>\n<li>Long-term survival benefits in specific populations, particularly those with <strong>diabetes</strong> or<strong> impaired LV function</strong>.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of breast cancer underwent Cobalt-60 radiotherapy. She now presents with respiratory distress, and imaging shows haziness in the left lung. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Radiation Pneumonitis", "correct": true}, {"label": "B", "text": "Recurrence of Breast Cancer", "correct": false}, {"label": "C", "text": "Pulmonary Embolism", "correct": false}, {"label": "D", "text": "Infective Pneumonia", "correct": false}], "correct_answer": "A. Radiation Pneumonitis", "question_images": ["https://image.prepladder.com/content/NibuZI2xe1tLqfV4nvUr1741087739.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiation damage to lung tissue, commonly from <strong>breast, lung, or <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> cancer radiotherapy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4-12 weeks</strong> post-radiotherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dry cough, dyspnea, <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> fever, chest pain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hazy opacities in the <strong>irradiated lung field</strong> (CT: <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> opacities, consolidation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corticosteroids (prednisone), supportive care</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old pregnant woman at 33 weeks gestation presents for a routine prenatal visit. She reports decreased fetal movements over the past two days. She has a history of gestational diabetes, and her pregnancy has been otherwise uneventful. The doctor decides to perform antepartum fetal surveillance. Which of the following is the most appropriate initial test to assess the fetal well-being in this scenario?", "options": [{"label": "A", "text": "Amniotic fluid index", "correct": false}, {"label": "B", "text": "Biophysical profile Contraction Stress test Non Stress test", "correct": false}, {"label": "C", "text": "Contraction Stress test", "correct": false}, {"label": "D", "text": "Non Stress test", "correct": true}], "correct_answer": "D. Non Stress test", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fetal movement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maternal observation and recording of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> movements to assess <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being and activity levels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-stress test (NST)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monitors <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heart rate <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> in response to <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> movements to assess <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biophysical profile (BPP)</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being based on <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heart rate accelerations, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> movements, muscle tone, breathing movements, and <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid volume</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Doppler velocimetry</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> to assess <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> in <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> vessels like <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> artery,middle cerebral <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (MCA), and <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> venosus aiding in the evaluation of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being and <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amniotic fluid index (AFI)</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures the depth of <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid to assess <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being and detect potential complications like <span class=\"customMeta\" data-dictid=\"41fc142ae61692777194c3f69d3d74\">oligohydramnios</span> or polyhydramnios</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contraction stress test (CST)</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluates <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> heart rate response to <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions to assess <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being and <span class=\"customMeta\" data-dictid=\"091c4fd1e61692777201ec50806bc4\">uteroplacental</span> function under controlled stress conditions.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50 year old female presented with a breast mass that was operated and the microscopic examination in given. What is the diagnosis?", "options": [{"label": "A", "text": "Lobular carcinoma breast", "correct": false}, {"label": "B", "text": "Medullary carcinoma", "correct": false}, {"label": "C", "text": "Mucinous carcinoma breast", "correct": true}, {"label": "D", "text": "Phylloids tumour", "correct": false}], "correct_answer": "C. Mucinous carcinoma breast", "question_images": ["https://image.prepladder.com/content/vvJJ4UZ1lehI5eE0h6Jv1741063384.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby presents with chronic diarrhea and a rash resembling acrodermatitis on the skin. Based on the clinical picture, what is the most likely deficiency?", "options": [{"label": "A", "text": "Zinc deficiency", "correct": true}, {"label": "B", "text": "Selenium deficiency", "correct": false}, {"label": "C", "text": "Niacin deficiency", "correct": false}, {"label": "D", "text": "Magnesium deficiency", "correct": false}], "correct_answer": "A. Zinc deficiency", "question_images": ["https://image.prepladder.com/content/5R6bsVjwlznnd5LiCAqv1741088845.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for nephrotic syndrome in children?", "options": [{"label": "A", "text": "Steroids", "correct": true}, {"label": "B", "text": "Steroids and cyclophosphamide", "correct": false}, {"label": "C", "text": "Cyclophosphamide", "correct": false}, {"label": "D", "text": "ACE inhibitors", "correct": false}], "correct_answer": "A. Steroids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steroid-Responsive <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steroid-Resistant <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic syndrome that responds well to <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> treatment.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nephrotic syndrome that does not improve despite adequate <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> treatment (e.g., <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> at 2 mg/kg/day for 6 weeks).</p>\n<p><strong>Types:</strong></p>\n<ul>\n<li><strong>Initial <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">Steroid</span> Resistance:</strong> Lack of response from the onset.</li>\n<li><strong>Late <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">Steroid</span> Resistance:</strong> Resistance develops after initial response.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minimal Change <span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\">Nephrotic</span> Syndrome (MCNS)</strong> accounts for about 80% of cases in children.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is often associated with <strong>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">Segmental</span> <span class=\"customMeta\" data-dictid=\"9b496e768c1692777188421dbac69f\">Glomerulosclerosis</span> (FSGS) </strong>or genetic mutations affecting podocytes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosed without <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> biopsy; characterised by heavy proteinuria, low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> albumin, and no significant <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> damage.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Further investigation (e.g., <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> biopsy) is required to determine the underlying cause.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Responds to high-dose corticosteroids (e.g., prednisolone)</strong><strong>,</strong> leading to <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> of <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> and oedema within 10-14 days.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment may include <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> agents, <span class=\"customMeta\" data-dictid=\"746f157681169277718323a004b1d4\">calcineurin</span> inhibitors, or other therapies, as corticosteroids are often ineffective.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the instrument:", "options": [{"label": "A", "text": "Bohler braun splint", "correct": true}, {"label": "B", "text": "Thomas splint", "correct": false}, {"label": "C", "text": "Volkmann splint", "correct": false}, {"label": "D", "text": "Cramer wire", "correct": false}], "correct_answer": "A. Bohler braun splint", "question_images": ["https://image.prepladder.com/content/VIPn9QRNyw9mbPcPCZA91741089331.png"], "explanation_images": ["https://image.prepladder.com/content/mGhcVlckSObxqQzakuBt1741059431.png", "https://image.prepladder.com/content/Q9DnAAi5h5lJsf4Xl2RM1741059475.png", "https://image.prepladder.com/content/sgL0lzIaDQy9ZSZjuowe1741059546.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old male presents with a one-week history of fever, headache, retro-orbital pain, and myalgia. Skin examination reveals multiple purpura and petechiae on the left shoulder, trunk, and legs. Similar cases have been reported linked to increased incidence of mosquito breeding. What is the most common neurological complication associated with this condition?", "options": [{"label": "A", "text": "Encephalopathy", "correct": true}, {"label": "B", "text": "Guillain-Barré Syndrome", "correct": false}, {"label": "C", "text": "Stroke", "correct": false}, {"label": "D", "text": "Encephalitis", "correct": false}], "correct_answer": "A. Encephalopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dengue encephalopathy</strong> is <strong>most commonly encountered neurological complication</strong> of <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> virus\n\t\t\t\t<ul>\n<li>linked primarily to <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> hemorrhagic fever and <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> shock syndrome</li>\n<li>EEG may show abnormalities such as burst <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> and seizures</li>\n<li>CSF profiles typically remain normal.</li>\n<li>Neuroimaging can be normal or reveal <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> cerebral edema.</li>\n</ul>\n</li>\n<li><strong>Encephalitis</strong></li>\n<li><strong>GBS</strong></li>\n<li><strong>Stroke</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiomyopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dengue virus-induced dilated <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> should always be considered if a <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> fever patient has <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> shock and signs and symptoms of congestive heart failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatic injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver involvement in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> is a crucial feature</li>\n<li>The effect ranges from an <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> rise in liver enzymes to the development of ALF</li>\n<li>The <strong>most common <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> manifestation</strong> reported was hepatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumonia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Staphylococcus <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> is an important accompanying problem seen in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> patient</li>\n<li>co-infection between <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> and <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> can result in <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> of pneumonia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orchitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Orchitis usually occurs together with epididymitis</li>\n<li>Commonly seen in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> between 14 and 35 years of age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue Hemorrhagic Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All of the following:</p>\n<ul>\n<li>Acute onset of fever</li>\n<li>2-7 days duration</li>\n<li>Hemorrhagic manifestations\n\t\t\t\t<ul>\n<li>Positive <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> test/Petechiae</li>\n<li>Ecchymosis</li>\n<li>Purpura/Bleeding from mucosa, GIT, <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">Injection</span> sites, etc</li>\n</ul>\n</li>\n<li>Platelet count ≤ 100,000 cells/cu.mm.</li>\n<li>Plasma leakage\n\t\t\t\t<ul>\n<li>Rising hematocrit\n\t\t\t\t\t<ul>\n<li>Hemoconcentration &gt;20%</li>\n</ul>\n</li>\n<li>Pleural effusion, ascites/Hypoproteinemia)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue Shock Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>DHF criteria plus Signs of Shock</li>\n<li>Tachycardia/Cool extremities/Weak pulse/Lethargy/Restlessness</li>\n<li>Pulse pressure &lt;20 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> with increased <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">Diastolic pressure</span> (e.g. 100/80)</li>\n<li>Hypotension (Systolic &lt;80 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for age &lt;5 years/80-90 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for older child and adults)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pulmonary oedema", "correct": true}, {"label": "B", "text": "Hydrothorax", "correct": false}, {"label": "C", "text": "Pleural effusion", "correct": false}, {"label": "D", "text": "Pulmonary fibrosis", "correct": false}], "correct_answer": "A. Pulmonary oedema", "question_images": ["https://image.prepladder.com/content/jC7m9GoC35vYWYGaGp1B1741088166.png"], "explanation_images": ["https://image.prepladder.com/content/l1qCE3cPb5oBdKZR1Ook1741088285.png", "https://image.prepladder.com/content/PAXM9NlkheiMDtBRIa7X1741088581.png", "https://image.prepladder.com/content/9bpwzviQXnkHsQpNQUr51741088224.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Edema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Edema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Left heart failure, volume overload</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ARDS, infections, sepsis, toxins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A-A</strong>lveolar oedema (Bat wings)</p>\n<p><strong>B-</strong>Kerley <strong>B</strong> lines</p>\n<p><strong>C-C</strong>ardiomegaly</p>\n<p><strong>D-D</strong>ilated Upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> vessels</p>\n<p><strong>E</strong>-Pleural <strong>E</strong>ffusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse alveolar infiltrates, normal heart size</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dyspnea, orthopnea, pink frothy sputum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe hypoxia, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diuretics, nitrates, and oxygen treat CHF</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oxygen, and <span class=\"customMeta\" data-dictid=\"f14b6fe4d3169277720152885b1b38\">ventilatory</span> support, treat the underlying cause</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a normal distribution, the mean value is 82, the SD is 1.5. Calculate the range of two standard deviations?", "options": [{"label": "A", "text": "79-85", "correct": true}, {"label": "B", "text": "60-68", "correct": false}, {"label": "C", "text": "50-57", "correct": false}, {"label": "D", "text": "40-49", "correct": false}], "correct_answer": "A. 79-85", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient sustained blunt trauma to the eye 6 months ago and now presents with blurring of vision. What is the most likely condition?", "options": [{"label": "A", "text": "Iridodialysis", "correct": true}, {"label": "B", "text": "Ankyloblepharaon", "correct": false}, {"label": "C", "text": "Vossius Ring", "correct": false}, {"label": "D", "text": "Cycloiriditis", "correct": false}], "correct_answer": "A. Iridodialysis", "question_images": ["https://image.prepladder.com/content/pVvzA0zGY1D5e3eB5ph01741087416.png"], "explanation_images": ["https://image.prepladder.com/content/8EtAhjrEd0JW5mpqD8u41741087450.png", "https://image.prepladder.com/content/5dwlXBblN74zK1FKMSV71741087492.png", "https://image.prepladder.com/content/eujieKwkgl4nItjGZsvf1741087622.png", "https://image.prepladder.com/content/QdxXv5YiUwmvYhJUZScE1741087685.png", "https://image.prepladder.com/content/5DARlcpICbanYswk87eF1741087845.png", "https://image.prepladder.com/content/fwHl2jOWXhCZgieQbVEa1741087870.png", "https://image.prepladder.com/content/TKHDSUdG6TVeUTXga5oH1741087898.png", "https://image.prepladder.com/content/Ejz0G0GnGqtIBLQQELlf1741087953.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a child presenting with a beaded appearance in the chest with the following X-ray, what is the diagnosis?", "options": [{"label": "A", "text": "Scurvy", "correct": false}, {"label": "B", "text": "Rickets", "correct": true}, {"label": "C", "text": "Beri Beri", "correct": false}, {"label": "D", "text": "Pellagra", "correct": false}], "correct_answer": "B. Rickets", "question_images": ["https://image.prepladder.com/content/LE5U20fmU5aCX7Ja9MUX1741088659.png"], "explanation_images": ["https://image.prepladder.com/content/SRkby1ipMLFDKZ5js7De1741088700.png", "https://image.prepladder.com/content/qvFZnVxPrRNxEidRh8j41741088875.png", "https://image.prepladder.com/content/9dbFWqspUHgg6yKZ7bGz1741088743.png", "https://image.prepladder.com/content/OdYZ10xtshst9x4z2mLJ1741088804.png", "https://image.prepladder.com/content/7hwrx64VrxVzPTQdmJEP1741088777.png", "https://image.prepladder.com/content/EQoWb0Pf5lxs5H8DVXPW1741088896.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>General:</strong>\n<ul>\n<li>Failure to thrive (malnutrition)</li>\n<li>Listlessness</li>\n<li>Protruding abdomen</li>\n<li>Muscle weakness (especially proximal)</li>\n<li>Hypocalcemic dilated cardiomyopathy</li>\n<li>Fractures (pathologic, minimal trauma)</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure</li>\n</ul>\n</li>\n<li><strong>Head:</strong>\n<ul>\n<li>Craniotabes: <span class=\"customMeta\" data-dictid=\"f469f168b3169277719839870c0ce5\">Softening</span> of <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> bones</li>\n<li>Frontal bossing</li>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"4fe2c29428169277720397dcedda57\">fontanel</span> <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> (usually closed by 2 yr)</li>\n<li>Delayed dentition</li>\n<li>Craniosynostosis</li>\n</ul>\n</li>\n<li><strong>Hypocalcemic Symptoms: </strong>\n<ul>\n<li>Tetany</li>\n<li>Seizures</li>\n<li>Stridor caused by laryngeal spasm</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest:</strong>\n<ul>\n<li>Rachitic rosary: Due to widening of the <span class=\"customMeta\" data-dictid=\"bfa9e996381692777185cdc8709772\">costochondral</span> junction</li>\n<li>Harrison groove: <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">Horizontal</span> depression along the lower <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chest due to pulling of softened ribs by the <span class=\"customMeta\" data-dictid=\"5b42867b61169277718692205c2447\">diaphragm</span> during inspiration</li>\n<li>Respiratory infections and atelectasis</li>\n</ul>\n</li>\n<li><strong>Back: </strong>\n<ul>\n<li>Scoliosis</li>\n<li>Kyphosis</li>\n<li>Lordosis</li>\n</ul>\n</li>\n<li><strong>Extremities: </strong>\n<ul>\n<li>Enlargement of wrists and ankles: Due to <span class=\"customMeta\" data-dictid=\"3480d51034169277718862050fed12\">growth plate</span> widening</li>\n<li>Valgus or <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> deformities</li>\n<li>Windswept <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (valgus <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of one leg with <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> of other leg)</li>\n<li>Anterior bowing of <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> and femur</li>\n<li>Coxa vara</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:633px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Age </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Daily dose of vitamin D3 for 12 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Alternative <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> dose regimen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Daily <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> supplementation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Daily <span class=\"customMeta\" data-dictid=\"c673060f4c16927771917496b672c8\">maintenance dose</span> (follow-up)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">2000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Not recommended</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">30-75 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">400 IU</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>6-12 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">2000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">The equivalent of 2000 IU/ day may be given on a weekly or monthly basis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">30-75 mg/kg/day</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">400 IU</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>&gt;12 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">3000IU</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">60,000 IU every 2 weeks for 5 doses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">30-75 mg/kg/day (up to 500 mg)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">600 IU</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the sign given in the image below:", "options": [{"label": "A", "text": "Beta 2 transferrin sign", "correct": false}, {"label": "B", "text": "Double target sign", "correct": true}, {"label": "C", "text": "Handkerchief sign", "correct": false}, {"label": "D", "text": "Tear drop sign", "correct": false}], "correct_answer": "B. Double target sign", "question_images": ["https://image.prepladder.com/content/ZaPwSORmz8zWcsfNDJfK1741087152.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the early sign of pregnancy on TVS?", "options": [{"label": "A", "text": "G sac", "correct": true}, {"label": "B", "text": "Yolk sac", "correct": false}, {"label": "C", "text": "Cardiac activity", "correct": false}, {"label": "D", "text": "Fetal pole", "correct": false}], "correct_answer": "A. G sac", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:442px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gestational <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> (1<sup>st</sup> <span class=\"customMeta\" data-dictid=\"250ea353d2169277719853a4313f1b\">sonographic</span> evidence of pregnancy)<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-5 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5.5 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fetal pole and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> activity <strong>(Options C and D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-6 weeks</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72 y/o woman presents with severe chest pain and shortness of breath after a stressful argument. She is post-menopausal with no history of heart disease. O/E, she is slightly tachycardic with normal blood pressure. An echocardiogram shows left ventricular ballooning during systole, and cardiac enzymes are minimally elevated. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypertensive Heart Disease", "correct": false}, {"label": "B", "text": "Takotsubo Cardiomyopathy", "correct": true}, {"label": "C", "text": "Coronary Artery Disease", "correct": false}, {"label": "D", "text": "Pulmonary Embolism", "correct": false}], "correct_answer": "B. Takotsubo Cardiomyopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Takotsubo <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> (Gebrochenes-Herz syndrome)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>About</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Takotsubo cardiomyopathy, also known as broken-heart syndrome or stress-induced cardiomyopathy, is a non-ischemic condition primarily affecting post-menopausal women.</li>\n<li>It features temporary left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> that resembles a <span class=\"customMeta\" data-dictid=\"881eca638f16927771889ba405ef07\">heart attack</span> but with minimal <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> release and no significant obstructive <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease.</li>\n<li>The name \"Takotsubo\" is derived from Japanese, meaning <span class=\"customMeta\" data-dictid=\"73fcea5285169277719431e7e4e696\">octopus</span> trap, reflecting the <span class=\"customMeta\" data-dictid=\"0d20ef4049169277718261e9075cbc\">ballooning</span> shape of the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> during contraction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Catecholamine Hypothesis:</strong> Elevated catecholamines (norepinephrine, epinephrine, dopamine) indicate stress-induced <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> overdrive, leading to <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> spasms and myocardial injury.</li>\n<li><strong>Microvascular Dysfunction:</strong> Impaired function is suggested by abnormalities in <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> flow reserve and <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> resistance.</li>\n<li><strong>Inflammation:</strong> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> may show myocardial oedema, necrosis, and fibrosis, with conditions like <span class=\"customMeta\" data-dictid=\"b37b57210716927771933ee216a834\">myocarditis</span> and <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> diseases potentially triggering TC.</li>\n<li><strong>Estrogen Deficiency:</strong> Exaggerated <span class=\"customMeta\" data-dictid=\"3f0b42b17016927772014c586d44b7\">vasoconstriction</span> and increased <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> activity in post-menopausal women contribute to TC.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Takotsubo <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> often mimics <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> syndrome.(MI)</li>\n<li><strong>Common Triggers:</strong>\n<ul>\n<li><strong>Emotional Stress:</strong> Events like the unexpected death of a loved one, domestic abuse, or financial loss.</li>\n<li><strong>Physical Stress:</strong> Serious medical diagnoses or natural disasters.</li>\n</ul>\n</li>\n<li><strong>Symptoms:</strong> Chest pain, dyspnea, and syncope. Some patients may have signs of heart failure, such as tachyarrhythmias or bradyarrhythmias.</li>\n<li>A late-peaking <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> may be present due to LVOTO.</li>\n<li>About 10% of patients may develop <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> shock.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common cause of bloody nipple discharge?", "options": [{"label": "A", "text": "Breast cancer", "correct": false}, {"label": "B", "text": "Fibroadenoma", "correct": false}, {"label": "C", "text": "Intraductal papilloma", "correct": true}, {"label": "D", "text": "Duct Ectasia", "correct": false}], "correct_answer": "C. Intraductal papilloma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">Nipple</span> Discharge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bloody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intraductal <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">Papilloma</span> (Most Common)</li>\n<li>Breast Carcinoma</li>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serous </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibrocystic Disease (Most Common)</li>\n<li>Breast Carcinoma</li>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Greenish/Blackish</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duct Ectasia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Milk (Galactorrhea)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Physiological (e.g., Pregnancy, Lactation)</li>\n<li>Hyperprolactinemia (e.g., <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">Pituitary</span> Adenoma, Hypothyroidism)</li>\n<li>Medications (e.g., Antipsychotics, Antidepressants, Oral Contraceptives)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purulent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breast Abscess</li>\n<li>Mastitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male presents with pain and swelling over the distal radius. X-ray shows an expansile lytic lesion in the metaphysis. Fine needle aspiration (FNA) reveals a bloody aspirate with hemosiderin-laden macrophages. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Giant cell tumor", "correct": false}, {"label": "B", "text": "Aneurysmal bone cyst", "correct": true}, {"label": "C", "text": "Osteosarcoma", "correct": false}, {"label": "D", "text": "Chondroblastoma", "correct": false}], "correct_answer": "B. Aneurysmal bone cyst", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aneurysmal Bone <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> (ABC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Giant Cell Tumor (GCT)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily affects children and teenagers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common in young adults (15-35 years)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Equal distribution between males and females</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in females (Female: Male ratio 1.5:1)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metaphyses</strong> of long bones (femur, tibia, humerus), spine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epiphyses</strong> of long bones (lower end of femur, upper end of tibia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pain and swelling</strong>; <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> lesions may cause neurological issues</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Swelling without pain</strong>; late stages show joint limitation and <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fracture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>FNAC: <strong>Hemosiderin +</strong></li>\n<li>Blood-filled <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces separated by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> septae</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>FNAC: <strong>No hemosiderin</strong></li>\n<li>Abundant giant cells with multiple <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> (&gt;150), <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> cells indicating malignancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Osteolytic lesion, multiple septations and fluid-fluid levels on MRI</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin <span class=\"customMeta\" data-dictid=\"d983a6cd671692777198ec423b3b90\">septa</span> with <strong>soap-bubble appearance</strong> on X-ray, <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> thin and expanded, no <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> reaction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Curettage, debridement, and in some cases radiation (cautiously)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with PMMA or bone grafting; Denosumab and bisphosphonates as <span class=\"customMeta\" data-dictid=\"e405fcd2f2169277718034536f004a\">adjunct</span> therapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which anti-tubercular drug is associated with mutations in the KATG gene?", "options": [{"label": "A", "text": "Rifampicin", "correct": false}, {"label": "B", "text": "Isoniazid", "correct": true}, {"label": "C", "text": "Moxifloxacin", "correct": false}, {"label": "D", "text": "Ethambutol", "correct": false}], "correct_answer": "B. Isoniazid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/P1RB2BcpTtULStTLkxx01741070348.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of resistance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KatG gene mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>INH is a prodrug, converted to the active <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> by catalase-peroxidase produced by the KATg gene. The mutated <span class=\"customMeta\" data-dictid=\"553253f1ce1692777183d395babc1b\">catalase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> does not <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the active drug</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>KasA gene mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Component of <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> mycolic acid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>InhA gene overexpression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes <span class=\"customMeta\" data-dictid=\"9a6a6e737e1692777185f1b77971e2\">cross-resistance</span> to <span class=\"customMeta\" data-dictid=\"765ad61235169277718731b19650f4\">Ethionamide</span> (second-line drug)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with arthritis, and arthroscopy reveals blackening of the joints. Which enzyme deficiency is most likely responsible for this condition?", "options": [{"label": "A", "text": "Homogentisate oxidase", "correct": true}, {"label": "B", "text": "Branched-chain alpha-ketoacid dehydrogenase", "correct": false}, {"label": "C", "text": "Tyrosinase", "correct": false}, {"label": "D", "text": "Fumarase", "correct": false}], "correct_answer": "A. Homogentisate oxidase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaptonuria (Homogentisate <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">Oxidase</span> Deficiency)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deficient Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogentisate oxidase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Accumulated Metabolite</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogentisic acid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Black <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (on standing), <span class=\"customMeta\" data-dictid=\"5aac9eb00e1692777194b0cca49c62\">ochronosis</span> (dark <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue pigmentation), early-onset arthritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Areas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Joints, <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> (ear, sclera, <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> discs)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urine darkening with alkalization, elevated <span class=\"customMeta\" data-dictid=\"d442747c48169277718942db69fa7e\">homogentisic acid</span> in urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low-protein diet (restricting <span class=\"customMeta\" data-dictid=\"5e52c07d0f1692777195dd08cc451f\">phenylalanine</span> &amp; tyrosine), vitamin C, <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> management</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male presented with weakness in the lower half of the right side of his face, with drooping of the angle of his mouth. He is unable to raise his eyebrows and close his eyes on both sides. Which of the following is the most appropriate diagnosis?", "options": [{"label": "A", "text": "Infranuclear facial palsy on right side", "correct": true}, {"label": "B", "text": "Supranuclear facial palsy on left side", "correct": false}, {"label": "C", "text": "Infranuclear facial on left side", "correct": false}, {"label": "D", "text": "Supranuclear facial on right side", "correct": false}], "correct_answer": "A. Infranuclear facial palsy on right side", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Upper <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">Motor Neuron</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">Lesion</span> (Supranuclear)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Lower <span class=\"customMeta\" data-dictid=\"29e1987f81169277719209260ba0f1\">Motor Neuron</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">Lesion</span> (Infranuclear)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lesion Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Motor cortex, connection from motor <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> to <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> in pons</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Facial nucleus, anywhere along CN VII</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Affected Side</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Contralateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Ipsilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Muscles Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lower muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Upper and lower muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Forehead Involved?</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Spared, due to <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> UMN innervation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Affected</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Variable; depends on size of lesion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Incomplete eye <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> (dry eyes, corneal ulceration), hyperacusis, loss of taste sensation to <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> tongue</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which sign of pregnancy denotes the following?", "options": [{"label": "A", "text": "Hegar Sign", "correct": true}, {"label": "B", "text": "Goodell Sign", "correct": false}, {"label": "C", "text": "Osiander sign", "correct": false}, {"label": "D", "text": "Palmer sign", "correct": false}], "correct_answer": "A. Hegar Sign", "question_images": ["https://image.prepladder.com/content/DSRtgSzoCveA6MLnYSAX1741058341.png"], "explanation_images": ["https://image.prepladder.com/content/ArMXi6LBuvkpP03Yz5NW1741105739.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Signs of Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Week of Pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hegar's sign</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Softening of the lower <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> segment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"05493772261692777201c10c4ee537\">vascularity</span> and <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> of the smooth muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-8 weeks of gestation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chadwick's sign</strong></p>\n<p><strong>(Jacquemier’s sign)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bluish discoloration of the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> and vagina</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/ArMXi6LBuvkpP03Yz5NW1741105739.png\" width=\"4167\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"05493772261692777201c10c4ee537\">vascularity</span> in response to hormonal changes in pregnancy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8th week</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Goodell's sign</strong><br/>\n<strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Softening of the cervix</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased vascularisation and edema.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6th week</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Piskacek's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymmetric <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the uterus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"52007706a216927771899e36747712\">implantation</span> of fertilised ovum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palmer's sign</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular and rhythmic <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to increased <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> levels, and the <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> adaptations of the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> preparing for labor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-8 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osiander's sign</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased pulsations felt through <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> fornices</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> by the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> arteries</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8th-12th week</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hartman’s sign/ <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">Placental</span> sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Implantation bleeding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Attachment of fertilized <span class=\"customMeta\" data-dictid=\"7c1d9800e2169277719426cf66bb68\">ovum</span> to the endometrium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not caused by food adulteration?", "options": [{"label": "A", "text": "Fluorosis", "correct": true}, {"label": "B", "text": "Epidemic dropsy", "correct": false}, {"label": "C", "text": "Neurolathyrism", "correct": false}, {"label": "D", "text": "Endemic ascites", "correct": false}], "correct_answer": "A. Fluorosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is excreted in the urine of patients with pentosuria?", "options": [{"label": "A", "text": "L-Xylulose", "correct": true}, {"label": "B", "text": "D-Ribose", "correct": false}, {"label": "C", "text": "D-Ribulose", "correct": false}, {"label": "D", "text": "D-Lactose", "correct": false}], "correct_answer": "A. L-Xylulose", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:430px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Essential Pentosuria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deficiency of <strong>L-xylulose reductase</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of <strong>L-xylulose</strong> in urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None (asymptomatic)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urine sugar analysis + Chromatography</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No treatment needed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the treatment option with the image given below:", "options": [{"label": "A", "text": "Type 1 Tympanoplasty", "correct": false}, {"label": "B", "text": "Type 2 tympanoplasty", "correct": false}, {"label": "C", "text": "Type 3 tympanoplasty", "correct": true}, {"label": "D", "text": "Type 4 tympanoplasty", "correct": false}], "correct_answer": "C. Type 3 tympanoplasty", "question_images": ["https://image.prepladder.com/content/AS0HT1SHGyfwWT28CNES1747846067.png"], "explanation_images": ["https://image.prepladder.com/content/3fYknAREzgQf0ThAQFjZ1747846131.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n<p>Repaired using a graft. (myringoplasty) <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: Eroded <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> and <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n<p>Graft placed on <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">incus</span> or remaining malleus. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: Absence of <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> and incus.</p>\n<p>Graft placed directly on <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> head (myringostapediopexy or <span class=\"customMeta\" data-dictid=\"e03b2f95ab1692777184437bf8f3c5\">columella</span> tympanoplasty).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: Only the <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> of the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> is present. It is exposed to the external ear.</p>\n<p>A <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> is placed between <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> and round windows, allowing sound to act directly on the <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> and the <span class=\"customMeta\" data-dictid=\"ae3483b8c91692777197c75b7af9a9\">round window</span> is shielded. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fenestration operation: Creation of a new window on the <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> semicircular canal, covering it with a <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> when the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> is fixed but the <span class=\"customMeta\" data-dictid=\"ae3483b8c91692777197c75b7af9a9\">round window</span> is functional.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old boy was brought to the emergency department with complaints of melena that contains gastric mucosa and acute intermittent pain in the right iliac region. On surgical exploration, the following structure was found, what is the diagnosis?", "options": [{"label": "A", "text": "Meckel's diverticulum", "correct": true}, {"label": "B", "text": "Appendicular lump", "correct": false}, {"label": "C", "text": "Carcinoid", "correct": false}, {"label": "D", "text": "Obstructed bowel loops", "correct": false}], "correct_answer": "A. Meckel's diverticulum", "question_images": ["https://image.prepladder.com/content/0Fs38ypib0HpzqMZeIa91741111424.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital true <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> of the small intestine, resulting from the incomplete <span class=\"customMeta\" data-dictid=\"e5922b669a169277719487f8bbabd3\">obliteration</span> of the <span class=\"customMeta\" data-dictid=\"4df1564f3c1692777202da97b54e7e\">vitelline</span> duct.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rule of 2’s</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2% population, 2 <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> from the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> valve, 2 inches in length, 2 types of <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> tissue (gastric, pancreatic), 2 years most common presentation, 2:1 male predominance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Painless <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> (melena), intestinal obstruction, diverticulitis, volvulus, intussusception.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Meckel’s scan (Tc-99m <span class=\"customMeta\" data-dictid=\"1771fe713b169277719506679fa243\">pertechnetate</span> scan for <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> mucosa).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (diverticulectomy or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> resection) if symptomatic.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not related to disease progression?", "options": [{"label": "A", "text": "Duration", "correct": true}, {"label": "B", "text": "Depth", "correct": false}, {"label": "C", "text": "Site", "correct": false}, {"label": "D", "text": "Stage of Cancer", "correct": false}], "correct_answer": "A. Duration", "question_images": ["https://image.prepladder.com/content/oZEgru0yYh1xXnXke3qR1741106706.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect on Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Depth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deeper invasion into muscle, cartilage, or bone increases severity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-risk sites (face, scalp, ears) have more aggressive behavior</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage of Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Later stages indicate increased tumor burden and invasion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slow growth means duration does not directly impact aggressiveness</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fetal anaemia is monitored by?", "options": [{"label": "A", "text": "MCA-PSV", "correct": true}, {"label": "B", "text": "Maternal blood", "correct": false}, {"label": "C", "text": "Fetal blood", "correct": false}, {"label": "D", "text": "Amniocentesis", "correct": false}], "correct_answer": "A. MCA-PSV", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/h3RPoBASLU2BtwxonBBk1741106737.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was presented to the OPD with complaints of greenish black matter in the nose with merciful smelling. What is the diagnosis?", "options": [{"label": "A", "text": "Allergic rhinitis", "correct": false}, {"label": "B", "text": "Atrophic rhinitis", "correct": true}, {"label": "C", "text": "Rhinitis caseosa", "correct": false}, {"label": "D", "text": "Rhinitis sicca", "correct": false}], "correct_answer": "B. Atrophic rhinitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Heredity</li>\n<li>Endocrine disturbance</li>\n<li>Racial factors</li>\n<li>Nutritional deficiency</li>\n<li><strong>Infective: <span class=\"customMeta\" data-dictid=\"50f3c6e8dd16927771902c55d555b8\">Klebsiella</span> ozaenae </strong></li>\n<li>Autoimmune</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n<p><strong>And Examination findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primarily affects females, starts around puberty</li>\n<li>Foul-smelling <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> discharge; patients are usually unaware of it themselves and have <span class=\"customMeta\" data-dictid=\"cc8a35010816927771819ba9cf19d8\">anosmia</span> <strong>(merciful anosmia).</strong></li>\n<li>Paradoxical <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> despite enlarged <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> chambers.</li>\n<li>Epistaxis from <span class=\"customMeta\" data-dictid=\"62b976e2941692777185c4b2eb180b\">crust</span> removal.</li>\n<li>Pale <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> mucosa, <span class=\"customMeta\" data-dictid=\"ae1132b13e1692777182aec918eee0\">atrophied</span> turbinates, potential septal perforation, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> dermatitis, <span class=\"customMeta\" data-dictid=\"8b3b29ae5516927771987d1b16beb1\">saddle</span> nose deformity.</li>\n<li>Possible extension to <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">pharynx</span> and <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> leading to <span class=\"customMeta\" data-dictid=\"65b19c9ce61692777182e7b765acf0\">atrophic pharyngitis</span> and laryngitis.</li>\n<li>Eustachian tube <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> cause hearing impairment.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the lymphatic structure from the histology section given below?", "options": [{"label": "A", "text": "Tonsil", "correct": false}, {"label": "B", "text": "Lymph node", "correct": false}, {"label": "C", "text": "Spleen", "correct": false}, {"label": "D", "text": "Thymus", "correct": true}], "correct_answer": "D. Thymus", "question_images": ["https://image.prepladder.com/content/91QlKfIL3bNM9kvYoSyO1741031704.png"], "explanation_images": ["https://image.prepladder.com/content/7aRs4SramQn5zoYtkOlU1741031801.png", "https://image.prepladder.com/content/18vgyfESyYDIakRoWoU61741031834.png", "https://image.prepladder.com/content/kZLkp3LGmPqu2MoLjyt21741031874.png", "https://image.prepladder.com/content/H3YVOsf6qq62A9CWVMEx1741031907.png", "https://image.prepladder.com/content/qGpc2Ik7btZpaug239qp1741089865.png", "https://image.prepladder.com/content/M0tw8pTTBJUnHn4agJZN1741031986.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A TB patient with HIV begins ART and experiences deterioration in health after 2 months. What is the likely cause?", "options": [{"label": "A", "text": "Development of drug resistance to TB drugs", "correct": false}, {"label": "B", "text": "Drug-drug interactions between TB and ART medications", "correct": false}, {"label": "C", "text": "Immunological changes in the body", "correct": true}, {"label": "D", "text": "Development of drug resistance to ART", "correct": false}], "correct_answer": "C. Immunological changes in the body", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which anti-epileptic drug is commonly associated with gum hypertrophy and dizziness as side effects?", "options": [{"label": "A", "text": "Carbamazepine", "correct": false}, {"label": "B", "text": "Phenytoin", "correct": true}, {"label": "C", "text": "Levetiracetam", "correct": false}, {"label": "D", "text": "Topiramate", "correct": false}], "correct_answer": "B. Phenytoin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with penicillin allergy presents with fever, burning micturition, and hearing problems accompanied by dizziness. Which drug is the most appropriate for the management?", "options": [{"label": "A", "text": "Azithromycin", "correct": false}, {"label": "B", "text": "Amikacin", "correct": false}, {"label": "C", "text": "Ciprofloxacin", "correct": true}, {"label": "D", "text": "Ampicillin-Clavulanic acid", "correct": false}], "correct_answer": "C. Ciprofloxacin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ciprofloxacin</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacokinetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Good oral absorption</li>\n<li>Bioavailability ~70%,Moderate <span class=\"customMeta\" data-dictid=\"082d1526db1692777188311b6eef04\">half-life</span> (~4-5 hours)</li>\n<li>Widely distributed in tissues and body fluids</li>\n<li>Renal excretion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections</li>\n<li>Prostatitis</li>\n<li>Pseudomonas aeruginosa (DOC)</li>\n<li><strong>Anthrax (Bacillus anthracis) (DOC)</strong></li>\n<li>Gastrointestinal infections (e.g., traveller's diarrhoea)</li>\n<li>Bone and joint infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gastrointestinal disturbances (nausea, diarrhoea).</li>\n<li>CNS effects (headache, dizziness).</li>\n<li>Tendonitis and <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> rupture.</li>\n<li>Photosensitivity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pregnancy</li>\n<li>Children (due to potential for <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> damage)</li>\n<li>Myasthenia gravis (can exacerbate muscle weakness)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is pressure epiphysis", "options": [{"label": "A", "text": "Head of Humerus", "correct": true}, {"label": "B", "text": "Elbow joint", "correct": false}, {"label": "C", "text": "Wrist joint", "correct": false}, {"label": "D", "text": "Sternum", "correct": false}], "correct_answer": "A. Head of Humerus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 29-year-old woman presents with abdominal pain, vaginal bleeding, and a history of amenorrhea for 6 weeks. Transvaginal ultrasound does not show an intrauterine gestational sac or features suggestive of ectopic pregnancy. Her serum β-hCG is 1,200 IU/L, which is below the discriminatory zone. What is the next step in management?", "options": [{"label": "A", "text": "Laparoscopy", "correct": false}, {"label": "B", "text": "Methotrexate therapy", "correct": false}, {"label": "C", "text": "Repeat β-hCG after 48 hours", "correct": true}, {"label": "D", "text": "Dilatation and curettage", "correct": false}], "correct_answer": "C. Repeat β-hCG after 48 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male presents with a history of vestibular schwannoma and psammoma bodies in the brain. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Meningioma", "correct": true}, {"label": "B", "text": "GBM (Glioblastoma Multiforme)", "correct": false}, {"label": "C", "text": "Pilocytic astrocytoma", "correct": false}, {"label": "D", "text": "Oligodendroglioma", "correct": false}], "correct_answer": "A. Meningioma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following image shows", "options": [{"label": "A", "text": "Open Neural tube defect", "correct": true}, {"label": "B", "text": "Meningocele", "correct": false}, {"label": "C", "text": "Spina bifida", "correct": false}, {"label": "D", "text": "Myelomeningocele", "correct": false}], "correct_answer": "A. Open Neural tube defect", "question_images": ["https://image.prepladder.com/content/xUQQKhVgV0echRR2vqDf1741106166.png"], "explanation_images": ["https://image.prepladder.com/content/7AIt0XOqKaezO5RN6UFd1741106101.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:604px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of <span class=\"customMeta\" data-dictid=\"78d32c50611692777199c6c6b9b525\">Spina</span> Bifida</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spina Bifida Occulta </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spine is abnormal, but the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord is unaffected.</li>\n<li>Overlying skin is usually normal.</li>\n<li>May have a small dimple, <span class=\"customMeta\" data-dictid=\"121d2a043516927772012d5faa616f\">tuft</span> of hair, or <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> over the skin indicating the defect.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meningocele </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Protrusion of a <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> of <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> through the vertebral defect.</li>\n<li>Contains only <strong>clear fluid</strong>, <strong>no <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> components</strong>.</li>\n<li><strong>Transillumination is positive</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myelomeningocele</strong><strong> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sac protrudes through the <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> and contains <strong>neural components</strong> herniating from the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Scientists administered norepinephrine to guinea pigs, resulting in an increase in systolic and diastolic blood pressure and a decrease in heart rate. What mechanism explains this response?", "options": [{"label": "A", "text": "Beta-1 receptor blockade", "correct": false}, {"label": "B", "text": "Alpha-1 receptor blockade", "correct": false}, {"label": "C", "text": "Baroreceptor stimulation", "correct": true}, {"label": "D", "text": "Baroreceptor inhibition", "correct": false}], "correct_answer": "C. Baroreceptor stimulation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Baroreceptors in <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> and aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> detect BP changes</li>\n<li>Increased BP <span class=\"customMeta\" data-dictid=\"ad337177ee1692777199de941a0cda\">stretches</span> receptors, sending signals to <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> via <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> and <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> nerves</li>\n<li>Medulla inhibits <span class=\"customMeta\" data-dictid=\"52abfe100916927772011ad20f3fda\">vasoconstrictor</span> center and stimulates <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> center</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Actions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vasodilation of blood vessels</li>\n<li>Decreased heart rate and <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> strength</li>\n<li>Reduced BP due to lower <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> resistance and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Maintains BP stability during activities like standing</li>\n<li>Fastest acting</li>\n<li>Tends to reset within 1-2 days for long-term regulation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person with the H/o long-term sexual relationship presented with painful ulcers on his genitals with tender lymphadenopathy. What is the diagnosis?", "options": [{"label": "A", "text": "Gonorrhoea", "correct": false}, {"label": "B", "text": "Chlamydia", "correct": false}, {"label": "C", "text": "LGV", "correct": false}, {"label": "D", "text": "Chancroid", "correct": true}], "correct_answer": "D. Chancroid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9iCuQE9Qj8H2ReO2Cq951741086520.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 49-year-old female from Nagaland presented with right-sided hearing loss and tinnitus. On examination, dull tympanic membrane with lymph nodes in the posterior triangle of the neck was seen. Which of the following is the management for the condition?", "options": [{"label": "A", "text": "Grommet insertion + Steroids", "correct": false}, {"label": "B", "text": "Grommet insertion", "correct": false}, {"label": "C", "text": "Steroids", "correct": false}, {"label": "D", "text": "Radiotherapy", "correct": true}], "correct_answer": "D. Radiotherapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A case of death of a married female within 3 years of marriage was reported. Inquest is done by?", "options": [{"label": "A", "text": "Judicial", "correct": false}, {"label": "B", "text": "Police", "correct": false}, {"label": "C", "text": "Coroner", "correct": false}, {"label": "D", "text": "Magistrate", "correct": true}], "correct_answer": "D. Magistrate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PI2pc0xvnk4xzs47PNkN1747840509.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Police Inquest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magistrate Inquest</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conducted by</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Police officer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Magistrate (DM, SDM, Judicial, or Executive Magistrate)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Involvement of witnesses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires signatures of panchas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Does not require witness signatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Witness statements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Admissible in court</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not admissible in court</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Can order arrest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No, but can arrest in cognizable offenses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can issue arrest warrants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exhumation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cannot order exhumation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can order <span class=\"customMeta\" data-dictid=\"9ede3648ef1692777187540bde750b\">exhumation</span> of a body</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autopsy orders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sends bodies for <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> indiscriminately</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Orders <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> only when necessary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Forensic analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cannot order chemical analysis of viscera</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can order chemical analysis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old child was brought with bow legs and on x-ray of wrist following were the findings. What is the diagnosis?", "options": [{"label": "A", "text": "Rickets", "correct": true}, {"label": "B", "text": "Scurvy", "correct": false}, {"label": "C", "text": "Hypophosphatemia", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "A. Rickets", "question_images": ["https://image.prepladder.com/content/ksKq0CUKsCVSvOnb1UvF1741087161.png"], "explanation_images": ["https://image.prepladder.com/content/MaeIdjipQgcgxAZyLGfV1741060320.png", "https://image.prepladder.com/content/s0fCIVY3wfk6V83OBIM21741060343.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with grade 4 hemorrhoids underwent surgery, identify the instrument.", "options": [{"label": "A", "text": "Haemorrhoids resection kit", "correct": false}, {"label": "B", "text": "Stapler kit", "correct": false}, {"label": "C", "text": "Haemorrhoids band kit", "correct": true}, {"label": "D", "text": "CO2 laser", "correct": false}], "correct_answer": "C. Haemorrhoids band kit", "question_images": ["https://image.prepladder.com/content/jHrsvAfCw6t7A1xkydIE1741111486.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade of Hemorrhoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 1</strong> (No prolapse)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lifestyle modification, fiber, sitz bath, <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> agents</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 2</strong> (Prolapse, <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> reduction)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rubber band ligation, sclerotherapy, <span class=\"customMeta\" data-dictid=\"82df9c600116927771907b7977a3b4\">infrared</span> coagulation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 3</strong> (Prolapse, manual reduction needed)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rubber band ligation, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> if persistent symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade 4</strong> (Irreducible prolapse)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical options: <span class=\"customMeta\" data-dictid=\"688498a587169277718835ead0f24e\">Hemorrhoidectomy</span> (excision or stapler), laser hemorrhoidoplasty</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the deficiency in the image shown below?", "options": [{"label": "A", "text": "Copper Deficiency", "correct": false}, {"label": "B", "text": "Zinc Deficiency", "correct": true}, {"label": "C", "text": "Vitamin C Deficiency", "correct": false}, {"label": "D", "text": "Vitamin D Deficiency", "correct": false}], "correct_answer": "B. Zinc Deficiency", "question_images": ["https://image.prepladder.com/content/rQ4lVL0jxWzoiewXJbmn1741064180.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:500px\">\n<tbody>\n<tr>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Diarrhea.</li>\n<li>Mood changes.</li>\n<li>Anorexia.</li>\n<li>Neurological disturbances.</li>\n<li>Hypogonadism</li>\n</ul>\n<br/>\n\t\t\t </td>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Growth retardation.</li>\n<li>Alopecia (hair loss).</li>\n<li>Weight loss.</li>\n<li>Recurrent infections.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old woman comes to the clinic for a routine follow-up. She has a history of mild hypertension, which is well-controlled with medication. She reports no symptoms such as palpitations, dizziness, or chest pain. An ECG of the patient is given below. What is the most likely diagnosis based on the ECG findings?", "options": [{"label": "A", "text": "Second-Degree AV Block", "correct": false}, {"label": "B", "text": "First-Degree AV Block", "correct": true}, {"label": "C", "text": "Third-Degree AV Block", "correct": false}, {"label": "D", "text": "Bundle Branch Block", "correct": false}], "correct_answer": "B. First-Degree AV Block", "question_images": ["https://image.prepladder.com/content/E4Q3HxOFLM41zAEFMq8Q1741080778.png"], "explanation_images": ["https://image.prepladder.com/content/YbLxBsoZEJ6tIfPuZ5do1741080790.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>First Degree AV Block</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>First-degree <span class=\"customMeta\" data-dictid=\"78a0565f7316927771827e4aca866c\">AV block</span> is characterized by a prolonged PR interval (&gt;0.20 seconds) without <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> from <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> to ventricles.</li>\n<li>The delay typically occurs in the AV node, but may also involve the atria, His bundle, or Purkinje fibers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Commonly attributed to increased <span class=\"customMeta\" data-dictid=\"5fb29f3cd516927772017bd29c2581\">vagal</span> tone in younger patients.</li>\n<li>In older patients, often due to fibrotic changes in the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> system.</li>\n<li>Other causes include <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> heart disease, myocardial infarction, <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> abnormalities, inflammation, infections, certain drugs, <span class=\"customMeta\" data-dictid=\"3107ad472c16927771900477b8dae0\">infiltrative</span> diseases, <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> diseases, and <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> degenerative diseases.</li>\n<li>Lymes disease, Chagas disease, Diphtheria, <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> arthritis, Scleroderma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Usually asymptomatic; patients are often unaware of the condition until discovered on an ECG.</li>\n<li>In cases where the PR interval exceeds 0.30 seconds, symptoms may resemble \"pacemaker syndrome,\" including dyspnea, malaise, lightheadedness, and chest pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is confirmed by a PR interval greater than 0.20 seconds on an ECG.</li>\n<li>PR interval can be marked (&gt;0.30 seconds) in some cases, and P waves may appear within preceding T waves.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Generally, no treatment is required; routine observation is sufficient.</li>\n<li>Pacemaker placement may be considered for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> patients with PR interval &gt;0.30 seconds or those with coexisting heart disease.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"2f4652078816927771814621857a81\">antiarrhythmic</span> medications are indicated, and surveillance with routine ECGs is recommended to monitor for worsening.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the population norm for an ASHA worker?", "options": [{"label": "A", "text": "700-1000", "correct": false}, {"label": "B", "text": "1000-1500", "correct": false}, {"label": "C", "text": "1000-2500", "correct": true}, {"label": "D", "text": "2000-2500", "correct": false}], "correct_answer": "C. 1000-2500", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child diagnosed with von Willebrand disease requires an understanding of the role of von Willebrand factor (vWF). What does von Willebrand factor primarily combine with?", "options": [{"label": "A", "text": "Glycoprotein Ib", "correct": true}, {"label": "B", "text": "Platelet factor 3", "correct": false}, {"label": "C", "text": "ADP", "correct": false}, {"label": "D", "text": "Prothrombin", "correct": false}], "correct_answer": "A. Glycoprotein Ib", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/E2CVJFlUdQPCJd1CXITs1741061179.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with gum bleeding, petechiae, poor wound healing, and other related symptoms. Which of the following vitamin deficiencies is most likely responsible for this presentation?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin B6", "correct": false}, {"label": "C", "text": "Vitamin B3", "correct": false}, {"label": "D", "text": "Vitamin C", "correct": true}], "correct_answer": "D. Vitamin C", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vitamin C <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> (Scurvy)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor dietary <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> (malnutrition, alcoholism, elderly, infants on cow's milk)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding gums, petechiae, bruising, corkscrew hairs, poor wound healing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subperiosteal hemorrhage, joint pain, anemia, weakness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical features, low <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"964b8993a1169277720279c9c96cd1\">vitamin C</span> levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vitamin C supplementation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presents with hirsutism, delayed periods, obesity. USG findings are given below. What is the likely diagnosis?", "options": [{"label": "A", "text": "PCOD", "correct": true}, {"label": "B", "text": "POI", "correct": false}, {"label": "C", "text": "OHSS", "correct": false}, {"label": "D", "text": "Thecal luteal cyst", "correct": false}], "correct_answer": "A. PCOD", "question_images": ["https://image.prepladder.com/content/1QEoR0tg65ZKBI11rUJP1741060448.png"], "explanation_images": ["https://image.prepladder.com/content/3yDy9AtuxKkuKzw1PSiF1741060538.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:653px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recommended Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical <span class=\"customMeta\" data-dictid=\"67593c3b001692777189ea37898103\">Hyperandrogenism</span> (or)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated total or free testosterone, or calculated indices (FAI, BioT). DHEAS and ANSD can be considered.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Hyperandrogenism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Modified Ferriman–Gallwey score <strong>≥4 to ≥8</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oligo-Anovulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oligo-amenorrhea (<strong>cycles &gt;35 days apart or &lt;8 menses/year</strong>).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Polycystic Ovarian <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">Morphology</span> (On USG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>≥20 follicles per ovary</strong> (in either ovary) or <strong>≥10 cm³ ovarian volume</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The ureter is safe in which type of hysterectomy?", "options": [{"label": "A", "text": "Open laparotomy", "correct": false}, {"label": "B", "text": "Laparoscopy", "correct": false}, {"label": "C", "text": "Robotic", "correct": false}, {"label": "D", "text": "Vaginal", "correct": true}], "correct_answer": "D. Vaginal", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hysterectomy Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ureteric Injury Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reasons</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Open laparotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct ureteric handling, risk during ligation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased risk due to <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> and <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> injuries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Robotic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate to high</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> but better visualization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaginal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lowest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal ureteric dissection, lower risk of injury</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which findings are suggestive of tubal pregnancy?", "options": [{"label": "A", "text": "Ovarian mass with single layer of endometrium", "correct": false}, {"label": "B", "text": "Adnexal mass with empty uterus", "correct": false}, {"label": "C", "text": "Trilayer endometrium without adnexal mass", "correct": false}, {"label": "D", "text": "Adnexal mass with empty uterus and fluid in pelvis", "correct": true}], "correct_answer": "D. Adnexal mass with empty uterus and fluid in pelvis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for the given image?", "options": [{"label": "A", "text": "Genital TB", "correct": true}, {"label": "B", "text": "Normal fallopian tube", "correct": false}, {"label": "C", "text": "Hydrosalphinx", "correct": false}, {"label": "D", "text": "Endometrosis", "correct": false}], "correct_answer": "A. Genital TB", "question_images": ["https://image.prepladder.com/content/4PuTLmQTzsznG9R96STP1741106856.png"], "explanation_images": ["https://image.prepladder.com/content/tXlKG5E0MCgZe3AYhU701741106868.png", "https://image.prepladder.com/content/wvDHm9Dc5LQrhmfci6T61741106915.png", "https://image.prepladder.com/content/P9sNna9we0FtyzkA2Jc91741106964.png", "https://image.prepladder.com/content/P0QwdPvpEDCSu9aLXZG01741107025.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man is found unconscious after a fall from a ladder. In the emergency department, his eyes do not open even in response to pain; he is making incomprehensible sounds, and he exhibits abnormal flexion in response to painful stimuli. What is his Glasgow Coma Scale (GCS) score?", "options": [{"label": "A", "text": "5", "correct": false}, {"label": "B", "text": "6", "correct": true}, {"label": "C", "text": "7", "correct": false}, {"label": "D", "text": "8", "correct": false}], "correct_answer": "B. 6", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:426px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Head Injury Severity: Clinical Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minor head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 15 with no LOC (loss of consciousness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 14 or 15 with LOC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 9 - 13</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe head injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GCS 3 - 8</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:297px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pupils Unreactive to Light</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pupil Reactivity Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both Pupils</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>One Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neither Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "This instrument is contraindicated for?", "options": [{"label": "A", "text": "Caesarean section", "correct": false}, {"label": "B", "text": "Obstructed labor", "correct": true}, {"label": "C", "text": "After coming head of breech", "correct": false}, {"label": "D", "text": "Occipital posterior position", "correct": false}], "correct_answer": "B. Obstructed labor", "question_images": ["https://image.prepladder.com/content/HD5i4V1SP7PxfJnVGmA31741059498.png"], "explanation_images": ["https://image.prepladder.com/content/iJXUe6hW36jrfNGhfXHm1741059640.png", "https://image.prepladder.com/content/tOo9VeBFlwIv5mWGUAmd1741059624.png", "https://image.prepladder.com/content/cszrCEBwSfXLNkQh80SE1741059611.png", "https://image.prepladder.com/content/nSEXxFEEtwaYvwzSvaGs1741059596.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Instrument</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Piper <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> </strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"209\" src=\"https://image.prepladder.com/content/iJXUe6hW36jrfNGhfXHm1741059640.png\" width=\"209\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asymmetrical blades (one solid, one fenestrated)</li>\n<li>Specifically for the after-coming head in <span class=\"customMeta\" data-dictid=\"6946dd732d1692777183e8fbb62785\">breech</span> deliveries.</li>\n<li>Allows application when access to the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head is limited.</li>\n<li>Designed for quick delivery of <strong>head-in <span class=\"customMeta\" data-dictid=\"6946dd732d1692777183e8fbb62785\">breech</span> births</strong></li>\n<li>It has distinct <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> curve, allows for application to the <strong>aftercoming head in <span class=\"customMeta\" data-dictid=\"6946dd732d1692777183e8fbb62785\">breech</span> delivery.</strong><strong> (Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simpson forceps</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"239\" src=\"https://image.prepladder.com/content/tOo9VeBFlwIv5mWGUAmd1741059624.png\" width=\"132\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long, curved blades.</li>\n<li>Sliding lock mechanism.</li>\n<li>Versatile - used for <strong>outlet and low-cavity applications.</strong></li>\n<li>Accommodates various <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head sizes.</li>\n<li>One of the most commonly used forceps.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wrigley's forceps</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"210\" src=\"https://image.prepladder.com/content/cszrCEBwSfXLNkQh80SE1741059611.png\" width=\"208\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Short, slightly curved blades.</li>\n<li>Fixed English-style lock.</li>\n<li>Designed for <strong>low or outlet <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> deliveries.</strong></li>\n<li>It is easier to manoeuvre when the <strong>fetal head is very low or visible.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kielland forceps</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"218\" src=\"https://image.prepladder.com/content/nSEXxFEEtwaYvwzSvaGs1741059596.png\" width=\"164\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long, almost straight blades</li>\n<li>Adjustable pivot.</li>\n<li>Designed for <strong>rotation of the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head</strong>.</li>\n<li>Useful for<strong> <span class=\"customMeta\" data-dictid=\"d4214cf5bc1692777194bd76243b92\">occiput</span> <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> positions. </strong><strong>(Option D)</strong></li>\n<li>Can accommodate <span class=\"customMeta\" data-dictid=\"e67797478a16927771821d950ff605\">asynclitism</span> (tilted <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> head).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the classical triad of acute cholangitis?", "options": [{"label": "A", "text": "Pain, jaundice, fever", "correct": true}, {"label": "B", "text": "Pain, jaundice, shock", "correct": false}, {"label": "C", "text": "Fever, jaundice, ↑WBC", "correct": false}, {"label": "D", "text": "Pain, ↑WBC, ↑Bilirubin", "correct": false}], "correct_answer": "A. Pain, jaundice, fever", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Cholangitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Often due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in the <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree, leading to bacterial infection by organisms like Klebsiella, E. coli, Enterobacter, Pseudomonas, and <span class=\"customMeta\" data-dictid=\"e58661c5961692777184ecb7121396\">Citrobacter</span> species.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Charcot's <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> - pain, jaundice, fever</strong></li>\n<li>Additional <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"b2332a96a2169277718756eb10e3e7\">epigastrium</span> and right <span class=\"customMeta\" data-dictid=\"c8bf2605091692777189746f65e812\">hypochondrium</span> is common.</li>\n<li>Severe Form: <strong>Reynolds pentad</strong> - <strong>persistent pain, fever, jaundice, shock, and altered mental status</strong></li>\n<li>Indicates <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> obstructive <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> cholangitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lab Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"57176262ed169277720233ee0ceb2a\">white blood cell</span> count, bilirubin, and <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> levels.</li>\n<li>Chronic cases may show <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> or hypertrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Recurrent <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">Pyogenic</span> Cholangitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>More common in East Asian populations, caused by <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> stones and infections</li>\n<li>Risk factors include <span class=\"customMeta\" data-dictid=\"c0433f52ad1692777194c2ffb6fc63\">parasitic</span> infections like <span class=\"customMeta\" data-dictid=\"1d97210e3416927771844d6a6b6242\">Clonorchis</span> sinensis and <span class=\"customMeta\" data-dictid=\"d4d6dc03c61692777182e9a842faf7\">Ascaris</span> lumbricoides.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When is a blood sample taken to diagnose neonatal hypothyroidism?", "options": [{"label": "A", "text": "Immediately from the umbilical cord", "correct": false}, {"label": "B", "text": "24 hours after delivery", "correct": false}, {"label": "C", "text": "23-48 hours after delivery", "correct": false}, {"label": "D", "text": "72 hours after delivery", "correct": true}], "correct_answer": "D. 72 hours after delivery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with telecanthus, hypertelorism, antimongoloid slant, and cardiac defects. What is the most likely chromosomal abnormality?", "options": [{"label": "A", "text": "Translocation", "correct": false}, {"label": "B", "text": "Inversion", "correct": false}, {"label": "C", "text": "Microdeletion", "correct": true}, {"label": "D", "text": "Trisomy", "correct": false}], "correct_answer": "C. Microdeletion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VkrJWduH3NVV2RJ4QFjo1741106028.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Microdeletion on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 22q11.2.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Developmental Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal development of the third and fourth pharyngeal pouches during embryogenesis.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:478px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Facial Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypertelorism (widely spaced eyes).</li>\n<li>Antimongoloid <span class=\"customMeta\" data-dictid=\"bc8b45183516927771983a212ad17a\">slant</span> of eyes.</li>\n<li>Low-set ears.</li>\n<li>Micrognathia (small jaw).</li>\n<li>Short philtrum.</li>\n<li>Bifid uvula.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypocalcaemic <span class=\"customMeta\" data-dictid=\"3d62cb9e271692777200980467ea01\">tetany</span> (due to hypoparathyroidism).</li>\n<li>Aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> anomalies.</li>\n<li>Thymic <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> or aplasia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T Cell Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present in 20–30% of patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ranges from mild <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> to severe <span class=\"customMeta\" data-dictid=\"141d29cc7f16927771890a8e0860e6\">immunodeficiency</span> requiring <span class=\"customMeta\" data-dictid=\"fbd2788fff16927772009c0137de78\">thymus</span> or HSCT.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with electric burns and stable vital signs, red-colored urine is observed. What is the most likely finding in the patient's serology?", "options": [{"label": "A", "text": "RBCs in urine", "correct": false}, {"label": "B", "text": "Increased creatinine levels", "correct": false}, {"label": "C", "text": "Decreased hemoglobin levels", "correct": false}, {"label": "D", "text": "Increased potassium levels", "correct": true}], "correct_answer": "D. Increased potassium levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:463px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathologic Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cloudy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nephrotic syndrome</li>\n<li>Phosphaturia</li>\n<li>Pyuria</li>\n<li>Chyluria</li>\n<li>Lipiduria</li>\n<li>Hyperoxaluria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cola coloured </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute Glomerulonephritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brown</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bile pigments</li>\n<li>Myoglobin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brownish-black</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bile pigments</li>\n<li>Melanin</li>\n<li>Methemoglobin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Green or Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pseudomonas UTI</li>\n<li>Biliverdin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orange</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bile pigments</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Red</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hematuria</li>\n<li>Hemoglobinuria</li>\n<li>Myoglobinuria <strong>(Rhabdomyolysis)</strong></li>\n<li>Porphyria</li>\n<li>Beetroot ingestion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Concentrated urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Black </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alkaptonuria</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the culture media used for tuberculosis?", "options": [{"label": "A", "text": "LJ medium", "correct": true}, {"label": "B", "text": "MacConkey medium", "correct": false}, {"label": "C", "text": "Blood agar", "correct": false}, {"label": "D", "text": "Chocolate agar", "correct": false}], "correct_answer": "A. LJ medium", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AH9qHhFJaoRVlfXkIUiK1741104996.png", "https://image.prepladder.com/content/0Lay65WXYwbjnZcV6npx1741105527.png", "https://image.prepladder.com/content/8iiuJtgYOLrszGlK1jgk1741105590.png", "https://image.prepladder.com/content/4KQKy8o8wRnbGu3GKQyq1741105154.png", "https://image.prepladder.com/content/gWHRBfabEW8lcdv4yTYu1741105135.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enriched Media</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Base medium enriched with 5-10% <span class=\"customMeta\" data-dictid=\"2a29598e9c169277718512eee3da8b\">defibrinated</span> sheep blood, used to grow moderately <span class=\"customMeta\" data-dictid=\"7723db033f16927772024ba220f823\">fastidious</span> bacteria and observe <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> reactions.</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/AH9qHhFJaoRVlfXkIUiK1741104996.png\" width=\"3971\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chocolate agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This is an enriched medium made by heating blood agar, which lyses red blood cells and releases nutrients such as haemoglobin and NAD. It supports the growth of <span class=\"customMeta\" data-dictid=\"7723db033f16927772024ba220f823\">fastidious</span> bacteria such as <span class=\"customMeta\" data-dictid=\"e8810d5c6b169277718827849b05a3\">Haemophilus</span> and <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> species.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/0Lay65WXYwbjnZcV6npx1741105527.png\" width=\"3994\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brain-heart <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> (BHI) broth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This is an enriched medium containing nutrients from brains and beef hearts, along with peptones, glucose, sodium chloride, and buffers. It supports the growth of non-fastidious and moderately <span class=\"customMeta\" data-dictid=\"7723db033f16927772024ba220f823\">fastidious</span> microorganisms.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/8iiuJtgYOLrszGlK1jgk1741105590.png\" width=\"1999\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>serum slope</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An enriched medium with high <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> content, prepared with eggs. Primarily used for the recovery and identification of <span class=\"customMeta\" data-dictid=\"5c14de20c01692777185f63bede46f\">Corynebacterium</span> diphtheriae from nose and throat specimens.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2350\" src=\"https://image.prepladder.com/content/4KQKy8o8wRnbGu3GKQyq1741105154.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><strong>Lowenstein-Jensen medium:</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Used specifically for cultivating <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> species, this enriched, selective medium contains glycerol, mineral salts, aspargine, malachite green, and hen’s eggs.</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/gWHRBfabEW8lcdv4yTYu1741105135.png\" width=\"3230\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman, a few weeks after delivery, complains of bloody discharge from nipple and fever. On examination, diffuse lump under areola. What is the diagnosis?", "options": [{"label": "A", "text": "Galactocele", "correct": false}, {"label": "B", "text": "Lactational mastitis", "correct": true}, {"label": "C", "text": "Mondor disease", "correct": false}, {"label": "D", "text": "Fibrocystic disease", "correct": false}], "correct_answer": "B. Lactational mastitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lactational Mastitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacterial infection due to milk <span class=\"customMeta\" data-dictid=\"ea73ce564216927771989ea1aa2c3d\">stasis</span> (commonly <em>Staphylococcus aureus</em>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breastfeeding, <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> trauma (cracks), poor latch, prolonged engorgement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, malaise, <strong>painful swollen breast</strong>, erythema, <strong>bloody or <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tender <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> mass</strong>, warmth, <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> over the affected breast</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breast <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> (if untreated)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequent breastfeeding, warm compress, analgesics, <strong>antibiotics (dicloxacillin, cephalexin)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which deficiency is most likely in a patient with delayed wound healing and alopecia?", "options": [{"label": "A", "text": "Zinc", "correct": true}, {"label": "B", "text": "Copper", "correct": false}, {"label": "C", "text": "Calcium", "correct": false}, {"label": "D", "text": "Vitamin D", "correct": false}], "correct_answer": "A. Zinc", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zinc</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Component of metalloenzymes</li>\n<li>Involved in protein, DNA, and <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> synthesis</li>\n<li>Necessary for <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> hormone receptors</li>\n<li>Essential for <span class=\"customMeta\" data-dictid=\"a3b0e644a6169277719912525dffae\">spermatogenesis</span> and <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> growth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features of <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">Zinc</span> Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diarrhea</li>\n<li><strong>Alopecia</strong></li>\n<li>Muscle wasting</li>\n<li>Depression</li>\n<li>Irritability</li>\n<li>Rash</li>\n<li><strong>Delayed wound healing</strong></li>\n<li>Scaly dermatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Level of <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">Zinc</span> Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> level &lt;12 μmol/L (70 μg/dL)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the level of lymph nodes indicated in the marked region of the neck in the given anatomical image.", "options": [{"label": "A", "text": "Level II", "correct": true}, {"label": "B", "text": "Level Ia", "correct": false}, {"label": "C", "text": "Level Ib", "correct": false}, {"label": "D", "text": "Level IV", "correct": false}], "correct_answer": "A. Level II", "question_images": ["https://image.prepladder.com/content/PFjXNKJtuJ4SSVXMTYA41741106358.png"], "explanation_images": ["https://image.prepladder.com/content/zJaV0kTQqZeUXQ8pMkvV1741106507.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Submental &amp; submandibular</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Divided into <span class=\"customMeta\" data-dictid=\"45d7632a0216927771898df908d43b\">Ia</span> (midline) &amp; Ib (lateral)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> nodes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jugulodigastric region (common in <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> CA)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mid-jugular region</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> &amp; cricoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> nodes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> &amp; clavicle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Level V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior triangle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spinal <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fracture:", "options": [{"label": "A", "text": "Depressed fracture", "correct": true}, {"label": "B", "text": "Linear fracture", "correct": false}, {"label": "C", "text": "Hinge fracture", "correct": false}, {"label": "D", "text": "Gutter fracture", "correct": false}], "correct_answer": "A. Depressed fracture", "question_images": ["https://image.prepladder.com/content/HjvaXUB3kYek38vYxw4U1741086932.png"], "explanation_images": ["https://image.prepladder.com/content/YiFLBqku6FTOjzax3wJq1741060573.png", "https://image.prepladder.com/content/onK1hGFQSfueiFaddICX1741060592.png", "https://image.prepladder.com/content/Zlr8iFHchhsdA7JXq4FH1741060608.png", "https://image.prepladder.com/content/Ke0VUG38SDJD8QRwV91X1741060664.png", "https://image.prepladder.com/content/itnjgJUSiq39izfu0uhF1741060690.png", "https://image.prepladder.com/content/NurZERQYVxov9C5mZmNY1741060738.png", "https://image.prepladder.com/content/Dy62gEKyrvLmbgNeB8nA1741060990.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Depressed Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Comminuted Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gutter Fracture</strong></p>\n<p style=\"text-align: center;\"><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Occurs when a fragment of the skull is pushed inward towards the brain.</li>\n<li style=\"text-align: center;\">Caused by blows from heavy objects with a small surface (e.g., hammers, bricks).</li>\n<li style=\"text-align: center;\">The shape of the depressed area may resemble the object that caused the injury.</li>\n</ul>\n<p style=\"text-align: center;\"><u>Variants:</u></p>\n<ul>\n<li style=\"text-align: center;\"><u>Elevated Fracture</u>: One end of the fractured fragment is raised above the skull, while the other is pushed inward. Caused by sharp objects like an axe.</li>\n<li style=\"text-align: center;\"><u>Pond Fracture</u>: Seen in infants, this smooth depression occurs without a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line, resembling <strong>a dent in a ping-pong ball.</strong> Caused by <span class=\"customMeta\" data-dictid=\"9427862c811692777194034ade4877\">obstetrics</span> <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> blade.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Involves multiple intersecting <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> lines, breaking the bone into several fragments.</li>\n<li style=\"text-align: center;\">Caused by high-impact trauma (e.g., vehicular accidents, crushing injuries).</li>\n<li style=\"text-align: center;\">It may occur alongside other fractures (e.g., fissured or depressed fractures).</li>\n<li style=\"text-align: center;\">Spider web-like patterns on an <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> are characteristic of <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> fractures.</li>\n<li style=\"text-align: center;\">In severe cases, bone fragments may penetrate the brain or become displaced.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">A <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> or channel is formed in the skull bone, often due to <strong>an <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> bullet wound. </strong></li>\n<li style=\"text-align: center;\">Frequently associated with <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> and depressed fractures of the inner skull table.</li>\n<li style=\"text-align: center;\">Bone fragments can cause injury to the <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> or brain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"186\" src=\"https://image.prepladder.com/content/YiFLBqku6FTOjzax3wJq1741060573.png\" width=\"235\"/></p>\n<p style=\"text-align: center;\"><strong>Depressed fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"282\" src=\"https://image.prepladder.com/content/onK1hGFQSfueiFaddICX1741060592.png\" width=\"142\"/></p>\n<p style=\"text-align: center;\"><strong>Comminuted fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"212\" src=\"https://image.prepladder.com/content/Zlr8iFHchhsdA7JXq4FH1741060608.png\" width=\"212\"/></p>\n<p style=\"text-align: center;\"><strong>Gutter fracture</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ring Fracture</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Motorcyclist <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Hinge Fracture)</strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Encircles the <strong>foramen magnum</strong> at the skull base.</li>\n<li style=\"text-align: center;\">Runs from the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica to the <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridges and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fossa.</li>\n<li style=\"text-align: center;\">It can extend to the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> and roof of the nose.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Transverse <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> at the skull base, <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> it and creating a <strong>\"hinge\" - nodding face sign</strong><strong>.</strong></li>\n<li style=\"text-align: center;\">It extends from one <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridge across the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica to the other <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridge.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Caused by:</p>\n<ul>\n<li style=\"text-align: center;\">Falls landing on feet/buttocks (force transmitted through the spine).</li>\n<li style=\"text-align: center;\">Heavy blows to the top of the skull/ vertex.</li>\n<li style=\"text-align: center;\">Twisting of the head on the spine.</li>\n<li style=\"text-align: center;\">Blows to the <span class=\"customMeta\" data-dictid=\"d4214cf5bc1692777194bd76243b92\">occiput</span> or chin.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Often caused by <strong>side impacts</strong>.</p>\n<p style=\"text-align: center;\"><br/>\n\t\t\t </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"261\" src=\"https://image.prepladder.com/content/Ke0VUG38SDJD8QRwV91X1741060664.png\" width=\"225\"/></p>\n<p style=\"text-align: center;\"><strong>Ring fracture</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"341\" src=\"https://image.prepladder.com/content/itnjgJUSiq39izfu0uhF1741060690.png\" width=\"337\"/></p>\n<p style=\"text-align: center;\"><strong>Hinge fracture</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fissured <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Linear Fracture)</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diastatic <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Sutural Fracture) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">The most common skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> accounts for about 70% of cases.</li>\n<li style=\"text-align: center;\">Linear cracks may involve the <span class=\"customMeta\" data-dictid=\"47effe8b551692777201331142edf5\">vertex</span> or skull base. It can affect the full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of the bone or just the inner/outer layers.</li>\n<li style=\"text-align: center;\">The <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line is <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> and fine, sometimes hard to detect on X-rays. It runs <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the compressive force.</li>\n<li style=\"text-align: center;\">No depression of bone fragments.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li style=\"text-align: center;\">Involves the separation of <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> sutures.</li>\n<li style=\"text-align: center;\">More common in children.</li>\n<li style=\"text-align: center;\">Often occurs with other skull fractures, especially fissured fractures.</li>\n<li style=\"text-align: center;\">Commonly seen at the <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">sagittal</span> suture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><u>Causes:</u></p>\n<ul>\n<li style=\"text-align: center;\">Impact against broad surfaces (e.g., falls or road traffic accidents)</li>\n<li style=\"text-align: center;\">Falls on <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> or buttocks, transmitting force upwards.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><u>Causes:</u></p>\n<ul>\n<li style=\"text-align: center;\">Blunt trauma to the head.</li>\n<li style=\"text-align: center;\"><strong>Increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure leads to <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> separation.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"156\" src=\"https://image.prepladder.com/content/NurZERQYVxov9C5mZmNY1741060738.png\" width=\"367\"/></p>\n<p style=\"text-align: center;\"><strong>Narrow <span class=\"customMeta\" data-dictid=\"b2af124a931692777203c9f8031b77\">fissure</span> skull fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"342\" src=\"https://image.prepladder.com/content/Dy62gEKyrvLmbgNeB8nA1741060990.png\" width=\"328\"/></p>\n<p style=\"text-align: center;\"><strong>Diastatic Fracture</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with fused carpal bones comes to your clinic. What is the gene associated with hand-feet syndrome?", "options": [{"label": "A", "text": "HOXA13", "correct": true}, {"label": "B", "text": "BCL6", "correct": false}, {"label": "C", "text": "FGFR", "correct": false}, {"label": "D", "text": "COl11", "correct": false}], "correct_answer": "A. HOXA13", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly female undergoing chemotherapy for breast cancer is experiencing significant hair loss. What is the most likely cause of her condition?", "options": [{"label": "A", "text": "Telogen Effluvium", "correct": false}, {"label": "B", "text": "Trichotillomania", "correct": false}, {"label": "C", "text": "Anagen Effluvium", "correct": true}, {"label": "D", "text": "Alopecia Areata", "correct": false}], "correct_answer": "C. Anagen Effluvium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following enzymes is dependent on Vitamin C for its activity?", "options": [{"label": "A", "text": "Lysyl dehydrogenase", "correct": false}, {"label": "B", "text": "Lysyl oxidase", "correct": false}, {"label": "C", "text": "Prolyl hydroxylase", "correct": true}, {"label": "D", "text": "Hydroxyprolyl kinase", "correct": false}], "correct_answer": "C. Prolyl hydroxylase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vitamin C Dependency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prolyl hydroxylase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hydroxylates <span class=\"customMeta\" data-dictid=\"e17970718c16927771967aa6347980\">proline</span> residues in <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> for stability.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lysyl hydroxylase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hydroxylates <span class=\"customMeta\" data-dictid=\"6413333d09169277719125b8a2a652\">lysine</span> residues in <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> for cross-linking.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lysyl oxidase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cross-links <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> via <span class=\"customMeta\" data-dictid=\"126202981a1692777181f2970b8c7f\">aldehyde</span> formation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No</strong> (Requires copper)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hydroxyprolyl kinase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phosphorylates hydroxyproline.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which therapy is given for cervical cancer?", "options": [{"label": "A", "text": "Immunotherapy", "correct": false}, {"label": "B", "text": "Hormonal therapy", "correct": false}, {"label": "C", "text": "Targeted therapy", "correct": false}, {"label": "D", "text": "Platinum-based therapy", "correct": true}], "correct_answer": "D. Platinum-based therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:782px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiotherapy (Brachytherapy, Teletherapy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemoradiation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IA1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Conization or extra fascial <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> (if <span class=\"customMeta\" data-dictid=\"51b378d6031692777184a20aa31718\">childbirth</span> is completed)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Intracavitary <span class=\"customMeta\" data-dictid=\"61c2938b191692777183fbbe51a17c\">brachytherapy</span> alone (not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>NIL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IA2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> or radical <span class=\"customMeta\" data-dictid=\"bfdf455449169277720023fbcbb064\">trachelectomy</span> with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> lymphadenectomy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IB1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> or radical <span class=\"customMeta\" data-dictid=\"bfdf455449169277720023fbcbb064\">trachelectomy</span> with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> lymphadenectomy.</p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>NIL</p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chemoradiation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IB2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Radical hysterectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IB3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chemoradiation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IIA1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> or chemoradiation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IIA2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chemoradiation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IIB-IVA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chemoradiation and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"b26b12affb16927771872ba42c137b\">exenteration</span> for central recurrences after radiotherapy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>External beam radiation therapy (40 to 50 Gy) for 5 weeks.</p>\n<p>Brachytherapy (post ext. Beam radiation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Concurrent chemotherapy, with <strong>cisplatin. (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>IVB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Palliative; <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> radiation to manage symptoms.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pelvic radiation (symptom control)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Systemic chemotherapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person got stabbed in his anterior thigh and died. His body was brought for postmortem. What type of injury is this?", "options": [{"label": "A", "text": "Incised wound", "correct": false}, {"label": "B", "text": "Penetrating wound", "correct": true}, {"label": "C", "text": "Puncture wound", "correct": false}, {"label": "D", "text": "Blunt force injury", "correct": false}], "correct_answer": "B. Penetrating wound", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ui6VqqeIGKGNNO2KuZzp1741019708.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stab wound/Punctured wound </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These are inflicted by <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> with long, narrow instruments having pointed (sometimes blunt) ends into the depth of the body, which is deeper than its length and width.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weapons used </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Knife (most common)</li>\n<li>Pieces of glass (broken glass bottle)</li>\n<li>Scissors</li>\n<li>Screwdrivers</li>\n<li>Pens</li>\n<li>Ice picks</li>\n<li>Forks</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of stab wounds </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Puncture wound: </strong><strong>(Option C)</strong>\n<ul>\n<li>Soft tissues are involved</li>\n</ul>\n</li>\n<li><strong>Penetrating wound: </strong>\n<ul>\n<li>Enters a <span class=\"customMeta\" data-dictid=\"1e856760501692777183f2469a5056\">body cavity</span> or a viscus</li>\n</ul>\n</li>\n<li><strong>Perforating wound: </strong>\n<ul>\n<li>Through-and-through <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> wounds</li>\n<li>The weapon enters the body from one side and <span class=\"customMeta\" data-dictid=\"89f5610ffd1692777184b03f1f88cc\">comes</span> out the other</li>\n<li>The wound of entry is larger than the exit</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Significance of the wound dimensions </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Length </strong>is slightly <strong>less than the <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">width</span> </strong>of the weapon due to the stretching of the skin.</li>\n<li><strong>Breadth </strong>is<strong> more than the <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> </strong>of weapon due to gaping.</li>\n<li><strong>Depth</strong>, the <strong>greatest dimension </strong>of the wound, corresponds to the <strong>length</strong> of the weapon's blade, which has completely entered the body without perforation.</li>\n<li><strong>Margins </strong>or edges of the wound are <strong>clean cut </strong>with usually no <span class=\"customMeta\" data-dictid=\"2ff3cc6c8a16927771802154170e4f\">abrasion</span> or bruising.\n\t\t\t\t<ul>\n<li>Margins by a pointed or <span class=\"customMeta\" data-dictid=\"a3a8e127bb1692777184393fdcbf10\">conical</span> weapon have <span class=\"customMeta\" data-dictid=\"55a1f34a051692777191fefd6dfafa\">lacerated</span> edges</li>\n<li>If the hilt guard of the weapon strikes the skin, a regular, sharp, and well-defined patterned <span class=\"customMeta\" data-dictid=\"2ff3cc6c8a16927771802154170e4f\">abrasion</span> or bruising is formed</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the National Deworming Day?", "options": [{"label": "A", "text": "10th February", "correct": true}, {"label": "B", "text": "10th August", "correct": false}, {"label": "C", "text": "10th March", "correct": false}, {"label": "D", "text": "11th January", "correct": false}], "correct_answer": "A. 10th February", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/99mTd95BGu1Ro04FBgVj1741064031.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Following a fight between 2 groups, a boy was brought with severe pain in the chest, distended neck veins, dyspnea, and a BP of 80/50 mmHg. X-ray shows the following findings: What is the diagnosis?", "options": [{"label": "A", "text": "Tension pneumothorax", "correct": true}, {"label": "B", "text": "Primary Spontaneous Pneumothorax", "correct": false}, {"label": "C", "text": "Traumatic Pneumothorax", "correct": false}, {"label": "D", "text": "Bilateral Pneumothorax", "correct": false}], "correct_answer": "A. Tension pneumothorax", "question_images": ["https://image.prepladder.com/content/WjV4qIzZwOHcUtgAZN7Y1741111598.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tension Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma, mechanical ventilation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe dyspnea, hypotension, JVD, <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> deviation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mediastinal shift away from affected side, hyperlucency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ruptured <span class=\"customMeta\" data-dictid=\"6136118183169277719961922f8790\">subpleural</span> blebs (tall, thin males)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden dyspnea, pleuritic pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperlucency without <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Traumatic Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blunt/penetrating trauma, rib fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dyspnea, pain, absent breath sounds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperlucency, no <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift unless tension develops</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilateral Pneumothorax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, seen in severe trauma, barotrauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Respiratory distress, hypoxia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral hyperlucency</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following enzymes is typically elevated in prostate cancer?", "options": [{"label": "A", "text": "Acid phosphatase", "correct": true}, {"label": "B", "text": "Alkaline phosphatase", "correct": false}, {"label": "C", "text": "Lactate dehydrogenase", "correct": false}, {"label": "D", "text": "Alpha-fetoprotein", "correct": false}], "correct_answer": "A. Acid phosphatase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with lower symmetric flaccidity and no cord reflex, suggesting which condition?", "options": [{"label": "A", "text": "Guillain-Barré syndrome", "correct": true}, {"label": "B", "text": "Multiple sclerosis", "correct": false}, {"label": "C", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "D", "text": "Spinal cord injury", "correct": false}], "correct_answer": "A. Guillain-Barré syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Guillain-Barré syndrome (GBS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Motor Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Progressive <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> paralysis</strong> <strong>(distal to proximal)</strong></li>\n<li><strong>Areflexia</strong></li>\n<li>Weakness in legs causing rubbery legs and <span class=\"customMeta\" data-dictid=\"acb259200b16927771908888d1377c\">instability</span> to stand</li>\n<li>Truncal paralysis, quadriplegia, neck floppiness</li>\n<li>Bilateral 7th nerve palsy</li>\n<li>Bulbar palsy\n\t\t\t\t<ul>\n<li>Difficulty in handling secretions leading to <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> pneumonia</li>\n<li>A leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> involvement.</li>\n</ul>\n</li>\n<li>Diaphragmatic paralysis\n\t\t\t\t<ul>\n<li>Ventilatory support is required in 30% of cases.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"c32b3a9fac16927771831530888fdf\">carbon dioxide</span> levels.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Sensory Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Glove-and-stocking distribution paresthesias</li>\n<li>Proprioception loss\n\t\t\t\t<ul>\n<li>Difficulty in climbing stairs</li>\n<li>Pain in the neck/arm/shoulder is similar to over-exercised muscle</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Sensory manifestations can occur before or along with motor manifestations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Autonomic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"3704fc52401692777186c42775c9fb\">dysregulation</span> (e.g., <span class=\"customMeta\" data-dictid=\"32742bce4316927771941ff62a9db7\">orthostatic</span> hypotension, bladder/bowel sparing/transient involvement)</li>\n<li>Wide fluctuations of blood pressure, arrhythmias, postural hypotension</li>\n<li>Reduced heart rate and blood pressure, <span class=\"customMeta\" data-dictid=\"fec88fc386169277719326fdef547f\">neurogenic</span> shock.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A total of 2000 patients were assessed for HIV. 200 were diagnosed positive. A new ELISA screening test was tested on the same group. It showed 260 as positive out of which only 130 had the disease. What is the specificity of the test?", "options": [{"label": "A", "text": "96%", "correct": true}, {"label": "B", "text": "80%", "correct": false}, {"label": "C", "text": "72%", "correct": false}, {"label": "D", "text": "68%", "correct": false}], "correct_answer": "A. 96%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old man was admitted with a murmur and blood culture positive for Gram-positive cocci. Choose the common agent causing prosthetic valve infective endocarditis.", "options": [{"label": "A", "text": "Streptococcus viridans", "correct": false}, {"label": "B", "text": "Staphylococcus epidermidis", "correct": true}, {"label": "C", "text": "Staphylococcus aureus", "correct": false}, {"label": "D", "text": "Enterococci", "correct": false}], "correct_answer": "B. Staphylococcus epidermidis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old woman presents to the emergency department 6 hours after ingesting a large quantity of paracetamol tablets. What is the most likely progression of paracetamol poisoning in this case?", "options": [{"label": "A", "text": "Increase in liver enzymes within 24 hours", "correct": true}, {"label": "B", "text": "Liver failure within 24 hours", "correct": false}, {"label": "C", "text": "Paracetamol achieves peak concentration within 4 hours", "correct": false}, {"label": "D", "text": "Recovery within 72 hours", "correct": false}], "correct_answer": "A. Increase in liver enzymes within 24 hours", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolism of Acetaminophen</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acetaminophen is mainly metabolized via <strong>phase II</strong> reactions into harmless<strong> sulfate</strong> and <strong>glucuronide</strong> metabolites.</li>\n<li>A small portion undergoes<strong> phase I </strong>metabolism by<strong> CYP2E1</strong>, forming the <span class=\"customMeta\" data-dictid=\"aad52f4a541692777188bfd2c5830b\">hepatotoxic</span> <span class=\"customMeta\" data-dictid=\"fceb6bf8d01692777192b8b179f554\">metabolite</span> <strong>N-acetyl-p-benzoquinone-imine (NAPQI)</strong>.</li>\n</ul>\n<p><strong>Detoxification of NAPQI</strong></p>\n<ul>\n<li>NAPQI is neutralized by binding to glutathione, forming water-soluble mercapturic acid, which is excreted via the kidneys.</li>\n</ul>\n<p><strong>Glutathione Depletion</strong></p>\n<ul>\n<li>When excessive NAPQI is produced, or <span class=\"customMeta\" data-dictid=\"f945849e691692777188ad7ce5b5e2\">glutathione</span> is depleted, NAPQI binds to <span class=\"customMeta\" data-dictid=\"d92a2c1a2f1692777188848354f32b\">hepatocyte</span> macromolecules, forming acetaminophen-protein adducts, causing <span class=\"customMeta\" data-dictid=\"d92a2c1a2f1692777188848354f32b\">hepatocyte</span> necrosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic alcohol use (induces CYP2E1, depletes glutathione).</li>\n<li>Starvation.</li>\n<li>Prior use of mixed-function oxidase-inducing drugs (e.g.,<strong> phenobarbital</strong>, <strong>INH</strong>).</li>\n<li><strong>Hepatitis C</strong> infection increases the risk of liver injury in overdose.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Symptoms (4-12 hrs)</strong>:</p>\n<ul>\n<li>Nausea, vomiting, diarrhea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, shock.</li>\n</ul>\n<p><strong>Delayed Symptoms (24-48 hrs)</strong>:</p>\n<ul>\n<li>Hepatic injury becomes apparent.</li>\n<li>Coagulopathy and encephalopathy.</li>\n<li>Maximal damage seen 3–5 days post-ingestion with <span class=\"customMeta\" data-dictid=\"c011dc417616927771816fef085ce1\">aminotransferase</span> levels &gt;10,000 IU/L.</li>\n<li>Renal failure and myocardial injury may occur.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stages of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"95b7c54ee116927771809963c4ee14\">acetaminophen</span> poisoning</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Time Post-Ingestion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>0–24 hours</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nausea, vomiting, and anorexia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>24–72 hours</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain; elevated liver enzymes (AST, ALT), and sometimes increased <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> and INR if <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> is severe.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>72–96 hours</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vomiting, signs of liver failure; peak levels of AST, ALT, bilirubin, and INR. Possible <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure and pancreatitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&gt; 5 days</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recovery of liver function or <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to multiple organ failure.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are the changes seen in irreversible cell injury", "options": [{"label": "A", "text": "Bleb formation", "correct": false}, {"label": "B", "text": "Amorphous density of mitochondria", "correct": true}, {"label": "C", "text": "Clumping of chromatin", "correct": false}, {"label": "D", "text": "Cellular Swelling", "correct": false}], "correct_answer": "B. Amorphous density of mitochondria", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate presents with a growing skin lesion, as shown in the image provided. The mother reports that the lesion has been increasing in size daily. What is the appropriate management?", "options": [{"label": "A", "text": "Observation", "correct": true}, {"label": "B", "text": "Excision and Laser Therapy", "correct": false}, {"label": "C", "text": "Immediate Biopsy due to Malignancy Risk", "correct": false}, {"label": "D", "text": "Cryotherapy", "correct": false}], "correct_answer": "A. Observation", "question_images": ["https://image.prepladder.com/content/EaA7GeCQQK4ZSKO2TL5I1741088795.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32 y/o pregnant woman presents for her routine antenatal check-up at 28 weeks gestation. She has a history of obesity but no previous history of diabetes. Her fasting plasma glucose level is 104 mg/dL, and her 2-hour plasma glucose level after a 75g Oral Glucose Tolerance Test (OGTT) is 167 mg/dL. Based on these findings, what is the most appropriate next step?", "options": [{"label": "A", "text": "Start lifestyle modifications and repeat OGTT at 32 weeks gestation.", "correct": false}, {"label": "B", "text": "Diagnose her with pre-existing diabetes and initiate insulin therapy.", "correct": false}, {"label": "C", "text": "Diagnose her with GDM and initiate dietary modifications with close monitoring of blood glucose levels.", "correct": true}, {"label": "D", "text": "Monitor her closely without intervention since her glucose levels are borderline.", "correct": false}], "correct_answer": "C. Diagnose her with GDM and initiate dietary modifications with close monitoring of blood glucose levels.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gestational Diabetes </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pre-existing Diabetes</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing </strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>During pregnancy</p>\n</td>\n<td colspan=\"2\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present before conception</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fasting <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> glucose</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>92 mg/dL</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>126 mg/dL (on two occasions)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-hour <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>180 mg/dL</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥200 mg/dL (with <span class=\"customMeta\" data-dictid=\"36a802ceb516927771893371227fb8\">hyperglycemic</span> symptoms)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-hour <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> glucose</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>153 mg/dL</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥200 mg/dL (during an <span class=\"customMeta\" data-dictid=\"1132c78e2716927771943d6ef17c70\">OGTT</span> in <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> individuals)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HbA1c</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥5.7-6.4%</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥6.5%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resolves after delivery.</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires <span class=\"customMeta\" data-dictid=\"901bf573f216927771905f0abedca2\">intensive</span> management before and during pregnancy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient shows flat affect. What does it indicate?", "options": [{"label": "A", "text": "Positive symptom", "correct": false}, {"label": "B", "text": "Negative symptom", "correct": true}, {"label": "C", "text": "Affect symptom", "correct": false}, {"label": "D", "text": "Cognitive symptom", "correct": false}], "correct_answer": "B. Negative symptom", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the use of Shakir's tape?", "options": [{"label": "A", "text": "Intersectoral coordination", "correct": false}, {"label": "B", "text": "Equitable distribution", "correct": false}, {"label": "C", "text": "Appropriate technology", "correct": true}, {"label": "D", "text": "Community participation", "correct": false}], "correct_answer": "C. Appropriate technology", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:400px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Red</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;11.5 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe Malnutrition</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>11.5-12.5 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Borderline Malnutrition</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Green</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;12.5 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is deficient in the mucopolysaccharidosis associated with Natowicz disease?", "options": [{"label": "A", "text": "Dermatan sulfate", "correct": false}, {"label": "B", "text": "Heparan sulfate", "correct": false}, {"label": "C", "text": "Keratan sulfate", "correct": false}, {"label": "D", "text": "Hyaluronic acid", "correct": true}], "correct_answer": "D. Hyaluronic acid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Accumulated GAG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS I (Hurler/Scheie)<br/>\n\t\t\t(Option A ruled out)<br/>\n\t\t\t(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>α-L-iduronidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatan sulfate, Heparan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS II (Hunter)<br/>\n\t\t\t(Option A ruled out)<br/>\n\t\t\t(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iduronate-2-sulfatase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatan sulfate, Heparan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS III (Sanfilippo)<br/>\n\t\t\t(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heparan N-sulfatase, etc.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heparan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS IV (Morquio)<br/>\n\t\t\t(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Galactosamine-6-sulfatase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Keratan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS VI (Maroteaux-Lamy)<br/>\n\t\t\t(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arylsulfatase B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS VII (Sly)<br/>\n\t\t\t(Option A ruled out)<br/>\n\t\t\t(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>β-Glucuronidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatan sulfate, Heparan sulfate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MPS IX (Natowicz)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyaluronidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyaluronan</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure?", "options": [{"label": "A", "text": "Retrograde pyelogram", "correct": false}, {"label": "B", "text": "Combined Retrograde Pyelogram and Ureteroscopy", "correct": false}, {"label": "C", "text": "Intravenous Pyelogram", "correct": true}, {"label": "D", "text": "Antegrade pyelography", "correct": false}], "correct_answer": "C. Intravenous Pyelogram", "question_images": ["https://image.prepladder.com/content/RLJF5y2jpRv0a8KGdEcp1741111710.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">Pyelogram</span> (IVP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV contrast injection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspected <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> obstruction, nephrolithiasis, tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast seen in kidneys, ureters, and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> on sequential films</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retrograde <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">Pyelogram</span> (RGP) </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> via <span class=\"customMeta\" data-dictid=\"3ee67fc1971692777185b21b950a61\">cystoscopy</span> into ureters</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suspected ureteral obstruction, non-visualization on IVP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast opacifies the <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> without nephrogram</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antegrade <span class=\"customMeta\" data-dictid=\"aabbf4882c169277719601141cd424\">Pyelography</span> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> percutaneously into the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pelvis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> obstruction, post-surgical assessment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contrast fills <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and ureters from above</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Combined RGP &amp; <span class=\"customMeta\" data-dictid=\"aba89fa6131692777201043967a365\">Ureteroscopy</span> </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ureteroscope inserted via <span class=\"customMeta\" data-dictid=\"3ee67fc1971692777185b21b950a61\">cystoscopy</span> + contrast study</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ureteric stones, strictures, or tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> along with contrast study</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked structure?", "options": [{"label": "A", "text": "Cystic artery", "correct": false}, {"label": "B", "text": "Right Hepatic artery", "correct": true}, {"label": "C", "text": "Hepatic duct", "correct": false}, {"label": "D", "text": "Cystic duct", "correct": false}], "correct_answer": "B. Right Hepatic artery", "question_images": ["https://image.prepladder.com/content/7vGJC3a2fSKtuZfJdDB81741105464.png"], "explanation_images": ["https://image.prepladder.com/content/l3G1WweZ7qBkY3roLwtP1741105597.png", "https://image.prepladder.com/content/rh4ubsFoW9av32ruf1Rr1741105663.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proper <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">Hepatic</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (branch of Common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">Hepatic</span> Artery)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs behind the common <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> and ascends toward the right <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> of the liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Branches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cystic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (to gallbladder), <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">Segmental</span> branches to liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the right <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> of the liver and gallbladder</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Injury during <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> can lead to <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> or <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> ischemia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A firefighter was admitted with fever, cough, culture shown in the image reveals gram-negative, oxidase-positive bacilli. Colonies transilluminating while passing under UV light. Choose the correct agent.", "options": [{"label": "A", "text": "Klebsiella", "correct": false}, {"label": "B", "text": "Staphylococcus aureus", "correct": false}, {"label": "C", "text": "Pseudomonas aeruginosa", "correct": true}, {"label": "D", "text": "Serratia", "correct": false}], "correct_answer": "C. Pseudomonas aeruginosa", "question_images": ["https://image.prepladder.com/content/avNa5GAFKOdpy5FyIOwx1741084441.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:692px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Specific Features for <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sample Collection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collect specimens such as sputum, urine, wound swabs, blood, ear discharge, eye discharge, or <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specimens vary based on the site of infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram stain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gram-negative rods</strong>; <span class=\"customMeta\" data-dictid=\"27cf09e9d316927771928763e99e0d\">motile</span> with flagella.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth on common laboratory media:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produces beta-hemolytic gray, moist colonies.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MacConkey agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produces pale, non-lactose fermenting colonies, <strong>Fluorescence under UV light.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nutrient agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produces large, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> colonies with a <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> sheen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peptone water</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Forms uniform <span class=\"customMeta\" data-dictid=\"e895ca709f1692777201b92e4f9aee\">turbidity</span> with surface pellicle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cetrimide Agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Selective medium that inhibits other <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">Gram-negative</span> bacteria; specifically selected for <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa; <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> production (e.g., pyocyanin).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>King’s medium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>used to increase <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> production by pseudomonas</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"8\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical Tests</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Various biochemical tests to identify specific <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> properties:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oxidase test </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positive</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Catalase test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ICUT Test:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indole test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Citrate test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urease test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Triple sugar test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shows <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"bc8b45183516927771983a212ad17a\">slant</span> with no gas and <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> sulfide.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PCR (Polymerase Chain Reaction), <span class=\"customMeta\" data-dictid=\"748392c25a1692777197c7f442ba28\">16S rRNA</span> sequencing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides specific and sensitive <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa DNA.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antimicrobial <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">Susceptibility</span> Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disk <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> method, Minimum <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">Inhibitory</span> Concentration (MIC) testing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Determines the <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> of <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa to various antibiotics.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Histopathological examination showed follicular cells with pink eosinophilic cytoplasm. It is seen in?", "options": [{"label": "A", "text": "Papillary CA", "correct": false}, {"label": "B", "text": "Follicular CA", "correct": true}, {"label": "C", "text": "Medullary CA", "correct": false}, {"label": "D", "text": "Anaplastic CA", "correct": false}], "correct_answer": "B. Follicular CA", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The toughness of bacterial cell walls is due to:", "options": [{"label": "A", "text": "Teichoic acid", "correct": false}, {"label": "B", "text": "Peptidoglycan", "correct": true}, {"label": "C", "text": "Lipopolysaccharides", "correct": false}, {"label": "D", "text": "Outer membrane", "correct": false}], "correct_answer": "B. Peptidoglycan", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gram-positive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gram-negative</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thick layer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peptidoglycan layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin layer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100 layer thick</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thickness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1–2-layer thickness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-5 %</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lipid content</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Peptidoglycans+++</strong></li>\n<li>Lipoproteins</li>\n<li><strong>Teichoic acid</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Lipopolysaccharide</strong></li>\n<li>Lipoproteins</li>\n<li>Peptidoglycan+</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Outer membrane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Present</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Periplasmic space + Porins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Teichoic acid (used for</strong></p>\n<p><strong>attachment)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pentapeptide cross bridge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NAM-NAG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Leading questions can be asked in?", "options": [{"label": "A", "text": "Cross-examination", "correct": true}, {"label": "B", "text": "Re-examination", "correct": false}, {"label": "C", "text": "Anytime", "correct": false}, {"label": "D", "text": "Examination in chief", "correct": false}], "correct_answer": "A. Cross-examination", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Examination-in-Chief (Direct Examination)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cross-Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Re-Examination</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Conducted By</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Party who calls the witness (e.g., public prosecutor)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Opposing party (typically defense)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Party who called the witness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Present all relevant facts</li>\n<li>Provide expert interpretation if applicable</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Challenge witness's credibility</li>\n<li>Elicit favorable facts</li>\n<li>Test accuracy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Clarify issues raised during cross-examination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Leading Questions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not allowed unless the witness is declared hostile <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Allowed (<strong>Sec. 146 BSA</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Not allowed <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nature of Questions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Open-ended questions to elicit narrative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Can include leading questions to control the narrative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Generally clarifying questions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Time Limit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Typically structured and may have time constraints</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>No set time limit; may last for hours or even days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Generally limited to <span class=\"customMeta\" data-dictid=\"68c95b7b5a169277718451643a0b35\">clarification</span> purposes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Judicial Oversight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Judge may intervene to ensure questions are relevant and not leading</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Court can disallow indecent or scandalous questions (Sec. 154, BSA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Judge monitors to ensure focus remains on clarification</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman diagnosed with schizophrenia had been compliant with her prescribed olanzapine for several months. However, she discontinued the treatment. Which of the following is the most likely reason for her discontinuation?", "options": [{"label": "A", "text": "Weight gain", "correct": true}, {"label": "B", "text": "Acute dystonia", "correct": false}, {"label": "C", "text": "Akathisia", "correct": false}, {"label": "D", "text": "Tardive dyskinesia", "correct": false}], "correct_answer": "A. Weight gain", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First Generation Antipsychotics</strong></p>\n<p><strong>(Typical)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Second Generation Antipsychotics</strong></p>\n<p><strong>(Atypical)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Second Generation Antipsychotics</strong></p>\n<p><strong>(Atypical)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>D2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial D2 Agonists</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>D2/5-HT2A Antagonists</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Haloperidol</li>\n<li>Fluphenazine</li>\n<li>Perphenazine</li>\n<li>Chlorpromazine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Aripiprazole</li>\n<li>Brexpiprazole</li>\n<li>Cariprazine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Risperidone</strong></li>\n<li>Olanzapine</li>\n<li>Quetiapine</li>\n<li>Ziprasidone</li>\n<li>Paliperidone</li>\n<li>Lurasidone</li>\n<li>Clozapine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extrapyramidal Side Effects (EPS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common with<strong> first-generation antipsychotics</strong>, including symptoms like\n\t\t\t\t<ul>\n<li><strong>Acute <span class=\"customMeta\" data-dictid=\"61747121f116927771862fad303b93\">dystonia</span> </strong>- Earliest, can occur within minutes of the <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> <strong> (Option B)</strong></li>\n<li><strong>Parkinson's</strong> - Occurs within days to weeks</li>\n<li><strong>Akathisia </strong>- Occurs within days to weeks<strong> (Option C)</strong></li>\n</ul>\n</li>\n<li>Alternatives for management include dose reduction, antiparkinson medications, or switching to medications with lower EPS risk.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tardive <span class=\"customMeta\" data-dictid=\"aa971a0b1c169277718621174b6657\">Dyskinesia</span> (TD)</strong></p>\n\t\t\t \n\n\t\t\t<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Affects 20-30% of patients on long-term <strong>first-generation antipsychotics</strong>, with higher risk in the elderly and those with cognitive or mood disorders.</li>\n<li>Prevention strategies include using the <strong>lowest effective doses </strong>and <strong>switching to other medications like Clozapine.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sedation</strong> &amp; <strong>Postural hypotension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Especially with low-potency antipsychotics.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Long-term antipsychotic</strong> use can elevate <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> levels, affecting sexual function and potentially leading to osteoporosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "OCPs are not protective for?", "options": [{"label": "A", "text": "Breast Ca", "correct": true}, {"label": "B", "text": "Colorectal Ca", "correct": false}, {"label": "C", "text": "Endometrial Ca", "correct": false}, {"label": "D", "text": "Ovarian Ca", "correct": false}], "correct_answer": "A. Breast Ca", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cancer Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect of <span class=\"customMeta\" data-dictid=\"606de5c78a1692777184fda50c9271\">COC</span> Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endometrial Cancer </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by <strong>≥30%</strong>, with greater protection in long-term users. The effect persists for years after discontinuation.</li>\n<li>More pronounced reduction seen in smokers, <span class=\"customMeta\" data-dictid=\"43663fecf11692777194c870d1d548\">obese</span> women, and those with low physical activity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ovarian Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by <strong>30–50%</strong>, with greater protection in long-term users. The effect persists for 10–15 years after stopping, even with short-term use (≥6 months).</li>\n<li>Protection extends to BRCA1/BRCA2 <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> carriers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colorectal Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by <strong>15–20%</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Breast Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>COC use increases risk by <strong>25%</strong>, especially in <span class=\"customMeta\" data-dictid=\"341daa40bb169277719303fbd1ce1a\">nulliparous</span> women who start before age 24 and use it for &gt;4 years.</li>\n<li>If breast cancer develops, it is usually <strong>well-differentiated with a good prognosis</strong>.</li>\n<li>The increased risk disappears after 10 years of stopping.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cervical Cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increased Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"606de5c78a1692777184fda50c9271\">COC</span> use increases risk, particularly of <strong>adenocarcinoma </strong>of the cervix.</li>\n<li>Women using COCs for ≥5 years have a higher risk, with risk increasing with longer duration.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A renal biopsy image is shown. Identify the cells marked in the histological section.", "options": [{"label": "A", "text": "Macula densa", "correct": false}, {"label": "B", "text": "Juxtaglomerular (JG) cells", "correct": false}, {"label": "C", "text": "Lacis cells", "correct": true}, {"label": "D", "text": "Podocytes", "correct": false}], "correct_answer": "C. Lacis cells", "question_images": ["https://image.prepladder.com/content/VAp0zr3E4pe4q0F0NaAJ1741086630.png"], "explanation_images": ["https://image.prepladder.com/content/VbQgTrifBe28I5KQmqqs1741086821.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Macula densa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">tubule</span> near <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> arteriole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Senses sodium concentration &amp; regulates <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> secretion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Juxtaglomerular (JG) cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Afferent arteriole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secrete <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> in response to low BP</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lacis cells (Extraglomerular mesangial cells)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> &amp; <span class=\"customMeta\" data-dictid=\"8833ce72c71692777187014d5585e7\">efferent</span> arterioles</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facilitate communication between <span class=\"customMeta\" data-dictid=\"948746a830169277719140f9f93879\">macula</span> densa and JG cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Podocytes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visceral layer of Bowman's capsule</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Filtration barrier in glomerulus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female who delivered a healthy term baby one week ago is now presenting to the OBG clinic with complaints of fishy-smelling pale brownish vaginal discharge. What is the nature of this discharge?", "options": [{"label": "A", "text": "Lochia Rubra", "correct": false}, {"label": "B", "text": "Lochia Serosa", "correct": true}, {"label": "C", "text": "Lochia Alba", "correct": false}, {"label": "D", "text": "Leukorrhea", "correct": false}], "correct_answer": "B. Lochia Serosa", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Lochia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lochia Rubra -red</strong></p>\n<p><strong>(</strong><strong>Option A</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in 1-4 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood</li>\n<li>Shreds of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> membranes and decidua</li>\n<li>Vernix caseosa</li>\n<li>Lanugo and meconium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lochia Serosa-yellowish or</strong></p>\n<p><strong>pink or pale brownish </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-9 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less <span class=\"customMeta\" data-dictid=\"8790b4667016927771979066e8958c\">RBC</span> but more leukocytes</li>\n<li>Wound exudate</li>\n<li>Mucus from the cervix</li>\n<li>Microorganisms (anaerobic <span class=\"customMeta\" data-dictid=\"8876d7c56816927771999e61073f60\">streptococci</span> and staphylococci)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lochia Alba-pale white</strong></p>\n<p><strong>(</strong><strong>Option C</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-15 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Decidual cells</li>\n<li>Leukocytes</li>\n<li>Mucus</li>\n<li>Cholesterin crystals, <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> and <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> epithelial cells</li>\n<li>Microorganisms.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the type of cartilage present in the histology section given below?", "options": [{"label": "A", "text": "Hyaline cartilage", "correct": true}, {"label": "B", "text": "Elastic cartilage", "correct": false}, {"label": "C", "text": "Articular cartilage", "correct": false}, {"label": "D", "text": "Fibrocartilage", "correct": false}], "correct_answer": "A. Hyaline cartilage", "question_images": ["https://image.prepladder.com/content/QKaYTbd98MRTjQLSPP7W1741087425.png"], "explanation_images": ["https://image.prepladder.com/content/DYdC8lSYjPO5ESEHmw7U1741087574.png", "https://image.prepladder.com/content/2BWo2bWkYTeJ0uYCIvC21741087557.png", "https://image.prepladder.com/content/pJCZfHC4qVZ5ZRzL7zqs1741087608.png", "https://image.prepladder.com/content/0WtN4PifsLB7SnD5jTTm1741087643.png", "https://image.prepladder.com/content/4QB0aNpvhxaMhjmzzbAQ1741087674.png", "https://image.prepladder.com/content/fPg1UTf1EDDoHx7vg79o1741087694.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:810px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hyaline <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">Cartilage</span> (Most Common) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Elastic <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">Cartilage</span> (Yellow cartilage) (Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fibrocartilage (Option D) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Matrix appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogeneous, basophilic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contains <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> fiber network</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Numerous <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> bundles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chondrocyte arrangement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Groups (cell nests/isogenous groups)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to hyaline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single rows or <span class=\"customMeta\" data-dictid=\"e2c83bc4de1692777190e11dbe140f\">isogenous</span> groups</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perichondrium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (except in <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Main fiber type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type II collagen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elastic fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I (primarily) and <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">Type II</span> collagen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Main functions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Structural support, forms <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surfaces</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides flexibility and resilience</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resists <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> and shearing, shock absorption</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Costal cartilage, <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> rings, <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Auricle, epiglottis, <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> tube</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intervertebral discs, menisci</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the key difference between Cisplatin and Carboplatin?", "options": [{"label": "A", "text": "Cisplatin is less neurotoxic than Carboplatin", "correct": false}, {"label": "B", "text": "Cisplatin causes fewer gastric issues compared to Carboplatin", "correct": false}, {"label": "C", "text": "Carboplatin is more neurotoxic than Cisplatin", "correct": false}, {"label": "D", "text": "Cisplatin has more nephrotoxic side effects compared to Carboplatin", "correct": true}], "correct_answer": "D. Cisplatin has more nephrotoxic side effects compared to Carboplatin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male experiences headache, nausea, and shortness of breath while trekking. The physician prescribes a drug to alleviate his symptoms. The drug administered primarily acts on which part of the nephron?", "options": [{"label": "A", "text": "Proximal convoluted tubule (PCT)", "correct": true}, {"label": "B", "text": "Loop of Henle", "correct": false}, {"label": "C", "text": "Distal convoluted tubule (DCT)", "correct": false}, {"label": "D", "text": "Collecting duct (CD)", "correct": false}], "correct_answer": "A. Proximal convoluted tubule (PCT)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AJk0aNkS8zd671lJp5yC1741042325.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23 year old male epileptic patient presented with pain in right shoulder region. Examination revealed that right upper limb was abducted and externally rotated and the movements could not be performed. Which of the following is most likely diagnosed", "options": [{"label": "A", "text": "Intrathoracic dislocation of shoulder", "correct": false}, {"label": "B", "text": "Luxation erecta", "correct": false}, {"label": "C", "text": "Subglenoid dislocation of shoulder", "correct": true}, {"label": "D", "text": "Posterior dislocation of shoulder", "correct": false}], "correct_answer": "C. Subglenoid dislocation of shoulder", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7wuleQW1cI23q8AoCGN51741061599.png", "https://image.prepladder.com/content/dKhnOSi1yaaYe2yRYrlJ1741061627.png", "https://image.prepladder.com/content/GDsfaMPluB1b8oprVNYC1741061642.png", "https://image.prepladder.com/content/QENfYtfbCfpBoGn519mn1741061669.png", "https://image.prepladder.com/content/Vt43htE4UrDtgcHN6FpD1741061695.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:663px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior dislocation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior dislocation</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior dislocation</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most common</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not very common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fall on an outstretched hand with an abducted and externally rotated shoulder.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs during <strong>seizures or convulsions</strong>.</p>\n<ul>\n<li>A fall onto a <strong>flexed, adducted arm</strong>.</li>\n<li>A direct impact to the <strong>anterior aspect of the shoulder</strong>.</li>\n<li>A fall onto an <strong>outstretched hand</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also called <strong>luxatio erecta.</strong></li>\n<li>Result from a severe hyper-abduction force.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and movement restriction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Duga’s test, Hamilton ruler test and Regimental <span class=\"customMeta\" data-dictid=\"3fb38cd2a416927771822103bd8bcd\">badge</span> test.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Callaway’s test and Regimental <span class=\"customMeta\" data-dictid=\"3fb38cd2a416927771822103bd8bcd\">badge</span> test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bryant’s test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arm Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abduction and external rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adduction and internal rotation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arm locked in hyperabduction with the hand positioned above the head.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The humeral head is displaced anteriorly and inferiorly, often under the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process <strong>(\"subcoracoid\" position).</strong></li>\n<li><strong>\"Hill-Sachs lesion\" </strong>(compression <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> on the <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">posterolateral</span> aspect of the humeral head).</li>\n<li><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"242\" src=\"https://image.prepladder.com/content/7wuleQW1cI23q8AoCGN51741061599.png\" width=\"187\"/></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The humeral head is displaced posteriorly, appearing closer to the scapula.</li>\n<li><strong>‘Light bulb sign</strong>’(humeral head appears rounded due to internal rotation).</li>\n<li><strong>‘Rim sign’</strong> (widening of the <span class=\"customMeta\" data-dictid=\"138e482a341692777188df645a942c\">glenohumeral</span> joint space).</li>\n<li><strong>‘Reverse Hill-Sachs lesion’</strong> (compression <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> on the <span class=\"customMeta\" data-dictid=\"f90b38d04f16927771818db430bf86\">anteromedial</span> humeral head).</li>\n<li><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"167\" src=\"https://image.prepladder.com/content/dKhnOSi1yaaYe2yRYrlJ1741061627.png\" width=\"192\"/></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The humeral head is displaced inferiorly below the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> cavity.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"252\" src=\"https://image.prepladder.com/content/GDsfaMPluB1b8oprVNYC1741061642.png\" width=\"187\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction techniques:</p>\n<ul>\n<li><strong>Kocher's method </strong>(Most commonly used)</li>\n<li>Hippocrates method</li>\n<li>Stimson’s technique</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction and immobility, followed by active exercises.</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Closed reduction</li>\n<li>Open reduction if soft tissue injuries are present</li>\n<li>Re-examination after reduction to avoid <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> injuries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early:</strong>\n<ul>\n<li>Neurovascular injuries</li>\n<li>Rotator <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> tear</li>\n</ul>\n</li>\n<li><strong>Delayed:</strong>\n<ul>\n<li>Recurrence</li>\n<li>Stiffness</li>\n<li>Unreduced dislocation</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrence</li>\n<li>Unreduced dislocation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Neurovascular injuries</li>\n<li>Recurrence</li>\n<li>Unreduced dislocation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Shoulder <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Subglenoid</strong>: The humeral head lies below the <span class=\"customMeta\" data-dictid=\"7649bd0f191692777188dcdf91af69\">glenoid</span> fossa.</li>\n<li><strong>Subclavicular</strong>: The humeral head is displaced beneath the clavicle.</li>\n<li><strong>Intrathoracic</strong>: The humeral head dislocates into the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> cavity, which is rare.</li>\n<li><strong>Subcoracoid</strong>: The humeral head lies below the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"595\" src=\"https://image.prepladder.com/content/QENfYtfbCfpBoGn519mn1741061669.png\" width=\"593\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of the <span class=\"customMeta\" data-dictid=\"70d60276a81692777185b5f6f71fa9\">deltoid</span> <span class=\"customMeta\" data-dictid=\"21f826cc7316927771858a31dad57d\">contour</span> (loss of shoulder roundness)</li>\n<li>The shoulder is <strong>extended, abducted and externally rotated</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Duga’s test</strong> is the inability to touch the opposite shoulder.</li>\n<li><strong>Hamilton ruler</strong> test is where the gap between the ruler and the arm is lost.</li>\n<li><strong>Callaway’s test</strong> is increased girth of the <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> on the dislocated side.</li>\n<li><strong>Bryant’s Test</strong> is where the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> axillary fold is displaced downward on the affected side.</li>\n<li><strong>Regiment batch sign</strong> is loss of sensation due to axillary nerve damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X-ray reveals that the humeral head is displaced anteriorly and inferiorly, often under the <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process <strong>(\"subcoracoid\" position)</strong></li>\n<li>An MRI is necessary to assess soft-tissue injuries and identify Bankart and Hill-Sachs lesions, which are complications of shoulder dislocations and increase the risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> due to joint instability.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"581\" src=\"https://image.prepladder.com/content/Vt43htE4UrDtgcHN6FpD1741061695.png\" width=\"457\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Kocher's method </strong>(Most common method) is the reduction by <strong>traction, external rotation, adduction, and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> rotation.</strong></li>\n<li>In <strong>Hippocrates' method, </strong>the surgeon pulls the semi-abducted arm firmly while using his foot in the <span class=\"customMeta\" data-dictid=\"a6218759db1692777182316d0cd2aa\">axilla</span> as a fulcrum to reduce the dislocation.<strong> </strong></li>\n<li><strong>Stimson’s technique</strong> is the reduction by applying weight for traction, using the body as counter traction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26 year old female was brought to ER post fire incidence. Her face and lower limbs were spared. Calculate the area of burn.", "options": [{"label": "A", "text": "5-10%", "correct": false}, {"label": "B", "text": "20-30%", "correct": false}, {"label": "C", "text": "10-15%", "correct": false}, {"label": "D", "text": "40-50%", "correct": true}], "correct_answer": "D. 40-50%", "question_images": ["https://image.prepladder.com/content/mggNti9SMWSMEA1pLy6G1741111356.png"], "explanation_images": ["https://image.prepladder.com/content/zwP5xDskgAhOfnkVFrak1741069571.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head &amp; neck</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Front of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Back of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18 x 2 = 36%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13.5 x 2 = 27%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perineum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs were not given for hypertension in pregnancy?", "options": [{"label": "A", "text": "Methyldopa", "correct": false}, {"label": "B", "text": "Enalapril", "correct": true}, {"label": "C", "text": "Labetalol", "correct": false}, {"label": "D", "text": "Nifedipine", "correct": false}], "correct_answer": "B. Enalapril", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Beta-blockers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Labetalol </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preferred. Generally safe and effective</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcium channel blockers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nifedipine </strong><strong>(Option D)</strong>,</p>\n<p>Amlodipine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Safe, less BP <span class=\"customMeta\" data-dictid=\"128186f064169277720116e786798a\">variability</span> compared to labetalol</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alpha-2 agonist</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methyl dopa</strong> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Safe but less effective in severe hypertension. It works by reducing <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> outflow and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance. However, it has <span class=\"customMeta\" data-dictid=\"dd4bbf3a1a16927771988e61c3d5e9\">sedative</span> effects and may cause fatigue or depression.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasodilators</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hydralazine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reserved for cases with cardiac/renal dysfunction</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:528px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ACE inhibitors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enalapril, </strong>Lisinopril</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with severe <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> malformations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Angiotensin-receptor blockers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Losartan, Valsartan</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not recommended at any point during pregnancy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman had a difficult labour. She complains of dribbling of urine 7 days after surgery. What is the diagnosis?", "options": [{"label": "A", "text": "VVF", "correct": true}, {"label": "B", "text": "UVF", "correct": false}, {"label": "C", "text": "Rectovaginal fistula", "correct": false}, {"label": "D", "text": "VUF", "correct": false}], "correct_answer": "A. VVF", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystoscopy with <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It involves inserting a <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> solution (methylene blue) to <strong>confirm the diagnosis.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI or CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> modalities may be used to assess complex cases or to plan <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> repair, providing detailed <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> information.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intravenous <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">pyelogram</span> (IVP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>(IVP)</strong> is a <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> test that is not typically used as a primary method to diagnose vesico-vaginal <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> (VVF).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conservative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Genitourinary fistulas may spontaneously close during continuous <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> using an <span class=\"customMeta\" data-dictid=\"3d7fbfbd7f1692777190bde80be811\">indwelling</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> catheter.</li>\n<li>In 10 per cent of cases, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> fistulas close spontaneously after 2 to 8 weeks of <span class=\"customMeta\" data-dictid=\"041fb2c22116927772007921f33a1e\">transurethral</span> catheterization, especially if the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> is small.</li>\n</ul>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transvaginal Repair:</p>\n<ul>\n<li>This approach involves accessing the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> through the <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> wall.</li>\n<li>It is suitable for smaller fistulas and those located in favourable positions that allow for direct access and closure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transabdominal Repair:</p>\n<ul>\n<li>Larger or more complex fistulas may require an <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> approach.</li>\n<li>This can be done via <span class=\"customMeta\" data-dictid=\"a422b7cfac1692777191bf0a3499e4\">laparotomy</span> (open surgery) or <span class=\"customMeta\" data-dictid=\"6aea253fe3169277719122813f8e25\">laparoscopy</span> (minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> surgery).</li>\n<li>Laparoscopy is preferred when feasible as it offers faster recovery and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> complications.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with respiratory difficulty and a history of chronic smoking. Pulmonary function testing shows a decrease in FEV1%. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Chronic Obstructive Pulmonary Disease (COPD)", "correct": true}, {"label": "B", "text": "Pulmonary Fibrosis", "correct": false}, {"label": "C", "text": "Interstitial Lung Disease", "correct": false}, {"label": "D", "text": "Asthma", "correct": false}], "correct_answer": "A. Chronic Obstructive Pulmonary Disease (COPD)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby is born with microcephaly, intracerebral calcification and chorioretinitis. Which teratogenic infections is the mother suffering from?", "options": [{"label": "A", "text": "Toxoplasma", "correct": true}, {"label": "B", "text": "CMV", "correct": false}, {"label": "C", "text": "Varicella", "correct": false}, {"label": "D", "text": "Rubella", "correct": false}], "correct_answer": "A. Toxoplasma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uyQKW3oEA7rxMIMDpXXt1741087707.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:699px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> infection with <em>Toxoplasma gondii</em> during pregnancy is the primary cause</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection during the first trimester: severe outcomes, lower transmission rate (~17%)</p>\n<p>Infection during third trimester: milder outcomes, higher transmission rate (~65%)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CNS:</strong> Hydrocephalus, <strong>intracranial calcifications</strong>, seizures, developmental delays, <strong>microcephaly </strong>in severe brain damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular:</strong> <strong>Chorioretinitis</strong>, vision impairment, strabismus, photophobia, epiphora</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Systemic:</strong> Hepatosplenomegaly, lymphadenopathy, prematurity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other:</strong> Jaundice, thrombocytopenia, rash, hearing loss</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:694px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fetal Ultrasound</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Performed every 2 weeks during <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> after diagnosis of <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PCR Analysis of <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">Amniotic</span> Fluid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for <span class=\"customMeta\" data-dictid=\"d554413593169277719693b8e38638\">prenatal</span> diagnosis of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> infection.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serologic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent or rising titers in dye/IFA tests, positive IgM-ELISA.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Newborn Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General, ophthalmologic, and neurologic exams; head <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> for <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> calcifications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lumbar <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> with analysis for Toxoplasma-specific <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> and IgM, total IgG, cells, glucose, and protein.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxoplasma Isolation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isolation from placenta, infant’s leukocytes, and <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> using PCR</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:655px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyrimethamine and Sulfadiazine, along with <span class=\"customMeta\" data-dictid=\"699ed0930f1692777203617cf3f0c7\">Folinic Acid</span> (Calcium Leucovorin)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Synergistic action against <em>Toxoplasma gondii</em>. Standard treatment for <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> toxoplasmosis. <strong>Folinic Acid </strong>is administered to prevent <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> caused by pyrimethamine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spiramycin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used in pregnant women during the first <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> to prevent vertical transmission.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regular <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> counts twice weekly to detect <span class=\"customMeta\" data-dictid=\"3925bbe5df1692777193bd03c159a8\">neutropenia</span> and other hematologic effects.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Following image denote which side of placenta?", "options": [{"label": "A", "text": "Fetal", "correct": true}, {"label": "B", "text": "Maternal", "correct": false}, {"label": "C", "text": "Decidual surface", "correct": false}, {"label": "D", "text": "Basal plate", "correct": false}], "correct_answer": "A. Fetal", "question_images": ["https://image.prepladder.com/content/8u1UC4mdlBSXmpvNRywE1741105929.png"], "explanation_images": ["https://image.prepladder.com/content/4Ryn6sWHuyJtLydc0ZW11741059943.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maternal surface (Basal plate)</strong><br/>\n<strong>(Options B &amp; D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fetal surface (Chorionic plate)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adherent to the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall.</li>\n<li>It is rough, <span class=\"customMeta\" data-dictid=\"68d37494591692777186d7c7ce4531\">dull</span> and dark red in colour</li>\n<li>It is divided into cotyledons by decidual septum.</li>\n<li>It helps <span class=\"customMeta\" data-dictid=\"517e55e7781692777181b4d509dbdd\">anchor</span> the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> to the uterus.</li>\n<li>Contains <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> blood sinus.</li>\n<li>Receives blood from <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> arteries.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The<strong> <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> cord is attached to the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> surface.</strong></li>\n<li>It is smooth, shiny and bluish-purple.</li>\n<li>It is covered with amnion.</li>\n<li>Takes part in <span class=\"customMeta\" data-dictid=\"efdaffab1b169277718873fda1f11e\">gaseous</span> and nutritional exchange.</li>\n<li>Highly <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> with <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> capillaries.</li>\n<li>Facilitates nutritional exchange via chorionic villi.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For the diagnosis of typhus, an antigen of Proteus is used. What is this type of antigen called?", "options": [{"label": "A", "text": "Sequestered antigen", "correct": false}, {"label": "B", "text": "Super antigen", "correct": false}, {"label": "C", "text": "Iso antigen", "correct": false}, {"label": "D", "text": "Heterophile antigen", "correct": true}], "correct_answer": "D. Heterophile antigen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Agglutination Test Result</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Epidemic and <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> typhus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Mainly agglutinates with OX19; sometimes with OX2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Tick-borne Spotted Fever</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Antibodies to both OX19 and OX2 elevated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Scrub Typhus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Raised antibodies to OXK</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Rickettsial Pox, Q Fever, Ehrlichiosis, Bartonellosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Negative test</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the OPD with hearing loss. On examination: Rinne test- Positive in the left ear and negative in the right ear Weber's test - lateralization towards the left Bone conduction test - Reduced in the right ear and similar in the left ear. Interpret the findings.", "options": [{"label": "A", "text": "Sensorineural hearing loss in left ear", "correct": false}, {"label": "B", "text": "Sensorineural hearing loss in right ear", "correct": true}, {"label": "C", "text": "Conductive hearing loss in left ear", "correct": false}, {"label": "D", "text": "Conductive hearing loss in right ear.", "correct": false}], "correct_answer": "B. Sensorineural hearing loss in right ear", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:473px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conductive Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensorineural Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal Hearing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rinne</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative (BC &gt; AC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (AC &gt; BC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (AC &gt; BC)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weber</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateralises to worse ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateralises to better ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heard equally</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Bone Conduction</strong></p>\n<p><strong>(ABC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears as long as the examiner</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears for a shorter duration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears as long as the examiner</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schwabach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lengthened</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the duration of abstinence post vasectomy?", "options": [{"label": "A", "text": "3 months", "correct": true}, {"label": "B", "text": "7 months", "correct": false}, {"label": "C", "text": "8 months", "correct": false}, {"label": "D", "text": "5 months", "correct": false}], "correct_answer": "A. 3 months", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of fracture is caused by a hammer?", "options": [{"label": "A", "text": "Linear", "correct": false}, {"label": "B", "text": "Depressed", "correct": true}, {"label": "C", "text": "Hinge", "correct": false}, {"label": "D", "text": "Ring", "correct": false}], "correct_answer": "B. Depressed", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bZqZU4kPstHOAgba90XF1741020348.png", "https://image.prepladder.com/content/RyC56O6y7ZFNKTZNOpmc1741020371.png", "https://image.prepladder.com/content/AxrL1f5Jnge8uwJaKwEq1741020387.png", "https://image.prepladder.com/content/WNAZ3uG1DO9A5v71GkVm1741088606.png", "https://image.prepladder.com/content/1u8fzyTQMsjWOfqoQdTy1741020421.png", "https://image.prepladder.com/content/ueUoY1kWMFjsUp6qAVDH1741020451.png", "https://image.prepladder.com/content/KEE9YBQeaP5iIUt2Yb9N1741020471.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Depressed Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Comminuted Fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gutter Fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occurs when a fragment of the skull is pushed inward towards the brain.</li>\n<li>Caused by blows from heavy objects with a small surface (e.g., hammers, bricks).</li>\n<li>The shape of the depressed area may resemble the object that caused the injury.</li>\n</ul>\n<p><u>Variants:</u></p>\n<ul>\n<li><u>Elevated Fracture</u>: One end of the fractured fragment is raised above the skull, while the other is pushed inward. Caused by sharp objects like an axe.</li>\n<li><u>Pond Fracture</u>: Seen in infants, this smooth depression occurs without a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line, resembling <strong>a dent in a ping-pong ball.</strong> Caused by <span class=\"customMeta\" data-dictid=\"9427862c811692777194034ade4877\">obstetrics</span> <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> blade.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves multiple intersecting <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> lines, breaking the bone into several fragments.</li>\n<li>Caused by high-impact trauma (e.g., vehicular accidents, crushing injuries).</li>\n<li>It may occur alongside other fractures (e.g., fissured or depressed fractures).</li>\n<li>Spider web-like patterns on an <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> are characteristic of <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> fractures.</li>\n<li>In severe cases, bone fragments may penetrate the brain or become displaced.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> or channel is formed in the skull bone, often due to <strong>an <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> bullet wound. </strong></li>\n<li>Frequently associated with <span class=\"customMeta\" data-dictid=\"9c8512bb5d169277718470669bd36e\">comminuted</span> and depressed fractures of the inner skull table.</li>\n<li>Bone fragments can cause injury to the <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> or brain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"785\" src=\"https://image.prepladder.com/content/bZqZU4kPstHOAgba90XF1741020348.png\" width=\"140\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Depressed fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/RyC56O6y7ZFNKTZNOpmc1741020371.png\" width=\"509\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Comminuted fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/AxrL1f5Jnge8uwJaKwEq1741020387.png\" width=\"1600\"/></p>\n<p><strong>Gutter fracture</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ring Fracture</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motorcyclist <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Hinge Fracture)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Encircles the <strong>foramen magnum</strong> at the skull base.</li>\n<li>Runs from the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica to the <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridges and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fossa.</li>\n<li>It can extend to the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> and roof of the nose.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transverse <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> at the skull base, <span class=\"customMeta\" data-dictid=\"073b3993a6169277719966873c2515\">splitting</span> it and creating a <strong>\"hinge\" - nodding face sign</strong><strong>.</strong></li>\n<li>It extends from one <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridge across the <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> turcica to the other <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> ridge.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by:</p>\n<ul>\n<li>Falls landing on feet/buttocks (force transmitted through the spine).</li>\n<li>Heavy blows to the top of the skull/ vertex.</li>\n<li>Twisting of the head on the spine.</li>\n<li>Blows to the <span class=\"customMeta\" data-dictid=\"d4214cf5bc1692777194bd76243b92\">occiput</span> or chin.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often caused by <strong>side impacts</strong>.</p>\n<br/>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1572\" src=\"https://image.prepladder.com/content/WNAZ3uG1DO9A5v71GkVm1741088606.png\" width=\"404\"/></p>\n<p><strong>Ring fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"550\" src=\"https://image.prepladder.com/content/1u8fzyTQMsjWOfqoQdTy1741020421.png\" width=\"393\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Hinge fracture</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fissured <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Linear Fracture)</strong></p>\n<p><strong>(Option A)</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diastatic <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> (Sutural Fracture) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The most common skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> accounts for about 70% of cases.</li>\n<li>Linear cracks may involve the <span class=\"customMeta\" data-dictid=\"47effe8b551692777201331142edf5\">vertex</span> or skull base. It can affect the full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of the bone or just the inner/outer layers.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line is <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> and fine, sometimes hard to detect on X-rays. It runs <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the compressive force.</li>\n<li>No depression of bone fragments.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves the separation of <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> sutures.</li>\n<li>More common in children.</li>\n<li>Often occurs with other skull fractures, especially fissured fractures.</li>\n<li>Commonly seen at the <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">sagittal</span> suture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><u>Causes:</u></p>\n<ul>\n<li>Impact against broad surfaces (e.g., falls or road traffic accidents)</li>\n<li>Falls on <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> or buttocks, transmitting force upwards.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><u>Causes:</u></p>\n<ul>\n<li>Blunt trauma to the head.</li>\n<li><strong>Increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure leads to <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> separation.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"326\" src=\"https://image.prepladder.com/content/ueUoY1kWMFjsUp6qAVDH1741020451.png\" width=\"537\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Narrow <span class=\"customMeta\" data-dictid=\"b2af124a931692777203c9f8031b77\">fissure</span> skull fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"329\" src=\"https://image.prepladder.com/content/KEE9YBQeaP5iIUt2Yb9N1741020471.png\" width=\"202\"/></p>\n\t\t\t \n\n\t\t\t<p><strong>Diastatic Fracture</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-week-old neonate was brought to the hospital with a complaint of non-bilious vomiting. While examining the baby, the physician noted a lump in the left epigastric region, which showed movement while feeding. What is the likely diagnosis of this child?", "options": [{"label": "A", "text": "Esophageal atresia", "correct": false}, {"label": "B", "text": "Duodenal atresia", "correct": false}, {"label": "C", "text": "IHPS", "correct": true}, {"label": "D", "text": "Intusussception", "correct": false}], "correct_answer": "C. IHPS", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/V5Z4QutDAmCnVSEbKT8n1741089057.png", "https://image.prepladder.com/content/7voN9YQ0ubZfI7FcThUp1741089109.png", "https://image.prepladder.com/content/O7t9dpSUzfzTcTbn5lFl1741089138.png", "https://image.prepladder.com/content/wjCPJEKSCNOJKxAgXGVM1741089175.png", "https://image.prepladder.com/content/jzsnOg242egnNtGPOkwi1741089201.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Risk Factors of <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> Hypertrophic Pyloric Stenosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>White race of northern European descent</li>\n<li>Male sex</li>\n<li>Familial History: Higher risk in offspring of mothers with CHPS (20% for sons, 10% for daughters)</li>\n<li>Twin Studies: Higher <span class=\"customMeta\" data-dictid=\"a5379e182d1692777184224652dcb1\">concordance</span> in <span class=\"customMeta\" data-dictid=\"e7afab7b981692777192aca13178fa\">monozygotic</span> twins suggests a genetic component</li>\n<li>Blood Groups: Infants with B and O blood groups.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Environmental Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Erythromycin Use: Especially if administered within the first two weeks of life</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> in infants whose mothers used macrolides during pregnancy or breastfeeding, particularly in females.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Associated Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Other <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> Defects Syndromes: Occasionally associated with <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">tracheoesophageal</span> <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> and <span class=\"customMeta\" data-dictid=\"35c595890e1692777189a68438427a\">hypoplasia</span> or <span class=\"customMeta\" data-dictid=\"133b86a0a516927771809ea08682e8\">agenesis</span> of the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"59733f304e1692777191d9deb34f10\">labial</span> frenulum.</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> gastroenteritis, Apert syndrome, Zellweger syndrome, <span class=\"customMeta\" data-dictid=\"5e54fdc4d3169277720003f231621d\">trisomy</span> 18, Smith-Lemli-Opitz syndrome, and Cornelia <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> Lange syndrome.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:558px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic findings of Contrast studies in CHPS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>String Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A thin line of contrast material passes through the narrowed pyloric channel, indicating severe narrowing due to hypertrophied muscle.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"499\" src=\"https://image.prepladder.com/content/7voN9YQ0ubZfI7FcThUp1741089109.png\" width=\"610\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Shoulder Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A bulge of the hypertrophied pyloric muscle into the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"96976bc5fc1692777181dc8403015a\">antrum</span> gives the appearance of a “shoulder.”</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"3692\" src=\"https://image.prepladder.com/content/O7t9dpSUzfzTcTbn5lFl1741089138.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Double <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">Tract</span> Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Parallel streaks of contrast material within the narrowed pyloric channel suggest the presence of a narrow passage for contrast flow.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"470\" src=\"https://image.prepladder.com/content/wjCPJEKSCNOJKxAgXGVM1741089175.png\" width=\"638\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mushroom sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bulging of the hypertrophic muscle into the 1st part of the duodenum.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"449\" src=\"https://image.prepladder.com/content/jzsnOg242egnNtGPOkwi1741089201.png\" width=\"474\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/F4I1GDij20fn65AhkXkq1744571219.mp3", "video": ""}, {"text": "Chronic malnutrition is best measured by?", "options": [{"label": "A", "text": "Height for age", "correct": true}, {"label": "B", "text": "Weight for age", "correct": false}, {"label": "C", "text": "Weight for height", "correct": false}, {"label": "D", "text": "Body mass index", "correct": false}], "correct_answer": "A. Height for age", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:662px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>WHO <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Malnutrition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderately underweight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight-for-age is between -2 and -3 SDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severely underweight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight-for-age is &lt; -3 SDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderately wasted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight-for-length/height is between -2 and -3 SDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severely wasted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weight-for-length/height is &lt; -3 SDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Malnutrition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weight-for-length/height or BMI-for-age is between -2 and -3 SDs.</li>\n<li>Mid-upper arm <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> (MUAC) is between 11.5 cm and 12.5 cm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Malnutrition:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weight-for-length/height or BMI-for-age is less than -3SDs.</li>\n<li>MUAC is less than 11.5 cm.</li>\n<li>The presence of <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"a8c53e6875169277719588cd709854\">pitting</span> oedema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderately Stunted (Moderate </strong><strong>Chronic Malnutrition)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Length/height-for-age</strong> is between -2 and -3 SDs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severely Stunted (Severe </strong><strong>Chronic Malnutrition</strong><strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Length/height-for-age </strong><strong>is &lt; -3 SDs. </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?", "options": [{"label": "A", "text": "Anhidrosis", "correct": false}, {"label": "B", "text": "Miosis", "correct": false}, {"label": "C", "text": "Ptosis", "correct": false}, {"label": "D", "text": "Exophthalmos", "correct": true}], "correct_answer": "D. Exophthalmos", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preganglionic </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postganglionic </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Brainstem <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> (tumours, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> diseases, demyelinating disorders)</li>\n<li>Spinal cord tumours</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pancoast tumour</li>\n<li>Carotid and Aortic aneurysms</li>\n<li>Neck lesions</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atherosclerosis of ICA (internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery))</li>\n<li>Nasopharyngeal tumours</li>\n<li>Cavernous <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> pathology</li>\n<li>Cluster headaches</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the defect in the given image:", "options": [{"label": "A", "text": "Open neural tube defect", "correct": true}, {"label": "B", "text": "Meningoencephalocele", "correct": false}, {"label": "C", "text": "Occult Spina bifida", "correct": false}, {"label": "D", "text": "Encephalocele", "correct": false}], "correct_answer": "A. Open neural tube defect", "question_images": ["https://image.prepladder.com/content/v0jD5lGGTQKHCZ9AG8fC1741088212.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Failure of proper <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube &amp; covering mesoderm/ectoderm; <strong>most common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> anomaly.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Primary NTDs have <span class=\"customMeta\" data-dictid=\"8dcd91eadf1692777193a72a442f37\">multifactorial</span> inheritance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Maternal risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Alcohol, radiation exposure, IDDM, valproate, carbamazepine, <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> and <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> deficiency.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Types of NTDs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spina bifida occulta, meningocele, encephalocele, myelomeningocele, anencephaly,</strong> <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> syndrome, <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> sinus, tethered cord, syringomyelia, diastematomyelia, lipoma, iniencephaly.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Spina bifida occulta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Midline <strong>defect of vertebral bodies without <span class=\"customMeta\" data-dictid=\"08b787c5a41692777196c0e16b3805\">protrusion</span> of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord or meninges</strong>; usually <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> and not of consequence.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Craniorachischisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Rare <span class=\"customMeta\" data-dictid=\"88900fc4c61692777191a66457050a\">malformation</span> with <strong>skull and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> bone defects</strong>; <strong>brain and nerves exposed</strong>; may have other defects like <span class=\"customMeta\" data-dictid=\"51aedf4b7a1692777189224a776ed8\">imperforate</span> anus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Meningocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Meninges herniate</strong> through vertebral arches or sacrum; <strong>spinal cord norma</strong>l. <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">Fluctuant</span> midline mass that may<strong> transilluminate.</strong> Surgery may be delayed in <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> cases with normal neuro findings and skin covering.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Myelomeningocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Most common in<strong> <span class=\"customMeta\" data-dictid=\"2d710fe8461692777191d18505790c\">lumbosacral</span> region</strong>; sac-like <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> structure with <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tissue; 80% develop <strong>hydrocephalus with <span class=\"customMeta\" data-dictid=\"bd04ba63bc1692777201f54e0ee060\">type II</span> Chiari malformation.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Anencephaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Large <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> of calvarium, meninges, and scalp; associated with <span class=\"customMeta\" data-dictid=\"552c5ff93a16927771977cf35eac28\">rudimentary</span> brain due to failure of <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of <span class=\"customMeta\" data-dictid=\"1f4bb4632d16927771975d96e35378\">rostral</span> neuropore.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Iniencephaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Retroflexion of head </strong>with <strong>occipital and upper spine defects,</strong> nearly absent neck; <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> can range from <span class=\"customMeta\" data-dictid=\"ca09d35fbc1692777180daa0f01405\">acrania</span> to minimal defect.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prenatal diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Detailed ultrasound, <strong>MSAFP</strong> (maternal <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> α-fetoprotein), <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid <span class=\"customMeta\" data-dictid=\"63b92227451692777180db3901b72f\">acetylcholinesterase</span> (<strong>AChE</strong>).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>0.4 mg <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> daily for <strong>all women of childbearing age</strong>; 4 mg daily for high-risk women (prior affected child).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Risk of recurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>3-4% after 1 affected child; 10% after 2 affected children.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Surgery for defect; VP <span class=\"customMeta\" data-dictid=\"950826ab361692777198366a25dfbf\">shunt</span> if <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">hydrocephalus</span> present. Open lesions should be closed within 24 hours. Antibiotics if infection is present.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of strenuous exercise skipped a meal and later consumed alcohol at a party. Alcohol inhibits which of the following biochemical processes, potentially leading to hypoglycemia?", "options": [{"label": "A", "text": "Gluconeogenesis", "correct": true}, {"label": "B", "text": "Glycogenolysis", "correct": false}, {"label": "C", "text": "Hexose Monophosphate (HMP) Shunt", "correct": false}, {"label": "D", "text": "Ketone Body Formation", "correct": false}], "correct_answer": "A. Gluconeogenesis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:472px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect of Alcohol</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑ <span class=\"customMeta\" data-dictid=\"70e624dfd41692777193efc364d5b4\">NADH</span> inhibits gluconeogenesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓ <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> production → Hypoglycemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness, dizziness, confusion, seizures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fasting, exercise, malnutrition, chronic alcoholism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV dextrose, <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> in alcoholics</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient admitted with fever and nuchal rigidity. CSF analysis shows decreased glucose and increased protein and neutrophils. Choose the correct treatment", "options": [{"label": "A", "text": "Ampicillin", "correct": false}, {"label": "B", "text": "Ceftriaxone", "correct": true}, {"label": "C", "text": "Penicillin", "correct": false}, {"label": "D", "text": "Vancomycin", "correct": false}], "correct_answer": "B. Ceftriaxone", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2s4Zs3oMYzbbCojGMWhv1741086633.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Bacterial <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">Meningitis</span> in Adults and Prevention</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Streptococcus pneumoniae and <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> meningitides</strong> are the primary causes.<strong> <span class=\"customMeta\" data-dictid=\"0df89fd47716927771914ac591d3a9\">Listeria</span> monocytogenes</strong> is a significant risk in adults over 50, especially in those with diabetes, alcoholism, or weakened immune systems.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiological Process</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/2s4Zs3oMYzbbCojGMWhv1741086633.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classic <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">Triad</span> of Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fever</strong></li>\n<li>Headache</li>\n<li><strong>Nuchal <span class=\"customMeta\" data-dictid=\"9ab07bba3016927771976de44bf865\">rigidity</span> (stiff neck)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Opening pressure: Elevated</li>\n<li><strong>Predominant cell type: <span class=\"customMeta\" data-dictid=\"0d0b0bf80b1692777196a0d5a44e03\">Polymorphonuclear</span> neutrophils (PMNs)</strong></li>\n<li><strong>Protein: Elevated</strong></li>\n<li><strong>Glucose: Decreased</strong></li>\n<li>Gross appearance: Turbid</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immediate Management: </strong>\n<ul>\n<li>Start with <strong>intravenous <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics</strong> to cover pathogens.</li>\n<li><strong>First-line <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> of choice: Ceftriaxone</strong></li>\n<li>Treatment is then adjusted based on the identified organism and its susceptibility</li>\n</ul>\n</li>\n<li><strong>Adjunctive Therapy:</strong> <strong>Dexamethasone</strong> may be given to reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and prevent complications, particularly if administered early.</li>\n<li><strong>Supportive Care:</strong> Manage complications like raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure and seizures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vaccines for H. influenzae type b, N. meningitidis, and S. pneumoniae. No vaccine currently exists for group B meningococcal infections.</li>\n<li><strong>Chemoprophylaxis</strong>: Close contacts of individuals with meningococcal <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> should receive <strong>prophylactic antibiotics </strong>like rifampicin, ciprofloxacin, <span class=\"customMeta\" data-dictid=\"765229d44a1692777182fb0343abf4\">azithromycin</span> or ceftriaxone to reduce the risk of secondary infections.\n\t\t\t\t<ul>\n<li><strong>Rifampicin - 600 mg 12 hourly for 2 days</strong></li>\n<li><strong>Ciprofloxacin - 500 mg single dose</strong></li>\n<li><strong>Azithromycin 500 mg single dose</strong></li>\n<li><strong>Ceftriaxone - 250 mg <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">Intramuscular</span> single dose</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the schedule of the OPV vaccine?", "options": [{"label": "A", "text": "6th week, 10th week and 14th week", "correct": true}, {"label": "B", "text": "6th week, 10th week &amp;amp; 9th month", "correct": false}, {"label": "C", "text": "6th week, 14th week &amp;amp; 9th month", "correct": false}, {"label": "D", "text": "6 to 12 weeks", "correct": false}], "correct_answer": "A. 6th week, 10th week and 14th week", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:693px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>IPV (salk type)</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>OPV (sabin type)</strong></p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Type of vaccine</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Killed formalised virus</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Live attenuated virus</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Mode of administration</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>S/C or IM (0.5 mL)</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Oral (2 drops)</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Type of immunity</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Only humoral</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Humoral and intestinal</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Prevention of</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Paralysis</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Paralysis + Intestinal re-infection</p>\n</th>\n</tr>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Control of epidemics</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Not useful</p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p>Effective</p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Storage &amp; transport</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less stringent conditions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires sub-zero temperatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shelf life</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Longer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>VAPP (Vaccine Associated <span class=\"customMeta\" data-dictid=\"14bba9af561692777194c8cadacf13\">Paralytic</span> Polio)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Zero incidences</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 per 1 million vaccines</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient sample positive for Infectious Hepatitis B. Choose the correct marker for thiscondition.", "options": [{"label": "A", "text": "HBe Ag", "correct": false}, {"label": "B", "text": "HBsAg + HBe", "correct": true}, {"label": "C", "text": "HBcAg", "correct": false}, {"label": "D", "text": "HBs + Anti Hbe", "correct": false}], "correct_answer": "B. HBsAg + HBe", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:714px\">\n<thead>\n<tr>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>HBsAg</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>HBeAg</strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBc </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBs </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Anti-HBe </strong></p>\n</th>\n<th scope=\"col\" style=\"vertical-align:top\">\n<p><strong>Interpretation </strong></p>\n</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection</strong></p>\n<p style=\"text-align: center;\">Highly infectious</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Chronic <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection, highly infectious</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Chronic <span class=\"customMeta\" data-dictid=\"b85d24394e1692777188090f0084ef\">HBV</span> infection, low infectivity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-/+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Recovery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">IgM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Window period</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Post-vaccination</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Dehydration is more severe in infants compared to adults. Which of the following is a true statement about infants?", "options": [{"label": "A", "text": "Extracellular fluid (ECF) is more than intracellular fluid (ICF)", "correct": false}, {"label": "B", "text": "Intracellular fluid (ICF) is more than extracellular fluid (ECF)", "correct": false}, {"label": "C", "text": "Total body water in infants is more than in adults", "correct": true}, {"label": "D", "text": "Extracellular fluid equals intracellular fluid", "correct": false}], "correct_answer": "C. Total body water in infants is more than in adults", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old child with mid-arm circumference of 105mm, upon providing therapeutic food, eagerly completed all of it. This patient is considered under?", "options": [{"label": "A", "text": "Uncomplicated SAM", "correct": true}, {"label": "B", "text": "Complicated SAM", "correct": false}, {"label": "C", "text": "Acute malnutrition", "correct": false}, {"label": "D", "text": "Normal nutrition", "correct": false}], "correct_answer": "A. Uncomplicated SAM", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uMNYfeg8L6lpJBtvCrPF1741087829.png", "https://image.prepladder.com/content/HY17D3N3QkKZWO5w5jzS1741087864.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:697px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Criteria for SAM</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"250\" src=\"https://image.prepladder.com/content/uMNYfeg8L6lpJBtvCrPF1741087829.png\" width=\"734\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Assessment for Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Check for the following complications:</p>\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (+++)</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"d4a253810c1692777181f708ba3dc6\">appetite</span> (fails <span class=\"customMeta\" data-dictid=\"d4a253810c1692777181f708ba3dc6\">appetite</span> test)</li>\n<li>Medical complications</li>\n<li>Presence of one or more danger signs (as per IMNCI guidelines)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on the presence or absence of complications:</p>\n<ul>\n<li>If <strong>NO </strong>complications <strong>→ Uncomplicated SAM → </strong>Supervised home management</li>\n<li>If <strong>YES</strong> (complications present)<strong> → Complicated SAM → </strong>Inpatient management in a healthcare facility</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child presents with a refractive error of -2D in the right eye and +1D in the left eye. Fundus examination reveals normal visual acuity and retinal findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myopia", "correct": false}, {"label": "B", "text": "Hyperopia", "correct": false}, {"label": "C", "text": "Anisometropia", "correct": true}, {"label": "D", "text": "Amblyopia", "correct": false}], "correct_answer": "C. Anisometropia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with fluctuating muscle weakness, especially affecting her speech and swallowing. Repetitive nerve stimulation shows a decremental response. Her blood tests are negative for acetylcholine receptor (AChR) antibodies. Which of the following antibodies is most likely responsible for her symptoms?", "options": [{"label": "A", "text": "Anti-dsDNA antibodies", "correct": false}, {"label": "B", "text": "Anti-MuSK antibodies", "correct": true}, {"label": "C", "text": "Anti-TPO antibodies", "correct": false}, {"label": "D", "text": "Anti-Ro antibodies", "correct": false}], "correct_answer": "B. Anti-MuSK antibodies", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autoantibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Target</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AChR antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acetylcholine receptors (AChR) on the <span class=\"customMeta\" data-dictid=\"978bd0e89f1692777196add72e1254\">postsynaptic</span> membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks signal transmission, leading to muscle weakness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MuSK antibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle-specific <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> (MuSK)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impairs AChR clustering and maintenance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found in AChR-negative patients; associated with <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> muscle weakness (speech, swallowing, chewing issues)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male was admitted with respiratory distress. CT showed a nasal polyp with fluid collection in the sinus. Drainage of which of the following is obstructed?", "options": [{"label": "A", "text": "Ethmoidal sinus", "correct": false}, {"label": "B", "text": "Sphenoidal sinus", "correct": false}, {"label": "C", "text": "Frontal sinus", "correct": false}, {"label": "D", "text": "Maxillary sinus", "correct": true}], "correct_answer": "D. Maxillary sinus", "question_images": ["https://image.prepladder.com/content/kkgY4xOUtJ6RmAMm7njV1741062143.png"], "explanation_images": ["https://image.prepladder.com/content/vVU8T4Ryapl4y0hP03kt1741062195.png", "https://image.prepladder.com/content/4poixIXw2H01XmjvYJY51741062221.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which adverse effect of Bleomycin is exacerbated by radiation exposure?", "options": [{"label": "A", "text": "Pulmonary toxicity", "correct": true}, {"label": "B", "text": "Gastric toxicity", "correct": false}, {"label": "C", "text": "Neural toxicity", "correct": false}, {"label": "D", "text": "Hepatotoxicity", "correct": false}], "correct_answer": "A. Pulmonary toxicity", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KsoOUlfO9sXQuxpFedwl1741037206.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the timing at which the triphenyl tetrazolium chloride can elicit findings post MI", "options": [{"label": "A", "text": "1 hour", "correct": false}, {"label": "B", "text": "30 minutes", "correct": false}, {"label": "C", "text": "3 hours", "correct": true}, {"label": "D", "text": "Immediately", "correct": false}], "correct_answer": "C. 3 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A disease with mitochondrial inheritance is inherited from which family member?", "options": [{"label": "A", "text": "Mother", "correct": true}, {"label": "B", "text": "Grandmother (paternal)", "correct": false}, {"label": "C", "text": "Father", "correct": false}, {"label": "D", "text": "Both mother and father", "correct": false}], "correct_answer": "A. Mother", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Maternal inheritance:</strong> All children of an affected female inherit the disease.</li>\n<li><strong>Homoplasmy:</strong> Presence of <span class=\"customMeta\" data-dictid=\"be003ab8e21692777193372f7699ef\">mtDNA</span> which is either <strong>all <span class=\"customMeta\" data-dictid=\"8cae1d992c169277720269fdff79fc\">wild type</span> or all mutated</strong>.</li>\n<li><strong>Heteroplasmy:</strong> Presence of <strong>both <span class=\"customMeta\" data-dictid=\"8cae1d992c169277720269fdff79fc\">wild type</span> (normal) and mutated</strong> <span class=\"customMeta\" data-dictid=\"be003ab8e21692777193372f7699ef\">mtDNA</span> in the same individual.</li>\n<li><strong>Threshold effect: </strong>Minimum percentage of mutated <span class=\"customMeta\" data-dictid=\"be003ab8e21692777193372f7699ef\">mtDNA</span> required for disease manifestation. In the presence of heteroplasmy, the threshold effect leads to <span class=\"customMeta\" data-dictid=\"128186f064169277720116e786798a\">variability</span> in clinical expression across different tissues and <span class=\"customMeta\" data-dictid=\"be003ab8e21692777193372f7699ef\">mtDNA</span> mutations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples (Mnemonic: KLMNOP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li><strong>Kearns-Sayre syndrome- </strong>Pigmentary retinopathy, cerebellar ataxia, heart block</li>\n<li><strong>Leber's <span class=\"customMeta\" data-dictid=\"ee5175c06116927771880846d1cbe0\">hereditary</span> <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuropathy- </strong>Subacute painless <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> visual failure</li>\n<li><strong>MELAS-</strong> Mitochondrial Encephalomyopathy, <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">Lactic</span> acidosis, Stroke-like episodes</li>\n<li><strong>MERRF- </strong>Myoclonic epilepsy, Seizures, Ataxia</li>\n<li><strong>NARP-</strong> Neuropathy, Ataxia, <span class=\"customMeta\" data-dictid=\"4f1a033cae1692777197a3a6937a0c\">Retinitis</span> pigmentosa</li>\n<li><strong>CPEO-</strong> Chronic progressive external ophthalmoplegia, <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> Ptosis</li>\n<li><strong>Pearson syndrome- </strong>Sideroblastic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> of childhood, pancytopenia, pancreatic involvement</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a forensic examination, a skull bone was brought by police whose cephalic index came out to be 85. Skull bone belongs to which race?", "options": [{"label": "A", "text": "Negroes", "correct": false}, {"label": "B", "text": "Aryan", "correct": false}, {"label": "C", "text": "European", "correct": false}, {"label": "D", "text": "Mongoloids", "correct": true}], "correct_answer": "D. Mongoloids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skull Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cephalic Index (CI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Population</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dolichocephalic</strong></p>\n<p>(Long-headed)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>70-74.99</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pure Aryans, Aborigines, African (Negroid) <strong>(Options A, B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mesaticephalic</strong></p>\n<p>(Medium-headed)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>75-79.99</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>European (Caucasoid), Chinese, Indians. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brachycephalic</strong></p>\n<p>(Short-headed)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>80-84.99</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>East Asian (Mongoloid)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presented with tingling sensation of lateral 3 digits with loss of sensation of base of thumb on the dorsal aspect of the hand. Which is the nerve involved?", "options": [{"label": "A", "text": "Radial nerve", "correct": true}, {"label": "B", "text": "Ulnar nerve", "correct": false}, {"label": "C", "text": "Median nerve", "correct": false}, {"label": "D", "text": "AIN", "correct": false}], "correct_answer": "A. Radial nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WGDmDmDI9h41NAgLhi8A1741087312.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Region</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Area Supplied</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventral (Palmar) Aspect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 3½ fingers + <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> palm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Median nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palmar surface of thumb, index, middle, and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> half of <span class=\"customMeta\" data-dictid=\"3095f536db1692777197c4502be897\">ring finger</span> + palm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial 1½ fingers + <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> palm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulnar nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palmar surface of <span class=\"customMeta\" data-dictid=\"05bd79dc1d1692777191acf30a7886\">little finger</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> half of <span class=\"customMeta\" data-dictid=\"3095f536db1692777197c4502be897\">ring finger</span> + palm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thenar <span class=\"customMeta\" data-dictid=\"c7cd7c82631692777187abb016ed2e\">eminence</span> (skin)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Median nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over the base of thumb (root of thumb, <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> side)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypothenar eminence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulnar nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Over the base of little finger</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dorsal Aspect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 3½ fingertips (nail beds)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Median nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"27cd397275169277719513776c38c8\">phalanges</span> of thumb, index, middle, and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> ring finger</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial 2½ fingers + hand dorsum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulnar nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal aspect of little finger, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> half of ring finger, and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> hand</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 1½ <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> + web space</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radial nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsum of hand near base of thumb, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> hand, and 1st web space</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Root (base) of thumb </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radial nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal aspect of thumb base and adjacent <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of hand</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 y/o asthmatic patient is scheduled for a minor surgical procedure. Which induction agent and muscle relaxant combination is safest for this patient?", "options": [{"label": "A", "text": "Propofol and Succinylcholine", "correct": false}, {"label": "B", "text": "Ketamine and d-tubocurarine", "correct": false}, {"label": "C", "text": "Ketamine and Vecuronium", "correct": true}, {"label": "D", "text": "Thiopental and Rocuronium", "correct": false}], "correct_answer": "C. Ketamine and Vecuronium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child presented with multiple burn injuries involving the entire head, neck &amp;amp; upper limb. What is the percentage of burn?", "options": [{"label": "A", "text": "25-30%", "correct": true}, {"label": "B", "text": "40-44%", "correct": false}, {"label": "C", "text": "18-20%", "correct": false}, {"label": "D", "text": "5-10%", "correct": false}], "correct_answer": "A. 25-30%", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head &amp; neck</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>18%</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Front of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Back of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18 x 2 = 36%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13.5 x 2 = 27%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper limb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>18%</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perineum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which segment of the nephron has the lowest osmolality under the influence of antidiuretic hormone (ADH)?", "options": [{"label": "A", "text": "Early distal tubule", "correct": true}, {"label": "B", "text": "Descending limb of the loop of Henle", "correct": false}, {"label": "C", "text": "Collecting duct", "correct": false}, {"label": "D", "text": "Late distal tubule", "correct": false}], "correct_answer": "A. Early distal tubule", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient with HIV presenting with bouts of cough and fever. Which medium is appropriate for diagnosis?", "options": [{"label": "A", "text": "Tinsdale media", "correct": false}, {"label": "B", "text": "Lowenstein-Jensen (LJ) medium", "correct": true}, {"label": "C", "text": "MacConkey agar", "correct": false}, {"label": "D", "text": "Loeffler serum slope (LSS)", "correct": false}], "correct_answer": "B. Lowenstein-Jensen (LJ) medium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:712px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sputum <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initial screening for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> TB.</li>\n<li>Samples are stained using the Ziehl-Neelsen method or Auramine-O <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB) under a microscope.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Quick and inexpensive. Can provide results within a few hours.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Low sensitivity, especially in cases of <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB or in patients with HIV.</li>\n<li>Cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> and non-tuberculous <span class=\"customMeta\" data-dictid=\"46f768d2e41692777193d69cbc7eec\">mycobacteria</span> (NTM).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Confirm the diagnosis of TB and assess drug susceptibility.</li>\n<li><strong>Solid Media:</strong> <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">Sputum</span> is inoculated onto solid culture media like <strong>Löwenstein-Jensen</strong><strong> </strong>or Middlebrook agar.</li>\n<li><strong>Liquid Media: </strong>Automated systems like <strong>BACTEC or MGIT</strong> are used to detect growth faster.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The gold standard for TB diagnosis.</li>\n<li>Allows for drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Time-consuming; results can take weeks.</li>\n<li>Requires specialized laboratory facilities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Xpert MTB/RIF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Detects <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> and <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</li>\n<li><strong>Method</strong>:\n\t\t\t\t<ul>\n<li>A cartridge-based system that performs <span class=\"customMeta\" data-dictid=\"6483f3ef3116927771935d328a8ab2\">nucleic acid</span> <span class=\"customMeta\" data-dictid=\"13e14b31b21692777181520d7c651c\">amplification</span> (NAAT).</li>\n<li>Sputum or other specimens are processed directly in the cartridge.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid results (within 2 hours).</li>\n<li>High sensitivity and specificity.</li>\n<li>Simultaneously detects <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More expensive than <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> microscopy.</li>\n<li>Does not provide full drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>LAMP (Loop-Mediated Isothermal Amplification)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Detects DNA of <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> tuberculosis.</li>\n<li><strong>Method</strong>:\n\t\t\t\t<ul>\n<li>Amplifies DNA at a constant temperature without the need for <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> cycling.</li>\n<li>Sputum or other specimens are used.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid results (within 1-2 hours).</li>\n<li>High <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> and sensitivity.</li>\n<li>Can be performed at the point of care.</li>\n<li>Used for patients with <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> with CD4+ counts of less than 100 cells/μL irrespective of signs and symptoms of TB.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Less widely available than PCR-based tests.</li>\n<li>Cannot detect <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> directly.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TrueNat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Point-of-care test for TB detection.</li>\n<li><strong>Method</strong>:\n\t\t\t\t<ul>\n<li>Uses a micro-PCR technology to amplify DNA.</li>\n<li>Results are available within 60 minutes.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Portable and easy to use in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> health facilities.</li>\n<li>Provides results quickly, facilitating immediate treatment decisions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Line <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">Probe</span> <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">Assay</span> (LPA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Detects TB and <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> (rifampicin and isoniazid).</li>\n<li><strong>Method</strong>:\n\t\t\t\t<ul>\n<li>Sputum samples are processed, and DNA is extracted.</li>\n<li>Amplified DNA is hybridized to specific probes on a <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> strip.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid results (within 1-2 days).</li>\n<li>Can detect multiple mutations associated with drug resistance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires a laboratory <span class=\"customMeta\" data-dictid=\"3a6d14db861692777198565f57828c\">setup</span> and trained personnel.</li>\n<li>Not suitable for all strains of TB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RFLP</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>IS6110 <span class=\"customMeta\" data-dictid=\"3668babc2b169277719777e6f04c66\">restriction fragment</span> length <span class=\"customMeta\" data-dictid=\"15d98152c61692777196a0f2fb42a0\">polymorphism</span> (RFLP)</strong> analysis is widely used for molecular epidemiological studies of tuberculosis.</li>\n<li>Restriction enzymes Nru I, EcoN I, Pst I, and Pvu II were used to analyze IS6110 fingerprints in <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> strains H37Rv (virulent) and H37Ra (avirulent).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with the palsy of the face as shown. Which of the following is most likely involved?", "options": [{"label": "A", "text": "7th nerve palsy", "correct": true}, {"label": "B", "text": "3rd nerve palsy", "correct": false}, {"label": "C", "text": "Erb’s palsy", "correct": false}, {"label": "D", "text": "Orbicularis oculi palsy", "correct": false}], "correct_answer": "A. 7th nerve palsy", "question_images": ["https://image.prepladder.com/content/dRzXZc28bPnpGYlZWnWa1741028210.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common cause of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy</li>\n<li>Characterized by idiopathic, <strong>LMN <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis</strong> of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> onset</li>\n<li><strong>Most commonly the <span class=\"customMeta\" data-dictid=\"4c41e52057169277719199abf55761\">Labyrinthine</span> segment</strong> of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve is involved.</li>\n<li><strong>Males and females are equally affected. </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic: Most common cause</strong></li>\n<li>Viral Infection: <strong>HSV</strong> &gt;&gt; <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">Herpes</span> zoster</li>\n<li>Vascular Ischemia</li>\n<li>Hereditary: Positive family history in 6-8%</li>\n<li>Autoimmune</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in diabetics (due to angiopathy) and pregnant women (due to fluid retention).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden onset of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> with inability to close the eye (Bell's phenomenon), <span class=\"customMeta\" data-dictid=\"0bead1317716927771827dc3e80706\">asymmetry</span> of the face, epiphora, drooping mouth, and dribbling of saliva.</li>\n<li>Associated symptoms may include ear pain, noise <span class=\"customMeta\" data-dictid=\"7794e5fd7a1692777190ee626ede62\">intolerance</span> (stapedial paralysis), or loss of taste (chorda tympani involvement).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is made by excluding other causes of <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>General: Reassurance, pain relief, eye protection and physiotherapy</li>\n<li>Medical: <strong>Prednisolone</strong> 60 mg per day for 5 days then <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by 10 mg per day (for a total treatment time of 10 days) and 50 mg per day (in two divided doses) for 10 days, <strong>Acyclovir (Adult doses)</strong></li>\n<li>Surgical: Nerve decompression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>85%-90% of patients fully recover </strong></li>\n<li>Incomplete resolution are mainly seen in recurrent/late recovery cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug is preferred for management of diabetes in a patient with cardiac and renal failure?", "options": [{"label": "A", "text": "SGLT2 inhibitors", "correct": true}, {"label": "B", "text": "Pioglitazone", "correct": false}, {"label": "C", "text": "Metformin", "correct": false}, {"label": "D", "text": "Sulfonylureas", "correct": false}], "correct_answer": "A. SGLT2 inhibitors", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Infections (vaginal thrush, balanoposthitis, Fournier’s gangrene) : Favour the growth of microbes in the lower urinary tract by providing an environment of excessive glucose.</li><li>↳ Infections (vaginal thrush, balanoposthitis, Fournier’s gangrene)</li><li>↳ Euglycemic ketoacidosis is due to inhibiting glucose reabsorption and the body’s preference for ketone bodies as an energy source after excess glucose excretion.</li><li>↳ Euglycemic ketoacidosis</li><li>↳ Osteoporosis: Rarely due to loss of calcium ions upon inhibition of the SGLT-2 receptors.</li><li>↳ Osteoporosis:</li><li>↳ Pioglitazone (Option B) is incorrect because pioglitazone (a thiazolidinedione, TZD) causes fluid retention , worsening heart failure .</li><li>↳ Pioglitazone (Option B)</li><li>↳ pioglitazone (a thiazolidinedione, TZD)</li><li>↳ fluid retention</li><li>↳ heart failure</li><li>↳ Metformin (Option C) is incorrect because although it is the first-line drug for type 2 diabetes , it is contraindicated in severe renal failure (eGFR &lt;30 mL/min/1.73m²) due to the risk of lactic acidosis .</li><li>↳ Metformin (Option C)</li><li>↳ first-line drug for type 2 diabetes</li><li>↳ contraindicated in severe renal failure (eGFR &lt;30 mL/min/1.73m²)</li><li>↳ risk of lactic acidosis</li><li>↳ Sulfonylureas (Option D) is incorrect because sulfonylureas (e.g., glibenclamide, glipizide) increase hypoglycemia risk , especially in renal impairment due to reduced clearance.</li><li>↳ Sulfonylureas (Option D)</li><li>↳ sulfonylureas (e.g., glibenclamide, glipizide)</li><li>↳ hypoglycemia risk</li><li>↳ renal impairment</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Edematous villi with chromosome XY was found. What will be the diagnosis?", "options": [{"label": "A", "text": "Complete mole", "correct": true}, {"label": "B", "text": "Partial mole", "correct": false}, {"label": "C", "text": "Cyst", "correct": false}, {"label": "D", "text": "Ectopic pregnancy", "correct": false}], "correct_answer": "A. Complete mole", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial Mole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete Mole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Karyotype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually 69, XXY or 69, XXX <strong>(triploid)</strong> <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually <strong>46, XX or 46, XY (diploid)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 paternal sets + 1 <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> set</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All paternal (empty egg + <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> duplication)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fetal tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It may be present but abnormal.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>β-hCG levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated, but lower than the complete mole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of persistent GTD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-10%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of choriocarcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-4%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-3%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Theca <span class=\"customMeta\" data-dictid=\"cb86764f631692777191898edd4296\">lutein</span> cysts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>HPE findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Focal <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> </strong>(some <span class=\"customMeta\" data-dictid=\"bbea63556f1692777202e8abdd66a4\">villi</span> are normal, others are edematous)</li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> blood vessels in some villi.</li>\n<li>Focal trophoblastic hyperplasia</li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> tissue (may include <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> red blood cells or embryonic/fetal parts).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diffuse <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> and hydropic swelling.</strong></li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> blood vessels in villi</li>\n<li>Marked <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> trophoblastic <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (both <span class=\"customMeta\" data-dictid=\"03a334f35e1692777185356e060797\">cytotrophoblast</span> and syncytiotrophoblast).</li>\n<li>No <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> tissue is present.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drug dosages is incorrect for the treatment of leprosy in adults?", "options": [{"label": "A", "text": "Dapsone 100 mg", "correct": false}, {"label": "B", "text": "Clofazimine 50 mg", "correct": false}, {"label": "C", "text": "Clofazimine 300 mg", "correct": false}, {"label": "D", "text": "Rifampicin 450 mg", "correct": true}], "correct_answer": "D. Rifampicin 450 mg", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paucibacillary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multibacillary</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Skin lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-5 lesions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;5 lesions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥1 nerve involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Slit skin smear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dapsone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clofazimine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rifampicin</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paucibacillary (PB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adult</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300 mg once a month &amp; 50 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>600 mg once a month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Child </strong></p>\n<p><strong>(9-14 yrs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>50 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>150 mg once a month &amp; 50 mg <em>alternate day</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>450 mg once a month</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Multibacillary (MB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adult</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300 mg once a month &amp; 50 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>600 mg once a month</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Child </strong></p>\n<p><strong>(9-14 yrs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>50 mg daily</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>150 mg once a month &amp; 50 mg<em> <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> day</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>450 mg once a month</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug-resistant <span class=\"customMeta\" data-dictid=\"f200a5b7181692777191c4f24b2a3e\">leprosy</span> Regimen</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intensive Phase</strong> (6 months)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continuation Phase </strong>(18 months)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rifampicin-resistant cases:</strong></p>\n<p>2 second line + 1 first line (Clofazimine)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ofloxacin + <span class=\"customMeta\" data-dictid=\"3d49c44f24169277719259eb6f9a14\">Minocycline</span> + Clofazimine</p>\n<p><strong>(or)</strong></p>\n<p>Ofloxacin + <span class=\"customMeta\" data-dictid=\"00c4a4fe9b1692777184136ffde6c9\">Clarithromycin</span> + Clofazimine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ofloxacin + <span class=\"customMeta\" data-dictid=\"3d49c44f24169277719259eb6f9a14\">Minocycline</span> + Clofazimine</p>\n<p><strong>(or)</strong></p>\n<p>Ofloxacin + Clofazimine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rifampicin &amp; <span class=\"customMeta\" data-dictid=\"d78dc549171692777194a4af6724c2\">ofloxacin</span> resistant cases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clarithromycin + <span class=\"customMeta\" data-dictid=\"3d49c44f24169277719259eb6f9a14\">Minocycline</span> + Clofazimine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(Clarithromycin or Minocycline) + Clofazimine</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is not reversed with the administration of atropine?", "options": [{"label": "A", "text": "Bradycardia", "correct": false}, {"label": "B", "text": "Muscle weakness due to neuromuscular blockade", "correct": true}, {"label": "C", "text": "Excessive salivation", "correct": false}, {"label": "D", "text": "Bronchoconstriction", "correct": false}], "correct_answer": "B. Muscle weakness due to neuromuscular blockade", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Atropine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anticholinergic drug (Muscarinic <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist)</li>\n<li>Competitive <span class=\"customMeta\" data-dictid=\"2e432a4f3c1692777181e8e244ca0e\">antagonist</span> at <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Competitive <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of <span class=\"customMeta\" data-dictid=\"28ec2061691692777196c06b1c0fd4\">postganglionic</span> <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors</li>\n<li><strong>Blocks all subtypes of <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors (M₁, M₂, M₃)</strong></li>\n<li>Direct <span class=\"customMeta\" data-dictid=\"19f2818be81692777201fa125ef03b\">vagolytic</span> action leading to <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> inhibition</li>\n<li>Allows preexisting <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> to predominate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharmacological Actions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Overall <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> <span class=\"customMeta\" data-dictid=\"bec9bb02501692777199b0f75e340e\">stimulant</span> action</li>\n<li>Stimulates <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> centers (vagal, respiratory, vasomotor)</li>\n<li>Depresses <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> <span class=\"customMeta\" data-dictid=\"8265e091151692777187f264d73f3b\">excitation</span> (antimotion <span class=\"customMeta\" data-dictid=\"73c1caf8d11692777198b1248373d3\">sickness</span> property)</li>\n<li>Suppresses <span class=\"customMeta\" data-dictid=\"bb6d2476421692777200c2af1ac0c8\">tremor</span> and <span class=\"customMeta\" data-dictid=\"9ab07bba3016927771976de44bf865\">rigidity</span> in parkinsonism</li>\n<li>High doses: <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> excitation, restlessness, hallucinations, delirium</li>\n<li>Very high doses: <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> depression and coma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. CVS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heart:</p>\n<ul>\n<li><strong>Tachycardia </strong>(primary effect) - blocks <strong>M₂</strong> receptors on SA node<strong> </strong><strong>(Option A Ruled Out)</strong></li>\n<li>Initial <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> may occur with IM/SC injection</li>\n<li>Abbreviates <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> period of <span class=\"customMeta\" data-dictid=\"c270267d20169277718081ecee6362\">A-V</span> node</li>\n<li>Facilitates <span class=\"customMeta\" data-dictid=\"c270267d20169277718081ecee6362\">A-V</span> conduction</li>\n<li>Shortens P-R interval</li>\n</ul>\n\t\t\t \n\n\t\t\t<p>Blood Pressure:</p>\n<ul>\n<li>No consistent/marked effect on BP</li>\n<li>Tachycardia and <span class=\"customMeta\" data-dictid=\"bd99ec780c16927772018a45db80c2\">vasomotor</span> center <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> tend to raise BP</li>\n<li>Histamine release and direct <span class=\"customMeta\" data-dictid=\"8827b8fae316927772019c9b7b884f\">vasodilator</span> action (at high doses) tend to lower BP</li>\n<li>Blocks <span class=\"customMeta\" data-dictid=\"000545992916927772017bc4c83041\">vasodepressor</span> action of <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">cholinergic</span> agonists</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Eye</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mydriasis (pupil dilation)</li>\n<li>Cycloplegia (paralysis of accommodation)</li>\n<li>Abolition of light reflex</li>\n<li>Effects last 7-10 days with <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> application</li>\n<li>May increase <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> tension, especially in narrow angle glaucoma</li>\n<li>Has mild local <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> action on cornea</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4. Smooth Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Relaxes all visceral smooth muscles with <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> (M₃ blockade)</li>\n<li>Reduces tone and <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> of GI contractions</li>\n<li>Slows passage of chyme; may cause constipation</li>\n<li>Causes <strong>bronchodilation</strong>, reduces <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> resistance <strong> </strong><strong>(Option D Ruled Out)</strong></li>\n<li>Relaxes <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> and <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> bladder</li>\n<li>Relaxation of <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> (less marked)</li>\n<li>Minimal effect on uterus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5. <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">Glandular</span> Secretions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Markedly <strong>decreases </strong>sweat, <strong>salivary</strong>, <span class=\"customMeta\" data-dictid=\"869f194fb11692777200fc402d40af\">tracheobronchial</span> and <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> secretions (<strong>M₃ </strong>blockade) <strong> </strong><strong>(Option C Ruled Out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6. Body Temperature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Higher doses can cause rise in body temperature</li>\n<li>Due to <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of <span class=\"customMeta\" data-dictid=\"8fab5233721692777199fc0bcd1210\">sweating</span> and <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of temperature regulating center</li>\n<li>Children are highly <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> to <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> fever</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relative Sensitivity of Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreasing order of sensitivity:</p>\n<p>Saliva, sweat, bronchial <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> &gt; eye, bronchial muscle, heart &gt; smooth muscle of intestine, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> &gt; <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> glands and smooth muscle</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate treatment for severe acne?", "options": [{"label": "A", "text": "Topical Tretinoin", "correct": false}, {"label": "B", "text": "Isotretinoin", "correct": true}, {"label": "C", "text": "Steroids", "correct": false}, {"label": "D", "text": "Antibiotics", "correct": false}], "correct_answer": "B. Isotretinoin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:518px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Acne Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Mild Acne</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Over-the-counter <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> treatments (benzoyl peroxide, salicylic acid)</li>\n<li>Topical retinoids (adapalene) <strong> (Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Moderate Acne</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Topical antibiotics (clindamycin, erythromycin)</li>\n<li>Oral antibiotics (doxycycline, minocycline)</li>\n<li>Topical retinoids <strong> (Option A ruled out)</strong></li>\n<li>Hormonal therapy (for females)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Severe Acne</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"e6a88ded8b1692777190caead269e4\">isotretinoin</span> (Most effective) <strong> (Option B)</strong></li>\n<li>Oral antibiotics</li>\n<li>Topical retinoids</li>\n<li>Hormonal therapy (for females)</li>\n<li>Intralesional corticosteroids (for <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> acne)<strong> </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with loss of sensation on the posterior surface of the ear along with a lesion. Which structure is most likely involved?", "options": [{"label": "A", "text": "Greater Auricular Nerve", "correct": true}, {"label": "B", "text": "Internal Jugular Vein", "correct": false}, {"label": "C", "text": "External Jugular Vein", "correct": false}, {"label": "D", "text": "External Carotid Artery", "correct": false}], "correct_answer": "A. Greater Auricular Nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A PLHIV came with multiple dog bites with a punctured wound. Choose the correctmanagement:", "options": [{"label": "A", "text": "Local wound cleaning", "correct": false}, {"label": "B", "text": "Vaccine", "correct": false}, {"label": "C", "text": "Local Treatment + RIG", "correct": false}, {"label": "D", "text": "Local Treatment + RIG + Vaccine", "correct": true}], "correct_answer": "D. Local Treatment + RIG + Vaccine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Exposure Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Touching or <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> animals</li>\n<li>Licking of intact skin</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ensure proper hygiene</li>\n<li>No treatment required</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nibbling on uncovered skin</li>\n<li>Minor <span class=\"customMeta\" data-dictid=\"5ca3a9c7051692777198d5bd67dd6c\">scratches</span> or abrasions without bleeding</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate wound <span class=\"customMeta\" data-dictid=\"c846a3af9016927772026af6f9b6db\">washing</span> with soap and water</li>\n</ul>\n<p><strong>Rabies vaccination:</strong></p>\n<ul>\n<li>Unvaccinated: Days 0, 3, 7, and 14</li>\n<li>Previously vaccinated: <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">Booster</span> doses on Days 0 and 3</li>\n<li>No <span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\">Rabies</span> <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">Immunoglobulin</span> (RIG) required</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Bites or <span class=\"customMeta\" data-dictid=\"5ca3a9c7051692777198d5bd67dd6c\">scratches</span> with bleeding</strong></li>\n<li>Licks on broken skin</li>\n<li>Exposure to <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes (mouth, eyes, nose)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immediate wound <span class=\"customMeta\" data-dictid=\"c846a3af9016927772026af6f9b6db\">washing</span> with soap and water, <span class=\"customMeta\" data-dictid=\"919f290c4f1692777203469825e662\">flush</span> for at least 15 minutes.</strong></li>\n<li><strong>Suture: </strong>Do not <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> the wound immediately, as it may spread the virus, instead delay it for 24 to 48 hours.</li>\n<li><strong>Rabies vaccination</strong><strong>:</strong>\n<ul>\n<li><strong>Unvaccinated: </strong>Full <span class=\"customMeta\" data-dictid=\"624ee3cb8d1692777195f4dce9b626\">PEP</span> series on Days 0, 3, 7, and 14</li>\n<li><strong>Previously vaccinated:</strong> <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">Booster</span> doses on Days 0 and 3</li>\n</ul>\n</li>\n<li><strong>Rabies <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">Immunoglobulin</span> (RIG):</strong>\n<ul>\n<li><strong>Equine <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> or ERIG</strong></li>\n<li><strong>Human <span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\">rabies</span> <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">Immunoglobulin</span> or HRIG </strong>\n<ul>\n<li>Preferred (free from the danger of sensitisation, <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> and <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> viruses)</li>\n<li>Dose: – 40 IU / kg IM</li>\n<li>Started on Day 0 along with <span class=\"customMeta\" data-dictid=\"f23be6aa561692777201ca2e1aaa27\">vaccination</span> (can be given up to 7 days).</li>\n<li>70% is given around the wound and, the rest is given distant from the wound.</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n<p>Required for unvaccinated individuals</p>\n<p>Not needed for previously vaccinated individuals</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely cause of lower right abdominal pain and rebound tenderness in a patient with Meckel's diverticulum?", "options": [{"label": "A", "text": "Perforation", "correct": false}, {"label": "B", "text": "Intestinal obstruction", "correct": false}, {"label": "C", "text": "Appendicitis", "correct": true}, {"label": "D", "text": "Cholecystitis", "correct": false}], "correct_answer": "C. Appendicitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An image of the mascot is shown below. Identify the related national health.", "options": [{"label": "A", "text": "National Leprosy eradication programme", "correct": true}, {"label": "B", "text": "National Tuberculosis Elimination Programme", "correct": false}, {"label": "C", "text": "National Anti-Malaria Programme", "correct": false}, {"label": "D", "text": "National Polio Surveillance Program", "correct": false}], "correct_answer": "A. National Leprosy eradication programme", "question_images": ["https://image.prepladder.com/content/nH0jHws3RlqTyzFjOjF11741109603.png"], "explanation_images": ["https://image.prepladder.com/content/uOxfxsMhOKubBlKkd0YT1741109650.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:548px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Level of Prevention</strong></p>\n<ul>\n<li>Health Education</li>\n<li>SPARSH program uses a cartoon girl known as Sapna who is in a village <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> awareness on Leprosy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Level of Prevention</strong></p>\n<ul>\n<li>Early diagnosis and treatment</li>\n<li>ASHA does detection</li>\n<li>ASHA gets cash incentives</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tertiary Prevention</strong></p>\n<ul>\n<li>Treatment of <span class=\"customMeta\" data-dictid=\"d4c88fcae71692777186aa1c32423a\">drug-resistant</span> leprosy</li>\n<li>Disability limitation and rehabilitation</li>\n<li>Reconstructive surgeries for deformities</li>\n<li>Crutches to walk</li>\n<li>Microcellular rubber footwear</li>\n<li>Self-care kits</li>\n</ul>\n<img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/uOxfxsMhOKubBlKkd0YT1741109650.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:324px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dose of <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> as <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> (single dose):</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 15 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>600 mg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-14 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>450 mg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-9 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>300 mg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Children &lt;20 kg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-15 mg/kg</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with features of short stature, muscle weakness, and learning disability. Chromosome analysis reveals a deletion on the short arm of chromosome 15p on the paternal side. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Angelman syndrome", "correct": false}, {"label": "B", "text": "Prader-Willi syndrome", "correct": true}, {"label": "C", "text": "Cri du chat syndrome", "correct": false}, {"label": "D", "text": "Rett syndrome", "correct": false}], "correct_answer": "B. Prader-Willi syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Spread of prostate cancer to lumbar vertebra is via?", "options": [{"label": "A", "text": "Arterial spread", "correct": false}, {"label": "B", "text": "Local spread", "correct": false}, {"label": "C", "text": "Lymphatic spread", "correct": false}, {"label": "D", "text": "Venous spread", "correct": true}], "correct_answer": "D. Venous spread", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Route</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism &amp; Common Sites</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct extension into the <strong>seminal vesicles, bladder, or rectum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obturator, internal &amp; external <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> nodes</strong> are commonly involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematogenous spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Via <strong>Batson’s <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> → <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> vertebrae, pelvis, femur, ribs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare, usually occurs <strong>late</strong> in disease progression</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following changes occurs during muscle contraction while exercising?", "options": [{"label": "A", "text": "M length increase", "correct": false}, {"label": "B", "text": "A length decrease", "correct": false}, {"label": "C", "text": "I length decrease", "correct": true}, {"label": "D", "text": "M length increase and I decrease", "correct": false}], "correct_answer": "C. I length decrease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JycTELSNfpPgLWRewaIm1741085943.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are protected by OCPs except?", "options": [{"label": "A", "text": "Carcinoma breast", "correct": true}, {"label": "B", "text": "Carcinoma endometrium", "correct": false}, {"label": "C", "text": "Colonic cancer", "correct": false}, {"label": "D", "text": "Ovarian cancer", "correct": false}], "correct_answer": "A. Carcinoma breast", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adverse Effects of Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pills (OCPs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications of Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">Contraceptive</span> Pills (OCPs)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiovascular Effects (due to <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> content)</strong></p>\n<ul>\n<li>Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> (MI)</li>\n<li>Cerebral <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> - Stroke</li>\n<li>Risk increases with age &gt;35 and cigarette smoking.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Carcinogenesis</strong></p>\n<ul>\n<li>Increased risk of <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> cancer</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Metabolic Effects (due to <span class=\"customMeta\" data-dictid=\"183d374ac91692777196c63c850299\">progesterone</span> content)</strong></p>\n<ul>\n<li>Elevated blood pressure</li>\n<li>Altered <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> levels</li>\n<li>Interference with blood clotting</li>\n<li>Interference with carbohydrate metabolism</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Thromboembolic Events</strong></p>\n<ul>\n<li>Deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> (DVT)</li>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (PE)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Others</strong></p>\n<ul>\n<li>Lactation: <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">Reduced</span> quantity and quality of breast milk</li>\n<li>Weight gain</li>\n<li>Migraine</li>\n<li>Breast tenderness</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Contraindications:</strong></p>\n<ul>\n<li>Cancer of the breast and genitals</li>\n<li>Liver disease</li>\n<li>Previous or present history of thromboembolism</li>\n<li>Cardiac abnormalities</li>\n<li>Congenital hyperlipidaemia</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Relative Contraindications (requiring medical surveillance):</strong></p>\n<ul>\n<li>Age over 40 years</li>\n<li>Smoking and age over 35 years</li>\n<li>Mild hypertension</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease</li>\n<li>Migraine</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old person presented with an ulcer on the medial canthus. The ulcer has rolled-out, beaded margins. Histopathology shows nesting cells with peripheral palisading patterns. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Squamous Cell Carcinoma (SCC)", "correct": false}, {"label": "B", "text": "Nevus", "correct": false}, {"label": "C", "text": "Basal Cell Carcinoma (BCC)", "correct": true}, {"label": "D", "text": "Melanoma", "correct": false}], "correct_answer": "C. Basal Cell Carcinoma (BCC)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After how long is a patient advised to use alternative contraception following a vasectomy?", "options": [{"label": "A", "text": "1 month", "correct": false}, {"label": "B", "text": "2 months", "correct": false}, {"label": "C", "text": "3 months", "correct": true}, {"label": "D", "text": "6 months", "correct": false}], "correct_answer": "C. 3 months", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman with forceps delivery 24 hours ago presents with pain in the perineum. Her BP is 80/60 and on examination, there is a swelling with bluish discolouration. Which of the following steps are advised not to do?", "options": [{"label": "A", "text": "Repair the wound in the ward", "correct": true}, {"label": "B", "text": "Give Blood Transfusion", "correct": false}, {"label": "C", "text": "Shift patient to OT", "correct": false}, {"label": "D", "text": "Inform senior about her", "correct": false}], "correct_answer": "A. Repair the wound in the ward", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male presents with left leg swelling and pain for 5 days and has a positive D-dimer test. Duplex ultrasonography confirms an extensive DVT involving the left popliteal and femoral veins. Which of the following is the most appropriate initial management strategy?", "options": [{"label": "A", "text": "Unfractionated heparin followed by warfarin", "correct": false}, {"label": "B", "text": "LMWH followed by oral anticoagulant", "correct": true}, {"label": "C", "text": "Catheter-directed thrombolysis", "correct": false}, {"label": "D", "text": "IVC filter placement", "correct": false}], "correct_answer": "B. LMWH followed by oral anticoagulant", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> with Duplex scanning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive; detects <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> by impaired <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and inability to <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> veins.</p>\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"91b98150ea169277718629280d911c\">echogenic</span> material completely <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> the <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> of vein</li>\n<li>Absence of compressibility</li>\n<li>Absence of blood flow</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venogram </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Accurate for detecting and locating <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> and differentiating <span class=\"customMeta\" data-dictid=\"3cd09dcb0e1692777194e41a18d184\">occlusive</span> and non-occlusive <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> but less commonly used due to invasiveness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impedance Plethysmography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures changes in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> volume and flow using a cuff. Less useful for calf <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> and previous thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrin and <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">Fibrinogen</span> Assays</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> products, including D-dimer.</p>\n<p>D-dimer has a high negative predictive value.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radioactive <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">Fibrinogen</span> Study</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses <span class=\"customMeta\" data-dictid=\"7cd1a840a2169277719756692d362d\">radiolabeled</span> <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">fibrinogen</span> to detect thrombus. Less commonly used.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRVI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-invasive; Useful for <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> veins and IVC.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subcutaneous LMWH: Rapidly anticoagulate confirmed <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> cases.</li>\n<li>Intravenous Unfractionated Heparin: For patients with significant <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment.</li>\n<li>Fondaparinux or Bivalirudin: Alternatives for those with <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">heparin</span> sensitivity or heparin-induced thrombocytopenia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transition to Oral Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Duration: At least 3 months or longer based on risk factors or recurrence.</li>\n<li>Novel anticoagulants (NOACs): Rivaroxaban, <span class=\"customMeta\" data-dictid=\"bd0e99d93a169277718152523f2534\">Apixaban</span> (factor Xa inhibitors), Dabigatran (direct <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> inhibitor).</li>\n<li>Vitamin K Antagonists: <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">Warfarin</span> (alternative to NOACs).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Heparin: <span class=\"customMeta\" data-dictid=\"0f61fd74c41692777180190320f12e\">Activated partial <span class=\"customMeta\" data-dictid=\"9b51982d06169277720063c9420fbb\">thromboplastin</span> time</span> (APTT).</li>\n<li>Warfarin: INR maintained between 2.0 to 3.0.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>For Patients with contraindications to Anticoagulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temporary <span class=\"customMeta\" data-dictid=\"b1fef54dba1692777190ee3669e3e0\">IVC</span> Filter:</strong> Consider if <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk prevents <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> or to prevent <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism. It does not treat the existing <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> and is associated with long-term complications. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endovascular Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thrombus removal, lysis, and stenting.</li>\n<li>Beneficial in selected patients, especially those with <span class=\"customMeta\" data-dictid=\"dae3263b2716927771896cfc9f45c8\">iliofemoral</span> thrombosis, to reduce risk of chronic post-thrombotic syndrome.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following health programmes supports DANIDA?", "options": [{"label": "A", "text": "TB", "correct": false}, {"label": "B", "text": "Blindness", "correct": true}, {"label": "C", "text": "Malaria", "correct": false}, {"label": "D", "text": "HIV", "correct": false}], "correct_answer": "B. Blindness", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vEmUAF8RSjdRqIvv4yz21741075539.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:595px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Agencies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Headquarters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Services in India</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>United States Agency for International Development (USAID)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><em>Washington</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malaria eradication</li>\n<li>Medical and <span class=\"customMeta\" data-dictid=\"6f686e0c91169277719346f95361c8\">nursing</span> education</li>\n<li>Health education</li>\n<li>Water supply and sanitation</li>\n<li>Nutrition and Family Planning</li>\n<li>Control of <span class=\"customMeta\" data-dictid=\"6f6ef8bf7c1692777184dfdf8cf45d\">Communicable</span> Diseases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Swedish International Development Agency (SIDA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><em>Sweden</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assisting the National TB Control Program</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Danish International Development Agency (DANIDA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><em>Denmark</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assisting the National <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">Blindness</span> Control Programme.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a long-standing history of diabetes presents with cataracts. Which of the following metabolic products is primarily responsible for cataract formation in this condition?", "options": [{"label": "A", "text": "Mannitol", "correct": false}, {"label": "B", "text": "Galactitol", "correct": false}, {"label": "C", "text": "Sorbitol", "correct": true}, {"label": "D", "text": "Fructose", "correct": false}], "correct_answer": "C. Sorbitol", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ys19euRMGOTRwz9l6vlj1741021676.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A married female died in unnatural condition within 3 years of marriage. Her father filed a report to police and inquiry will be done under which section?", "options": [{"label": "A", "text": "194 BNSS/174 CrPC", "correct": false}, {"label": "B", "text": "196 BNSS/176 CrPC", "correct": true}, {"label": "C", "text": "116 BNS &amp;amp; 194 BNSS", "correct": false}, {"label": "D", "text": "106 BNS &amp;amp; 194 BNSS", "correct": false}], "correct_answer": "B. 196 BNSS/176 CrPC", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Police Inquest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magistrate Inquest</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conducted by</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Police officer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Magistrate (DM, SDM, Judicial, or Executive Magistrate)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Involvement of witnesses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires signatures of panchas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Does not require witness signatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Witness statements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Admissible in court</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not admissible in court</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Can order arrest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No, but can arrest in cognizable offenses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can issue arrest warrants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exhumation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cannot order exhumation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can order <span class=\"customMeta\" data-dictid=\"9ede3648ef1692777187540bde750b\">exhumation</span> of a body</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autopsy orders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sends bodies for <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> indiscriminately</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Orders <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> only when necessary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Forensic analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cannot order chemical analysis of viscera</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can order chemical analysis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 9-month-old child was admitted to ICU with a history of recurrent sinusitis and otitis media by Staphylococcus aureus. Blood test shows decreased serum IgA, IgG, IgM, IgE, and plasma B cells. What is the diagnosis?", "options": [{"label": "A", "text": "Ataxia telangiectasia", "correct": false}, {"label": "B", "text": "Chronic granulomatosis disease", "correct": false}, {"label": "C", "text": "Bruton syndrome", "correct": true}, {"label": "D", "text": "DiGeorge syndrome", "correct": false}], "correct_answer": "C. Bruton syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A group of students consumed fried rice in a restaurant. Six hours later, they start vomiting. What is the etiological agent?", "options": [{"label": "A", "text": "Bacillus cereus", "correct": true}, {"label": "B", "text": "Clostridium botulinum", "correct": false}, {"label": "C", "text": "Escherichia coli", "correct": false}, {"label": "D", "text": "Shigella dysentriae", "correct": false}], "correct_answer": "A. Bacillus cereus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Food Poisoning</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li><strong>Two distinct forms: diarrhoeal and emetic</strong>.</li>\n<li><strong>Diarrhoeal form:</strong> <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">Linked</span> to contaminated meat, poultry, vegetables, and pasta; symptoms appear 8-16 hours post-ingestion.</li>\n<li>Symptoms: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain, diarrhoea (vomiting less common, fever rare)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li><strong>Emetic form</strong><strong>:</strong> Associated with cooked rice, especially <strong>fried rice</strong>; <strong>nausea and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> within 1-6 hours. </strong></li>\n<li>Some cases may include diarrhoea</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Other Infections</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li><strong>Opportunistic infections:</strong> <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">Ocular</span> infections, meningitis, septicemia, endocarditis, osteomyelitis</li>\n</ul>\n<ul>\n<li>More common in <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> individuals, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> drug users, neonates, and post-surgical patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:646px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnostic Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Food Poisoning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Culture of implicated food essential.</li>\n<li>&gt;10<sup>5</sup> B. cereus cells per <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> confirms the diagnosis.</li>\n<li>Quantitative <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> cultures with at least 10<sup>5</sup> cells per <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> support diagnosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Culture Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Aerobic growth at 37°C on sheep blood agar.</li>\n<li>β-hemolytic colonies with frosted glass appearance.</li>\n<li>Motile, lecithinase positive, fermenting salicin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Selective Media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>MYPA aids in isolating B. cereus from faeces and other sources</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Spore-forming, <span class=\"customMeta\" data-dictid=\"c72cd5f69316927771883c73649d86\">Gram-positive</span> bacilli.</li>\n<li>Motile</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Under IDSP, which diseases are included under sentinel surveillance?", "options": [{"label": "A", "text": "HIV + HBV", "correct": true}, {"label": "B", "text": "HIV + TB", "correct": false}, {"label": "C", "text": "Malaria + Dengue", "correct": false}, {"label": "D", "text": "Measles + Diphtheria", "correct": false}], "correct_answer": "A. HIV + HBV", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During spermatogenesis, which of the following hormones inhibits Follicle-Stimulating Hormone (FSH) secretion?", "options": [{"label": "A", "text": "Testosterone", "correct": false}, {"label": "B", "text": "Inhibin", "correct": true}, {"label": "C", "text": "Luteinizing Hormone (LH)", "correct": false}, {"label": "D", "text": "Androgen", "correct": false}], "correct_answer": "B. Inhibin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a class of 100 students, 80% students were immunised with measles, 12 were affected. What is the secondary attack rate?", "options": [{"label": "A", "text": "60%", "correct": true}, {"label": "B", "text": "80%", "correct": false}, {"label": "C", "text": "70%", "correct": false}, {"label": "D", "text": "50%", "correct": false}], "correct_answer": "A. 60%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young female has episodes of binge eating followed by self-induced vomiting. Which of the following acid- base disturbace is she likely to have?", "options": [{"label": "A", "text": "Respiratory acidosis", "correct": false}, {"label": "B", "text": "Respiratory alkalosis", "correct": false}, {"label": "C", "text": "Metabolic acidosis", "correct": false}, {"label": "D", "text": "Metabolic alkalosis", "correct": true}], "correct_answer": "D. Metabolic alkalosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kvgXPbwHX6BSIqD70Hex1741030324.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Binge Eating Episodes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Recurring episodes of <span class=\"customMeta\" data-dictid=\"45c64c16b516927771832de6bd0523\">binge</span> eating, occurring at least weekly for the last 3 months.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Compensatory Behaviors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Purging behaviors (self-induced vomiting, <span class=\"customMeta\" data-dictid=\"452c3c115d169277719186b3353c18\">laxative</span> abuse, diuretics), excessive exercise.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>BMI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Often normal or slightly <span class=\"customMeta\" data-dictid=\"e01b899fb61692777194fb4270ce6f\">overweight</span> (compared to <span class=\"customMeta\" data-dictid=\"8deb4a7e2b1692777181c91be40ed9\">anorexia</span> nervosa).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Physical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Parotid <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> (may see increased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> amylase)</li>\n<li style=\"text-align: center;\">Enamel <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> (from vomiting)</li>\n<li style=\"text-align: center;\">Mallory-Weiss syndrome (esophageal tears)</li>\n</ul>\n<p style=\"text-align: center;\">These signs appear due to repeated purging.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Electrolyte Disturbances</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Commonly <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> and hypochloremia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Metabolic Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\"><strong>Metabolic alkalosis</strong> due to vomiting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Physical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li style=\"text-align: center;\">Dorsal hand calluses from <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (Russell sign).</li>\n</ul>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"251\" src=\"https://image.prepladder.com/content/kvgXPbwHX6BSIqD70Hex1741030324.png\" width=\"296\"/></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old unvaccinated child presents with fever, rash, and Bitot spots. What is the appropriate line of management?", "options": [{"label": "A", "text": "Measles Vaccine + Vitamin A Supplementation", "correct": false}, {"label": "B", "text": "Only Measles Vaccine", "correct": false}, {"label": "C", "text": "Only Vitamin A Supplementation", "correct": true}, {"label": "D", "text": "Supportive Care", "correct": false}], "correct_answer": "C. Only Vitamin A Supplementation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FX1w2vvuC1ioCwcEPxwE1741089321.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:703px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Measles</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>ssRNA paramyxovirus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>10 days from exposure to onset of fever and 14 days to the appearance of rash</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Source of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Person with measles</li>\n<li>Infective material</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Period of communicability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>4 days before and 4 days after the appearance of rash</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prodromal stage</strong>:</p>\n<ul>\n<li>Fever</li>\n<li>Cough</li>\n<li>Coryza with sneezing</li>\n<li>Conjunctivitis with lacrimation</li>\n<li><strong>Koplik’s spots-</strong><em> </em>grayish-white spots on the <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">buccal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (<strong>Pathognomonic</strong> feature)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Eruptive stage</strong>:</p>\n<ul>\n<li>Dusky red macular/maculopapular rash, which starts behind the ears and progresses to the face, neck and then to trunks and limbs.</li>\n<li>In the absence of complications, the lesions and fever disappear after 3-4 days.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Post <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> stage:</strong></p>\n<ul>\n<li>After the <span class=\"customMeta\" data-dictid=\"8d4614c31316927771874f34d090a9\">eruptive</span> stage, it leads to weight loss, weakness, fatigue, diarrhea.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Isolation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>7 days from the onset of rash</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Difference between <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> and <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Both rashes are maculopapular</li>\n<li>The <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> is more <span class=\"customMeta\" data-dictid=\"8793eea96e169277718446e2ea701a\">confluent</span> and botchy, whereas the <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> is <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> or non-confluent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinically diagnosed based on <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> and koplik’s spots</li>\n<li>Gold standard: PCR</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No specific treatment</li>\n<li>Symptomatic management only</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with rheumatoid arthritis is taking indomethacin and an ACE inhibitor for hypertension. What potential side effect is likely to be seen?", "options": [{"label": "A", "text": "Hyperkalemia", "correct": true}, {"label": "B", "text": "Hypercalcemia", "correct": false}, {"label": "C", "text": "Hypernatremia", "correct": false}, {"label": "D", "text": "Hyperphosphatemia", "correct": false}], "correct_answer": "A. Hyperkalemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug Interaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Implication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors + <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> Supplements/K-sparing diuretics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk of <span class=\"customMeta\" data-dictid=\"8bf09336411692777189d1a79bf6a5\">hyperkalemia</span> due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> by <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors combined with potassium-retaining agents.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monitoring <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels is crucial to avoid hyperkalemia, which can cause serious <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> issues such as arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors + NSAIDs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NSAIDs can reduce the anti-hypertensive effects of <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors and decrease <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> blood flow, increasing the risk of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure (ARF) or oliguria.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Use caution when combining NSAIDs with <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors, and closely monitor <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, particularly in high-risk patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors + Lithium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ACE inhibitors can increase the <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of lithium, potentially leading to <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> toxicity.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monitor <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> levels carefully when starting or adjusting <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors in patients taking lithium, and adjust the <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">dosage</span> as needed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors + Antacids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"cf91922bb816927771839a51f2d1e6\">bioavailability</span> of <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors due to binding with antacids.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Administer <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors at least two hours before or after antacids to maintain their efficacy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ACE Inhibitors + Diuretics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diuretics enhance the <span class=\"customMeta\" data-dictid=\"bf6247405e16927771891b6a068d36\">hypotensive</span> effects of <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors by depleting sodium and raising <span class=\"customMeta\" data-dictid=\"3567fba5001692777197a712b10a39\">renin</span> levels.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In patients already on diuretics, start <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors at a low dose to minimise the risk of excessive <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> reduction initially.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male presents to the emergency department with a strong urge to urinate but is unable to do so. He has a history of perineal trauma. On examination, blood is noted at the external urethral meatus. Which structure is most likely injured?", "options": [{"label": "A", "text": "Bulbar urethra", "correct": true}, {"label": "B", "text": "Posterior urethral valve", "correct": false}, {"label": "C", "text": "Intraperitoneal Bladder rupture", "correct": false}, {"label": "D", "text": "Membranous urethra", "correct": false}], "correct_answer": "A. Bulbar urethra", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urethral Segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (Anterior)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Straddle injuries, <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> trauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood at meatus, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention, <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> hematoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (Posterior)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pelvic fractures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-riding prostate, inability to pass urine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intraperitoneal <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">Bladder</span> Rupture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blunt <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> trauma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peritonitis, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> ascites</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Urethral Valve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital anomaly</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent UTIs, voiding difficulty</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old met with a bike accident and presented with the following finding. What is the diagnosis?", "options": [{"label": "A", "text": "Anterior hip dislocation", "correct": true}, {"label": "B", "text": "Posterior hip dislocation", "correct": false}, {"label": "C", "text": "Superior hip dislocation", "correct": false}, {"label": "D", "text": "Both a and b", "correct": false}], "correct_answer": "A. Anterior hip dislocation", "question_images": ["https://image.prepladder.com/content/33ECoaZhkud2FQ6XdDK91741087423.png"], "explanation_images": ["https://image.prepladder.com/content/NPQCcxl5hsgf8CLUAAOZ1741087485.png", "https://image.prepladder.com/content/33ECoaZhkud2FQ6XdDK91741087423.png", "https://image.prepladder.com/content/PAfjIQCWLjvM8sCHv51z1741059939.png", "https://image.prepladder.com/content/YdT8KH1yLO0TmyRgGSH71741059974.png", "https://image.prepladder.com/content/JXtWOXe0wpraZRzwbvFD1741060016.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:722px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"1954a47dd6169277720351aed9c4c0\">fracture-dislocation</span> of hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Mechanism of injury:</strong><br/>\n\t\t\t </p>\n<p>Caused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>Femoral head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Femoral head displaced from the acetabulum.</li>\n<li>The thigh is internally rotated, the <span class=\"customMeta\" data-dictid=\"0404f7b31816927771912f2b470952\">lesser trochanter</span> is not seen, and Shenton’s line is broken.</li>\n<li>May require a <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> for associated fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening </strong><strong>of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"705\" src=\"https://image.prepladder.com/content/NPQCcxl5hsgf8CLUAAOZ1741087485.png\" width=\"732\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p style=\";\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"627\" src=\"https://image.prepladder.com/content/33ECoaZhkud2FQ6XdDK91741087423.png\" width=\"1889\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"402\" src=\"https://image.prepladder.com/content/PAfjIQCWLjvM8sCHv51z1741059939.png\" width=\"276\"/>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"386\" src=\"https://image.prepladder.com/content/YdT8KH1yLO0TmyRgGSH71741059974.png\" width=\"237\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"378\" src=\"https://image.prepladder.com/content/JXtWOXe0wpraZRzwbvFD1741060016.png\" width=\"302\"/>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A forensic expert received a summons from the district court to record his evidence in a criminal case, but two days prior, he already received a summons for a civil case in the same district court for the same date. What should the doctor do?", "options": [{"label": "A", "text": "Inform both courts and wait.", "correct": false}, {"label": "B", "text": "Attend the court for which the summons came first.", "correct": false}, {"label": "C", "text": "Attend the court for the criminal case.", "correct": true}, {"label": "D", "text": "Do not attend either court.", "correct": false}], "correct_answer": "C. Attend the court for the criminal case.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the afferent limb of the corneal reflex?", "options": [{"label": "A", "text": "Optic nerve", "correct": false}, {"label": "B", "text": "Facial nerve", "correct": false}, {"label": "C", "text": "Trigeminal nerve", "correct": true}, {"label": "D", "text": "Trochlear nerve", "correct": false}], "correct_answer": "C. Trigeminal nerve", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Afferent Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Efferent Nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Accommodation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>II (Optic nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>III (Oculomotor nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Corneal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₁ (Ophthalmic, <span class=\"customMeta\" data-dictid=\"cdd6d30ff216927771933bc53be84b\">nasociliary</span> branch)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Bilateral VII (Facial nerve, <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> branch - orbicularis oculi)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cough</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve, also <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">phrenic</span> and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerves)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Gag</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>IX (Glossopharyngeal nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>X (Vagus nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Jaw Jerk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₃ (Mandibular branch, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> from masseter)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₃ (Mandibular branch, motor to masseter)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lacrimation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>V₁ (Ophthalmic branch) (loss of <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> does not preclude emotional tears)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>VII (Facial nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pupillary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>II (Optic nerve)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>III (Oculomotor nerve)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is correct regarding indirect ophthalmoscopy?", "options": [{"label": "A", "text": "The image is erect and real.", "correct": false}, {"label": "B", "text": "The condenser lens needs to be kept close to the eye.", "correct": false}, {"label": "C", "text": "It provides 15x magnification.", "correct": false}, {"label": "D", "text": "It provides 3-5x magnification.", "correct": true}], "correct_answer": "D. It provides 3-5x magnification.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xaFsHF03IYHMQsLkoT8s1741023721.png", "https://image.prepladder.com/content/y5lmzjZP1vA2Qbty0MYk1741023727.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Direct Ophthalmoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indirect Ophthalmoscopy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image of <span class=\"customMeta\" data-dictid=\"415c59955f16927771947b9c105bbf\">ophthalmoscope</span> </strong></p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/xaFsHF03IYHMQsLkoT8s1741023721.png\" width=\"629\"/></td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1480\" src=\"https://image.prepladder.com/content/y5lmzjZP1vA2Qbty0MYk1741023727.png\" width=\"1600\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Erect, virtual</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Real, inverted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>About 15x (more in myopes, less in hypermetropes)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>About 2.5x with a +20D lens, smaller with stronger lenses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Field of View</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited, detailed central <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> examination</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Larger field of view</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Routine <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Essential for assessing <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> lesions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prerequisites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Semi-darkroom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Darkroom, dilated pupils, <span class=\"customMeta\" data-dictid=\"00ab88c6091692777185ea2685fa40\">convex</span> lens (+20D), <span class=\"customMeta\" data-dictid=\"eadd1d717a16927771833964224058\">binocular</span> ophthalmoscope</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient’s laboratory results were positive for malarial antigen, and the Widal test findings were as follows: O ag &amp;gt;1:300, H ag &amp;gt;1:20, A &amp;gt;1:20, B &amp;gt;1:20. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Recent infection by Salmonella spp", "correct": true}, {"label": "B", "text": "Patient has taken TAB vaccine", "correct": false}, {"label": "C", "text": "Past infection", "correct": false}, {"label": "D", "text": "Reconvalescence", "correct": false}], "correct_answer": "A. Recent infection by Salmonella spp", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:564px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Widal Test Result</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Suggestive of</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rise of TO and TH antibody</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enteric fever due to S. Typhi</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rise of TO and AH antibody</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enteric fever due to S. Paratyphi A</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rise of TO and BH antibody</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enteric fever due to S. Paratyphi B</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rise of only TO antibody</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recent infection due to S. Typhi or S. Paratyphi A or B</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rise of only TH antibody</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Convalescent stage / <span class=\"customMeta\" data-dictid=\"c57ee8d25f1692777181b1645ee4ef\">Anamnestic</span> response</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rise of all TH, AH, BH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-TAB <span class=\"customMeta\" data-dictid=\"f23be6aa561692777201ca2e1aaa27\">vaccination</span> antibodies (Option B)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man with a psychiatric disorder has become very aggressive. He speaks very rapidly and sleeps very little. He exhibits hyperactive behavior after discontinuing his prescribed medication. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Depression", "correct": false}, {"label": "B", "text": "Bipolar disorder - manic episode", "correct": true}, {"label": "C", "text": "Schizophrenia", "correct": false}, {"label": "D", "text": "Substance- induced mood disorder", "correct": false}], "correct_answer": "B. Bipolar disorder - manic episode", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bipolar I Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bipolar II Disorder</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by at least<strong> 1 episode of mania</strong> and<strong> 1 episode of depression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by at least <strong>1 episode of hypomania</strong> and<strong> 1 episode of depression</strong><strong> (Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M=F</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>F&gt;M</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mean age of onset is 30yrs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mean age of onset is slightly higher</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:264px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic criteria for Mania</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>M</strong>ood Changes: Elation/ irritability</li>\n</ul>\n<p>+ ≥3 of the following symptoms (4 if <span class=\"customMeta\" data-dictid=\"31383b73d01692777190c6880a580b\">irritable</span> mood) for at least <strong>1 week</strong>:</p>\n<ul>\n<li><strong>D</strong>istractibility.</li>\n<li><strong>I</strong>mpulsivity/ high-risk activities</li>\n</ul>\n<ul>\n<li><strong>G</strong>randiosity/ Inflated Self-Esteem</li>\n<li><strong>F</strong>light of Ideas (Racing and expansive thoughts)</li>\n<li><strong>A</strong>ctivity increased (Hyperactivity)</li>\n<li><strong>S</strong>leep deficit (decreased need for sleep)</li>\n<li><strong>T</strong>alkativeness/ Pressured speech</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presents with a painful red granular lesion on the vulva accompanied by bilateral lymphadenopathy. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Chancroid", "correct": true}, {"label": "B", "text": "Neisseria Gonorrhoeae Infection", "correct": false}, {"label": "C", "text": "Granuloma Inguinale", "correct": false}, {"label": "D", "text": "Lymphogranuloma Venereum", "correct": false}], "correct_answer": "A. Chancroid", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Chancroid</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Causative organism</strong></td>\n<td><em>Haemophilus ducreyi</em></td>\n</tr>\n<tr>\n<td><strong>Incubation period</strong></td>\n<td>3–10 days</td>\n</tr>\n<tr>\n<td><strong>Ulcer</strong></td>\n<td><strong>Painful</strong>, non-indurated, soft <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> borders and <strong>granular base</strong></td>\n</tr>\n<tr>\n<td><strong>Number of ulcers</strong></td>\n<td>Often <strong>multiple</strong></td>\n</tr>\n<tr>\n<td><strong>Lymphadenopathy</strong></td>\n<td><strong>Painful</strong>, <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> or bilateral, may <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> <strong>buboes</strong> (fluctuant <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes)</td>\n</tr>\n<tr>\n<td><strong>Base of ulcer</strong></td>\n<td>Necrotic, purulent, bleeds on contact</td>\n</tr>\n<tr>\n<td><strong>Tenderness</strong></td>\n<td>Marked</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A villager was assaulted by 4-5 people &amp;amp; brought to hospital in serious condition. His dying declaration was being taken in hospital. What is correct regarding this process?", "options": [{"label": "A", "text": "Magistrate can record the statement", "correct": true}, {"label": "B", "text": "Doctor can record the statement", "correct": false}, {"label": "C", "text": "Leading questions can be asked", "correct": false}, {"label": "D", "text": "Oath is compulsory before recording the statement", "correct": false}], "correct_answer": "A. Magistrate can record the statement", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:733px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Dying Declaration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Dying Deposition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Recorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Anyone—Magistrate/doctor/village headman/police/any member of the public</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Always recorded by a Magistrate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Oath </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not required</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Must be taken</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Accused or his counsel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not present</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Always present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Cross-examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not done</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Done</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Legal value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Comparatively less</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Much more</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Admissibility if declarant survives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not admitted, but has corroborative value</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Fully admitted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Nature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Merely recording of statement</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Complete court procedure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Type of evidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Documentary</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Status in India</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Followed</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not followed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p><strong>Leading Qs </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Not Permitted</p>\n</td>\n<td style=\"border-bottom:1px solid #808080; border-left:1px solid #808080; border-right:1px solid #808080; border-top:1px solid #808080; vertical-align:top\">\n<p>Permitted</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a history of dysphagia, which is more pronounced for liquids than solids. Which radiological sign is most likely to be seen?", "options": [{"label": "A", "text": "Rat-tail sign", "correct": true}, {"label": "B", "text": "Filling defect", "correct": false}, {"label": "C", "text": "Corkscrew esophagus", "correct": false}, {"label": "D", "text": "Apple-core lesion", "correct": false}], "correct_answer": "A. Rat-tail sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/R6MgHinwvVI8otCHzJqs1741088479.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rat-tail sign</strong> (Correct Answer)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Achalasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smooth tapering of the <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> at the LES</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Filling defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal tumors, strictures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irregular <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"55052c0f0616927771829c99eec183\">barium</span> column</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corkscrew esophagus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> (DES)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple non-peristaltic contractions creating a \"corkscrew\" pattern</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Apple-core lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal or <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> cancer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Constricted <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> edges, resembling an apple core</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common causative organism of prosthetic heart valve endocarditis?", "options": [{"label": "A", "text": "S. viridans", "correct": false}, {"label": "B", "text": "S. aureus", "correct": false}, {"label": "C", "text": "S. epidermidis", "correct": true}, {"label": "D", "text": "Staphylococcus", "correct": false}], "correct_answer": "C. S. epidermidis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a routine pediatric check-up, a mother brings her 5 month old baby to the clinic. The pediatrician observes that the baby actively looks at his mother’s face and seems to respond with interest as she talks to him, showing recognition and engagement. When is this milestone normally achieved?", "options": [{"label": "A", "text": "2 months", "correct": false}, {"label": "B", "text": "3 months", "correct": true}, {"label": "C", "text": "6 months", "correct": false}, {"label": "D", "text": "9 months", "correct": false}], "correct_answer": "B. 3 months", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Developmental Milestones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gross Motor Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fine Motor Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Social Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Language Milestones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 month</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alerts to sounds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Social smile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neck holding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recognises mother, anticipates feed <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cooing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Laugh Loud</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rolls over</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bidextrous reach</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sits in <span class=\"customMeta\" data-dictid=\"83962896b5169277720032c8e8bd50\">tripod</span> position</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unidextrous reach</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recognize strangers, stranger anxiety</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monosyllables</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sits without support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stands with support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immature pincer grasp</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Waves bye bye</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bisyllables</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Creeps well, stands without support</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mature pincer grasp</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Comes when called, plays simple ball game</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 to 2 words with meaning</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Walks alone , creeps upstairs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Imitates scribbling, tower of 2 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jargon speech</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs, explores drawers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scribbles, tower of 3 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copies parents in task</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8 to 10 words vocabulary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Walks up and downstairs (2 <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> per step), jumps</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tower of 6 blocks, vertical and <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> stroke</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asks for food, drink, toilet, pulls people to show toys</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 to 3 word sentences</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rides tricycle, <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> going upstairs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tower of 9 blocks, copies circle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shares toys, knows full name and gender</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asks questions, tells name and gender</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hops on one foot, <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> going downstairs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copies cross, bridge with blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Plays cooperatively in a group, goes to toilet alone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Says song or poem, tells stories</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Copies triangle, gate with blocks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps in household tasks, dresses and undresses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asks meaning of words</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 310 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. 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Now she has developed an ulcer in the burn scar as shown in the image below. What is the most probable diagnosis ?", "options": [{"label": "A", "text": "Marjolin’s ulcer", "correct": true}, {"label": "B", "text": "Venous ulcer", "correct": false}, {"label": "C", "text": "Arterial ulcer", "correct": false}, {"label": "D", "text": "Cellulitis", "correct": false}], "correct_answer": "A. Marjolin’s ulcer", "question_images": ["https://image.prepladder.com/content/jCYJ4Oo8qL6EPcTf0oRN1692684444.png"], "explanation_images": [], "explanation": "<p>Correct option A - Marjolin’s u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presents with complaints of dysphagia, halitosis, and regurgitation . Radiological imaging shows a blind pouch at the level of the pharynx. What is the likely diagnosis ?", "options": [{"label": "A", "text": "Pulsion diverticula", "correct": true}, {"label": "B", "text": "Achalasia cardia", "correct": false}, {"label": "C", "text": "CA Esophagus", "correct": false}, {"label": "D", "text": "GERD", "correct": false}], "correct_answer": "A. Pulsion diverticula", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"cf49aa21c616927771961992dfef4e\"&gt;Pulsion&lt;/span&gt; Diverticu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "ABCD 2 scoring includes all the following parameters except?", "options": [{"label": "A", "text": "Age", "correct": false}, {"label": "B", "text": "Hypertension", "correct": false}, {"label": "C", "text": "History of stroke", "correct": true}, {"label": "D", "text": "Diabetes Mellitus", "correct": false}], "correct_answer": "C. History of stroke", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - History of stroke </p>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>Age</strong></td>\n<td><strong>Blood pressure</strong></td>\n<td><strong>Clinical features</strong></td>\n<td><strong>Duration of TIA</strong></td>\n<td><strong>DM</strong></td>\n</tr>\n<tr>\n<td><strong>No point</strong></td>\n<td>&lt;60 years</td>\n<td>&lt;140/90 mmHg</td>\n<td>No speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> and no <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> weakness</td>\n<td>&lt;10 minutes</td>\n<td>Absent</td>\n</tr>\n<tr>\n<td><strong>1 point</strong></td>\n<td>≥60 years</td>\n<td>≥140/90 mmHg</td>\n<td>Speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> present but no <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> weakness</td>\n<td>10-59 minutes</td>\n<td>Present</td>\n</tr>\n<tr>\n<td><strong>2 point</strong></td>\n<td style=\"text-align:center\">-</td>\n<td style=\"text-align:center\">-</td>\n<td>Unilateral weakness</td>\n<td>≥60 minutes</td>\n<td style=\"text-align:center\">-</td>\n</tr>\n</tbody>\n\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>Age</strong></td>\n<td><strong>Blood pressure</strong></td>\n<td><strong>Clinical features</strong></td>\n<td><strong>Duration of TIA</strong></td>\n<td><strong>DM</strong></td>\n</tr>\n<tr>\n<td><strong>No point</strong></td>\n<td>&lt;60 years</td>\n<td>&lt;140/90 mmHg</td>\n<td>No speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> and no <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> weakness</td>\n<td>&lt;10 minutes</td>\n<td>Absent</td>\n</tr>\n<tr>\n<td><strong>1 point</strong></td>\n<td>≥60 years</td>\n<td>≥140/90 mmHg</td>\n<td>Speech <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> present but no <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> weakness</td>\n<td>10-59 minutes</td>\n<td>Present</td>\n</tr>\n<tr>\n<td><strong>2 point</strong></td>\n<td>-</td>\n<td>-</td>\n<td>Unilateral weakness</td>\n<td>≥60 minutes</td>\n<td>-</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man, a smoker, presented to the OPD with complaints of fatigue. He is known to be anemic and his sister had a history of endometrial cancer. The physician is considering appropriate colorectal cancer screening methods for this patient. Which screening method should be recommended for colorectal malignancy in this patient?", "options": [{"label": "A", "text": "Barium enema", "correct": false}, {"label": "B", "text": "Colonoscopy every 10 years", "correct": true}, {"label": "C", "text": "Check for occult blood in stool", "correct": false}, {"label": "D", "text": "Flexible sigmoidoscopy yearly", "correct": false}], "correct_answer": "B. Colonoscopy every 10 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"0c22b22aab169277718457c4c8d6c3\"&gt;Colonoscopy&lt;/span&gt; ev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a complicated delivery, a mother died. Which of the following is the most common Direct cause of maternal death?", "options": [{"label": "A", "text": "Embolism", "correct": false}, {"label": "B", "text": "Heart Disease", "correct": false}, {"label": "C", "text": "Hemorrhage", "correct": true}, {"label": "D", "text": "Anemia", "correct": false}], "correct_answer": "C. Hemorrhage", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hDuopNovH6y4fliz71rW1697716177.png"], "explanation": "<p>Correct Option C - \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female presents with redness and a Peau d'orange appearance involving more than 2/3 of her breast, without any palpable lump in the breast. On further evaluation, it is found that the skin involvement extends to the chest wall and is suggestive of inflammatory carcinoma . What is the appropriate TNM staging for this patient?", "options": [{"label": "A", "text": "T4a", "correct": false}, {"label": "B", "text": "T4b", "correct": false}, {"label": "C", "text": "T3", "correct": false}, {"label": "D", "text": "T4d", "correct": true}], "correct_answer": "D. T4d", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D - T4d</p>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>T Category</strong></td>\n<td><strong>T Criteria</strong></td>\n</tr>\n<tr>\n<td>TX</td>\n<td>Primary tumor cannot be assessed</td>\n</tr>\n<tr>\n<td>T0</td>\n<td>No evidence of primary tumor</td>\n</tr>\n<tr>\n<td>Tis (DCIS)</td>\n<td>Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in situ</td>\n</tr>\n<tr>\n<td>Tis (Paget)</td>\n<td>Paget disease not associated with <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> or DCIS</td>\n</tr>\n<tr>\n<td>T1a</td>\n<td>Tumor size ≤1 mm</td>\n</tr>\n<tr>\n<td>T1b</td>\n<td>Tumor size &gt;1 mm but ≤5 mm</td>\n</tr>\n<tr>\n<td>T1c</td>\n<td>Tumor size &gt;5 mm but ≤10 mm</td>\n</tr>\n<tr>\n<td>T1d</td>\n<td>Tumor size &gt;10 mm but ≤20 mm</td>\n</tr>\n<tr>\n<td>T2</td>\n<td>Tumor size &gt;20 mm but ≤50 mm</td>\n</tr>\n<tr>\n<td>T3</td>\n<td>Tumor size &gt;50mm</td>\n</tr>\n<tr>\n<td>T4a</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> invasion</td>\n</tr>\n<tr>\n<td>T4b</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"f446058fd81692777191e035c08229\">macroscopic</span> skin changes including <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> and/or satellite skin nodules and/or edema</td>\n</tr>\n<tr>\n<td>T4c</td>\n<td>Tumor with criteria of both T4a and T4b</td>\n</tr>\n<tr>\n<td>T4d</td>\n<td>Inflammatory carcinoma</td>\n</tr>\n</tbody>\n\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td><strong>T Category</strong></td>\n<td><strong>T Criteria</strong></td>\n</tr>\n<tr>\n<td>TX</td>\n<td>Primary tumor cannot be assessed</td>\n</tr>\n<tr>\n<td>T0</td>\n<td>No evidence of primary tumor</td>\n</tr>\n<tr>\n<td>Tis (DCIS)</td>\n<td>Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in situ</td>\n</tr>\n<tr>\n<td>Tis (Paget)</td>\n<td>Paget disease not associated with <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> or DCIS</td>\n</tr>\n<tr>\n<td>T1a</td>\n<td>Tumor size ≤1 mm</td>\n</tr>\n<tr>\n<td>T1b</td>\n<td>Tumor size &gt;1 mm but ≤5 mm</td>\n</tr>\n<tr>\n<td>T1c</td>\n<td>Tumor size &gt;5 mm but ≤10 mm</td>\n</tr>\n<tr>\n<td>T1d</td>\n<td>Tumor size &gt;10 mm but ≤20 mm</td>\n</tr>\n<tr>\n<td>T2</td>\n<td>Tumor size &gt;20 mm but ≤50 mm</td>\n</tr>\n<tr>\n<td>T3</td>\n<td>Tumor size &gt;50mm</td>\n</tr>\n<tr>\n<td>T4a</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> invasion</td>\n</tr>\n<tr>\n<td>T4b</td>\n<td>Tumor with <span class=\"customMeta\" data-dictid=\"f446058fd81692777191e035c08229\">macroscopic</span> skin changes including <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> and/or satellite skin nodules and/or edema</td>\n</tr>\n<tr>\n<td>T4c</td>\n<td>Tumor with criteria of both T4a and T4b</td>\n</tr>\n<tr>\n<td>T4d</td>\n<td>Inflammatory carcinoma</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 39-year-old patient presented with RTA and is brought to ER with a pulse rate of 120/min, and SBP of &amp;lt;80mmHg. Despite intravenous fluid resuscitation and BT, the patient's condition deteriorates with ongoing profuse bleeding from the liver . Identify the procedure shown in the image done to control massive liver bleed.", "options": [{"label": "A", "text": "Kocher maneuver", "correct": false}, {"label": "B", "text": "Pringle’s maneuver", "correct": true}, {"label": "C", "text": "Cattell-Braasch maneuver", "correct": false}, {"label": "D", "text": "Mattox maneuver", "correct": false}], "correct_answer": "B. Pringle’s maneuver", "question_images": ["https://image.prepladder.com/content/mLpkfs26tDRHHbEP5oCd1692686136.jpeg", "https://image.prepladder.com/content/L7JB9TAdDSwWdKIkxvBz1695740045.png"], "explanation_images": [], "explanation": "<p>Correct option B - Pringle's maneuv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of material is in the mesh used in Lichtenstein hernioplasty?", "options": [{"label": "A", "text": "Polypropylene", "correct": true}, {"label": "B", "text": "Polyglactin", "correct": false}, {"label": "C", "text": "Polydioxanone", "correct": false}, {"label": "D", "text": "Polyacrilamide", "correct": false}], "correct_answer": "A. Polypropylene", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Polypropylene: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old patient presents with a unique psychological phenomenon in which they believe that a close family member has been replaced by an imposter with an uncanny resemblance. This is commonly seen in which type of dementia?", "options": [{"label": "A", "text": "Alzheimer's disease", "correct": false}, {"label": "B", "text": "Lewy body dementia", "correct": true}, {"label": "C", "text": "Vascular dementia", "correct": false}, {"label": "D", "text": "Frontotemporal dementia", "correct": false}], "correct_answer": "B. Lewy body dementia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old patient had a RTA and was brought to the emergency room with bradycardia and a high BP. The GCS of this patient is &amp;lt; 8. What should be the immediate management in this patient?", "options": [{"label": "A", "text": "Urgent CT head", "correct": false}, {"label": "B", "text": "Intubate and IPPV", "correct": true}, {"label": "C", "text": "Thrombolysis", "correct": false}, {"label": "D", "text": "Normal saline infusion", "correct": false}], "correct_answer": "B. Intubate and IPPV", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"ec62425aa9169277719050edbb4d55\"&gt;Intubate&lt;/span&gt; and IPPV (Intermittent &lt;span class=\"customMeta\" data-dictid=\"3121d7693a169277719696af2cead1\"&gt;Positive Pressure&lt;/span&gt; Ventilation)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-years-old patient presents with complaints of sudden and irresistible urges to take action . This is the characteristic of which symptom?", "options": [{"label": "A", "text": "Impulse", "correct": true}, {"label": "B", "text": "Hallucination", "correct": false}, {"label": "C", "text": "Delusion", "correct": false}, {"label": "D", "text": "Pseudohallucination", "correct": false}], "correct_answer": "A. Impulse", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Impu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient presents with persistent feelings of sadness, fatigue, loss of appetite and lack of motivation for the past several weeks. On further assessment, the patient reports a decreased interest in activities that were once enjoyable and a general sense of hopelessness. Which of the following is the key symptom of depression?", "options": [{"label": "A", "text": "Suicidal ideations", "correct": false}, {"label": "B", "text": "Low mood", "correct": true}, {"label": "C", "text": "Loss of interest in pleasurable activity", "correct": false}, {"label": "D", "text": "Loss of Appetite", "correct": false}], "correct_answer": "B. Low mood", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B- L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a layer of esophagus?", "options": [{"label": "A", "text": "Mucosa", "correct": false}, {"label": "B", "text": "Submucosa", "correct": false}, {"label": "C", "text": "Serosa", "correct": true}, {"label": "D", "text": "Muscularis", "correct": false}], "correct_answer": "C. Serosa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old male presents with a 5-day history of abdominal pain, fever and vomiting . On examination, there is a palpable mass in right iliac fossa with leukocytosis . What is the management plan for this condition?", "options": [{"label": "A", "text": "Ochsner-Sherren regime", "correct": true}, {"label": "B", "text": "Alvarado scoring", "correct": false}, {"label": "C", "text": "Laparoscopic appendectomy", "correct": false}, {"label": "D", "text": "Cholecystectomy", "correct": false}], "correct_answer": "A. Ochsner-Sherren regime", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Ochsner-Sherren reg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with alopecia of unknown origin and abdominal discomfort. What could be the most likely diagnosis based on the image below, which was retrieved from the stomach following a surgery?", "options": [{"label": "A", "text": "Trichobezoar", "correct": true}, {"label": "B", "text": "Splenic rupture", "correct": false}, {"label": "C", "text": "Pancreatic necrosis", "correct": false}, {"label": "D", "text": "Carcinoma stomach", "correct": false}], "correct_answer": "A. Trichobezoar", "question_images": ["https://image.prepladder.com/content/YsC6phNttfZk3PRLnfW41692686912.png"], "explanation_images": [], "explanation": "<p>Correct Option A- Trich\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn baby presents with bilious vomiting and abdominal distension within 2 days of birth . An X-ray abdomen was performed which is shown below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Duodenal atresia", "correct": true}, {"label": "B", "text": "Pyloric stenosis", "correct": false}, {"label": "C", "text": "Esophageal atresia", "correct": false}, {"label": "D", "text": "Gas in bowel", "correct": false}], "correct_answer": "A. Duodenal atresia", "question_images": ["https://image.prepladder.com/content/N6dne6ZO9SObHXyvupjE1692687072.png"], "explanation_images": [], "explanation": "<p>Correct option A - Du\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is showing stubbornness, rigidity and frugality . In which stage we can see this kind of behaviour due to fixation according to psychosexual stages of development?", "options": [{"label": "A", "text": "Anal", "correct": true}, {"label": "B", "text": "Oral", "correct": false}, {"label": "C", "text": "Phallic", "correct": false}, {"label": "D", "text": "Genital", "correct": false}], "correct_answer": "A. Anal", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A- A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 39-year-old male who had a road traffic accident and suffered from chest trauma was admitted to the ER. About 1800 ml of blood loss from the chest tube in an hour. What is the next step in management for this condition?", "options": [{"label": "A", "text": "Emergency Thoracotomy", "correct": true}, {"label": "B", "text": "Conservative for next 6-hours", "correct": false}, {"label": "C", "text": "Continue resuscitation", "correct": false}, {"label": "D", "text": "Wait &amp;amp; watch", "correct": false}], "correct_answer": "A. Emergency Thoracotomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Emergency Th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with aortic dissection, injury to which of the following structure will cause hiccups?", "options": [{"label": "A", "text": "Phrenic nerve", "correct": true}, {"label": "B", "text": "Abdominal aorta", "correct": false}, {"label": "C", "text": "Thoracic aorta", "correct": false}, {"label": "D", "text": "Spinal accesory nerve", "correct": false}], "correct_answer": "A. Phrenic nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\"&gt;Phrenic&lt;/span&gt; nerve: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are features of pseudohallucinations, except?", "options": [{"label": "A", "text": "They occur without external stimulus", "correct": false}, {"label": "B", "text": "They are perceived in the outer objective space", "correct": true}, {"label": "C", "text": "They are not vivid", "correct": false}, {"label": "D", "text": "They are done voluntarily", "correct": false}], "correct_answer": "B. They are perceived in the outer objective space", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B- They are perceived in the outer objectiv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45 year old patient with a history of kidney stones that were surgically removed 2 years ago presents with complaints of fever and flank pain. Imaging done is shown here. What would be the most appropriate next step in the management of this patient?", "options": [{"label": "A", "text": "Laparotomy to remove the stones", "correct": false}, {"label": "B", "text": "Lithotripsy to remove recurrent stone", "correct": false}, {"label": "C", "text": "Leave the foreign body inside", "correct": false}, {"label": "D", "text": "Cystoscopic retrieval of foreign Body", "correct": true}], "correct_answer": "D. Cystoscopic retrieval of foreign Body", "question_images": ["https://image.prepladder.com/content/1fxPJEztudIvlF4rPrCw1698985337.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"8a8a7309fc169277718529cb457969\"&gt;Cystoscopic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"cbe99c8c751692777197bc9fcb503b\"&gt;retrieval&lt;/span&gt; of foreign B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 36-year-old male patient on psychiatric medication developed a sudden hypertensive episode after taking wine . He is on antidepressants . Which of the following drug the person be taking?", "options": [{"label": "A", "text": "MAO inhibitors", "correct": true}, {"label": "B", "text": "Amitriptyline", "correct": false}, {"label": "C", "text": "SSRI", "correct": false}, {"label": "D", "text": "Trazodone", "correct": false}], "correct_answer": "A. MAO inhibitors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"0307bca2ef1692777191b7df13d4b3\"&gt;MAO&lt;/span&gt; inhibitors (monoamine &lt;span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\"&gt;oxidase&lt;/span&gt; inhibitors)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old female presented to a psychiatrist with symptoms of low mood, loss of interest, loss of appetite and difficulty sleeping for 2 months. The diagnosis of a major depressive disorder is made by the psychiatrist. Which drug is best for the above-mentioned disorder?", "options": [{"label": "A", "text": "Buspirone", "correct": false}, {"label": "B", "text": "Lithium", "correct": false}, {"label": "C", "text": "Divalproex", "correct": false}, {"label": "D", "text": "Fluoxetine", "correct": true}], "correct_answer": "D. Fluoxetine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D - Flu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male patient presents with progressive dysphagia to solids and liquids and the manometry findings include uncoordinated or absent peristalsis with increased LES resting pressure . What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Stomach cancer", "correct": false}, {"label": "B", "text": "Cancer esophagus", "correct": false}, {"label": "C", "text": "GERD", "correct": false}, {"label": "D", "text": "Achalasia cardia", "correct": true}], "correct_answer": "D. Achalasia cardia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nZronbiGnnBBeTU2qrdf1697717318.png"], "explanation": "<p>Correct option D - &lt;span class=\"customMeta\" data-dictid=\"b032d2af58169277718080a9060b14\"&gt;Achalasia&lt;/span&gt; cardia \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a known case of HTN came in with complaints of headaches for five days. All classical signs, increased metanephrine levels, and other investigations indicate pheochromocytoma. What is the best imaging modality for this patient?", "options": [{"label": "A", "text": "CECT Chest and Abdomen", "correct": false}, {"label": "B", "text": "Sestamibi scan", "correct": false}, {"label": "C", "text": "MIBG", "correct": true}, {"label": "D", "text": "USG", "correct": false}], "correct_answer": "C. MIBG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - MIBG\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which fluid is administered most commonly during intraoperative blood loss?", "options": [{"label": "A", "text": "Isolyte P", "correct": false}, {"label": "B", "text": "Crystalloids", "correct": true}, {"label": "C", "text": "Blood", "correct": false}, {"label": "D", "text": "Colloids", "correct": false}], "correct_answer": "B. Crystalloids", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - Crystalloids: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with abdominal pain in the emergency room. . On examination, there is blackish discoloration involving the periumbilical skin . What is the most likely diagnosis for this presentation?", "options": [{"label": "A", "text": "Acute pancreatitis", "correct": true}, {"label": "B", "text": "Necrotizing fasciitis", "correct": false}, {"label": "C", "text": "Chronic pancreatitis", "correct": false}, {"label": "D", "text": "Traumatic fat necrosis", "correct": false}], "correct_answer": "A. Acute pancreatitis", "question_images": ["https://image.prepladder.com/content/ixEC3qlnzj3uTiHwPdQk1714383788.png"], "explanation_images": ["https://image.prepladder.com/content/gpP0KKonxRaQBDKI5wYW1714383802.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with a history of chronic alcohol consumption is admitted to the hospital with features of confusion, vision loss and an unsteady gait . He is unable to remember the most recent incidents. Which vitamin deficiency is responsible for his symptoms?", "options": [{"label": "A", "text": "Ascorbic acid", "correct": false}, {"label": "B", "text": "Retinol", "correct": false}, {"label": "C", "text": "Thiamine", "correct": true}, {"label": "D", "text": "Folate", "correct": false}], "correct_answer": "C. Thiamine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - &lt;span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\"&gt;Thiamine&lt;/span&gt; (Vitamin B1)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following condition is depicted in the given CT image ?", "options": [{"label": "A", "text": "Cirrhosis", "correct": false}, {"label": "B", "text": "HCC", "correct": false}, {"label": "C", "text": "Congenital Adrenal Hyperplasia", "correct": true}, {"label": "D", "text": "Hepatitis", "correct": false}], "correct_answer": "C. Congenital Adrenal Hyperplasia", "question_images": ["https://image.prepladder.com/content/44ujWdFrdwneABk7iBE51692688485.jpeg"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\"&gt;Congenital&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\"&gt;Adrenal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\"&gt;Hyperplasia&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old patient had a RTA and was brought to the ER. On examination, his GCS was E2M4V2 and his CT scan is given below. Which of the following is the preferred treatment in this condition?", "options": [{"label": "A", "text": "Ventilation", "correct": false}, {"label": "B", "text": "Craniotomy with evacuation of hematoma", "correct": true}, {"label": "C", "text": "Anticoagulants", "correct": false}, {"label": "D", "text": "Steroids", "correct": false}], "correct_answer": "B. Craniotomy with evacuation of hematoma", "question_images": ["https://image.prepladder.com/content/LIffCTmyiuuo99bLoyAQ1692688656.jpeg"], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"cecf1b86e61692777185f281991f2d\"&gt;Craniotomy&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\"&gt;evacuation&lt;/span&gt; of h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old patient presented with varicose veins. What is the investigation of choice for varicose veins?", "options": [{"label": "A", "text": "Duplex scan", "correct": true}, {"label": "B", "text": "Plethysmography", "correct": false}, {"label": "C", "text": "MRI", "correct": false}, {"label": "D", "text": "CT", "correct": false}], "correct_answer": "A. Duplex scan", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Du\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents after undergoing a Billroth II gastrectomy operation and complains of symptoms suggestive of dumping syndrome , including vomiting and diarrhea occurring approximately 20 minutes after meals. What should be the initial management for this patient's condition?", "options": [{"label": "A", "text": "Low fat diet", "correct": false}, {"label": "B", "text": "Small frequent meals", "correct": true}, {"label": "C", "text": "Insulin and protein", "correct": false}, {"label": "D", "text": "Reverse Billroth II to Billroth I", "correct": false}], "correct_answer": "B. Small frequent meals", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - Small frequ\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the Intubation of choice in a Maxillofacial trauma patient?", "options": [{"label": "A", "text": "Tracheostomy", "correct": true}, {"label": "B", "text": "Laryngeal mask airway", "correct": false}, {"label": "C", "text": "Orotracheal intubation", "correct": false}, {"label": "D", "text": "Mask ventilation", "correct": false}], "correct_answer": "A. Tracheostomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Trach\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most preferred site for the insertion of the intercostal tube drain?", "options": [{"label": "A", "text": "Upper border of lower rib", "correct": true}, {"label": "B", "text": "Lower border of upper rib", "correct": false}, {"label": "C", "text": "Lower border of lower rib", "correct": false}, {"label": "D", "text": "Middle of intercostal space", "correct": false}], "correct_answer": "A. Upper border of lower rib", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Upper border of lower rib \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female patient presents to the emergency department with chills and rigors . She has acute pain in right flank region . The imaging is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cholecystitis", "correct": false}, {"label": "B", "text": "Emphysematous pyelonephritis", "correct": true}, {"label": "C", "text": "Small bowel obstruction", "correct": false}, {"label": "D", "text": "Volvulus", "correct": false}], "correct_answer": "B. Emphysematous pyelonephritis", "question_images": ["https://image.prepladder.com/content/1H4qFDsGINPiWn2u3W4z1695740105.png"], "explanation_images": [], "explanation": "<p>Correct option B - Emphysematous pyeloneph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which part of cranial fossa is injured in Raccoon eyes?", "options": [{"label": "A", "text": "Anterior cranial fossa", "correct": true}, {"label": "B", "text": "Middle cranial fossa", "correct": false}, {"label": "C", "text": "Posterior cranial fossa", "correct": false}, {"label": "D", "text": "Bone aponeurotic layer", "correct": false}], "correct_answer": "A. Anterior cranial fossa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;Anterior&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\"&gt;cranial&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old male patient presents with urinary complaints. He has a history of working in a dye factory in the past. On USG examination, his bladder walls are found to be thickened and irregular. What is the most appropriate management for this patient?", "options": [{"label": "A", "text": "Instillation of BCG", "correct": false}, {"label": "B", "text": "Cystoscopy with tumor removal", "correct": false}, {"label": "C", "text": "Intravesical mitomycin C", "correct": false}, {"label": "D", "text": "Radical cystectomy", "correct": true}], "correct_answer": "D. Radical cystectomy", "question_images": ["https://image.prepladder.com/content/fv0eH683GOMJfoowy53h1692689157.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Radical C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn presents with bilious vomiting. Which sign is depicted in the following radiograph?", "options": [{"label": "A", "text": "Double bubble sign", "correct": true}, {"label": "B", "text": "Air crescent sign", "correct": false}, {"label": "C", "text": "Cupola sign", "correct": false}, {"label": "D", "text": "Triple bubble sign:", "correct": false}], "correct_answer": "A. Double bubble sign", "question_images": ["https://image.prepladder.com/content/1d9iMreTaf0TOVi4XoqK1695741126.png"], "explanation_images": [], "explanation": "<p>Correct option A - Double bubble sig\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Radiological sign</strong></td>\n<td><strong>Seen in</strong></td>\n</tr>\n<tr>\n<td>Double bubble sign</td>\n<td>Duodenal atresia</td>\n</tr>\n<tr>\n<td>Air <span class=\"customMeta\" data-dictid=\"0539eefe3f169277718547881d187d\">crescent</span> sign</td>\n<td>Invasive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> aspergillosis</td>\n</tr>\n<tr>\n<td>Cupola sign</td>\n<td>Pneumoperitoneum</td>\n</tr>\n<tr>\n<td>Triple bubble sign</td>\n<td>Jejunal atresia</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 39-year-old female presented in the OPD with bloody discharge from the nipple . On examination, it was found to be from a single lactiferous duct . What is the treatment for bloody nipple discharge with single duct involvement?", "options": [{"label": "A", "text": "Microdochectomy", "correct": true}, {"label": "B", "text": "Hadfield’s procedure", "correct": false}, {"label": "C", "text": "Microdiscectomy", "correct": false}, {"label": "D", "text": "IV antibiotics + Incision", "correct": false}], "correct_answer": "A. Microdochectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - Microdochectomy \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the best investigation to assess renal perfusion?", "options": [{"label": "A", "text": "DTPA scan", "correct": true}, {"label": "B", "text": "DMSA scan", "correct": false}, {"label": "C", "text": "RGU", "correct": false}, {"label": "D", "text": "CT urogram", "correct": false}], "correct_answer": "A. DTPA scan", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"6497d3860316927771867148ec55df\"&gt;DTPA&lt;/span&gt; (diethylenetriaminepentaacetic acid)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with a head injury after a hammer fell on the skull. CT is shown below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Concussion", "correct": false}, {"label": "B", "text": "Epidural hematoma", "correct": false}, {"label": "C", "text": "Depressed skull fracture", "correct": true}, {"label": "D", "text": "Subarachnoid hemorrhage", "correct": false}], "correct_answer": "C. Depressed skull fracture", "question_images": ["https://image.prepladder.com/content/hDwXksAKSEZUl4k0INHq1695741226.png"], "explanation_images": ["https://image.prepladder.com/content/hDwXksAKSEZUl4k0INHq1695741226.png"], "explanation": "<p>Correct option C - Depressed skull fractu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old patient presents with recurrent urinary tract infections and left flank pain . CT scan of the abdomen was performed and the image is shown below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Horseshoe kidney", "correct": true}, {"label": "B", "text": "Polycystic kidney disease", "correct": false}, {"label": "C", "text": "Renal ectopia", "correct": false}, {"label": "D", "text": "Hydronephrosis", "correct": false}], "correct_answer": "A. Horseshoe kidney", "question_images": ["https://image.prepladder.com/content/KsvN28Z1nzlkwcVKPl4A1692689818.png"], "explanation_images": [], "explanation": "<p>Correct option A - Horseshoe k\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has a painless, palpable bony mass near the metaphysis of a long bone . X-ray done shows the following finding. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Multiple myeloma", "correct": false}, {"label": "C", "text": "Osteochondroma", "correct": true}, {"label": "D", "text": "Osteoid osteoma", "correct": false}], "correct_answer": "C. Osteochondroma", "question_images": ["https://image.prepladder.com/content/T2VsSqRkGyQyN53nZRhd1692690597.jpeg"], "explanation_images": ["https://image.prepladder.com/content/T2VsSqRkGyQyN53nZRhd1692690597.jpeg", "https://image.prepladder.com/content/nTALEOirPNXRx4OtX8pa1711617368.png", "https://image.prepladder.com/content/5GCgjszpyg8QMHFaeHKQ1711617358.png"], "explanation": "<p>Correct option C - Osteoch\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>X-ray finding</strong></td>\n</tr>\n<tr>\n<td><strong>Osteochondroma</strong></td>\n<td>\n<p>Bony outgrowth with a <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> cap</p>\n<p><img src=\"https://image.prepladder.com/content/T2VsSqRkGyQyN53nZRhd1692690597.jpeg\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Osteosarcoma</strong></td>\n<td>\n<p>Destructive and <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with aggressive features such as <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> reaction, <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> destruction and soft tissue extension</p>\n<p><img src=\"https://image.prepladder.com/content/nTALEOirPNXRx4OtX8pa1711617368.png\" style=\"height:894px; width:651px\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Multiple myeloma</strong></td>\n<td>Lytic lesions throughout the bone, often <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as \"punched-out\" lesions</td>\n</tr>\n<tr>\n<td><strong>Osteoid osteoma</strong></td>\n<td>\n<p>Small <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> <span class=\"customMeta\" data-dictid=\"00375928541692777193ce8621da42\">nidus</span> surrounded by dense <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> bone</p>\n<p><img src=\"https://image.prepladder.com/content/5GCgjszpyg8QMHFaeHKQ1711617358.png\" style=\"height:544px; width:381px\"/></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following nerve is damaged in the picture of the patient given below?", "options": [{"label": "A", "text": "Radial nerve", "correct": true}, {"label": "B", "text": "Ulnar nerve", "correct": false}, {"label": "C", "text": "Median nerve", "correct": false}, {"label": "D", "text": "Axillary nerve", "correct": false}], "correct_answer": "A. Radial nerve", "question_images": ["https://image.prepladder.com/content/9dmfDQiZI74K7rCY5Zsw1692690868.png"], "explanation_images": ["https://image.prepladder.com/content/HVylnXNYTvDil6gZpS3O1711618367.png", "https://image.prepladder.com/content/d5xMPPMejiCOH6bUXnJP1711618390.png"], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\"&gt;Radial&lt;/span&gt; nerv\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"text-align:center\"><strong>Nerve Injury</strong></td>\n</tr>\n<tr>\n<td><strong>Radial nerve</strong></td>\n<td>\n<p>Wrist drop</p>\n<p><img src=\"https://image.prepladder.com/content/HVylnXNYTvDil6gZpS3O1711618367.png\" style=\"height:522px; width:495px\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Ulnar nerve</strong></td>\n<td>\n<p>Claw hand</p>\n<p><img src=\"https://image.prepladder.com/content/d5xMPPMejiCOH6bUXnJP1711618390.png\" style=\"height:521px; width:290px\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Median nerve</strong></td>\n<td>Paraesthesia of thumb, index and middle finger</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What condition is shown in the image?", "options": [{"label": "A", "text": "Biceps tendon rupture", "correct": true}, {"label": "B", "text": "Triceps muscle rupture", "correct": false}, {"label": "C", "text": "Humerus fracture", "correct": false}, {"label": "D", "text": "Tennis elbow", "correct": false}], "correct_answer": "A. Biceps tendon rupture", "question_images": ["https://image.prepladder.com/content/rCA7qK8JJ1oxotswww2W1692691070.jpeg"], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"6b395fd7b21692777183cf78e12920\"&gt;Biceps&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\"&gt;tendon&lt;/span&gt; ruptu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 11-year-old patient presents with an outward angulation of the forearm in relation to the upper arm . The patient reports occasional discomfort and limitation in the range of motion of the affected arm. What is the most likely diagnosis for this patient's condition?", "options": [{"label": "A", "text": "Cubitus varus", "correct": false}, {"label": "B", "text": "Cubitus valgus", "correct": true}, {"label": "C", "text": "Gunstock deformity", "correct": false}, {"label": "D", "text": "Coxa vara", "correct": false}], "correct_answer": "B. Cubitus valgus", "question_images": ["https://image.prepladder.com/content/j4hA1AprYytbfKB9XI8W1692878873.png"], "explanation_images": ["https://image.prepladder.com/content/kexyOhpcdjgxuiJbvuIs1711619639.png", "https://image.prepladder.com/content/aBb2896U1aKshZClwH4Z1711619679.png"], "explanation": "<p>Correct option B - &lt;span class=\"customMeta\" data-dictid=\"5a7668926a1692777185299ac4cf5a\"&gt;Cubitus&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\"&gt;valgus&lt;/span&g\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Cubitus valgus</strong></td>\n<td>Outward <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> in relation to the upper arm</td>\n</tr>\n<tr>\n<td><strong>Cubitus varus</strong></td>\n<td>Inward <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> in relation to the upper arm</td>\n</tr>\n<tr>\n<td><strong>Gunstock deformity</strong></td>\n<td>\n<ul>\n<li>Inward <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> due to a <span class=\"customMeta\" data-dictid=\"e9c1a7fec316927771915c5460d9a7\">malunion</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> after a fracture</li>\n<li>The <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> appears bent, resembling the shape of a gunstock</li>\n</ul>\n<p><img src=\"https://image.prepladder.com/content/kexyOhpcdjgxuiJbvuIs1711619639.png\" style=\"height:897px; width:673px\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Coxa vara</strong></td>\n<td>Decrease in the angle between the head and neck of the <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> leading to an inward <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the thigh bone</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 14-year-old patient presents to the outpatient department with a noticeable deformity of the neck and upper back. On physical examination, the patient's scapula is observed to be elevated and medially rotated, giving it the appearance of an equilateral triangle. The patient also has limited neck mobility. The patient and their family report that the deformity has been present since birth and has not improved over time. What is the likely diagnosis for this patient's condition?", "options": [{"label": "A", "text": "Separated shoulder deformity", "correct": false}, {"label": "B", "text": "Torticollis", "correct": false}, {"label": "C", "text": "Klippel-Feil deformity", "correct": true}, {"label": "D", "text": "Congenital scoliosis", "correct": false}], "correct_answer": "C. Klippel-Feil deformity", "question_images": ["https://image.prepladder.com/content/REnoPVf63k1liU1dMQOW1693230697.png"], "explanation_images": ["https://image.prepladder.com/content/x8zPYVbVIIXZCH1vDDBP1711626266.png"], "explanation": "<p>Correct option C - Klippel-F\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient has limited hip movement and complains of pain and discomfort in the hip region . Which of the following test is done to identify flexion deformity at the hip?", "options": [{"label": "A", "text": "Thomas test", "correct": true}, {"label": "B", "text": "Lasegue test", "correct": false}, {"label": "C", "text": "Telescopy", "correct": false}, {"label": "D", "text": "McMurray test", "correct": false}], "correct_answer": "A. Thomas test", "question_images": ["https://image.prepladder.com/content/RKNmJxtpktag1tXy0ne41692879330.png"], "explanation_images": ["https://image.prepladder.com/content/RKNmJxtpktag1tXy0ne41692879330.png"], "explanation": "<p>Correct option A - Th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which carcinoma is the possible diagnosis in the image given below?", "options": [{"label": "A", "text": "Basal cell carcinoma", "correct": false}, {"label": "B", "text": "Squamous cell carcinoma", "correct": false}, {"label": "C", "text": "Malignant melanoma", "correct": true}, {"label": "D", "text": "Hepatocellular carcinoma", "correct": false}], "correct_answer": "C. Malignant melanoma", "question_images": ["https://image.prepladder.com/content/w4iMDwjWBUWkrPpKAiaw1692879788.png"], "explanation_images": ["https://image.prepladder.com/content/ki2H3qH2MJOVGnUuhU0L1711628487.png", "https://image.prepladder.com/content/qVIEmridsHIP4yl3khb11711628541.png", "https://image.prepladder.com/content/nxZMB3R4Ucmd6RaGH7Fq1711628574.png"], "explanation": "<p>Correct option C - &lt;span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\"&gt;Malignant&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e42297345d16927771922d2d0dc020\"&gt;melanoma&lt;/span&g\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Malignant melanoma</strong></td>\n<td>\n<p>Irregularly shaped, dark-colored <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with uneven borders</p>\n<p><img src=\"https://image.prepladder.com/content/ki2H3qH2MJOVGnUuhU0L1711628487.png\" style=\"height:469px; width:827px\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Basal cell carcinoma</strong></td>\n<td>\n<p>Flesh-colored or pinkish <span class=\"customMeta\" data-dictid=\"c8ac1f988c169277718317d8480ac7\">bump</span> with a central depression and raised edges</p>\n<p><img src=\"https://image.prepladder.com/content/qVIEmridsHIP4yl3khb11711628541.png\" style=\"height:590px; width:777px\"/></p>\n</td>\n</tr>\n<tr>\n<td><strong>Squamous cell carcinoma</strong></td>\n<td>\n<p>Firm, red <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">nodule</span> or a scaly, crusted lesion</p>\n<p><img src=\"https://image.prepladder.com/content/nxZMB3R4Ucmd6RaGH7Fq1711628574.png\" style=\"height:549px; width:719px\"/></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient presents to the OPD with a history of prolonged use of steroids for a skin condition. The patient complains of an expanding rash that has become less red and itchy since using the steroids. On examination, there are well-defined, slightly raised, erythematous plaques with central clearing and a scaly border on various parts of the body. What is the most likely diagnosis for this patient's condition?", "options": [{"label": "A", "text": "Tinea incognito", "correct": true}, {"label": "B", "text": "Tinea corporis", "correct": false}, {"label": "C", "text": "Tinea cruris", "correct": false}, {"label": "D", "text": "Tinea pedis", "correct": false}], "correct_answer": "A. Tinea incognito", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"dbb566df9216927772009e22e9d078\"&gt;Tinea&lt;/span&gt; incog\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following instrument is shown in the image below?", "options": [{"label": "A", "text": "Veress needle", "correct": true}, {"label": "B", "text": "Hasson Cannula", "correct": false}, {"label": "C", "text": "Large Bore Cannula", "correct": false}, {"label": "D", "text": "Small bore cannula", "correct": false}], "correct_answer": "A. Veress needle", "question_images": ["https://image.prepladder.com/content/1AqL8TXToWPXyhztmwyb1695741410.png"], "explanation_images": ["https://image.prepladder.com/content/sc8sa8OWjiGPzAoDGQDW1747752778.png", "https://image.prepladder.com/content/ycQM8am8YnNRIcO1uwDb1747752821.png"], "explanation": "<p>Correct Option A- Veress N\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 45-year-old patient undergoing a preoperative assessment for a surgical procedure, which classification of Mallampati score is assigned based on the following description: Hard palate, soft palate, uvula, tip of the uvula, and tonsil pillars are visible. No oropharyngeal structures are obstructing the view.", "options": [{"label": "A", "text": "Grade I", "correct": true}, {"label": "B", "text": "Grade II", "correct": false}, {"label": "C", "text": "Grade III", "correct": false}, {"label": "D", "text": "Grade IV", "correct": false}], "correct_answer": "A. Grade I", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nJq4jlSuTDHTIF4LI2R81714990475.png"], "explanation": "<p>Correct Option A- &lt;span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\"&gt;Grade&lt;/span&gt; I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 60-year-old patient who has just experienced a cardiac arrest, which of the following interventions is not a part of the Advanced Cardiovascular Life Support (ACLS) protocol?", "options": [{"label": "A", "text": "Amiodarone", "correct": false}, {"label": "B", "text": "Defibrillation", "correct": false}, {"label": "C", "text": "Adrenaline", "correct": false}, {"label": "D", "text": "Soda Bicarbonate", "correct": true}], "correct_answer": "D. Soda Bicarbonate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D- &lt;span class=\"customMeta\" data-dictid=\"91ce1734d7169277719861b8b87f9f\"&gt;Soda&lt;/span&gt; B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vertebral level corresponds to Tuffier’s line, a clinically relevant anatomical landmark?", "options": [{"label": "A", "text": "L2-L3", "correct": false}, {"label": "B", "text": "L4-L5", "correct": true}, {"label": "C", "text": "L5-S1", "correct": false}, {"label": "D", "text": "L3-L4", "correct": false}], "correct_answer": "B. L4-L5", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B- L4-L5: </p>\n<p><strong>References:</strong></p>\n<ul><li>↳ This is the correct vertebral level corresponding to Tuffier's line. Tuffier's line is drawn between the highest points of the iliac crests, and it usually intersects the spine at the level of the fourth lumbar vertebra (L4) or the fifth lumbar vertebra (L5). It is an important reference for lumbar punctures because it helps determine the appropriate level for inserting the needle into the spinal canal without risk of damaging the spinal cord.</li><li>↳ Incorrect Options:</li><li>↳ Incorrect Options:</li><li>↳ Option A- L2-L3: This vertebral level is not relevant to Tuffier's line. Tuffier's line, also known as the intercristal line, is an anatomical landmark that corresponds to the highest point of the iliac crests. It is used as a reference point for lumbar punctures (spinal taps). L2-L3 would not be the correct level for Tuffier's line.</li><li>↳ Option A- L2-L3:</li><li>↳ Option C- L5-S1: This vertebral level is not directly related to Tuffier's line. Tuffier's line is typically drawn above the level of L5-S1, as it corresponds to the highest points of the iliac crests. Lumbar punctures are usually performed below L5-S1, at the L3-L4 or L4-L5 level.</li><li>↳ Option C- L5-S1:</li><li>↳ Option D- L3-L4: This vertebral level is close to the correct answer but not exactly accurate. While Tuffier's line intersects the spine around the L4-L5 level, some sources might mention L3-L4 as an approximate reference point. However, the more precise and commonly accepted landmark is L4-L5.</li><li>↳ Option D- L3-L4:</li></u\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child is brought to the clinic with a generalized vesicular rash covering the entire body. The child's parents report that the rash started as red spots and quickly developed into fluid-filled blisters. The child also has a mild fever and is feeling irritable. What is the most likely diagnosis for this child's condition?", "options": [{"label": "A", "text": "Varicella", "correct": true}, {"label": "B", "text": "Shingles", "correct": false}, {"label": "C", "text": "Smallpox", "correct": false}, {"label": "D", "text": "Dermatomyocytis", "correct": false}], "correct_answer": "A. Varicella", "question_images": ["https://image.prepladder.com/content/tlCBvBWynPmmMxuqRB6z1692695764.jpeg"], "explanation_images": [], "explanation": "<p>Correct Option A – &lt;span class=\"customMeta\" data-dictid=\"cf329b8cef169277720107b1efa15b\"&gt;Varicella&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not correct for the device depicted below:", "options": [{"label": "A", "text": "Based on infrared emitted from RBCs", "correct": true}, {"label": "B", "text": "Localizes calcified plaque", "correct": false}, {"label": "C", "text": "Checks blood flow", "correct": false}, {"label": "D", "text": "Checks thickness of artery and vein", "correct": false}], "correct_answer": "A. Based on infrared emitted from RBCs", "question_images": ["https://image.prepladder.com/content/LFbrQCGdCk07eOQjnxhv1700119115.png"], "explanation_images": [], "explanation": "<p>Correct option A - Based on &lt;span class=\"customMeta\" data-dictid=\"82df9c600116927771907b7977a3b4\"&gt;infrared&lt;/span&gt; emitted from RBC\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following mineral deficiency is associated with poor wound healing, dermatitis, diarrhoea and alopecia?", "options": [{"label": "A", "text": "Iron", "correct": false}, {"label": "B", "text": "Calcium", "correct": false}, {"label": "C", "text": "Magnesium", "correct": false}, {"label": "D", "text": "Zinc", "correct": true}], "correct_answer": "D. Zinc", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\"&gt;Zinc&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents with a bluish translucent extravasation cystic sublingual swelling . The swelling is accompanied by visible veins over the swelling and is transilluminant . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Thyroglossal cyst", "correct": false}, {"label": "B", "text": "Dermoid cyst", "correct": false}, {"label": "C", "text": "Ranula", "correct": true}, {"label": "D", "text": "Sublingual tumour", "correct": false}], "correct_answer": "C. Ranula", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - Ranu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents with a facial appearance that is marked by thickened, coarse, and deeply furrowed skin. The skin appears to be involved in the cheeks, forehead, and nose. The patient complains of numbness and weakness in the extremities. On examination, there are hypopigmented and erythematous patches with loss of sensation. What is the medical condition characterized by the term “Leonine facies”?", "options": [{"label": "A", "text": "Lepromatous Leprosy", "correct": true}, {"label": "B", "text": "Acromegaly", "correct": false}, {"label": "C", "text": "Myasthenia gravis", "correct": false}, {"label": "D", "text": "Bells palsy", "correct": false}], "correct_answer": "A. Lepromatous Leprosy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"2b635d48ce1692777191e4be9f89d6\"&gt;Lepromatous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"f200a5b7181692777191c4f24b2a3e\"&gt;Leprosy&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child presents with a swelling in the subhyoid region of the neck that moves with deglutition and protrusion of the tongue. What is the recommended treatment for this patient?", "options": [{"label": "A", "text": "Total thyroidectomy", "correct": false}, {"label": "B", "text": "Ramstedt's operation", "correct": false}, {"label": "C", "text": "Hemi-thyroidectomy", "correct": false}, {"label": "D", "text": "Sistrunk's operation", "correct": true}], "correct_answer": "D. Sistrunk's operation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Sistrunk\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient is scheduled to undergo laparoscopic surgery. The surgical team plans to create a pneumoperitoneum to facilitate the procedure. Which gas is commonly used for creating the pneumoperitoneum in laparoscopic surgeries?", "options": [{"label": "A", "text": "Helium", "correct": false}, {"label": "B", "text": "Oxygen", "correct": false}, {"label": "C", "text": "Nitrogen", "correct": false}, {"label": "D", "text": "Carbon dioxide", "correct": true}], "correct_answer": "D. Carbon dioxide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The involvement of which of the following results in the given condition below?", "options": [{"label": "A", "text": "Arteries", "correct": false}, {"label": "B", "text": "Vein", "correct": false}, {"label": "C", "text": "Lymphatics", "correct": true}, {"label": "D", "text": "DVT", "correct": false}], "correct_answer": "C. Lymphatics", "question_images": ["https://image.prepladder.com/content/6pjzpidziyDtg7E1iwoY1692696309.jpeg"], "explanation_images": [], "explanation": "<p>Correct Option C - Lymph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female patient undergoes a routine thyroid examination, during which a palpable thyroid nodule is discovered. Fine-needle aspiration cytology confirms the presence of papillary thyroid cancer. All of the following statements are true regarding papillary thyroid cancer Except:", "options": [{"label": "A", "text": "It often presents with cervical lymph node metastases.", "correct": false}, {"label": "B", "text": "It is the most common type of thyroid cancer.", "correct": false}, {"label": "C", "text": "It arises from parafollicular C-cells", "correct": true}, {"label": "D", "text": "It is TSH dependent", "correct": false}], "correct_answer": "C. It arises from parafollicular C-cells", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - It arises from parafollicular C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old patient presents with following skin lesions characterized by red and scaly patches. The patient also complains of a painful and swollen finger joint. On examination, the finger joint appears inflamed and tender to touch. What is the most likely diagnosis for this patient's condition?", "options": [{"label": "A", "text": "Psoriatic Arthritis", "correct": true}, {"label": "B", "text": "Pseudo gout", "correct": false}, {"label": "C", "text": "Osteoarthritis", "correct": false}, {"label": "D", "text": "Reactive arthritis", "correct": false}], "correct_answer": "A. Psoriatic Arthritis", "question_images": ["https://image.prepladder.com/content/UzW4F1YmpkWUpRSwy7wx1693231106.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Psoriatic &lt;span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\"&gt;Arthritis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Medical termination of pregnancy can be done upto 24 weeks in case of?", "options": [{"label": "A", "text": "Congenital malformation", "correct": false}, {"label": "B", "text": "Minors", "correct": false}, {"label": "C", "text": "Contraception failure", "correct": false}, {"label": "D", "text": "Rape victim", "correct": true}], "correct_answer": "D. Rape victim", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/f5etYiCIsFMgLkbLa3bl1697693388.png"], "explanation": "<p>Correct Option D -Rape v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Following the death of a 40-year-old male patient, his relatives mention that he had a tattoo on his body. However, upon autopsy, no tattoo is observed on the skin. What is the best location to check for the presence of the tattoo?", "options": [{"label": "A", "text": "Spleen", "correct": false}, {"label": "B", "text": "Artery", "correct": false}, {"label": "C", "text": "Lymph node", "correct": true}, {"label": "D", "text": "Liver", "correct": false}], "correct_answer": "C. Lymph node", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\"&gt;Lymph&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\"&gt;node&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a forensic autopsy, a gunshot victim is examined, and the doctor observes that the firearm injury has a stellate shape. What will be the range of gunshot?", "options": [{"label": "A", "text": "Close shot", "correct": false}, {"label": "B", "text": "Contact shot", "correct": true}, {"label": "C", "text": "Near shot", "correct": false}, {"label": "D", "text": "Distant shot", "correct": false}], "correct_answer": "B. Contact shot", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Contact sh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a forensic investigation, the police recover a beheaded skull bone and receive a photograph of a missing person from their relatives. These two samples can be analyzed using which technique?", "options": [{"label": "A", "text": "Fingerprint", "correct": false}, {"label": "B", "text": "DNA Fingerprint", "correct": false}, {"label": "C", "text": "Superimposition", "correct": true}, {"label": "D", "text": "Cheiloscopy", "correct": false}], "correct_answer": "C. Superimposition", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Su\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A doctor was summoned as a public witness to appear and record his evidence in court. What is correct about this witness?", "options": [{"label": "A", "text": "Oral evidence", "correct": false}, {"label": "B", "text": "Common witness", "correct": false}, {"label": "C", "text": "Expert witness", "correct": true}, {"label": "D", "text": "Hostile witness", "correct": false}], "correct_answer": "C. Expert witness", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - E\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child presenting for a dental examination, what is the expected number of permanent and temporary teeth?", "options": [{"label": "A", "text": "20 &amp;amp; 4", "correct": true}, {"label": "B", "text": "24 &amp;amp; 0", "correct": false}, {"label": "C", "text": "16 &amp;amp; 8", "correct": false}, {"label": "D", "text": "12 &amp;amp; 12", "correct": false}], "correct_answer": "A. 20 &amp; 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 20 &amp;amp; 4 \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male patient was found unconscious in his backyard, the leaves of a plant similar to the one shown below were found scattered around him. He is now presenting with symptoms of nausea, vomiting, abdominal pain, diarrhea, and irregular heart rate. Identify the plant given below likely responsible for these symptoms?", "options": [{"label": "A", "text": "Yellow oleander", "correct": true}, {"label": "B", "text": "Ricinus communis", "correct": false}, {"label": "C", "text": "Datura", "correct": false}, {"label": "D", "text": "Papaver somniferum", "correct": false}], "correct_answer": "A. Yellow oleander", "question_images": ["https://image.prepladder.com/content/bqKqd8TZomCUlV34FhiL1692702667.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Yellow &lt;span class=\"customMeta\" data-dictid=\"97f6e0800216927771943d9243419c\"&gt;Oleander&lt;/span&gt; (Thevetia peruviana)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The dead body of a 30-year-old male drowning victim was brought in for autopsy. Upon examination, multiple cuts were observed on the victim's arm. What finding is likely to be seen in this scenario?", "options": [{"label": "A", "text": "Defense wound", "correct": true}, {"label": "B", "text": "Self inflicted injury", "correct": false}, {"label": "C", "text": "Accidental cut wound from falling", "correct": false}, {"label": "D", "text": "Washer-women hands", "correct": false}], "correct_answer": "A. Defense wound", "question_images": ["https://image.prepladder.com/content/bVNDKvYyk04EemtUdwLs1697800465.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Defense wou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42 year old patient, a case of road traffic accident presented with EDH due to involvement of Middle Meningeal Artery. Where will the impact of collision be?", "options": [{"label": "A", "text": "Pterion", "correct": true}, {"label": "B", "text": "Angle of mandible", "correct": false}, {"label": "C", "text": "Lambdoid suture", "correct": false}, {"label": "D", "text": "Nasion", "correct": false}], "correct_answer": "A. Pterion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man with a history of chronic alcoholism goes to a liquor store and purchases two bottles of liquor. Approximately one hour later, after consuming alcohol, he presents to the emergency department with complaints of abdominal discomfort, acute confusion, vision loss, and an unsteady gait. What is the most appropriate treatment for his condition?", "options": [{"label": "A", "text": "Naloxone", "correct": false}, {"label": "B", "text": "Ethyl alcohol", "correct": true}, {"label": "C", "text": "Flumazenil", "correct": false}, {"label": "D", "text": "Atropine", "correct": false}], "correct_answer": "B. Ethyl alcohol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"4331e1dd521692777187b06284eb2e\"&gt;Ethyl&lt;/span&gt; alcoh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When does the talus become ossified during intrauterine life?", "options": [{"label": "A", "text": "3 months", "correct": false}, {"label": "B", "text": "7 months", "correct": true}, {"label": "C", "text": "9 months", "correct": false}, {"label": "D", "text": "2 months", "correct": false}], "correct_answer": "B. 7 months", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 7 months \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child was brought to the emergency department after consuming a significant quantity of iron tablets at home. The child is presenting with severe abdominal pain, profuse gastrointestinal bleeding episodes, and lethargy. What is the preferred treatment for this case?", "options": [{"label": "A", "text": "Pencillamine", "correct": false}, {"label": "B", "text": "BAL", "correct": false}, {"label": "C", "text": "Activated charcoal", "correct": false}, {"label": "D", "text": "Deferoxamine Mesylate", "correct": true}], "correct_answer": "D. Deferoxamine Mesylate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male patient after an injury presented with a deformity as shown in the image. Which nerve will be damaged in the given condition?", "options": [{"label": "A", "text": "Ulnar Nerve", "correct": false}, {"label": "B", "text": "Radial Nerve", "correct": true}, {"label": "C", "text": "Median Nerve", "correct": false}, {"label": "D", "text": "Musculocutaneous Nerve", "correct": false}], "correct_answer": "B. Radial Nerve", "question_images": ["https://image.prepladder.com/content/80tM6poMWzbSeXYxucu41692704364.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\"&gt;Radial&lt;/span&gt; Nerv\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nerve involved</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cause of injury</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical features</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radial nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crutch palsy; Saturday night palsy; <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> midshaft humerus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of extension at multiple joints; <span class=\"customMeta\" data-dictid=\"686792a7fd16927772025815b2dd97\">Wrist drop</span> (loss of wrist extension); weakness of <span class=\"customMeta\" data-dictid=\"d3daf86e63169277719936e262ff26\">supination</span> and finger extension; <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss on arm, forearm, and <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of hand</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person who had a road traffic accident presented to ER with injury to bulbar urethra. What can be the location of collection of the urine due to this injury?", "options": [{"label": "A", "text": "Inguinal pouch", "correct": false}, {"label": "B", "text": "Peritoneal cavity", "correct": false}, {"label": "C", "text": "Ischiorectal fossa", "correct": false}, {"label": "D", "text": "Anterior abdominal wall", "correct": true}], "correct_answer": "D. Anterior abdominal wall", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;Anterior&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\"&gt;abdominal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old male was climbing the stair, suddenly he fell &amp;amp; an iron nail hit on his neck. After the injury, the patient is having a hard time shrugging his shoulders and he is having difficulty turning his head. This might be due to an injury to?", "options": [{"label": "A", "text": "Spinal accessory Nerve", "correct": true}, {"label": "B", "text": "Deltoid Muscle", "correct": false}, {"label": "C", "text": "Sternocleidomastoid Muscle", "correct": false}, {"label": "D", "text": "Long thoracic Nerve", "correct": false}], "correct_answer": "A. Spinal accessory Nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\"&gt;Spinal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\"&gt;accessory&lt;/span&gt; Nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old female, who works as a maid complained of knee pain and swelling. Which of the following area gets damaged in Housemaid’s knee?", "options": [{"label": "A", "text": "A", "correct": false}, {"label": "B", "text": "B", "correct": true}, {"label": "C", "text": "C", "correct": false}, {"label": "D", "text": "D", "correct": false}], "correct_answer": "B. B", "question_images": ["https://image.prepladder.com/content/tZQkpl5h1B7y3U4rYotB1692704965.jpeg"], "explanation_images": [], "explanation": "<p>Correct Option B - B (Prepatellar bursa)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old female who had the extraction of her 3rd molar tooth reported loss of sensation in the anterior 2/3rd of the tongue and floor of the mouth. Which nerve is most likely to be damaged?", "options": [{"label": "A", "text": "Lingual Nerve", "correct": true}, {"label": "B", "text": "Glossopharyngeal Nerve", "correct": false}, {"label": "C", "text": "Spinal Accessory Nerve", "correct": false}, {"label": "D", "text": "Chorda Tympani Nerve", "correct": false}], "correct_answer": "A. Lingual Nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"f7c3ba6f1c1692777191e58e8571b0\"&gt;Lingual&lt;/span&gt; Nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which bone is most likely to be fractured in an injury to the anatomical snuff box?", "options": [{"label": "A", "text": "Scaphoid", "correct": true}, {"label": "B", "text": "Lunar", "correct": false}, {"label": "C", "text": "Cuboid", "correct": false}, {"label": "D", "text": "Trapezius", "correct": false}], "correct_answer": "A. Scaphoid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\"&gt;Scaphoid&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer sprayed a chemical in the pool which causes inhibition of complex-III of the electron transport chain. Identify the inhibitor?", "options": [{"label": "A", "text": "Rotenone", "correct": false}, {"label": "B", "text": "TTFA", "correct": false}, {"label": "C", "text": "Cyanide", "correct": false}, {"label": "D", "text": "Antimycin", "correct": true}], "correct_answer": "D. Antimycin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The given finding is associated with ?", "options": [{"label": "A", "text": "Trisomy 13", "correct": false}, {"label": "B", "text": "Trisomy 21", "correct": true}, {"label": "C", "text": "Klinefelter’s", "correct": false}, {"label": "D", "text": "Trisomy 18", "correct": false}], "correct_answer": "B. Trisomy 21", "question_images": ["https://image.prepladder.com/content/fttK7MwLmqrBlcsNfTjE1693233954.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"5e54fdc4d3169277720003f231621d\"&gt;Trisomy&lt;/span&gt; 2\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 2-year-old child with a sudden onset of noisy breathing, which type of stridor is most likely to be represented by the image below?", "options": [{"label": "A", "text": "Inspiratory", "correct": true}, {"label": "B", "text": "Expiratory", "correct": false}, {"label": "C", "text": "Biphasic", "correct": false}, {"label": "D", "text": "None of these", "correct": false}], "correct_answer": "A. Inspiratory", "question_images": ["https://image.prepladder.com/content/GoXjIrisuhVJ0KH3uFJu1692705841.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the vertebral level shown by the blue line in the image?", "options": [{"label": "A", "text": "L2-L3", "correct": false}, {"label": "B", "text": "L4-L5", "correct": true}, {"label": "C", "text": "L5-S1", "correct": false}, {"label": "D", "text": "L3-L4", "correct": false}], "correct_answer": "B. L4-L5", "question_images": ["https://image.prepladder.com/content/A6W5Z4VRbna6c1IGI6w61693231956.png"], "explanation_images": [], "explanation": "<p>Correct Option B - L4-L5 </p>\n<p><strong>References:</strong></p>\n<ul><li>↳ If the blue line is at the L4-L5 level, then this option is correct. L4-L5 refers to the intervertebral space between the fourth lumbar vertebra (L4) and the fifth lumbar vertebra (L5). This is a common area for vertebral numbering and is often used as a reference point in medical and anatomical contexts.</li><li>↳ Incorrect Options:</li><li>↳ Incorrect Options:</li><li>↳ Option A - L2-L3: This option is incorrect as the blue line is at the L4-L5 level. The L2-L3 level would be higher up on the spine, and if the blue line is visibly at L4-L5, then this option is not the correct answer.</li><li>↳ Option A - L2-L3:</li><li>↳ Option C - L5-S1: This option is incorrect as the blue line is at the L4-L5 level. L5-S1 refers to the intervertebral space between the fifth lumbar vertebra (L5) and the first sacral vertebra (S1), which is lower down the spine. If the blue line is at L4-L5, then this option is not the correct answer.</li><li>↳ Option C - L5-S1:</li><li>↳ Option D - L3-L4: This option is incorrect as the blue line is at the L4-L5 level. L3-L4 refers to the intervertebral space between the third lumbar vertebra (L3) and the fourth lumbar vertebra (L4). If the blue line is visible at the L4-L5 level, then this option is not the correct answer.</li><li>↳ Option D - L3-L4:</li></u\n<p><strong>References:</strong></p>\n<ul><li>↳ L4-L5 refers to the intervertebral space between the fourth lumbar vertebra (L4) and the fifth lumbar vertebra (L5). This is a common area for vertebral numbering and is often used as a reference point in medical and anatomical contexts.</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cholera is known to cause diarrhea through its interaction with specific receptors in the human body. Which of the following is known to make it easier for cholera toxin to enter the body through the intestinal mucosa?", "options": [{"label": "A", "text": "GLUT 1", "correct": false}, {"label": "B", "text": "GM2 ganglioside", "correct": false}, {"label": "C", "text": "Cephalin", "correct": false}, {"label": "D", "text": "GM1 ganglioside", "correct": true}], "correct_answer": "D. GM1 ganglioside", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - GM1 gang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old woman is being evaluated for daytime sleepiness and memory loss which have been present for the past 1 year. Her BMI is 43, her BP is 170/98 mmHg. In an awake state, ABG shows pO2 70 mmHg, pCO2 53 mmHg, HCO3 33 mmol/L. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Obesity Hypoventilation Syndrome", "correct": true}, {"label": "B", "text": "Central Sleep Apnea", "correct": false}, {"label": "C", "text": "Narcolepsy", "correct": false}, {"label": "D", "text": "Obstructive sleep Apnea", "correct": false}], "correct_answer": "A. Obesity Hypoventilation Syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\"&gt;Obesity&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"272d378524169277718972cc77dc98\"&gt;Hypoventilation&lt;/span&gt; Syndrome (OHS)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient with chronic sinusitis and nasal congestion, which anatomical structure is the most likely drainage pathway for the bulla ethmoidalis?", "options": [{"label": "A", "text": "Middle meatus", "correct": true}, {"label": "B", "text": "Superior meatus", "correct": false}, {"label": "C", "text": "Inferior meatus", "correct": false}, {"label": "D", "text": "Middle concha", "correct": false}], "correct_answer": "A. Middle meatus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Middle meatu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old man presented with swelling due to a collection of blood around the eyes after sustaining a head injury. Which structural attachment is the cause of this condition?", "options": [{"label": "A", "text": "Aponeurosis attachment", "correct": true}, {"label": "B", "text": "Periosteum", "correct": false}, {"label": "C", "text": "Cellulitis", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Aponeurosis attachment", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"52cb21596b1692777181aa72f1feb5\"&gt;Aponeurosis&lt;/span&gt; attach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A infant developed difficulty in breathing. His symptoms improve with crying. In which disease, symptoms get improve with crying?", "options": [{"label": "A", "text": "Atrophic rhinitis", "correct": false}, {"label": "B", "text": "Acute rhinosinusitis", "correct": false}, {"label": "C", "text": "Allergic rhinitis", "correct": false}, {"label": "D", "text": "Choanal atresia", "correct": true}], "correct_answer": "D. Choanal atresia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\"&gt;Choanal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-month-old infant is brought to the pediatrician due to feeding difficulties, vomiting, and failure to thrive. The child's history reveals that the infant wasborn full-term and had a normal birth weight. On physical examination, the infant appears jaundiced, and the liver is palpable below the costal margin. Oil drop Cataracts are also noted on eye examination. Laboratory tests show elevated levels of galactose in the blood and urine. Based on these clinical findings, which enzyme deficiency is most likely responsible for this presentation?", "options": [{"label": "A", "text": "G6PD (Glucose-6-phosphate dehydrogenase)", "correct": false}, {"label": "B", "text": "GALT (Galactose-1-phosphate uridylyltransferase)", "correct": true}, {"label": "C", "text": "ALDH (Aldehyde dehydrogenase)", "correct": false}, {"label": "D", "text": "PKU (Phenylalanine hydroxylase)", "correct": false}], "correct_answer": "B. GALT (Galactose-1-phosphate uridylyltransferase)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"c6e368ee6b169277718891cd4af5a4\"&gt;GALT&lt;/span&gt; (Galactose-1-phosphate uridylyltransferase)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old patient presents with a swelling below the ear and complains of pain in the lobule of the ear. The patient also reports difficulty in completely closing the left eye and experiences trouble while eating food. What nerve is most likely to be damaged in this case?", "options": [{"label": "A", "text": "Greater Auricular nerve", "correct": false}, {"label": "B", "text": "Auriculotemporal nerve", "correct": false}, {"label": "C", "text": "Facial nerve", "correct": true}, {"label": "D", "text": "Vagus nerve", "correct": false}], "correct_answer": "C. Facial nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\"&gt;Facial&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 year old man present with sudden onset of right sided hemiparesis for last 3 hours. BP is 200/100 mmHg. NCCT Head showed brain bleed and right hemiparesis. All of the following are to be done for management, Except?", "options": [{"label": "A", "text": "Thrombolysis", "correct": true}, {"label": "B", "text": "BP Control", "correct": false}, {"label": "C", "text": "Edema management", "correct": false}, {"label": "D", "text": "Elective hyperventilation", "correct": false}], "correct_answer": "A. Thrombolysis", "question_images": ["https://image.prepladder.com/content/2mOGpEJOPfjS8POg8ryK1692706376.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old patient weighing 80 kilograms has been diagnosed with an acute ischemic stroke and is recommended for thrombolysis with alteplase. What should the initial stat dose in milligrams be?", "options": [{"label": "A", "text": "8", "correct": true}, {"label": "B", "text": "10", "correct": false}, {"label": "C", "text": "12", "correct": false}, {"label": "D", "text": "15", "correct": false}], "correct_answer": "A. 8", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What investigation is carried out immediately after a child is suspected of having inhaled a foreign body?", "options": [{"label": "A", "text": "Rigid bronchoscopy", "correct": false}, {"label": "B", "text": "Chest X-ray", "correct": true}, {"label": "C", "text": "Direct laryngoscopy", "correct": false}, {"label": "D", "text": "Flexible endoscopy", "correct": false}], "correct_answer": "B. Chest X-ray", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Chest X\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following will show Hypokalemia Except ?", "options": [{"label": "A", "text": "RTA1", "correct": false}, {"label": "B", "text": "RTA 2", "correct": false}, {"label": "C", "text": "RTA 4", "correct": true}, {"label": "D", "text": "Ureterosigmidostomy", "correct": false}], "correct_answer": "C. RTA 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - RTA 4 (Renal &lt;span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\"&gt;Tubular&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\"&gt;Acidosis&lt;/span&gt; Type 4)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn infant is brought to the clinic with jaundice and a white, punctate, and scattered opacity in the central lens. The condition is consistent with Oil drop cataract. Which of the following metabolic disorders is most likely responsible for this presentation?", "options": [{"label": "A", "text": "Phenylketonuria (PKU)", "correct": false}, {"label": "B", "text": "Maple syrup urine disease", "correct": false}, {"label": "C", "text": "Galactosemia", "correct": true}, {"label": "D", "text": "Wilson's disease", "correct": false}], "correct_answer": "C. Galactosemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - G\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Oxaloacetate is produced from which of the following amino acid?", "options": [{"label": "A", "text": "Alanine", "correct": false}, {"label": "B", "text": "Lysine", "correct": false}, {"label": "C", "text": "Leucine", "correct": false}, {"label": "D", "text": "Aspartate", "correct": true}], "correct_answer": "D. Aspartate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common site of ranula?", "options": [{"label": "A", "text": "Floor of the mouth", "correct": true}, {"label": "B", "text": "Tonsil", "correct": false}, {"label": "C", "text": "Uvula", "correct": false}, {"label": "D", "text": "Cingula", "correct": false}], "correct_answer": "A. Floor of the mouth", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Floor of the mouth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following minerals is best known for insulin secretion stabilisation?", "options": [{"label": "A", "text": "Cadmium", "correct": false}, {"label": "B", "text": "Copper", "correct": false}, {"label": "C", "text": "Iron", "correct": false}, {"label": "D", "text": "Zinc", "correct": true}], "correct_answer": "D. Zinc", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Z\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is brought with a 2-week history of not feeding well and excessive irritability. History of TB for sister is present and is taking treatment for it. In workup, LP was performed. Which of the following is likely to be found in CSF?", "options": [{"label": "A", "text": "Lymphocytosis, low sugar, and high protein", "correct": true}, {"label": "B", "text": "Lymphocytosis, high sugar, and high protein", "correct": false}, {"label": "C", "text": "Neutrophils, low sugar and low protein", "correct": false}, {"label": "D", "text": "Neutrophils, low sugar and high protein", "correct": false}], "correct_answer": "A. Lymphocytosis, low sugar, and high protein", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Lymphocytosis, low sugar and high\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with a mild cold who also has adenoid facies has been identified as having chronic adenoid hypertrophy. Which is the best surgical management for this condition?", "options": [{"label": "A", "text": "Coblator", "correct": true}, {"label": "B", "text": "Microdebrider", "correct": false}, {"label": "C", "text": "Curettage", "correct": false}, {"label": "D", "text": "Breathing exercise and symptomatic treatment", "correct": false}], "correct_answer": "A. Coblator", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Penicillin was given to the patient and immune hemolytic anemia develops. Which type of hypersensitivity reaction is this?", "options": [{"label": "A", "text": "Type 1", "correct": false}, {"label": "B", "text": "Type 2", "correct": true}, {"label": "C", "text": "Type 3", "correct": false}, {"label": "D", "text": "Type 4", "correct": false}], "correct_answer": "B. Type 2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Type 2\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man presents with movement disorder and tremors in hand, along with the development of cognitive and emotional problems. Which of the following medical disorders is the likely diagnosis?", "options": [{"label": "A", "text": "Parkinson's disease", "correct": false}, {"label": "B", "text": "Frederich's ataxia", "correct": false}, {"label": "C", "text": "Alzheimer’s disease", "correct": false}, {"label": "D", "text": "Huntington's disease", "correct": true}], "correct_answer": "D. Huntington's disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Hunting\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old patient presenting with non-caseating granulomas and a saddle nose perforation, what is the most likely diagnosis?", "options": [{"label": "A", "text": "TB", "correct": false}, {"label": "B", "text": "Leprosy", "correct": false}, {"label": "C", "text": "Wegener’s granulomatosis", "correct": true}, {"label": "D", "text": "Syphilis", "correct": false}], "correct_answer": "C. Wegener’s granulomatosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Wegener's &lt;span class=\"customMeta\" data-dictid=\"2db4616dd0169277718891a2a1b67c\"&gt;granulomatosis&lt;/span&gt; (Granulomatosis with Polyangiitis)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which organelle is DNA present?", "options": [{"label": "A", "text": "Mitochondria", "correct": true}, {"label": "B", "text": "Lysosome", "correct": false}, {"label": "C", "text": "Endoplasmic reticulum", "correct": false}, {"label": "D", "text": "Cytoplasm", "correct": false}], "correct_answer": "A. Mitochondria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Mitoch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents to the clinic with complaints of frequent diarrhea, abdominal cramps, bloating, and weight loss over the past two weeks. She mentions that she recently traveled to a rural area for a camping trip and drank untreated stream water during her stay. On physical examination, no fever is noted, but mild tenderness is present in the right upper quadrant of the abdomen. Stool examination reveals the presence of trophozoites and cysts with characteristic \"falling leaf\" motility under microscopy. Which organism is most likely responsible for this patient's symptoms?", "options": [{"label": "A", "text": "Salmonella typhi", "correct": false}, {"label": "B", "text": "Entamoeba histolytica", "correct": false}, {"label": "C", "text": "Giardia lamblia", "correct": true}, {"label": "D", "text": "Cryptosporidium parvum", "correct": false}], "correct_answer": "C. Giardia lamblia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e86529e39b1692777188e4c97842e0\"&gt;Giardia&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"cf8c63d39d1692777191eaefc48221\"&gt;lamblia&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following jvp findings seen in a patient with muffled heart sounds, hypotension and raised JVP?", "options": [{"label": "A", "text": "Absent x descent", "correct": false}, {"label": "B", "text": "Absent y descent", "correct": true}, {"label": "C", "text": "C waves are enlarged", "correct": false}, {"label": "D", "text": "A waves are absent", "correct": false}], "correct_answer": "B. Absent y descent", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hormone-sensitive lipase is activated by all of the following EXCEPT?", "options": [{"label": "A", "text": "Glucagon", "correct": false}, {"label": "B", "text": "Epinephrine", "correct": false}, {"label": "C", "text": "ACTH", "correct": false}, {"label": "D", "text": "Insulin", "correct": true}], "correct_answer": "D. Insulin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Insu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "65-year-old man is brought to the hospital with complaints of suddenly not making any sense while speaking using non-sensical grammar though he can speak quickly. He could communicate effectively prior to this. Which of the following defect is present in this patient?", "options": [{"label": "A", "text": "Motor aphasia", "correct": false}, {"label": "B", "text": "Anomic aphasia", "correct": false}, {"label": "C", "text": "Fluent aphasia", "correct": true}, {"label": "D", "text": "Conduction aphasia", "correct": false}], "correct_answer": "C. Fluent aphasia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Fluent aph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old female with a history of rheumatic heart disease underwent prosthetic valve replacement surgery 6 months ago. He presents to the cardiology clinic with complaints of fever, fatigue, and worsening shortness of breath over the past few weeks. Physical examination reveals a new heart murmur and splinter hemorrhages on the nail beds. Based on the clinical presentation, what is the most likely causative organism responsible for this patient's infective endocarditis?", "options": [{"label": "A", "text": "Staphylococcus epidermidis", "correct": true}, {"label": "B", "text": "Streptococcus viridans", "correct": false}, {"label": "C", "text": "Enterococcus faecalis", "correct": false}, {"label": "D", "text": "Staphylococcus saprophyticus", "correct": false}], "correct_answer": "A. Staphylococcus epidermidis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\"&gt;Staphylococcus&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presenting with autophony, bilateral limb weakness and normal tympanic membrane that move with respiration. What is the probable cause of these symptoms?", "options": [{"label": "A", "text": "Meningioma", "correct": false}, {"label": "B", "text": "Multiple sclerosis", "correct": false}, {"label": "C", "text": "Weight loss", "correct": true}, {"label": "D", "text": "Wegener’s granulomatosis", "correct": false}], "correct_answer": "C. Weight loss", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Weight L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the rate-limiting enzyme of heme synthesis pathway?", "options": [{"label": "A", "text": "HMB synthase", "correct": false}, {"label": "B", "text": "δ Amino-Levulinic Acid dehydratase", "correct": false}, {"label": "C", "text": "δ Amino-Levulinic Acid synthase", "correct": true}, {"label": "D", "text": "Ferrochelatase", "correct": false}], "correct_answer": "C. δ Amino-Levulinic Acid synthase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - δ Amino-Levulinic Acid &lt;span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\"&gt;synthase&lt;/span&gt; (ALA Synthase)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Scissoring gait will occur due to increases firing of Which of the following nerve?", "options": [{"label": "A", "text": "Superior gluteal nerve", "correct": false}, {"label": "B", "text": "Inferior gluteal nerve", "correct": false}, {"label": "C", "text": "Obturator nerve", "correct": true}, {"label": "D", "text": "Femoral nerve", "correct": false}], "correct_answer": "C. Obturator nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"215af9957a1692777194e73b21a340\"&gt;Obturator&lt;/span&gt; Nerv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient presents with a skin infection characterized by itching, redness, and scaling. Microscopic examination of a skin sample reveals a pencil-shaped appearance. Which of the following is the most likely causative organism responsible for this skin infection?", "options": [{"label": "A", "text": "Trichophyton", "correct": true}, {"label": "B", "text": "Microsporum", "correct": false}, {"label": "C", "text": "Epidermophyton", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Trichophyton", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5afed2459b1692777200c48063ee7e\"&gt;Trichophyton&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old male with CAD comes to the physician for a follow-up examination. His blood pressure is 130/80 mm Hg, height of 182 cm, weight of 85 kg, and a BMI of 25 kg/m². Serum studies shows a glucose concentration of 95 mg/dL and homocysteine concentration of 19.3 μmol/L (N=5–15). Serum lipid concentrations are within the normal range. which of the following enzyme deficiencies is most likely to be found in this patient?", "options": [{"label": "A", "text": "Homogentisate oxidase", "correct": false}, {"label": "B", "text": "Cystathionine beta synthase", "correct": true}, {"label": "C", "text": "Cystathionine gamma synthase", "correct": false}, {"label": "D", "text": "HGPRTase", "correct": false}], "correct_answer": "B. Cystathionine beta synthase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B -Cystathionine &lt;span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\"&gt;beta&lt;/span&gt; synth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old male presented with nasal obstruction. On examination there was an irregular mass protruding from the choanae. What is the possible diagnosis?", "options": [{"label": "A", "text": "Thornwaldt cyst", "correct": false}, {"label": "B", "text": "Antro-choanal polyp", "correct": true}, {"label": "C", "text": "Hypertrophic rhinitis", "correct": false}, {"label": "D", "text": "Adenoid hypertrophy", "correct": false}], "correct_answer": "B. Antro-choanal polyp", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Antro-ch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient diagnosed with Dialysis Dementia, what deposition is seen in the cerebral cortex?", "options": [{"label": "A", "text": "Amyloid beta-2", "correct": true}, {"label": "B", "text": "Amyloid beta microglobulin", "correct": false}, {"label": "C", "text": "Amyloid transthyretin", "correct": false}, {"label": "D", "text": "Amyloid Beta", "correct": false}], "correct_answer": "A. Amyloid beta-2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Amyloid beta-2\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 46-year-old farmer present with a traumatic ulcer in the eye. Microscopic examination reveals septate hyphae at an acute angle. Which of the following will be the causative organism?", "options": [{"label": "A", "text": "Mucor", "correct": false}, {"label": "B", "text": "Aspergillosis", "correct": true}, {"label": "C", "text": "Candida", "correct": false}, {"label": "D", "text": "Rhizopus", "correct": false}], "correct_answer": "B. Aspergillosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Asperg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Induction of labour is not done in which of the following ?", "options": [{"label": "A", "text": "Central placenta previa", "correct": true}, {"label": "B", "text": "Gestational HTN", "correct": false}, {"label": "C", "text": "PROM", "correct": false}, {"label": "D", "text": "Abruptio placenta", "correct": false}], "correct_answer": "A. Central placenta previa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Central &lt;span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\"&gt;placenta&lt;/span&gt; prev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Antibody seen in Acute Inflammatory Demyelinating Polyneuropathy will belong to which class?", "options": [{"label": "A", "text": "Ig G", "correct": true}, {"label": "B", "text": "Ig M", "correct": false}, {"label": "C", "text": "Ig E", "correct": false}, {"label": "D", "text": "Ig A", "correct": false}], "correct_answer": "A. Ig G", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - (IgG)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child presents to the pediatric clinic with complaints of joint pain, swelling, and difficulty in walking. On examination, the child is found to have a tender, swollen knee joint and a history of recent sore throat. Laboratory investigations reveal elevated antistreptolysin O (ASO) titers. A renal biopsy is performed, and it shows glomerular changes consistent with PSGN. Which of the following organisms is most likely responsible for both the acute rheumatic fever and PSGN in this patient?", "options": [{"label": "A", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "B", "text": "Streptococcus pyogenes", "correct": true}, {"label": "C", "text": "Streptococcus agalactiae", "correct": false}, {"label": "D", "text": "Streptococcus mutans", "correct": false}], "correct_answer": "B. Streptococcus pyogenes", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Streptococcus pyogenes \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 13-year-old boy who accompanied his father to a fish farming region in his hometown accidentally consumes a white odourless chemical. He was under some medication and post-meal he developed toxicity of the drug. Which of the the following toxin is most likely to cause this condition?", "options": [{"label": "A", "text": "Alkyl guanides", "correct": false}, {"label": "B", "text": "BAL", "correct": false}, {"label": "C", "text": "Antimycin A", "correct": true}, {"label": "D", "text": "Rotenone", "correct": false}], "correct_answer": "C. Antimycin A", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is correct regarding Wolf Parkinson's white syndrome?", "options": [{"label": "A", "text": "Short PJ Interval", "correct": false}, {"label": "B", "text": "Broad QRS interval", "correct": true}, {"label": "C", "text": "Tall Tented T waves", "correct": false}, {"label": "D", "text": "Prolonged PR interval", "correct": false}], "correct_answer": "B. Broad QRS interval", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Broad QRS interv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate admitted with the features of meningitis. Bacteria isolated from CSF is bacitracin resistant. Neonatal meningitis is caused by which organism?", "options": [{"label": "A", "text": "Pneumococcus", "correct": false}, {"label": "B", "text": "Streptococcus pyogenes", "correct": false}, {"label": "C", "text": "Streptococcus agalactiae", "correct": true}, {"label": "D", "text": "Meningococci", "correct": false}], "correct_answer": "C. Streptococcus agalactiae", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"9562e26acc16927771995a2028dd05\"&gt;Streptococcus&lt;/span&gt; agalactiae (Group B Streptococcus)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "40 year lady presents with difficulty in eating due to persistent dry mouth. She also has grittiness in eyes due to dry eyes. On examination, dental caries is noted with enlarged cervical lymph nodes. Possible diagnosis is:", "options": [{"label": "A", "text": "MCTD", "correct": false}, {"label": "B", "text": "Sarcoidosis", "correct": false}, {"label": "C", "text": "Sjogren syndrome", "correct": true}, {"label": "D", "text": "Wegener’s granulomatosis", "correct": false}], "correct_answer": "C. Sjogren syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sjog\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old female came to the emergency department with a bleeding condition and dental caries. Which vitamin supplementation from the list below would be best for treating this condition?", "options": [{"label": "A", "text": "Vitamin B1", "correct": false}, {"label": "B", "text": "Vitamin B9", "correct": false}, {"label": "C", "text": "Vitamin D", "correct": false}, {"label": "D", "text": "Vitamin K", "correct": true}], "correct_answer": "D. Vitamin K", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28 year old patient presented with watery diarrhoea and dysentery. After taking history, it is noted that he had eaten Oysters on his recent trip. Which of the following can be responsible for his symptoms?", "options": [{"label": "A", "text": "Vibrio Parahemolyticus", "correct": true}, {"label": "B", "text": "Staph aureus", "correct": false}, {"label": "C", "text": "E. coli", "correct": false}, {"label": "D", "text": "Vibio Cholerae", "correct": false}], "correct_answer": "A. Vibrio Parahemolyticus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"1497756cc616927772020759b759d5\"&gt;Vibrio&lt;/span&gt; Parahemolyticu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "70 year old man presents with low back ache and progressive pallor. On work up, KFT is deranged. LFT is normal with normal level of Albumin, but gamma globulins are disproportionately increased. X ray spine shows multiple lytic lesions. Which of the following is the cell of origin of the diagnosis of this patient?", "options": [{"label": "A", "text": "Lymphocyte", "correct": false}, {"label": "B", "text": "Plasma cell", "correct": true}, {"label": "C", "text": "Histiocytes", "correct": false}, {"label": "D", "text": "Monocytes", "correct": false}], "correct_answer": "B. Plasma cell", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old patient presents to the hospital with symptoms of hydrophobia, which is often associated with rabies infection. The clinician decides to perform further diagnostic tests on the patient's corneal scraping to confirm the diagnosis. Which of the following tests is the most appropriate and accurate for confirming the diagnosis in this patient?", "options": [{"label": "A", "text": "RT- PCR", "correct": true}, {"label": "B", "text": "Viral culture", "correct": false}, {"label": "C", "text": "Antibody detection by ELISA", "correct": false}, {"label": "D", "text": "Direct fluorescent antibody test", "correct": false}], "correct_answer": "A. RT- PCR", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - RT- PCR\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient presented with pedal oedema, raised JVP till mandible and ascites. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cardiac failure", "correct": true}, {"label": "B", "text": "Renal failure", "correct": false}, {"label": "C", "text": "Liver failure", "correct": false}, {"label": "D", "text": "Brain injury", "correct": false}], "correct_answer": "A. Cardiac failure", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Cardiac failu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calcitonin is a marker of which malignancy?", "options": [{"label": "A", "text": "Papillary thyroid cancer", "correct": false}, {"label": "B", "text": "Follicular thyroid cancer", "correct": false}, {"label": "C", "text": "Medullary thyroid cancer", "correct": true}, {"label": "D", "text": "Anaplastic thyroid cancer", "correct": false}], "correct_answer": "C. Medullary thyroid cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Medullary &lt;span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\"&gt;thyroid&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old bedridden patient develops sudden onset breathlessness and chest pain . CTPA was done. Which of the following non-invasive investigations will be useful to confirm the etiology of this presentation?", "options": [{"label": "A", "text": "D dimer", "correct": false}, {"label": "B", "text": "MRI", "correct": false}, {"label": "C", "text": "Coagulogram", "correct": false}, {"label": "D", "text": "Doppler", "correct": true}], "correct_answer": "D. Doppler", "question_images": ["https://image.prepladder.com/content/fwAiIVwFivdgZns2U2Qf1692710087.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male patient presents to the ophthalmology clinic with complaints of visual disturbances. He reports that he is unable to see on the left side from the left eye and the left side from his right eye. However, he notices that his central vision remains intact and unaffected. The patient denies any recent trauma or other significant medical history. What is the most likely visual deficit that the patient is experiencing?", "options": [{"label": "A", "text": "Quadrantanopia", "correct": false}, {"label": "B", "text": "Heteronymous hemianopia", "correct": false}, {"label": "C", "text": "Homonymous hemianopia", "correct": false}, {"label": "D", "text": "Homonymous hemianopia with macular sparing", "correct": true}], "correct_answer": "D. Homonymous hemianopia with macular sparing", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\"&gt;Homonymous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\"&gt;hemianopia&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\"&gt;macular&lt;/span&gt; sparing\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is required for MTP at 21 weeks for a fetus diagnosed with meningomyelocele?", "options": [{"label": "A", "text": "Consent of husband with opinion of one doctor", "correct": false}, {"label": "B", "text": "Her consent with opinion of 2 doctors", "correct": true}, {"label": "C", "text": "Opinion of 2 doctors", "correct": false}, {"label": "D", "text": "All above", "correct": false}], "correct_answer": "B. Her consent with opinion of 2 doctors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Her consent with opinion of 2\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "23 year old person with a history of flank Pain and fatigue and history of red coloured urine. On investigation there were more than 20 RBC/ hpf and microscopy showed dysmorphic RBC. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Minimal change disease", "correct": false}, {"label": "B", "text": "PSGN", "correct": true}, {"label": "C", "text": "UTI", "correct": false}, {"label": "D", "text": "Bladder calculi", "correct": false}], "correct_answer": "B. PSGN", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - PSGN\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male patient, who works in an iron factory, presents to the clinic with complaints of visual disturbances. He reports that his vision has been gradually worsening and he has noticed a change in the color perception. On examination, the ophthalmologist observes the presence of iron deposits in the eye. What is the most likely ocular condition responsible for the iron deposits in the eye and the patient's visual disturbances?", "options": [{"label": "A", "text": "Siderosis bulbi", "correct": true}, {"label": "B", "text": "Hemochromatosis", "correct": false}, {"label": "C", "text": "Retinitis pigmentosa", "correct": false}, {"label": "D", "text": "Age-related macular degeneration", "correct": false}], "correct_answer": "A. Siderosis bulbi", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"e4d583e26b1692777198454df4b41d\"&gt;Siderosis&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"7be1c27a4f16927771831ce746bc8e\"&gt;bulbi&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which type of cataract surgery is suturing with 10-0 nylon commonly performed?", "options": [{"label": "A", "text": "Phacoemulsification", "correct": false}, {"label": "B", "text": "Extracapsular cataract extraction (ECCE)", "correct": true}, {"label": "C", "text": "Intracapsular cataract extraction (ICCE)", "correct": false}, {"label": "D", "text": "Manual small incision cataract surgery (MSICS)", "correct": false}], "correct_answer": "B. Extracapsular cataract extraction (ECCE)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"ab0f3917ce1692777187309ec78709\"&gt;Extracapsular&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\"&gt;cataract&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"00456bf7d8169277718782edf9fa2c\"&gt;extraction&lt;/span&gt; (ECCE)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old patient presents with chronic dacryocystitis . She complains of recurrent tearing, discharge, and mild swelling in the inner corner of the eye . The clinical findings and history are consistent with chronic dacryocystitis. What should be the treatment of choice for this patient ?", "options": [{"label": "A", "text": "Lacrimal sac massage", "correct": false}, {"label": "B", "text": "Dacryocystorhinostomy", "correct": true}, {"label": "C", "text": "Syringing", "correct": false}, {"label": "D", "text": "Probing", "correct": false}], "correct_answer": "B. Dacryocystorhinostomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Dacryocystorhinostomy: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child presented to emergency department with complaints of bleeding from the nose. Which of the following artery is most affected?", "options": [{"label": "A", "text": "Anterior ethmoidal artery", "correct": false}, {"label": "B", "text": "Posterior ethmoidal artery", "correct": false}, {"label": "C", "text": "Sphenopalatine artery", "correct": true}, {"label": "D", "text": "Greater palatine artery", "correct": false}], "correct_answer": "C. Sphenopalatine artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the underlying defect in the congenital malformation shown below?", "options": [{"label": "A", "text": "Morulation", "correct": false}, {"label": "B", "text": "Neurulation", "correct": false}, {"label": "C", "text": "Lateral folding", "correct": false}, {"label": "D", "text": "Gastrulation", "correct": true}], "correct_answer": "D. Gastrulation", "question_images": ["https://image.prepladder.com/content/3wEAWfryN1Dm0UIkwvAm1693231638.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Gastru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male patient presents to the ophthalmology clinic with a history of eye trauma with vegetative material .He complains of severe eye pain, redness, tearing, and photophobia. Microscopic examination of the corneal scraping reveals septate hyphae at an acute angle. What is the most likely causative agent responsible for this condition?", "options": [{"label": "A", "text": "Fungal corneal ulcer", "correct": true}, {"label": "B", "text": "Bacterial corneal ulcer", "correct": false}, {"label": "C", "text": "Viral corneal ulcer", "correct": false}, {"label": "D", "text": "Acanthamoeba corneal ulcer", "correct": false}], "correct_answer": "A. Fungal corneal ulcer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Fungal Corneal Ulcer \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the amount of milk given to a term baby in first 24 hours after delivery?", "options": [{"label": "A", "text": "40ml/kg", "correct": false}, {"label": "B", "text": "50ml/kg", "correct": false}, {"label": "C", "text": "60ml/kg", "correct": true}, {"label": "D", "text": "80ml/kg", "correct": false}], "correct_answer": "C. 60ml/kg", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C: 60ml/kg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What dye is used in staining for the anterior capsule of lens ?", "options": [{"label": "A", "text": "Trypan blue", "correct": true}, {"label": "B", "text": "Brilliant blue", "correct": false}, {"label": "C", "text": "Fluorescent green", "correct": false}, {"label": "D", "text": "Lissamine green", "correct": false}], "correct_answer": "A. Trypan blue", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"8275dbfca6169277720057579b2116\"&gt;Trypan Blue&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presented to the clinic with complaints of malnutrition and severe dehydration. What would be the choice of IV fluid for this patient?", "options": [{"label": "A", "text": "ORS", "correct": false}, {"label": "B", "text": "NS", "correct": false}, {"label": "C", "text": "RL in 5% Dextrose", "correct": true}, {"label": "D", "text": "DNS", "correct": false}], "correct_answer": "C. RL in 5% Dextrose", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - RL in 5% D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10 year old child presented to the clinic with complaints of recurrent infection. Physical examination shows low height for age and Z line score is &amp;lt;-2SD. The parents also have a history of incorrect feeding method. What is the appropriate term for the above mentioned condition?", "options": [{"label": "A", "text": "Stunting", "correct": true}, {"label": "B", "text": "Wasting", "correct": false}, {"label": "C", "text": "Malnutrition", "correct": false}, {"label": "D", "text": "Kwashiorkor", "correct": false}], "correct_answer": "A. Stunting", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Stunting\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which trimester is a quadruple test done for antenatal screening of Down syndrome?", "options": [{"label": "A", "text": "1st trimester", "correct": false}, {"label": "B", "text": "3rd trimester", "correct": false}, {"label": "C", "text": "2nd trimester", "correct": true}, {"label": "D", "text": "4th trimester", "correct": false}], "correct_answer": "C. 2nd trimester", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 2\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old child presents with a 14 cm tender mass in the flank region. The parents report noticing the mass gradually increasing in size over the past few weeks. On physical examination, the child appears well but discomforted due to the mass. The mass is non-fluctuant, firm, and non-mobile, with no signs of inflammation or skin changes. There are no other associated symptoms. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Wilm’s tumor", "correct": true}, {"label": "B", "text": "Angiomyolipoma", "correct": false}, {"label": "C", "text": "Renal cell carcinoma", "correct": false}, {"label": "D", "text": "Neuroblastoma", "correct": false}], "correct_answer": "A. Wilm’s tumor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Wilm's tu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which manoeuvre is performed when the fetal scalp is visible at the vulva as Shown in the image below", "options": [{"label": "A", "text": "Ritgen maneuver", "correct": true}, {"label": "B", "text": "Loveset’s maneuver", "correct": false}, {"label": "C", "text": "Pinard maneuver", "correct": false}, {"label": "D", "text": "Mauriceau-Smellie-Veit maneuver", "correct": false}], "correct_answer": "A. Ritgen maneuver", "question_images": ["https://image.prepladder.com/content/e9bX9f9egMZ9ohLyDvQK1700120098.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Ritgen Maneuv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Just after delivery, the position of the uterus corresponds to the level of how many weeks?", "options": [{"label": "A", "text": "20 weeks", "correct": true}, {"label": "B", "text": "16 weeks", "correct": false}, {"label": "C", "text": "12 weeks", "correct": false}, {"label": "D", "text": "28 weeks", "correct": false}], "correct_answer": "A. 20 weeks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 20 week\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primigravida with severe abdominal pain and vaginal bleeding presents to the ER at 32 weeks. On examination uterus is tender and fetus was not palpable. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Abruptio placenta", "correct": true}, {"label": "B", "text": "Placenta previa", "correct": false}, {"label": "C", "text": "Rupture uterus", "correct": false}, {"label": "D", "text": "Polyhydramnios", "correct": false}], "correct_answer": "A. Abruptio placenta", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"f5df620f42169277718051194dc6e4\"&gt;Abruptio&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is an outlet forcep?", "options": [{"label": "A", "text": "Wrigley forcep", "correct": true}, {"label": "B", "text": "Piper forcep", "correct": false}, {"label": "C", "text": "Kielland's forcep", "correct": false}, {"label": "D", "text": "Das forcep", "correct": false}], "correct_answer": "A. Wrigley forcep", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Wrigley F\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are Hyperestrogenic conditions except.", "options": [{"label": "A", "text": "Ovarian cancer", "correct": false}, {"label": "B", "text": "Low BMI", "correct": true}, {"label": "C", "text": "Use of Tamoxifen", "correct": false}, {"label": "D", "text": "Endometriosis", "correct": false}], "correct_answer": "B. Low BMI", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Low BMI\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old hypertensive patient presented with complaints of blurred vision and headaches. On retinal examination, the following findings were observed: multiple flame-shaped hemorrhages, cotton wool spots, and disc edema. Based on the Keith-Wagner classification, which grade of hypertensive retinopathy is this patient most likely classified as?", "options": [{"label": "A", "text": "GRADE 1", "correct": false}, {"label": "B", "text": "GRADE 2", "correct": false}, {"label": "C", "text": "GRADE 3", "correct": false}, {"label": "D", "text": "GRADE 4", "correct": true}], "correct_answer": "D. GRADE 4", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Grade</strong></th>\n<th><strong>Fundus Findings</strong></th>\n<th><strong>Clinical Features</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Grade 1</td>\n<td>Mild arteriolar narrowing</td>\n<td>Usually asymptomatic</td>\n</tr>\n<tr>\n<td>Grade 2</td>\n<td>Moderate arteriolar narrowing + AV nicking</td>\n<td>Often <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or mild symptoms</td>\n</tr>\n<tr>\n<td>Grade 3</td>\n<td>Grade 2 + Flame-shaped hemorrhages + Cotton <span class=\"customMeta\" data-dictid=\"eaae57387d1692777202060f299953\">wool</span> spots + hard exudates</td>\n<td>Visual symptoms possible</td>\n</tr>\n<tr>\n<td>Grade 4</td>\n<td>Grade 3 + Papilledema (disc edema)</td>\n<td>Malignant <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> symptoms like headache, blurred vision</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most likely diagnosis if the middle swab is stained with Dye in Methylene Blue-3 swab test?", "options": [{"label": "A", "text": "Vesicovaginal Fistula", "correct": true}, {"label": "B", "text": "Urethrovaginal fistula", "correct": false}, {"label": "C", "text": "Uretero- vaginal fistula", "correct": false}, {"label": "D", "text": "All above", "correct": false}], "correct_answer": "A. Vesicovaginal Fistula", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oaXcEjGv7MOI777JW1Gs1715326683.png"], "explanation": "<p>Correct Option A -Vesicovaginal Fistu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following hormones are secreted by sertoli cells and Leydig cells respectively?", "options": [{"label": "A", "text": "DHA and testosterone", "correct": false}, {"label": "B", "text": "Testosterone and inhibin", "correct": false}, {"label": "C", "text": "Testosterone and DHA", "correct": false}, {"label": "D", "text": "Inhibin and testosterone", "correct": true}], "correct_answer": "D. Inhibin and testosterone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D-Inh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Suction and evacuation is best done at?", "options": [{"label": "A", "text": "12 weeks", "correct": true}, {"label": "B", "text": "15 weeks", "correct": false}, {"label": "C", "text": "6 weeks", "correct": false}, {"label": "D", "text": "18 weeks", "correct": false}], "correct_answer": "A. 12 weeks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 12 week\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of inheritance?", "options": [{"label": "A", "text": "Autosomal Dominant", "correct": true}, {"label": "B", "text": "Autosomal Recessive", "correct": false}, {"label": "C", "text": "X-linked dominant", "correct": false}, {"label": "D", "text": "X-linked recessive", "correct": false}], "correct_answer": "A. Autosomal Dominant", "question_images": ["https://image.prepladder.com/content/Ogrj79EVG6dyACKyDgcA1692767080.png"], "explanation_images": ["https://image.prepladder.com/content/LvR2VwfshHJqQUHzjU2w1712123892.png"], "explanation": "<p>Correct Option A - Autosomal Dominant Inh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qgLHVT7ieMfxEUmylquU1748416143.mp3", "video": ""}, {"text": "A 32 year old female presents on 5th postnatal day, with complaints of low mood and mild depressive symptoms that are transient and self-limited. The depressive symptoms include sadness, crying, exhaustion, irritability, anxiety, decreased sleep, decreased concentration, and labile mood. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Postpartum blues", "correct": true}, {"label": "B", "text": "Postpartum psychosis", "correct": false}, {"label": "C", "text": "Postpartum depression", "correct": false}, {"label": "D", "text": "Postpartum hemorrhage", "correct": false}], "correct_answer": "A. Postpartum blues", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\"&gt;Postpartum&lt;/span&gt; blu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old pregnant woman who has the thalassemia trait visits the clinic for genetic counseling. Her husband is also confirmed to have the thalassemia trait. Considering their genetic background, what is the likelihood of their next offspring having thalassemia?", "options": [{"label": "A", "text": "100%", "correct": false}, {"label": "B", "text": "50%", "correct": false}, {"label": "C", "text": "75%", "correct": false}, {"label": "D", "text": "25%", "correct": true}], "correct_answer": "D. 25%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fY65XLDLuSmjk3jxX7iN1748416313.mp3", "video": ""}, {"text": "Warthin's tumor is also called?", "options": [{"label": "A", "text": "Adenolymphoma", "correct": true}, {"label": "B", "text": "Pleomorphic adenoma", "correct": false}, {"label": "C", "text": "Mucoepidermoid carcinoma", "correct": false}, {"label": "D", "text": "Acinic cell carcinoma", "correct": false}], "correct_answer": "A. Adenolymphoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Adenolymph\n<table>\n<tbody>\n<tr>\n<td>Name</td>\n<td>Warthin's tumor (also known as <strong>adenolymphoma or <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> <span class=\"customMeta\" data-dictid=\"7ed146244a169277719141d7316a85\">lymphomatous</span> cystadenoma</strong>)</td>\n</tr>\n<tr>\n<td>Definition</td>\n<td>Warthin's tumor is a <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> tumor that primarily occurs in the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and is characterized by a <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> structure with <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> tissue and <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> epithelial projections.</td>\n</tr>\n<tr>\n<td>Prevalence</td>\n<td>It is the second most common <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> tumor, primarily affecting middle-aged to older adults, with a higher <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> in males.</td>\n</tr>\n<tr>\n<td>Clinical Presentation</td>\n<td>- Painless, slow-growing mass or lump in the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> region. - Rarely associated with pain or discomfort.</td>\n</tr>\n<tr>\n<td>Risk Factors</td>\n<td>The exact cause is unknown, but there is an association with smoking, especially in men.</td>\n</tr>\n<tr>\n<td>Diagnosis</td>\n<td>- Clinical examination: <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">Palpation</span> of a firm, mobile mass in the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> area. - Imaging: Ultrasound, CT scan, or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> may reveal characteristic features. - Fine-needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> (FNA): Often performed to confirm the diagnosis and rule out other salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> tumors.</td>\n</tr>\n<tr>\n<td>Histological Features</td>\n<td>- <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">Cystic</span> spaces with <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> projections. - <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">Lymphoid</span> stroma. - Bilayered oncocytic epithelium.</td>\n</tr>\n<tr>\n<td>Treatment</td>\n<td>- <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> excision: The primary treatment involves complete removal of the tumor while preserving the surrounding salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> tissue. - <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">Recurrence</span> is rare after excision.</td>\n</tr>\n<tr>\n<td>Complications</td>\n<td>- Although Warthin's tumors are benign, complications can occur during or after surgery, such as damage to the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve or salivary ducts. - Infrequent <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> or development of other salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> tumors.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis of the image given below ?", "options": [{"label": "A", "text": "Microcephaly", "correct": false}, {"label": "B", "text": "Cervical spina bifida", "correct": false}, {"label": "C", "text": "Myelomeningocele", "correct": false}, {"label": "D", "text": "Anencephaly craniorachischisis", "correct": true}], "correct_answer": "D. Anencephaly craniorachischisis", "question_images": ["https://image.prepladder.com/content/0Y8MtY1z36JpJxcqrQMi1692768250.png"], "explanation_images": [], "explanation": "<p>Correct Option D- O\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old female patient presents with a palpable thyroid nodule and occasional neck discomfort. She has no history of radiation exposure to the neck. On physical examination, a solitary, firm, non-tender thyroid nodule is noted. Ultrasound reveals a hypoechoic nodule with microcalcifications. Fine-needle aspiration biopsy is performed, and histological analysis reveals characteristic nuclear changes. What is the most common thyroid cancer in this patient?", "options": [{"label": "A", "text": "Papillary carcinoma", "correct": true}, {"label": "B", "text": "Follicular carcinoma", "correct": false}, {"label": "C", "text": "Medullary carcinoma", "correct": false}, {"label": "D", "text": "Anaplastic carcinoma", "correct": false}], "correct_answer": "A. Papillary carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition shown below?", "options": [{"label": "A", "text": "Condyloma lata", "correct": false}, {"label": "B", "text": "Molluscum contagiosum", "correct": false}, {"label": "C", "text": "Condyloma accuminata", "correct": true}, {"label": "D", "text": "None of Above", "correct": false}], "correct_answer": "C. Condyloma accuminata", "question_images": ["https://image.prepladder.com/content/XWVLDSltQv4xYrRYJkUZ1692768395.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"2ed8a5f8f2169277718404b6d69c6c\"&gt;Condyloma&lt;/span&gt; acu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Molar pregnancy is a form of abnormal pregnancy, in which the formed placental-like tissue sometimes invades the wall of the uterus . Molar pregnancy is usually diagnosed early in pregnancy due to bleeding, abnormal features in ultrasound scans and higher than usual levels of pregnancy hormone. Which of the following hormone is mainly increased in the condition shown in the given image:", "options": [{"label": "A", "text": "FSH", "correct": false}, {"label": "B", "text": "LH", "correct": false}, {"label": "C", "text": "GnRH", "correct": false}, {"label": "D", "text": "HCG", "correct": true}], "correct_answer": "D. HCG", "question_images": ["https://image.prepladder.com/content/NFCS8i2th66yg38hi0aP1692769235.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\"&gt;HCG&lt;/span&gt; (Human Chorionic Gonadotropin)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate antidote for Benzodiazepine overdose?", "options": [{"label": "A", "text": "Flumazenil", "correct": true}, {"label": "B", "text": "Flurazepam", "correct": false}, {"label": "C", "text": "Barbiturates", "correct": false}, {"label": "D", "text": "Buspirone", "correct": false}], "correct_answer": "A. Flumazenil", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Flu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old pregnant lady comes to the emergency department at 32 weeks gestation with BP 150/120 mmHg, pedal edema, and proteinuria on urine dipstick test is 2+. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pre-eclampsia", "correct": true}, {"label": "B", "text": "Abruptio placenta", "correct": false}, {"label": "C", "text": "PPH", "correct": false}, {"label": "D", "text": "Placenta Previa", "correct": false}], "correct_answer": "A. Pre-eclampsia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common side effect induced by cisplatin chemotherapy?", "options": [{"label": "A", "text": "GI symptoms", "correct": true}, {"label": "B", "text": "Neuropathy", "correct": false}, {"label": "C", "text": "Cardiotoxicity", "correct": false}, {"label": "D", "text": "Myopathy", "correct": false}], "correct_answer": "A. GI symptoms", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - GI\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is studied in PCOD?", "options": [{"label": "A", "text": "Urine study", "correct": false}, {"label": "B", "text": "Sleep study", "correct": false}, {"label": "C", "text": "Serum testosterone level", "correct": true}, {"label": "D", "text": "Both A &amp;amp; B", "correct": false}], "correct_answer": "C. Serum testosterone level", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\"&gt;Serum&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\"&gt;testosterone&lt;/span&gt; lev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Male infertility is diagnosed with karyotype 47 XXY. Which of the following statement is false:", "options": [{"label": "A", "text": "Decreased FSH", "correct": true}, {"label": "B", "text": "Hyalinisation of seminiferous tubules", "correct": false}, {"label": "C", "text": "Decreased testis size", "correct": false}, {"label": "D", "text": "Azoospermia", "correct": false}], "correct_answer": "A. Decreased FSH", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Decreased FSH\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 35-year-old pregnant woman at 32 weeks of gestation, which of the following conditions is oxytocin contraindicated for?", "options": [{"label": "A", "text": "Placenta covering internal os", "correct": true}, {"label": "B", "text": "Induction of labor in post-term pregnancy", "correct": false}, {"label": "C", "text": "Augmentation of labor in case of slow progress", "correct": false}, {"label": "D", "text": "Preterm labor with cervical dilation of 3 cm", "correct": false}], "correct_answer": "A. Placenta covering internal os", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\"&gt;Placenta&lt;/span&gt; covering\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which cellular process does Bedaquiline primarily target to exert its therapeutic effect, and how does this mechanism contribute to its antimycobacterial activity?", "options": [{"label": "A", "text": "ATP synthesis inhibition", "correct": true}, {"label": "B", "text": "Mycolic acid synthesis inhibition", "correct": false}, {"label": "C", "text": "Protein inhibition", "correct": false}, {"label": "D", "text": "Inhibiting reverse transcriptase enzyme", "correct": false}], "correct_answer": "A. ATP synthesis inhibition", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\"&gt;ATP&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\"&gt;synthesis&lt;/span&gt; inh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the dose of Misoprostol in medical abortion?", "options": [{"label": "A", "text": "800 Micrograms", "correct": true}, {"label": "B", "text": "25 Micrograms", "correct": false}, {"label": "C", "text": "200 Micrograms", "correct": false}, {"label": "D", "text": "400 Micrograms", "correct": false}], "correct_answer": "A. 800 Micrograms", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 800 Microg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which medication is commonly used as preoperative management for pheochromocytoma to control blood pressure and prevent hypertensive crises?", "options": [{"label": "A", "text": "Captopril", "correct": false}, {"label": "B", "text": "Propranolol", "correct": false}, {"label": "C", "text": "Nifedipine", "correct": false}, {"label": "D", "text": "Phenoxybenzamine", "correct": true}], "correct_answer": "D. Phenoxybenzamine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Ph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following statement is correct in pregnancy?", "options": [{"label": "A", "text": "GFR decrease", "correct": false}, {"label": "B", "text": "Platelets increase", "correct": false}, {"label": "C", "text": "Serum creatinine decrease", "correct": true}, {"label": "D", "text": "Both B &amp;amp; C", "correct": false}], "correct_answer": "C. Serum creatinine decrease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\"&gt;Serum&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\"&gt;creatinine&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred drug for the treatment of facial nerve palsy?", "options": [{"label": "A", "text": "Acyclovir", "correct": false}, {"label": "B", "text": "Ceftriaxone", "correct": false}, {"label": "C", "text": "Prednisolone", "correct": true}, {"label": "D", "text": "Naproxen", "correct": false}], "correct_answer": "C. Prednisolone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following combination of biomedical waste management is correct regarding the disposal of an Expired tablet?", "options": [{"label": "A", "text": "Red bag - hydroclaving", "correct": false}, {"label": "B", "text": "Blue bag - incineration", "correct": false}, {"label": "C", "text": "Yellow bag- incineration", "correct": true}, {"label": "D", "text": "Yellow bag - burial", "correct": false}], "correct_answer": "C. Yellow bag- incineration", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70 year old male presents with low back ache and progressive pallor. On work up: KFT is deranged, LFT is normal with normal level of albumin and gamma globulin increased disproportionately. X-ray spine shows multiple lytic lesions. Which of the following is the most probable diagnosis?", "options": [{"label": "A", "text": "Multiple myeloma", "correct": true}, {"label": "B", "text": "MGUS", "correct": false}, {"label": "C", "text": "Immunoglobulin light chain amyloidosis (AL)", "correct": false}, {"label": "D", "text": "Solitary plasmacytoma.", "correct": false}], "correct_answer": "A. Multiple myeloma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Mu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to SDG proposed goals towards 2030, Which of the following is the target for maternal mortality rate reduction?", "options": [{"label": "A", "text": "&amp;lt;60/100000", "correct": false}, {"label": "B", "text": "&amp;lt;70/100000", "correct": true}, {"label": "C", "text": "&amp;lt;50/100000", "correct": false}, {"label": "D", "text": "&amp;lt;80/100000", "correct": false}], "correct_answer": "B. &lt;70/100000", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &amp;lt;7\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IDzkeYuu46C0Jod5AeYI1746268928.mp3", "video": ""}, {"text": "A 45-year-old patient presents with severe headaches, seizures, and progressive neurological deficits. Imaging reveals a large mass with areas of necrosis and irregular borders in the brain. The biopsy confirms the diagnosis of a malignant tumor. Which of the following options represents the most common type of brain tumor in adults?", "options": [{"label": "A", "text": "Medulloblastoma", "correct": false}, {"label": "B", "text": "Meningioma", "correct": false}, {"label": "C", "text": "Retinoblastoma", "correct": false}, {"label": "D", "text": "Glioblastoma", "correct": true}], "correct_answer": "D. Glioblastoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - G\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statement is correct about triage?", "options": [{"label": "A", "text": "Red- ambulatory", "correct": false}, {"label": "B", "text": "Yellow- stable need observation", "correct": true}, {"label": "C", "text": "Black- minor injuries", "correct": false}, {"label": "D", "text": "Green- life threatening", "correct": false}], "correct_answer": "B. Yellow- stable need observation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Yellow - stable, need observ\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HFnxVYqJQa08maxXyyzF1746268014.mp3", "video": ""}, {"text": "Which type of hypersensitivity reaction is a type 2 lepra reaction?", "options": [{"label": "A", "text": "Type I hypersensitivity", "correct": false}, {"label": "B", "text": "Type II hypersensitivity", "correct": false}, {"label": "C", "text": "Type III hypersensitivity", "correct": true}, {"label": "D", "text": "Type IV hypersensitivity", "correct": false}], "correct_answer": "C. Type III hypersensitivity", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Type III hypersensitiv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In endemic area what will be the dose of Vitamin A for 1-6 year old baby?", "options": [{"label": "A", "text": "2 lakh IU orally for 6 months", "correct": true}, {"label": "B", "text": "1 lakh IU orally for 6 months", "correct": false}, {"label": "C", "text": "2 lakh IU for 6 weeks", "correct": false}, {"label": "D", "text": "2 lakh IU for 1 year", "correct": false}], "correct_answer": "A. 2 lakh IU orally for 6 months", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 2 lakh IU orally for 6 month\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient arrives at the emergency room with complaints of respiratory discomfort. The patient has been experiencing shortness of breath, coughing, and chest pain for the past few weeks. The patient's medical history is unremarkable, and there is no significant smoking history. Upon further investigation, a lung biopsy is performed, and microscopic examination reveals the presence of asteroid bodies. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Sarcoidosis", "correct": true}, {"label": "B", "text": "RA", "correct": false}, {"label": "C", "text": "Sjogren syndrome", "correct": false}, {"label": "D", "text": "SLE", "correct": false}], "correct_answer": "A. Sarcoidosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XfSqq4Bv9sFmcbu7B6Xg1717155050.png", "https://image.prepladder.com/content/XfSqq4Bv9sFmcbu7B6Xg1717155050.png"], "explanation": "<p>Correct Option A - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are features of irreversible injury except:", "options": [{"label": "A", "text": "Blebs formation", "correct": true}, {"label": "B", "text": "Karyolysis", "correct": false}, {"label": "C", "text": "Amorphous densities", "correct": false}, {"label": "D", "text": "Pyknotic nucleus", "correct": false}], "correct_answer": "A. Blebs formation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is correct regarding Ayushman Bharat scheme?", "options": [{"label": "A", "text": "Rs 5 lakh/per family per year is given", "correct": true}, {"label": "B", "text": "Rs 10 lakh/per family per year is given", "correct": false}, {"label": "C", "text": "Rs 6 lakh/per family per year is given", "correct": false}, {"label": "D", "text": "Rs 2 lakh/per family per year is given", "correct": false}], "correct_answer": "A. Rs 5 lakh/per family per year is given", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Rs 5 lakh/per family per year is giv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is treated with McCall’s Culdoplasty?", "options": [{"label": "A", "text": "Enterocele", "correct": true}, {"label": "B", "text": "Ureterocele", "correct": false}, {"label": "C", "text": "Cystocele", "correct": false}, {"label": "D", "text": "Both A &amp;amp; C", "correct": false}], "correct_answer": "A. Enterocele", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - E\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a part of Urban health care delivery system?", "options": [{"label": "A", "text": "PHC", "correct": false}, {"label": "B", "text": "CHC", "correct": false}, {"label": "C", "text": "Swasthya chowki", "correct": false}, {"label": "D", "text": "Subcenter", "correct": true}], "correct_answer": "D. Subcenter", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vlRKf2btHWkZXdGoD4is1714459673.png"], "explanation": "<p>Correct Option D - Su\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Galactokinesis is governed by:", "options": [{"label": "A", "text": "Prolactin", "correct": false}, {"label": "B", "text": "Estrogen", "correct": false}, {"label": "C", "text": "Oxytocin", "correct": true}, {"label": "D", "text": "Progesterone", "correct": false}], "correct_answer": "C. Oxytocin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - O\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diet is not advised in celiac sprue disease?", "options": [{"label": "A", "text": "Rice", "correct": false}, {"label": "B", "text": "Wheat", "correct": true}, {"label": "C", "text": "Dhal", "correct": false}, {"label": "D", "text": "Ragi", "correct": false}], "correct_answer": "B. Wheat", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Wh\n<table>\n<tbody>\n<tr>\n<td>Definition</td>\n<td>Celiac disease, also known as <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> <span class=\"customMeta\" data-dictid=\"15ba4af6a9169277719905f80d2b20\">sprue</span> disease, is an <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> disorder in which the <span class=\"customMeta\" data-dictid=\"eba893313f16927771906290ce7e79\">ingestion</span> of gluten, a protein found in wheat, barley, and rye, triggers an <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> that damages the lining of the small intestine.</td>\n</tr>\n<tr>\n<td>Prevalence</td>\n<td>Celiac disease is relatively common, with a global <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> estimated at around 1% of the population.</td>\n</tr>\n<tr>\n<td>Symptoms</td>\n<td>- <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">Gastrointestinal</span> symptoms: Diarrhea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, bloating, and constipation. - Non-gastrointestinal symptoms: Fatigue, anemia, <span class=\"customMeta\" data-dictid=\"fedc53b3161692777186553c8f8d7d\">dermatitis</span> herpetiformis (skin rash), joint pain, and neurological symptoms.</td>\n</tr>\n<tr>\n<td>Diagnosis</td>\n<td>- Blood tests: Anti-tissue <span class=\"customMeta\" data-dictid=\"4a47b71b801692777200d06df00a08\">transglutaminase</span> (tTG) antibodies, anti-endomysial antibodies (EMA), and anti-deamidated <span class=\"customMeta\" data-dictid=\"21f6d7d8df1692777188deb1006c47\">gliadin</span> <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">peptide</span> (DGP) antibodies. - Small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> biopsy: The gold standard for diagnosis, showing characteristic <span class=\"customMeta\" data-dictid=\"838d2bdb8516927772023871643ffb\">villous</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> and inflammation. - Genetic testing: HLA-DQ2 and HLA-DQ8 testing can be supportive but not diagnostic.</td>\n</tr>\n<tr>\n<td>Treatment</td>\n<td>A strict <span class=\"customMeta\" data-dictid=\"e4cd865af41692777188fd3bf1aee5\">gluten-free diet</span> is the primary treatment for <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> disease. This involves avoiding all sources of gluten, including wheat, barley, and rye.</td>\n</tr>\n<tr>\n<td>Complications</td>\n<td>- <span class=\"customMeta\" data-dictid=\"819ebcc6691692777191f968d41a03\">Malabsorption</span> of nutrients: <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">Celiac</span> disease can lead to nutrient deficiencies, including iron, calcium, and vitamins. - Osteoporosis: Due to impaired <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> absorption. - <span class=\"customMeta\" data-dictid=\"fedc53b3161692777186553c8f8d7d\">Dermatitis</span> herpetiformis: A chronic skin condition associated with <span class=\"customMeta\" data-dictid=\"c2b5c161b71692777184c75775751a\">celiac</span> disease. - Increased risk of associated <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> disorders.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the treatment of bacterial vaginosis (BV), which antibiotic is not recommended by the Centers for Disease Control and Prevention (CDC) guidelines?", "options": [{"label": "A", "text": "Metronidazole", "correct": false}, {"label": "B", "text": "Tinidazole", "correct": false}, {"label": "C", "text": "Clindamycin", "correct": false}, {"label": "D", "text": "Erythromycin", "correct": true}], "correct_answer": "D. Erythromycin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Eryth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old female patient presents to the clinic with complaints of fatigue, weakness, and pale skin. On further investigation, her complete blood count reveals a microcytic anemia. What is the likely diagnosis for this patient?", "options": [{"label": "A", "text": "Alcoholism", "correct": false}, {"label": "B", "text": "Chronic Kidney disease", "correct": false}, {"label": "C", "text": "Hemolytic anemia", "correct": false}, {"label": "D", "text": "Iron deficiency anemia", "correct": true}], "correct_answer": "D. Iron deficiency anemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Iron &lt;span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\"&gt;deficiency&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sperm count on a seminormal is 16 million/ml, with 40% motility and &amp;lt;1% of sperm with normal morphology. What is the term for this condition?", "options": [{"label": "A", "text": "Oligospermia", "correct": false}, {"label": "B", "text": "Normospermia", "correct": false}, {"label": "C", "text": "Asthenospermia", "correct": false}, {"label": "D", "text": "Teratospermia", "correct": true}], "correct_answer": "D. Teratospermia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female patient presents with skin lesions, respiratory symptoms, and enlarged lymph nodes. Skin lesions appear as raised, erythematous nodules, and a chest X-ray shows bilateral hilar lymphadenopathy. A biopsy of the affected tissues is performed. Microscopic examination reveals the presence of granulomas without central necrosis. What is the most likely histological finding in this scenario?", "options": [{"label": "A", "text": "Caseating granuloma", "correct": false}, {"label": "B", "text": "Stellate granuloma", "correct": false}, {"label": "C", "text": "Non-caseating granuloma", "correct": true}, {"label": "D", "text": "Eosinophilic granuloma", "correct": false}], "correct_answer": "C. Non-caseating granuloma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JcWrwDO69xSdy3f0tiOg1712122238.png", "https://image.prepladder.com/content/JcWrwDO69xSdy3f0tiOg1712122238.png"], "explanation": "<p>Correct Option C - Non-caseating granu\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td><strong>Granulomatous disease</strong></td>\n<td><strong>Specific features</strong></td>\n</tr>\n<tr>\n<td>Tuberculosis</td>\n<td>Caseating granulomas with central necrosis</td>\n</tr>\n<tr>\n<td>Leprosy</td>\n<td>Non-caseating granulomas with <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> bacilli</td>\n</tr>\n<tr>\n<td>Sarcoidosis</td>\n<td>\n<p>Non-caseating granulomas with Schaumann bodies</p>\n<p><img src=\"https://image.prepladder.com/content/JcWrwDO69xSdy3f0tiOg1712122238.png\"/></p>\n</td>\n</tr>\n<tr>\n<td>Crohn's disease</td>\n<td>Non-caseating granulomas in the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> tract</td>\n</tr>\n<tr>\n<td>Wegener's granulomatosis</td>\n<td>Necrotizing granulomas with vasculitis</td>\n</tr>\n<tr>\n<td>Berylliosis</td>\n<td>Non-caseating granulomas with <span class=\"customMeta\" data-dictid=\"d8970d6c401692777182ef5e543622\">beryllium</span> exposure</td>\n</tr>\n<tr>\n<td>Cat-scratch disease</td>\n<td>Granulomas with <span class=\"customMeta\" data-dictid=\"bcca1a959c16927771845f711facaf\">central necrosis</span> and Warthin-Starry staining</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which international agency helps in construction of sanitary latrines( toilet building) in India?", "options": [{"label": "A", "text": "USAID", "correct": false}, {"label": "B", "text": "CURE", "correct": false}, {"label": "C", "text": "Redcross", "correct": false}, {"label": "D", "text": "FORD", "correct": true}], "correct_answer": "D. FORD", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - FORD\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 31-year-old female presented with a history of vaginal delivery 2 days ago and complained of pain and sensory loss in the anterolateral aspect of the thigh. Which of the following nerve is involved?", "options": [{"label": "A", "text": "Sciatic Nerve", "correct": false}, {"label": "B", "text": "Obturator Nerve", "correct": false}, {"label": "C", "text": "Ilioinguinal Nerve", "correct": false}, {"label": "D", "text": "The lateral cutaneous nerve of thigh", "correct": true}], "correct_answer": "D. The lateral cutaneous nerve of thigh", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - The &lt;span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\"&gt;lateral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\"&gt;cutaneous&lt;/span&gt; nerve of thigh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Diabetic screening for the pregnant mother in India is done between:", "options": [{"label": "A", "text": "24-28W", "correct": true}, {"label": "B", "text": "32-36W", "correct": false}, {"label": "C", "text": "18-24W", "correct": false}, {"label": "D", "text": "14-18W", "correct": false}], "correct_answer": "A. 24-28W", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 24-28 week\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of a newborn delivered by an HIV-positive woman who was not receiving treatment, what is the recommended initial course of treatment to reduce the risk of mother-to-child transmission of HIV?", "options": [{"label": "A", "text": "Nevirapine 6 months", "correct": false}, {"label": "B", "text": "Zidovudine 6 weeks", "correct": false}, {"label": "C", "text": "Nevirapine + Zidovudine + Lamivudine6 weeks", "correct": true}, {"label": "D", "text": "Nevirapine 6 weeks", "correct": false}], "correct_answer": "C. Nevirapine + Zidovudine + Lamivudine6 weeks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"5b737ea2b4169277719338ba5f0a07\"&gt;Nevirapine&lt;/span&gt; + &lt;span class=\"customMeta\" data-dictid=\"929423b7711692777202c3adc5f32c\"&gt;Zidovudine&lt;/span&gt; + &lt;span class=\"customMeta\" data-dictid=\"548c02a1cf1692777191e70df694f8\"&gt;Lamivudine&lt;/span&gt; 6 week\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the management of CMV retinitis, which drug is considered the drug of choice?", "options": [{"label": "A", "text": "Cotrimoxazole", "correct": false}, {"label": "B", "text": "Valacyclovir", "correct": false}, {"label": "C", "text": "Tenofovir", "correct": false}, {"label": "D", "text": "Ganciclovir", "correct": true}], "correct_answer": "D. Ganciclovir", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male patient with a history of chronic inflammatory conditions presents with fatigue, weakness, and pallor. Laboratory investigations reveal microcytic hypochromic anemia. Further evaluation suggests an underlying disorder affecting iron metabolism. Which cytokine is most likely inhibiting the activity of ferroportin in this patient?", "options": [{"label": "A", "text": "IL-1", "correct": false}, {"label": "B", "text": "IL-6", "correct": true}, {"label": "C", "text": "IFN-gamma", "correct": false}, {"label": "D", "text": "TNF-Alpha", "correct": false}], "correct_answer": "B. IL-6", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - IL-6\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old school-going girl came for a health checkup. Her Hb is 9 g/dL. Which of the following government programs is likely to provide significant benefit to her health?", "options": [{"label": "A", "text": "Rashtriya bal swasthya karyakram", "correct": true}, {"label": "B", "text": "Janani suraksha yojana", "correct": false}, {"label": "C", "text": "Pradhan Mantri Matru Vandana Yojana", "correct": false}, {"label": "D", "text": "Navjat Shishu Karyakram yojna", "correct": false}], "correct_answer": "A. Rashtriya bal swasthya karyakram", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Rashtriya &lt;span class=\"customMeta\" data-dictid=\"eff14f005f16927771826bf88cb6c5\"&gt;Bal&lt;/span&gt; Swasthya Karyak\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the management of Thalamic Dejerine Syndrome, which of the following drugs is the least useful?", "options": [{"label": "A", "text": "Pregabalin", "correct": false}, {"label": "B", "text": "Carbamazepine", "correct": false}, {"label": "C", "text": "Gabapentin", "correct": false}, {"label": "D", "text": "NSAID analgesic", "correct": true}], "correct_answer": "D. NSAID analgesic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"b924074dfe16927771933b6d50eaac\"&gt;NSAID&lt;/span&gt; Analg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 37-year-old male patient presents with infertility and respiratory infections. Which of the following is the most likely diagnosis ?", "options": [{"label": "A", "text": "Primary ciliary dyskinesia", "correct": true}, {"label": "B", "text": "Akinesia", "correct": false}, {"label": "C", "text": "Tardive dyskinesia", "correct": false}, {"label": "D", "text": "Athetosis", "correct": false}], "correct_answer": "A. Primary ciliary dyskinesia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Primary &lt;span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\"&gt;Ciliary&lt;/span&gt; Dysk\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Criteria of mid arm circumference in Shakir's tape for severe acute malnutrition ?", "options": [{"label": "A", "text": "&amp;lt; 11.5", "correct": true}, {"label": "B", "text": "&amp;lt;12.5", "correct": false}, {"label": "C", "text": "&amp;lt;13.5", "correct": false}, {"label": "D", "text": "&amp;lt;14.5", "correct": false}], "correct_answer": "A. &lt; 11.5", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &amp;lt; 11.5\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not classified as a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression?", "options": [{"label": "A", "text": "Fluoxetine", "correct": false}, {"label": "B", "text": "Sertraline", "correct": false}, {"label": "C", "text": "Trazadone", "correct": true}, {"label": "D", "text": "Escitalopram", "correct": false}], "correct_answer": "C. Trazadone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient with a history of chronic liver disease presents with symptoms of nausea, vomiting, edema, and ascites. On examination, his liver function tests are severely deranged. Further investigation reveals a diagnosis of hepatocellular carcinoma. The pathogenesis of this condition is most likely related to:", "options": [{"label": "A", "text": "Benzol", "correct": false}, {"label": "B", "text": "Arsenic", "correct": false}, {"label": "C", "text": "Aflatoxin", "correct": true}, {"label": "D", "text": "Vinyl chloride", "correct": false}], "correct_answer": "C. Aflatoxin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old patient presents with progressive memory loss, cognitive decline, and behavioral changes. Imaging reveals characteristic amyloid plaques and neurofibrillary tangles in the brain. On further investigation, the accumulation of a specific protein is found to be a hallmark of this disease. What is the protein responsible for the amyloidosis seen in Alzheimer's disease?", "options": [{"label": "A", "text": "Amyloid beta protein", "correct": true}, {"label": "B", "text": "ATTR", "correct": false}, {"label": "C", "text": "Amyloid beta 2 protein", "correct": false}, {"label": "D", "text": "Acal", "correct": false}], "correct_answer": "A. Amyloid beta protein", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Amyloid &lt;span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\"&gt;beta&lt;/span&gt; protein: \n<table>\n<tbody>\n<tr>\n<td>Definition</td>\n<td>Alzheimer's disease is a progressive neurodegenerative disorder characterized by memory loss, cognitive decline, and behavioral changes. It is the most common cause of dementia.</td>\n</tr>\n<tr>\n<td>Prevalence</td>\n<td>Alzheimer's disease is a widespread global health issue, affecting <span class=\"customMeta\" data-dictid=\"fedf65ed431692777192f0de4f27ba\">millions</span> of people, with a higher <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> in older adults.</td>\n</tr>\n<tr>\n<td>Risk Factors</td>\n<td>- Age: The risk of developing Alzheimer's disease increases with age. - Genetics: Family history and specific genes, such as the APOE ε4 allele, play a role. - <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">Cardiovascular</span> health: Conditions like <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> and diabetes may increase the risk.</td>\n</tr>\n<tr>\n<td>Stages</td>\n<td>Alzheimer's disease typically progresses through stages: - Mild cognitive <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> (MCI) - Mild Alzheimer's disease - Moderate Alzheimer's disease - Severe Alzheimer's disease</td>\n</tr>\n<tr>\n<td>Clinical Features</td>\n<td>- Memory loss - Difficulty with problem-solving and planning - Language problems - Confusion - Mood changes (e.g., depression, anxiety) - <span class=\"customMeta\" data-dictid=\"40f8eaa3d01692777186cb3e1d6c69\">Disorientation</span> - Behavioral changes</td>\n</tr>\n<tr>\n<td>Diagnosis</td>\n<td>- Clinical assessment and cognitive testing. - Neuroimaging, such as <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> or CT scans, to rule out other causes. - Biomarkers like <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid analysis or <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> PET scans may help confirm the diagnosis.</td>\n</tr>\n<tr>\n<td>Treatment</td>\n<td>- Medications: <span class=\"customMeta\" data-dictid=\"aefa9aaa9216927771841998c2c30a\">Cholinesterase</span> inhibitors and N-methyl-D-aspartate (NMDA) <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists may help manage symptoms. - Non-pharmacological approaches: Cognitive stimulation, physical exercise, and counseling. - Supportive care and assistance with daily living tasks.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female delivered a male baby developed PPH was treated with ergometrine but not able to stop the bleeding. Which of the following is a prostaglandin derivative that can be used in the treatment of this patient?", "options": [{"label": "A", "text": "Misoprostol", "correct": false}, {"label": "B", "text": "Dinoprost", "correct": false}, {"label": "C", "text": "Carboprost", "correct": true}, {"label": "D", "text": "Latanoprost", "correct": false}], "correct_answer": "C. Carboprost", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32 year old male presented to emergency department with crush injury to the hand. He had a TT injection when he was 25 years old. The wound has been cleaned. What is the recommended next step of management?", "options": [{"label": "A", "text": "TT only", "correct": true}, {"label": "B", "text": "Td only", "correct": false}, {"label": "C", "text": "TT with Ig", "correct": false}, {"label": "D", "text": "Td with Ig", "correct": false}], "correct_answer": "A. TT only", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has developed hepatitis A for more than 15 days. What is the correct statement ?", "options": [{"label": "A", "text": "Early Acute", "correct": false}, {"label": "B", "text": "Acute", "correct": true}, {"label": "C", "text": "Chronic", "correct": false}, {"label": "D", "text": "Severe", "correct": false}], "correct_answer": "B. Acute", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Acu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male patient presents with fever, night sweats, and pleural effusion. On further investigation, he is diagnosed with Primary Effusion Lymphoma. What is the most likely causative agent responsible for this condition?", "options": [{"label": "A", "text": "HHV-8", "correct": true}, {"label": "B", "text": "EBV", "correct": false}, {"label": "C", "text": "HPV", "correct": false}, {"label": "D", "text": "HIV", "correct": false}], "correct_answer": "A. HHV-8", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which category of bioterrorism, does Anthrax belong?", "options": [{"label": "A", "text": "CAT A", "correct": true}, {"label": "B", "text": "CAT B", "correct": false}, {"label": "C", "text": "CAT C", "correct": false}, {"label": "D", "text": "CAT D", "correct": false}], "correct_answer": "A. CAT A", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - CAT A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male with complaints of urine hesitancy and retention of urine comes to ER. On investigation, his USG shows residual urine of 130 ml. Which of the following drug is used in the treatment of this patient?", "options": [{"label": "A", "text": "Calcium channel blockers", "correct": false}, {"label": "B", "text": "5 alpha reductase inhibitors", "correct": true}, {"label": "C", "text": "ACE inhibitors", "correct": false}, {"label": "D", "text": "Aldosterone antagonist", "correct": false}], "correct_answer": "B. 5 alpha reductase inhibitors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 5 &lt;span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\"&gt;alpha&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\"&gt;reductase&lt;/span&gt; inh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Denominator in incidence rate is?", "options": [{"label": "A", "text": "Total observed population", "correct": false}, {"label": "B", "text": "Total population at risk in a year", "correct": true}, {"label": "C", "text": "Total live births", "correct": false}, {"label": "D", "text": "Total new cases in a year", "correct": false}], "correct_answer": "B. Total population at risk in a year", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Total population at risk\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JuS4cKCvBIGALBx1ikDC1746267878.mp3", "video": ""}, {"text": "Thyroid hormone acts via which type of receptor?", "options": [{"label": "A", "text": "Cytoplasmic", "correct": false}, {"label": "B", "text": "Tyrosine kinase", "correct": false}, {"label": "C", "text": "Nuclear", "correct": true}, {"label": "D", "text": "GPCR", "correct": false}], "correct_answer": "C. Nuclear", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Nuclear: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the yoke muscles for Levodepression?", "options": [{"label": "A", "text": "LSO and RIR", "correct": false}, {"label": "B", "text": "RSO and LIR", "correct": true}, {"label": "C", "text": "RIO and LIR", "correct": false}, {"label": "D", "text": "LIO and RIR", "correct": false}], "correct_answer": "B. RSO and LIR", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8XRZKaTgM9oxIkItPifh1715333931.png"], "explanation": "<p>Correct Option B - RSO (Right Superior Oblique) and LIR (Left &lt;span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\"&gt;Inferior&lt;/span&gt; Rectus)\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:578px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Function</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior rectus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior rectus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior oblique</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior oblique</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intorsion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extorsion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secondary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intorsion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extorsion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tertiary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adduction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adduction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abduction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abduction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In Carcinoma cervix, which chemotherapeutic agent is used?", "options": [{"label": "A", "text": "Paclitaxel", "correct": false}, {"label": "B", "text": "Cyclophosphamide", "correct": false}, {"label": "C", "text": "Cisplatin", "correct": true}, {"label": "D", "text": "Topotecan", "correct": false}], "correct_answer": "C. Cisplatin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of cancer won't be affected if a patient uses OCP, which is a protective factor for?", "options": [{"label": "A", "text": "Endometrial cancer", "correct": true}, {"label": "B", "text": "Cervical cancer", "correct": false}, {"label": "C", "text": "Breast cancer", "correct": false}, {"label": "D", "text": "Bladder cancer", "correct": false}], "correct_answer": "A. Endometrial cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: E\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is number of the deliveries performed by Type-A PHC in a month?", "options": [{"label": "A", "text": "less than 20", "correct": true}, {"label": "B", "text": "20 or above", "correct": false}, {"label": "C", "text": "less than 30", "correct": false}, {"label": "D", "text": "30 or above", "correct": false}], "correct_answer": "A. less than 20", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Less Than 2\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type B</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Deliveries/ month: &lt;20</li>\n</ul>\n<p>Staffing pattern</p>\n<ul>\n<li>MBBS MO: 1</li>\n<li>Ayush MO: 1</li>\n<li>Total Staff: 13-18</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Deliveries/ month: ≥20</li>\n</ul>\n<p>Staffing pattern</p>\n<ul>\n<li>MBBS MO: 2</li>\n<li>Ayush MO: 1</li>\n<li>Total Staff: 14-21</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the least likely condition to happen if a group of colleagues took an excursion to a high altitude-mountain region?", "options": [{"label": "A", "text": "Increase PaO2", "correct": true}, {"label": "B", "text": "Increase in RBC &amp;amp; Hb", "correct": false}, {"label": "C", "text": "Increased mitochndria", "correct": false}, {"label": "D", "text": "Hyperventilation", "correct": false}], "correct_answer": "A. Increase PaO2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Increase PaO2: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male patient presents to the clinic with a complaint of sudden visual blurring that lasted for a short duration . He reports that during the episode, he completely lost vision in his left eye for a few minutes and then regained his vision . The patient denies any pain, headache, or other associated symptoms during the episode. What is the most likely diagnosis ?", "options": [{"label": "A", "text": "Amaurosis fugax", "correct": true}, {"label": "B", "text": "Central retinal artery occlusion", "correct": false}, {"label": "C", "text": "Central retinal vein occlusion", "correct": false}, {"label": "D", "text": "Hypertensive retinopathy", "correct": false}], "correct_answer": "A. Amaurosis fugax", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"2d543b30f11692777181065432d64e\"&gt;Amaurosis&lt;/span&gt; Fug\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not included in STEP approach?", "options": [{"label": "A", "text": "Blood group", "correct": true}, {"label": "B", "text": "Blood pressure", "correct": false}, {"label": "C", "text": "Blood sugar", "correct": false}, {"label": "D", "text": "Blood lipid", "correct": false}], "correct_answer": "A. Blood group", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Blood grou\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which co-transporter is primarily responsible for facilitating glucose absorption across the basolateral membrane of an enterocytein this scenario ?", "options": [{"label": "A", "text": "SGLT1", "correct": false}, {"label": "B", "text": "GLUT2", "correct": true}, {"label": "C", "text": "GLUT5", "correct": false}, {"label": "D", "text": "SGLT2", "correct": false}], "correct_answer": "B. GLUT2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - GLUT2: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3 year old child came in the opd with severe diarrhea , vomiting, skin, deeply sunken eyes and no urine output. On examination baby is severely dehydrated, lethargic,high respiratory rate and BP of 80/60mmHg. Which fluid is given for management?", "options": [{"label": "A", "text": "ORS", "correct": false}, {"label": "B", "text": "Ringer lactate with 5% dextrose", "correct": true}, {"label": "C", "text": "Normal Saline", "correct": false}, {"label": "D", "text": "Dextrose", "correct": false}], "correct_answer": "B. Ringer lactate with 5% dextrose", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ringer &lt;span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\"&gt;Lactate&lt;/span&gt; with 5%\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After undergoing lithium therapy for a year, all of the following adverse effects are visible, except:", "options": [{"label": "A", "text": "Hypothyroidism", "correct": false}, {"label": "B", "text": "Tremors", "correct": false}, {"label": "C", "text": "Diabetes insipidus", "correct": false}, {"label": "D", "text": "Tardive dyskinesia", "correct": true}], "correct_answer": "D. Tardive dyskinesia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"d93ab38f5316927772001828e5e817\"&gt;Tardive&lt;/span&gt; dysk\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug is commonly used for refraction in a child with accommodative squint?", "options": [{"label": "A", "text": "1% Atropine", "correct": true}, {"label": "B", "text": "Cyclopentolate", "correct": false}, {"label": "C", "text": "Tropicamide", "correct": false}, {"label": "D", "text": "Homatropine", "correct": false}], "correct_answer": "A. 1% Atropine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 1% A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In an experiment 39 was the highest number but was mistaken for 93. It will affect which of the following?", "options": [{"label": "A", "text": "Mean will remain same, median will increase", "correct": false}, {"label": "B", "text": "Mean and median both will increase", "correct": false}, {"label": "C", "text": "Mean will increase, median will remain same", "correct": true}, {"label": "D", "text": "Both mean and median will decrease", "correct": false}], "correct_answer": "C. Mean will increase, median will remain same", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C- Mean will increase, &lt;span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\"&gt;median&lt;/span&gt; will remain th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BPh7Vg2FC7BdBVkAbr1O1746267742.mp3", "video": ""}, {"text": "Identify the graph below:", "options": [{"label": "A", "text": "Point source single exposure epidemic", "correct": false}, {"label": "B", "text": "Common source, Continuous exposure epidemic", "correct": false}, {"label": "C", "text": "Intermittent Exposure", "correct": false}, {"label": "D", "text": "Propagated epidemic", "correct": true}], "correct_answer": "D. Propagated epidemic", "question_images": ["https://image.prepladder.com/content/x5Bbtw5774Z6R5hPHXmI1692775094.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Propag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1ZSbqAE8WTESIMdHSGOy1746267243.mp3", "video": ""}, {"text": "IV irritants were given as a result bradycardia,hypotension and apnea was developed. This represents which one of the following reflexes?", "options": [{"label": "A", "text": "Bezold jarisch reflex", "correct": true}, {"label": "B", "text": "Bainbridge reflex", "correct": false}, {"label": "C", "text": "Cushing reflex", "correct": false}, {"label": "D", "text": "None of them", "correct": false}], "correct_answer": "A. Bezold jarisch reflex", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Bezold-Jarisch reflex: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male patient presents with altered sensation in the extremities, difficulty with coordination, and speech problems. On examination, it is noted that the pupillary light reaction is absent, but the accommodation reaction is present. Which condition is most likely responsible for this presentation?", "options": [{"label": "A", "text": "Neurosyphilis", "correct": true}, {"label": "B", "text": "Horner’s syndrome", "correct": false}, {"label": "C", "text": "Papilledema", "correct": false}, {"label": "D", "text": "Optic Neuritis", "correct": false}], "correct_answer": "A. Neurosyphilis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Neurosyph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 30-year-old woman with a body weight of 55 kg, what is the recommended daily protein intake?", "options": [{"label": "A", "text": "45gm", "correct": true}, {"label": "B", "text": "55gm", "correct": false}, {"label": "C", "text": "60gm", "correct": false}, {"label": "D", "text": "70gm", "correct": false}], "correct_answer": "A. 45gm", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 45g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child came to ER presenting with fever, cough, runny nose, and a characteristic red rash.Which of the following statements about measles disease is incorrect?", "options": [{"label": "A", "text": "Incubation period of 14 days", "correct": false}, {"label": "B", "text": "Strain used is Edmonston Zagreb", "correct": false}, {"label": "C", "text": "Period of communicability is 14 days after rash", "correct": true}, {"label": "D", "text": "Transmitted primarily through respiratory droplets.", "correct": false}], "correct_answer": "C. Period of communicability is 14 days after rash", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Period of communicability is 14 days after rash\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Kartagener syndrome is associated with defects in which of the following structures?", "options": [{"label": "A", "text": "Microvilli", "correct": false}, {"label": "B", "text": "Microtubules", "correct": false}, {"label": "C", "text": "Cilia", "correct": true}, {"label": "D", "text": "Microfilaments", "correct": false}], "correct_answer": "C. Cilia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old female patient visits the ophthalmology clinic with complaints of experiencing vertical diplopia while walking downstairs. Upon further inquiry, it is noted that the patient tends to tilt her head to one side in order to alleviate the diplopia. Which cranial nerve palsy should be suspected in this patient?", "options": [{"label": "A", "text": "3rd nerve", "correct": false}, {"label": "B", "text": "6th nerve", "correct": false}, {"label": "C", "text": "7th nerve", "correct": false}, {"label": "D", "text": "4th nerve", "correct": true}], "correct_answer": "D. 4th nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 4th nerv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the context of a national public health initiative aimed at addressing anemia, which of the following program follows the \"6x6x6 strategy\" ?", "options": [{"label": "A", "text": "Anemia mukt bharat", "correct": true}, {"label": "B", "text": "Poshan Abhiyan", "correct": false}, {"label": "C", "text": "Kishori Shakti Yojana", "correct": false}, {"label": "D", "text": "None of these", "correct": false}], "correct_answer": "A. Anemia mukt bharat", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Anemia Mukt Bh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following functions is NOT attributed to the intestinal epithelium ?", "options": [{"label": "A", "text": "Absorption of the ions", "correct": false}, {"label": "B", "text": "Bile salts secretion", "correct": true}, {"label": "C", "text": "Mucous secretion", "correct": false}, {"label": "D", "text": "Secretion of digestive enzyme", "correct": false}], "correct_answer": "B. Bile salts secretion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient presenting with recurrent chalazion, which cancer should be suspected?", "options": [{"label": "A", "text": "Sebaceous cell carcinoma", "correct": true}, {"label": "B", "text": "Squamous cell carcinoma", "correct": false}, {"label": "C", "text": "Basal cell carcinoma", "correct": false}, {"label": "D", "text": "Kaposi’s sarcoma", "correct": false}], "correct_answer": "A. Sebaceous cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\"&gt;Sebaceous&lt;/span&gt; cell &lt;span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\"&gt;carcinoma&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "No. of live births/1000 women in reproductive age group?", "options": [{"label": "A", "text": "Total fertility rate", "correct": false}, {"label": "B", "text": "General Fertility rate", "correct": true}, {"label": "C", "text": "Net Reproduction Rate", "correct": false}, {"label": "D", "text": "Crude birth Rate", "correct": false}], "correct_answer": "B. General Fertility rate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - General &lt;span class=\"customMeta\" data-dictid=\"2238ef34bc16927772024c3becf614\"&gt;Fertility&lt;/span&gt; R\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9bCNmKRFA5SFVHNrAHZw1746266788.mp3", "video": ""}, {"text": "A 35-year-old patient underwent an endoscopic examination of the gastrointestinal tract due to recurrent abdominal discomfort and altered bowel habits. Identify the a rrow-marked structure in the given image .", "options": [{"label": "A", "text": "Bruner gland", "correct": true}, {"label": "B", "text": "Intestinal cells of kajal", "correct": false}, {"label": "C", "text": "Crypts of lieberkuhn", "correct": false}, {"label": "D", "text": "Peyer's patch", "correct": false}], "correct_answer": "A. Bruner gland", "question_images": ["https://image.prepladder.com/content/bNKO4DOKsc0jdfvAjHLz1715076310.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Brunner's G\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old patient with known HIV infection and presenting with persistent cough, fever, and weight loss, which diagnostic test is considered the investigation of choice for detecting tuberculosis (TB)?", "options": [{"label": "A", "text": "Culture", "correct": false}, {"label": "B", "text": "Chest x-ray", "correct": false}, {"label": "C", "text": "CBNAAT", "correct": true}, {"label": "D", "text": "PCR", "correct": false}], "correct_answer": "C. CBNAAT", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are given as emergency contraceptives except:", "options": [{"label": "A", "text": "LNG 0.75 mg 2 tab", "correct": false}, {"label": "B", "text": "Ethyline Estradiol tablet", "correct": false}, {"label": "C", "text": "Ulipristal", "correct": false}, {"label": "D", "text": "OCP 2 tab within 24 hrs, repeat dose after 14 days", "correct": true}], "correct_answer": "D. OCP 2 tab within 24 hrs, repeat dose after 14 days", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - OCP 2 tab within 24 hrs, repeat dose after 14\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old patient presented to the hospital with a complaint of chronic headache. Upon further investigation, a tumor was identified in the hypothalamus region, which was exerting pressure on the supraoptic nucleus. This structural alteration was found to be affecting hormonal regulation. Which hormone imbalance is most likely associated with this condition?", "options": [{"label": "A", "text": "ACTH", "correct": false}, {"label": "B", "text": "GH", "correct": false}, {"label": "C", "text": "ADH", "correct": true}, {"label": "D", "text": "TSH", "correct": false}], "correct_answer": "C. ADH", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - ADH (Antidiuretic Hormone)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "School health program is under", "options": [{"label": "A", "text": "PHC", "correct": true}, {"label": "B", "text": "CHC", "correct": false}, {"label": "C", "text": "DH", "correct": false}, {"label": "D", "text": "Health and wellness centres", "correct": false}], "correct_answer": "A. PHC", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - PHC (Primary Health Centre)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the adjacent graph, plateau phase represents which one of the following properties?", "options": [{"label": "A", "text": "Elasticity", "correct": false}, {"label": "B", "text": "Plasticity", "correct": true}, {"label": "C", "text": "Contractility", "correct": false}, {"label": "D", "text": "Automaticity", "correct": false}], "correct_answer": "B. Plasticity", "question_images": ["https://image.prepladder.com/content/97HvKglYEH7jUbOObCkC1714647840.png"], "explanation_images": [], "explanation": "<p>Correct Option B - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a hospital pharmacy setting, a budget of 50,000 Rs is allocated for the purchase of three types of drugs: 35,000 Rs for A drugs, 10,000 Rs for B drugs, and the remaining amount for C drugs. Which type of analysis is being used in this scenario?", "options": [{"label": "A", "text": "Network Analysis", "correct": false}, {"label": "B", "text": "ABC Analysis", "correct": true}, {"label": "C", "text": "VED Analysis", "correct": false}, {"label": "D", "text": "System Analysis", "correct": false}], "correct_answer": "B. ABC Analysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"fac9d822e71692777180f9d788f747\"&gt;ABC&lt;/span&gt; A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/638SpmIsYwJTj4dx4PLV1746266621.mp3", "video": ""}, {"text": "A 40-year-old male with a known case of HIV infection and a CD4 count less than 50 cells/μL. Which of the following infections is he at risk of developing?", "options": [{"label": "A", "text": "Candida", "correct": false}, {"label": "B", "text": "Staph. aureus", "correct": false}, {"label": "C", "text": "Disseminated MAC Infection", "correct": false}, {"label": "D", "text": "Pneumocystis jirovecii", "correct": true}], "correct_answer": "D. Pneumocystis jirovecii", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child presenting to a clinic with a history of cough, runny nose, conjunctivitis, fever, and a rash that initially arises behind the ears and then spreads to the chest, back, and abdomen. What is the likely diagnosis?", "options": [{"label": "A", "text": "Measles", "correct": true}, {"label": "B", "text": "Dengue", "correct": false}, {"label": "C", "text": "Rubella", "correct": false}, {"label": "D", "text": "Chickenguny", "correct": false}], "correct_answer": "A. Measles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient presenting with hypopigmented patches, loss of cold sensation followed by hot, touch and pain along with a palpable ulnar nerve. What is the likely diagnosis?", "options": [{"label": "A", "text": "TB", "correct": false}, {"label": "B", "text": "Leprosy", "correct": true}, {"label": "C", "text": "HIV", "correct": false}, {"label": "D", "text": "Candida", "correct": false}], "correct_answer": "B. Leprosy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents with a peculiar speech. On further evaluation, a defect in the Wernicke's area of his brain is identified. Which of the following condition is associated with the given defect?", "options": [{"label": "A", "text": "He can make the decision what he speaks", "correct": false}, {"label": "B", "text": "Senseless continuous speaking", "correct": true}, {"label": "C", "text": "He is able to understand words and speak properly", "correct": false}, {"label": "D", "text": "He is understanding language but unable to speak", "correct": false}], "correct_answer": "B. Senseless continuous speaking", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Senseless continuous speaking\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient who was involved in a road traffic accident presents to the hospital with intense superficial pain in his hand due to the injury. Which type of nerve fiber must be selectively targeted to inhibit his pain?", "options": [{"label": "A", "text": "A delta", "correct": true}, {"label": "B", "text": "A gamma", "correct": false}, {"label": "C", "text": "A alpha", "correct": false}, {"label": "D", "text": "C fibre", "correct": false}], "correct_answer": "A. A delta", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"f7d3133242169277718518c059ad55\"&gt;Delta&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old person presents to the outpatient department with a 6-month history of increased urine output and increased water intake. On investigation, the following results are obtained: HbA1C - 5.5%, Blood glucose - 80 mg/dL, Postprandial glucose - 130 mg/dL, and decreased urine osmolarity. What would be the most probable diagnosis for this given condition?", "options": [{"label": "A", "text": "DM", "correct": false}, {"label": "B", "text": "Diabetes Insipidius", "correct": true}, {"label": "C", "text": "Conn's Disease", "correct": false}, {"label": "D", "text": "Addison disease", "correct": false}], "correct_answer": "B. Diabetes Insipidius", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Diabetes Insipidu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old person arrives at the ER with complaints of tachycardia, hypertension, and hypokalemia. On further investigation, the person's serum aldosterone levels are elevated, while renin levels are suppressed. What would be the most probable diagnosis for this given condition?", "options": [{"label": "A", "text": "Conn's syndrome", "correct": true}, {"label": "B", "text": "Cushing disease", "correct": false}, {"label": "C", "text": "Pheochromocytoma", "correct": false}, {"label": "D", "text": "Diabetes Mellitus", "correct": false}], "correct_answer": "A. Conn's syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Conn's syndrome (Primary Hyperaldosteronism)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following factors were found to have an inhibitory effect on insulin secretion in the study conducted on a group of individuals investigating insulin regulation?", "options": [{"label": "A", "text": "Epinephrine", "correct": true}, {"label": "B", "text": "Gastric Inhibitory polypeptide", "correct": false}, {"label": "C", "text": "Acetylcholine", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Epinephrine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Epineph\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Factors and Conditions that Increase or Decrease <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">Secretion</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Increase <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> Secretion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Decrease <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">Secretion</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased blood glucose</p>\n<p>Increased blood free <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids</p>\n<p>Increased blood <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</p>\n<p>Gastrointestinal hormones (gastrin, cholecystokinin, secretin, <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> peptide)</p>\n<p>Glucagon, growth hormone, cortisol</p>\n<p>Parasympathetic stimulation; acetylcholine</p>\n<p>b-Adrenergic stimulation</p>\n<p>Insulin resistance; obesity</p>\n<p>Sulfonylurea drugs (glyburide, tolbutamide)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased blood glucose</p>\n<p>Fasting</p>\n<p>Somatostatin</p>\n<p>a-Adrenergic activity</p>\n<p>Leptin</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female was diagnosed with lead poisoning. What is the probable enzyme defect responsible for her condition?", "options": [{"label": "A", "text": "ALA synthase", "correct": false}, {"label": "B", "text": "ALA dehydratase", "correct": true}, {"label": "C", "text": "Heme synthase", "correct": false}, {"label": "D", "text": "Coproporphyrinogen oxidase", "correct": false}], "correct_answer": "B. ALA dehydratase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"eaa99cd1ab16927771803509d276b7\"&gt;ALA&lt;/span&gt; deh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following locations can cardiolipin be found?", "options": [{"label": "A", "text": "Outer mitochondrial membrane", "correct": false}, {"label": "B", "text": "Inner mitochondrial membrane", "correct": true}, {"label": "C", "text": "Cytosol", "correct": false}, {"label": "D", "text": "Mitochondrial matrix", "correct": false}], "correct_answer": "B. Inner mitochondrial membrane", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Inner mitoch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a 9-year-old boy who presents with hematuria, hypertension, facial puffiness for 3 days, and a recent history of throat infection two weeks ago, with urine examination showing albumin positivity?", "options": [{"label": "A", "text": "Group B beta-hemolytic streptococci", "correct": false}, {"label": "B", "text": "Staphylococcus aureus", "correct": false}, {"label": "C", "text": "Group A beta-hemolytic streptococci", "correct": true}, {"label": "D", "text": "Staphylococcus epidermidis", "correct": false}], "correct_answer": "C. Group A beta-hemolytic streptococci", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Group A beta-h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a 25-year-old male who presented with fever and has the following viral marker results: HBsAg: Positive and IgM anti-HBc antibody: Positive", "options": [{"label": "A", "text": "Acute hepatitis", "correct": true}, {"label": "B", "text": "Chronic hepatitis", "correct": false}, {"label": "C", "text": "Window period", "correct": false}, {"label": "D", "text": "Persistent infection", "correct": false}], "correct_answer": "A. Acute hepatitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; h\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HBs Ag</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anti <span class=\"customMeta\" data-dictid=\"81bb02697216927771887f2fffc386\">Hbs</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anti <span class=\"customMeta\" data-dictid=\"fda2696aa71692777188bfc39ce487\">Hbc</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HBe Ag </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">IgM</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"d3d938151416927771887e91804b5b\">Hep</span> B Highly infectious</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"d3d938151416927771887e91804b5b\">Hep</span> B</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recovery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">IgM</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gap period</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vaccinated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">IgG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low level carrier/ Remote infection</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Among the following conditions, which one does not result from exotoxins?", "options": [{"label": "A", "text": "Meningitis", "correct": true}, {"label": "B", "text": "HUS", "correct": false}, {"label": "C", "text": "Toxic shock syndrome", "correct": false}, {"label": "D", "text": "Pseudomembranous colitis", "correct": false}], "correct_answer": "A. Meningitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Mening\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Endotoxin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Exotoxin </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present in <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> – A</p>\n<p>In <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> negative cell wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Made of proteins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gram negative bacteria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In both GNB and GPC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heat stabile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heat labile</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low antigenicity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High antigenicity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Needed in large amounts to create effects</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small amounts can mediate effects</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Produces constant effect</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable effect</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Release on <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> of cell</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Released as secretions</p>\n<p>Except <span class=\"customMeta\" data-dictid=\"3cb8b8422c16927771836b57b4c79e\">botulinum toxin</span> – released on <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> of cell</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female presented with a history of profuse vaginal discharge. The discharge has a fishy odour. Microscopy revealed the cell shown in the image. What is the probable diagnosis?", "options": [{"label": "A", "text": "Herpes", "correct": false}, {"label": "B", "text": "Candida albicans", "correct": false}, {"label": "C", "text": "Trichomonas vaginalis", "correct": false}, {"label": "D", "text": "Bacterial vaginosis", "correct": true}], "correct_answer": "D. Bacterial vaginosis", "question_images": ["https://image.prepladder.com/content/VDBEo1GPOtdWeh3NdqMq1699533125.png"], "explanation_images": ["https://image.prepladder.com/content/WjKJBJpf2l0HtIfrREKm1699534227.png"], "explanation": "<p>Correct Option D - Bacterial vag\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acidic pH </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Alkaline pH &gt; 7</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Candidiasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bacterial <span class=\"customMeta\" data-dictid=\"38a4d9f2381692777201cdc420326a\">vaginosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trichomoniasis </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dimorphic Fungi</li>\n</ul>\n<p> Blastospores (Spreads)</p>\n<p> Mycelia (Invasion &amp; adherence)</p>\n<ul>\n<li>Curdy white <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> on <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> wall on removal causes Petechiae</li>\n<li>Out of proportion Pruritus</li>\n<li>Complicated / uncomplicated</li>\n</ul>\n<p><strong>Uncomplicated </strong></p>\n<ul>\n<li>Seen in normal women</li>\n<li>Good prognosis</li>\n<li>a/w albicans</li>\n</ul>\n<p><strong>Complicated </strong></p>\n<ul>\n<li>In <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> (in DM, TB, pregnancy etc)</li>\n<li>Recurrent, Severe</li>\n<li>a/w non-albicans</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hemphilus vaginalis aka Gardenella vaginalis</li>\n</ul>\n<p><strong>AMSEL’S &gt;/= 3 out of 4 </strong></p>\n<ul>\n<li>Creamy discharge</li>\n<li>Whift Test: +ve\n\t\t\t\t<ul>\n<li>Secretion + 10% KOH → amines</li>\n</ul>\n</li>\n<li>Fishy odour</li>\n<li>Clue Cells: <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> with embeded bacteria</li>\n</ul>\n<p style=\"text-align: center;\"><img src=\"https://image.prepladder.com/content/WjKJBJpf2l0HtIfrREKm1699534227.png\" style=\"height:219px; width:260px\"/></p>\n<p style=\"text-align: center;\">Clue cells</p>\n<ul>\n<li>No Pruritis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>By <span class=\"customMeta\" data-dictid=\"bf14a61da11692777200d31b43047d\">Trichomonas</span> vaginalis Flagellate protozoan</li>\n</ul>\n<p> Motile organism cause severe <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> &amp; severe pruritis</p>\n<ul>\n<li>Colpitis Macularis (Strawberry Vagina)</li>\n<li>Greenish yellow, Frothy discharge</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Treatment </strong>\n<ul>\n<li>Azoles</li>\n<li>Oral</li>\n<li>Fluconazole</li>\n<li>Rx both male &amp; female</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Treatment </strong>\n<ul>\n<li>METRONIDAZOLE</li>\n<li>Rx the Women (no sexual transmission)</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Treatment </strong>\n<ul>\n<li>METRONIDAZOLE</li>\n<li>Rx both man &amp; women</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vaccines should healthcare workers receive?", "options": [{"label": "A", "text": "Cholera", "correct": false}, {"label": "B", "text": "HPV", "correct": false}, {"label": "C", "text": "Hepatitis", "correct": true}, {"label": "D", "text": "Rabies", "correct": false}], "correct_answer": "C. Hepatitis", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Vaccine</th>\n<th>Reason</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Hepatitis B</strong></td>\n<td>Bloodborne transmission risk from patients</td>\n</tr>\n<tr>\n<td><strong>Influenza</strong></td>\n<td>Seasonal spread in hospital settings</td>\n</tr>\n<tr>\n<td><strong>MMR</strong></td>\n<td>Protection against measles, mumps, rubella</td>\n</tr>\n<tr>\n<td><strong>Tdap</strong></td>\n<td>For pertussis, tetanus, <span class=\"customMeta\" data-dictid=\"233cc736b01692777186a2a5ac98f1\">diphtheria</span> protection</td>\n</tr>\n<tr>\n<td><strong>Varicella</strong></td>\n<td>For non-immune HCWs, to prevent chickenpox</td>\n</tr>\n<tr>\n<td><strong>COVID-19</strong></td>\n<td>For <span class=\"customMeta\" data-dictid=\"703c39de691692777194908dd125e5\">pandemic</span> and <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> control</td>\n</tr>\n<tr>\n<td><strong>Rabies</strong></td>\n<td><strong>Only for specific risk groups</strong> like lab workers or veterinarians</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following medications limit the accessibility of thymidylate?", "options": [{"label": "A", "text": "Rituximab", "correct": false}, {"label": "B", "text": "Cisplatin", "correct": false}, {"label": "C", "text": "5-fluorouracil", "correct": true}, {"label": "D", "text": "Methotrexate", "correct": false}], "correct_answer": "C. 5-fluorouracil", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 5-fluorou\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which chemotherapeutic medication may lead to renal tubular damage in a patient?", "options": [{"label": "A", "text": "Cisplatin", "correct": true}, {"label": "B", "text": "Streptozocin", "correct": false}, {"label": "C", "text": "Methysergide", "correct": false}, {"label": "D", "text": "Cyclophosphamide", "correct": false}], "correct_answer": "A. Cisplatin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is brought to the clinic with a fever and has been experiencing continuous seizures for the last 30 minutes. The caregivers report no seizure-free intervals during this time. What is the most appropriate immediate action to manage this patient?", "options": [{"label": "A", "text": "Manage the fever and wait for seizure to subside", "correct": false}, {"label": "B", "text": "Give midazolam immediately", "correct": true}, {"label": "C", "text": "Give clobazam immediately", "correct": false}, {"label": "D", "text": "Manage the airway and wait for seizure to subside", "correct": false}], "correct_answer": "B. Give midazolam immediately", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Give &lt;span class=\"customMeta\" data-dictid=\"a2e652a5261692777192d6890d6cf4\"&gt;midazolam&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 35-year-old female with sickle cell disease who presents with unprovoked pain in her extremities and torso, thromboembolic events are suspected. What is the initial medication that should be administered for prophylaxis of thromboembolic events in this patient?", "options": [{"label": "A", "text": "LMWH", "correct": true}, {"label": "B", "text": "Warfarin", "correct": false}, {"label": "C", "text": "Aspirin", "correct": false}, {"label": "D", "text": "Dabigatran", "correct": false}], "correct_answer": "A. LMWH", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - LMWH\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The graph depicting the post-mortem cooling process is typically expected to have what shape?", "options": [{"label": "A", "text": "Hyperbolic", "correct": false}, {"label": "B", "text": "Sigmoid", "correct": true}, {"label": "C", "text": "Linear", "correct": false}, {"label": "D", "text": "Parabolic", "correct": false}], "correct_answer": "B. Sigmoid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JFJWor5CROPgKPATxBMC1699592940.png", "https://image.prepladder.com/content/JFJWor5CROPgKPATxBMC1699592940.png"], "explanation": "<p>Correct Option B - Sig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the number 9 in the provided diagram on hypertension represent?", "options": [{"label": "A", "text": "Diagnosed and untreated", "correct": false}, {"label": "B", "text": "Diagnosed and treated", "correct": false}, {"label": "C", "text": "Inadequately treated", "correct": false}, {"label": "D", "text": "Adequately treated", "correct": true}], "correct_answer": "D. Adequately treated", "question_images": ["https://image.prepladder.com/content/coHZHnUTqi6T5nXd0GV01699593216.png"], "explanation_images": ["https://image.prepladder.com/content/9vfIXuTEkeLq9WjsJUaL1699593387.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WopVwYeBHtVAYZhUaOjN1746266423.mp3", "video": ""}, {"text": "A patient presents with complaints of sudden onset headache, palpitation, and profuse sweating . The patient has had multiple similar episodes in the past. During these episodes, the patient's blood pressure is elevated . A 24-hour urine metanephrine is elevated . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Addison's disease", "correct": false}, {"label": "B", "text": "Renal artery stenosis", "correct": false}, {"label": "C", "text": "Pheochromocytoma", "correct": true}, {"label": "D", "text": "Hyperthyroidism", "correct": false}], "correct_answer": "C. Pheochromocytoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - Pheoch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old male presents to the physician with complaints of fever, abdominal pain and diarrhoea for 3 days . He further gives the history of consumption of raw fish 3 days back . The patient is otherwise vitally stable, and other general physical examinations reveal no abnormalities. Further investigation reveals that there is no pus in the stool . Culture grew in Wagatsuma agar . Which causative agent is the most likely to have caused this illness?", "options": [{"label": "A", "text": "Vibrio cholera", "correct": false}, {"label": "B", "text": "Salmonella typhi", "correct": false}, {"label": "C", "text": "Shigella sonnei", "correct": false}, {"label": "D", "text": "Vibrio parahaemolyticus", "correct": true}], "correct_answer": "D. Vibrio parahaemolyticus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D - &lt;span class=\"customMeta\" data-dictid=\"1497756cc616927772020759b759d5\"&gt;Vibrio&lt;/span&gt; parahaemolyticu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which substance plays a role as a mediator in chronic inflammation?", "options": [{"label": "A", "text": "IL-1", "correct": false}, {"label": "B", "text": "TNF-α", "correct": false}, {"label": "C", "text": "TGF-β", "correct": true}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "C. TGF-β", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - TGF\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Kz9YwhsX0nyr3BSXM0d01747057767.mp3", "video": ""}, {"text": "A 30-year-old man joins a pilgrimage to a shrine at a mountain peak . At the summit, he develops tightness in the chest, associated with breathlessness and altered sensorium . Which of the following can be given for symptomatic relief?", "options": [{"label": "A", "text": "Mannitol", "correct": false}, {"label": "B", "text": "Digoxin", "correct": false}, {"label": "C", "text": "Diltiazem", "correct": false}, {"label": "D", "text": "Acetazolamide", "correct": true}], "correct_answer": "D. Acetazolamide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female reports recurring episodes of discomfort, pain, and a sensation of pressure behind her left eye. She exhibits intermittent reducible proptosis, and her symptoms intensify when she bends forward. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Orbital hemangioma", "correct": false}, {"label": "B", "text": "Orbital varices", "correct": true}, {"label": "C", "text": "Orbital metastasis", "correct": false}, {"label": "D", "text": "Orbital dermoid cyst", "correct": false}], "correct_answer": "B. Orbital varices", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\"&gt;Orbital&lt;/span&gt; v\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the initial management approach for urinary symptoms in a patient with benign prostatic hyperplasia (BPH) ?", "options": [{"label": "A", "text": "TURP: Transurethral resection of prostate", "correct": false}, {"label": "B", "text": "Tamsulosin", "correct": true}, {"label": "C", "text": "Finasteride", "correct": false}, {"label": "D", "text": "Observation", "correct": false}], "correct_answer": "B. Tamsulosin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Tamsu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient undergoing chemotherapy was given an antiemetic, after which he developed symptoms like acute dystonia, bradykinesia, and tremors . Which of the following drugs would have caused these symptoms?", "options": [{"label": "A", "text": "Ondansetron", "correct": false}, {"label": "B", "text": "Metoclopramide", "correct": true}, {"label": "C", "text": "Meclizine", "correct": false}, {"label": "D", "text": "Scopolamine", "correct": false}], "correct_answer": "B. Metoclopramide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While performing a caloric test, what type of nystagmus would you expect on cold water irrigation ?", "options": [{"label": "A", "text": "Nystagmus towards the same side", "correct": false}, {"label": "B", "text": "Nystagmus towards the opposite side", "correct": true}, {"label": "C", "text": "Central nystagmus", "correct": false}, {"label": "D", "text": "Positional nystagmus", "correct": false}], "correct_answer": "B. Nystagmus towards the opposite side", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - &lt;span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\"&gt;nystagmus&lt;/span&gt; towards th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common primary intraocular malignancy in adults?", "options": [{"label": "A", "text": "Retinoblastoma", "correct": false}, {"label": "B", "text": "Malignant Choroidal melanoma", "correct": true}, {"label": "C", "text": "Reticulum cell sarcoma", "correct": false}, {"label": "D", "text": "Neurofibroma", "correct": false}], "correct_answer": "B. Malignant Choroidal melanoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\"&gt;Malignant&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"cea77d01ce1692777184854450c378\"&gt;Choroidal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What statement accurately describes radiotherapy?", "options": [{"label": "A", "text": "Intensity is inversely proportional to square of the distance", "correct": true}, {"label": "B", "text": "Vomiting is a late adverse reaction", "correct": false}, {"label": "C", "text": "Rapidly proliferating cells are most radioresistant", "correct": false}, {"label": "D", "text": "All the adverse effects are reversible", "correct": false}], "correct_answer": "A. Intensity is inversely proportional to square of the distance", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Intensity is inversely proportional to square of th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which government program aims to provide health checkups and services for children aged 0-18, including a focus on those not attending school?", "options": [{"label": "A", "text": "Rashtriya Bal Swasthya Karyakaram", "correct": true}, {"label": "B", "text": "Janani Suraksha Yojna", "correct": false}, {"label": "C", "text": "Navjaat Shishu Suraksha Karyakaram", "correct": false}, {"label": "D", "text": "Mid day meal program", "correct": false}], "correct_answer": "A. Rashtriya Bal Swasthya Karyakaram", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Rashtriya &lt;span class=\"customMeta\" data-dictid=\"eff14f005f16927771826bf88cb6c5\"&gt;Bal&lt;/span&gt; Swasthya Karyak\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How should the steroid therapy be administered for a 55-year-old male diagnosed with Addison's disease?", "options": [{"label": "A", "text": "Bolus dose of 100mg", "correct": false}, {"label": "B", "text": "Bolus of 100mg, followed by 200mg over 24 hours", "correct": true}, {"label": "C", "text": "Bolus of 200 mg, followed by 500 mg over 24 hours", "correct": false}, {"label": "D", "text": "Infusion of 500 mg over 24 hours", "correct": false}], "correct_answer": "B. Bolus of 100mg, followed by 200mg over 24 hours", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"8d138d554c16927771835be732558c\"&gt;Bolus&lt;/span&gt; of 100mg, followed by 200mg over 24 hou\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of hernia is a funicular hernia ?", "options": [{"label": "A", "text": "Direct inguinal hernia", "correct": false}, {"label": "B", "text": "Indirect inguinal hernia", "correct": true}, {"label": "C", "text": "Femoral hernia", "correct": false}, {"label": "D", "text": "Umbilical hernia", "correct": false}], "correct_answer": "B. Indirect inguinal hernia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\"&gt;Indirect&lt;/span&gt; inguinal h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common type of anorectal fistula ?", "options": [{"label": "A", "text": "Intersphincteric", "correct": true}, {"label": "B", "text": "Trans-sphincteric", "correct": false}, {"label": "C", "text": "Suprasphincteric", "correct": false}, {"label": "D", "text": "Extrasphincteric", "correct": false}], "correct_answer": "A. Intersphincteric", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pHmEzRFlgIAU13o0QphH1705036187.png"], "explanation": "<p>Correct Option A - Intersphincteric:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Type 1</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Intersphincteric</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Type 2</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Trans-sphincteric</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Type 3</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Suprasphincteric</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Type 4</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">Extrasphincteric</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what age would a child normally be able to make a tower of 6 cubes, turn a doorknob, and use pronouns like \"I\" \"me\" or \"you\" ?", "options": [{"label": "A", "text": "36 months", "correct": false}, {"label": "B", "text": "18 months", "correct": false}, {"label": "C", "text": "15 months", "correct": false}, {"label": "D", "text": "24 months", "correct": true}], "correct_answer": "D. 24 months", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D - \n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:500px\">\n<tbody>\n<tr>\n<td>15 months</td>\n<td>Tower of 2 cubes</td>\n</tr>\n<tr>\n<td>18 months</td>\n<td>Tower of 3 cubes</td>\n</tr>\n<tr>\n<td>2 years</td>\n<td>Tower of 6 cubes</td>\n</tr>\n<tr>\n<td>3 years</td>\n<td>Tower of 9 cubes</td>\n</tr>\n<tr>\n<td>4 years</td>\n<td>Makes a bridge with cubes</td>\n</tr>\n<tr>\n<td>5 years</td>\n<td>Makes a gate with cubes</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 292 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Failure of closure of rostral neuropore at 25th day leads to?", "options": [{"label": "A", "text": "Hydranencephaly", "correct": false}, {"label": "B", "text": "Rachischisis", "correct": false}, {"label": "C", "text": "Anencephaly", "correct": true}, {"label": "D", "text": "Spina bifida", "correct": false}], "correct_answer": "C. Anencephaly", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Anenceph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what level is the inferior scapular angle located?", "options": [{"label": "A", "text": "T2", "correct": false}, {"label": "B", "text": "T4", "correct": false}, {"label": "C", "text": "T6", "correct": false}, {"label": "D", "text": "T7", "correct": true}], "correct_answer": "D. T7", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The rotator cuff includes the following muscles all except;", "options": [{"label": "A", "text": "Supraspinatus", "correct": false}, {"label": "B", "text": "Infraspinatus", "correct": false}, {"label": "C", "text": "Teres major", "correct": true}, {"label": "D", "text": "Teres minor", "correct": false}], "correct_answer": "C. Teres major", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which single muscle is involved in the actions of arm's flexion, adduction and medial rotation?", "options": [{"label": "A", "text": "Serratus Anterior", "correct": false}, {"label": "B", "text": "Pectoralis major", "correct": true}, {"label": "C", "text": "Pectoralis minor", "correct": false}, {"label": "D", "text": "Subclavius", "correct": false}], "correct_answer": "B. Pectoralis major", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZQed9EA3UnhoPDlX14vM1715864644.png"], "explanation": "<p>Correct option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "One of the nerves supplying the upper limb, the upper lateral cutaneous nerve of arm, supplying the skin overlying the posterior border of the deltoid muscle as well as covering the long head of the triceps, is a branch of:", "options": [{"label": "A", "text": "Musculocutaneous nerve", "correct": false}, {"label": "B", "text": "Radial nerve", "correct": false}, {"label": "C", "text": "Ulnar nerve", "correct": false}, {"label": "D", "text": "Axillary nerve", "correct": true}], "correct_answer": "D. Axillary nerve", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Branch of Axillary Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supply</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior Branch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> portion of the <span class=\"customMeta\" data-dictid=\"70d60276a81692777185b5f6f71fa9\">deltoid</span> muscle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior Branch</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies <span class=\"customMeta\" data-dictid=\"8ad930500b1692777200545684a556\">teres</span> minor muscle and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> portion of the <span class=\"customMeta\" data-dictid=\"70d60276a81692777185b5f6f71fa9\">deltoid</span> muscle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cutaneous Branches</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the skin over the lower part of the <span class=\"customMeta\" data-dictid=\"70d60276a81692777185b5f6f71fa9\">deltoid</span> muscle and the superior <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> aspect of the arm.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle originates from the medial epicondyle of the humerus?", "options": [{"label": "A", "text": "Supinator", "correct": false}, {"label": "B", "text": "Pronator quadratus", "correct": false}, {"label": "C", "text": "Pronator teres", "correct": true}, {"label": "D", "text": "Brachioradialis", "correct": false}], "correct_answer": "C. Pronator teres", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An injury to the shown area can lead to fracture of which bone", "options": [{"label": "A", "text": "Lunate", "correct": false}, {"label": "B", "text": "Scaphoid", "correct": true}, {"label": "C", "text": "Hamate", "correct": false}, {"label": "D", "text": "Trapezium", "correct": false}], "correct_answer": "B. Scaphoid", "question_images": ["https://image.prepladder.com/content/OAih61o34gKIQvxTqIGk1692343382.png"], "explanation_images": ["https://image.prepladder.com/content/RKIwuOtttA0M3PUwU2Ru1716442559.png"], "explanation": "<p>Correct Option B: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with hypothenar muscle wasting and loss of sensation of medial one and a half digits. Which nerve is involved", "options": [{"label": "A", "text": "Musculocutaneous", "correct": false}, {"label": "B", "text": "Radial", "correct": false}, {"label": "C", "text": "Ulnar", "correct": true}, {"label": "D", "text": "Median", "correct": false}], "correct_answer": "C. Ulnar", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AIRqRLW7jaWrt2oGlBZ11716442734.png", "https://image.prepladder.com/content/YXYVbtbOOS4vEbL4MCKr1716442751.png"], "explanation": "<p>Correct option C.\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Testicular artery is a branch of:", "options": [{"label": "A", "text": "Abdominal aorta", "correct": true}, {"label": "B", "text": "Common iliac artery", "correct": false}, {"label": "C", "text": "External iliac artery", "correct": false}, {"label": "D", "text": "Internal iliac artery", "correct": false}], "correct_answer": "A. Abdominal aorta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cr6NxnkkZJAFXmTSkub81712654616.png"], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Deep inguinal ring is formed in:", "options": [{"label": "A", "text": "External oblique aponeurosis", "correct": false}, {"label": "B", "text": "Internal oblique aponeurosis", "correct": false}, {"label": "C", "text": "Transversus abdominis", "correct": false}, {"label": "D", "text": "Transversalis fascia", "correct": true}], "correct_answer": "D. Transversalis fascia", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Inguinal ligament is formed due to", "options": [{"label": "A", "text": "Cremaster muscle", "correct": false}, {"label": "B", "text": "External oblique aponeurosis", "correct": true}, {"label": "C", "text": "Internal oblique aponeurosis", "correct": false}, {"label": "D", "text": "Transversus abdominis", "correct": false}], "correct_answer": "B. External oblique aponeurosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ztduTihwdorRRhPtZGFw1712654723.png"], "explanation": "<p>Correct option B. \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Abduction at the hip joint is done by", "options": [{"label": "A", "text": "Gluteus maximus", "correct": false}, {"label": "B", "text": "Gluteus medius", "correct": true}, {"label": "C", "text": "Obturator internus", "correct": false}, {"label": "D", "text": "Quadratus femoris", "correct": false}], "correct_answer": "B. Gluteus medius", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked tendon in the diagram:", "options": [{"label": "A", "text": "Extensor hallucis longus", "correct": true}, {"label": "B", "text": "Flexor hallucis longus", "correct": false}, {"label": "C", "text": "Extensor digitorum longus", "correct": false}, {"label": "D", "text": "Tibialis anterior", "correct": false}], "correct_answer": "A. Extensor hallucis longus", "question_images": ["https://image.prepladder.com/content/syd77p5CYjC77YvDpc7v1712733906.png"], "explanation_images": [], "explanation": "<p>Correct option :A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How many chest compressions per minute are performed during CPR in adults?", "options": [{"label": "A", "text": "30-50 per minute", "correct": false}, {"label": "B", "text": "50-72 per minute", "correct": false}, {"label": "C", "text": "100-120 per minute", "correct": true}, {"label": "D", "text": "120-200 per minute", "correct": false}], "correct_answer": "C. 100-120 per minute", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3HsrwZkoheqBe3mIFVQQ1712046744.png"], "explanation": "<p>Correct Option C - 100-120 per minu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Spinal anaesthesia in an adult is given at this level:", "options": [{"label": "A", "text": "T12-L1", "correct": false}, {"label": "B", "text": "L1-L2", "correct": false}, {"label": "C", "text": "L3-L4", "correct": true}, {"label": "D", "text": "L5-S1", "correct": false}], "correct_answer": "C. L3-L4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CXmt3aJVaM4R8ooQdsAg1715663935.png"], "explanation": "<p>Correct Option C - L3-L4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Colour of nitrous oxide cylinder is?", "options": [{"label": "A", "text": "Blue", "correct": true}, {"label": "B", "text": "Blue body with white shoulder", "correct": false}, {"label": "C", "text": "White", "correct": false}, {"label": "D", "text": "Black", "correct": false}], "correct_answer": "A. Blue", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Color</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Pin index</strong></p>\n</td>\n</tr>\n<tr>\n<td>O<sub>2</sub> cylinder</td>\n<td>Black body + white shoulder</td>\n<td>2,5</td>\n</tr>\n<tr>\n<td>N<sub>2</sub>O cylinder</td>\n<td>Blue</td>\n<td>3,5</td>\n</tr>\n<tr>\n<td>Air cylinder</td>\n<td>Grey body + Black + Black white shoulder</td>\n<td>1,5</td>\n</tr>\n<tr>\n<td>CO<sub>2</sub> cylinder</td>\n<td>Grey</td>\n<td>2,6</td>\n</tr>\n<tr>\n<td>Cyclopropane</td>\n<td>Orange</td>\n<td>3,6</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The duration of spinal anaesthesia is based directly on:", "options": [{"label": "A", "text": "Dose", "correct": true}, {"label": "B", "text": "Height", "correct": false}, {"label": "C", "text": "Age", "correct": false}, {"label": "D", "text": "Total body fat", "correct": false}], "correct_answer": "A. Dose", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/v3VaPIFsJnJVZkdRUuYH1715664026.png", "https://image.prepladder.com/content/TSZnRw7BUzXwHFSbUnp41715664046.png"], "explanation": "<p>Correct Option A - D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Enolase is inhibited by which of the following substances?", "options": [{"label": "A", "text": "NaF", "correct": true}, {"label": "B", "text": "Fluoroacetate", "correct": false}, {"label": "C", "text": "Iodoacetate", "correct": false}, {"label": "D", "text": "Potassium oxalate", "correct": false}], "correct_answer": "A. NaF", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Maple syrup urine disease is due to a deficiency of:", "options": [{"label": "A", "text": "α-keto acid dehydrogenase", "correct": true}, {"label": "B", "text": "α-keto acid carboxylase", "correct": false}, {"label": "C", "text": "α-keto acid desulphate", "correct": false}, {"label": "D", "text": "α-keto acid oxidase", "correct": false}], "correct_answer": "A. α-keto acid dehydrogenase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - α-keto acid dehydrog\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Collagen is rich in which amino acid:", "options": [{"label": "A", "text": "Glycine", "correct": true}, {"label": "B", "text": "Arginine", "correct": false}, {"label": "C", "text": "Phenyl - alanine", "correct": false}, {"label": "D", "text": "Tyrosine", "correct": false}], "correct_answer": "A. Glycine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Nitric oxide is derived from:", "options": [{"label": "A", "text": "Arginine", "correct": true}, {"label": "B", "text": "Histidine", "correct": false}, {"label": "C", "text": "Glycine", "correct": false}, {"label": "D", "text": "Aspartate", "correct": false}], "correct_answer": "A. Arginine", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Product</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nitric <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">Oxide</span> (NO)</p>\n</td>\n<td>\n<p>A <span class=\"customMeta\" data-dictid=\"f9016f36fd1692777198b0fd5e9c6d\">signaling</span> molecule involved in various <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> processes</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Creatine</p>\n</td>\n<td>\n<p>Plays a role in <span class=\"customMeta\" data-dictid=\"d2408af1a1169277718723820ab540\">energy metabolism</span> and muscle function</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Polyamines (Putrescine, Spermidine, Spermine)</p>\n</td>\n<td>\n<p>Essential for cell growth, proliferation, and differentiation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ornithine</p>\n</td>\n<td>\n<p>Precursor for the <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> of polyamines</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Urea</p>\n</td>\n<td>\n<p>Produced as a byproduct of the <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> cycle</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Proline</p>\n</td>\n<td>\n<p>Non-essential <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid with structural and regulatory functions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Glutamate</p>\n</td>\n<td>\n<p>A <span class=\"customMeta\" data-dictid=\"e28fd027b416927771932bc23ba0a5\">neurotransmitter</span> and important <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> intermediate</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Agmatine</p>\n</td>\n<td>\n<p>Involved in <span class=\"customMeta\" data-dictid=\"66748a30e91692777193358c35b2b0\">neurotransmission</span> and regulation of <span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\">nitric</span> oxide</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which coenzyme is required for the de novo synthesis of fatty acids?", "options": [{"label": "A", "text": "NADPH", "correct": true}, {"label": "B", "text": "TPP", "correct": false}, {"label": "C", "text": "FAD", "correct": false}, {"label": "D", "text": "NAD", "correct": false}], "correct_answer": "A. NADPH", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Except for which of the following, all are cofactors for Dehydrogenase?", "options": [{"label": "A", "text": "NADP", "correct": false}, {"label": "B", "text": "FAD", "correct": false}, {"label": "C", "text": "NAD", "correct": false}, {"label": "D", "text": "SAM", "correct": true}], "correct_answer": "D. SAM", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - SAM\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which glycogen storage disease is associated with the alkaline pH of skeletal muscle after strenuous exercise?", "options": [{"label": "A", "text": "Mc Ardle's disease", "correct": true}, {"label": "B", "text": "Von — Gierke's disease", "correct": false}, {"label": "C", "text": "Her's disease", "correct": false}, {"label": "D", "text": "Pompe's disease", "correct": false}], "correct_answer": "A. Mc Ardle's disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option:A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most potent lipid phase antioxidant?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin E", "correct": true}, {"label": "C", "text": "Vitamin C", "correct": false}, {"label": "D", "text": "Vitamin K", "correct": false}], "correct_answer": "B. Vitamin E", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Wernicke encephalopathy caused by deficiency of which vitamin?", "options": [{"label": "A", "text": "Vit B1", "correct": true}, {"label": "B", "text": "Vit B2", "correct": false}, {"label": "C", "text": "Vit B7", "correct": false}, {"label": "D", "text": "Vit B12", "correct": false}], "correct_answer": "A. Vit B1", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is the most specific biomarker for pheochromocytoma, a rare tumor that typically arises in the chromaffin cells (pheochromocytes) of the adrenal gland and is usually benign?", "options": [{"label": "A", "text": "VMA", "correct": true}, {"label": "B", "text": "Catecholamine", "correct": false}, {"label": "C", "text": "5 - HIAA", "correct": false}, {"label": "D", "text": "Serotonin", "correct": false}], "correct_answer": "A. VMA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following releases histamine?", "options": [{"label": "A", "text": "Mast cells", "correct": true}, {"label": "B", "text": "Eosinophils", "correct": false}, {"label": "C", "text": "T — cells", "correct": false}, {"label": "D", "text": "NK cells", "correct": false}], "correct_answer": "A. Mast cells", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\"&gt;Mast&lt;/span&g\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Cells</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Chemicals Produced</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Adrenal <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">Cortex</span> Cells</p>\n</td>\n<td>\n<p>Cortisol, Aldosterone</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Adrenal <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">Medulla</span> Cells</p>\n</td>\n<td>\n<p>Epinephrine, Norepinephrine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Parathyroid Chief Cells</p>\n</td>\n<td>\n<p>Parathyroid Hormone (PTH)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pituitary <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> Cells</p>\n</td>\n<td>\n<p>Growth Hormone, Prolactin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pineal <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">Gland</span> Cells</p>\n</td>\n<td>\n<p>Melatonin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Testicular Leydig Cells</p>\n</td>\n<td>\n<p>Testosterone</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mast Cells</p>\n</td>\n<td>\n<p>Histamine, Prostaglandins</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Adipocytes</p>\n</td>\n<td>\n<p>Leptin, Adiponectin</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old female presents with a history of fever and oral ulcers and has developed erythematous lesions on her face. Comment on the diagnosis.", "options": [{"label": "A", "text": "SLE", "correct": true}, {"label": "B", "text": "Dermatomyositis", "correct": false}, {"label": "C", "text": "Melasma", "correct": false}, {"label": "D", "text": "Rosacea", "correct": false}], "correct_answer": "A. SLE", "question_images": ["https://image.prepladder.com/content/EaI7MnUuGJ7vv1NzuM6m1747750888.png"], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Demographics</strong></td>\n<td>Young females (childbearing age)</td>\n</tr>\n<tr>\n<td><strong>Fever</strong></td>\n<td>Common <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptom</td>\n</tr>\n<tr>\n<td><strong>Oral ulcers</strong></td>\n<td>Typically painless</td>\n</tr>\n<tr>\n<td><strong>Malar rash</strong></td>\n<td>Butterfly-shaped <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> over cheeks and nose</td>\n</tr>\n<tr>\n<td><strong>Photosensitivity</strong></td>\n<td>Rash worsens with sun exposure</td>\n</tr>\n<tr>\n<td><strong>Other features</strong></td>\n<td>Arthritis, serositis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> involvement, ANA/anti-dsDNA positivity</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following lesion was noticed in a patient with a history of involuntary weight loss. What is the diagnosis?", "options": [{"label": "A", "text": "Acanthosis nigricans", "correct": true}, {"label": "B", "text": "Leser-Trélat sign", "correct": false}, {"label": "C", "text": "Actinic keratosis", "correct": false}, {"label": "D", "text": "Intertriginous Candida", "correct": false}], "correct_answer": "A. Acanthosis nigricans", "question_images": ["https://image.prepladder.com/content/Zmbf8eSFGXTcLhpYtBrj1710486049.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is incorrect regarding the displayed lesio n?", "options": [{"label": "A", "text": "The lesions are infectious to seronegative individuals", "correct": false}, {"label": "B", "text": "Can be associated with meningoencephalitis", "correct": false}, {"label": "C", "text": "Bilaterally symmetrical dermatomal vesicular eruption", "correct": true}, {"label": "D", "text": "Geniculate ganglion is involved in Ramsay Hunt syndrome", "correct": false}], "correct_answer": "C. Bilaterally symmetrical dermatomal vesicular eruption", "question_images": ["https://image.prepladder.com/content/5KAclsiyxRM9TthWpBHe1713958343.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Bilaterally &lt;span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\"&gt;symmetrical&lt;/span&gt; dermatomal &lt;span class=\"customMeta\" data-dictid=\"4b0fee14c816927772016e67cf3a13\"&gt;vesicular&lt;/span&gt; eru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The shown instrument i s:", "options": [{"label": "A", "text": "Single cutting razor", "correct": false}, {"label": "B", "text": "Double cutting razor", "correct": false}, {"label": "C", "text": "Humby’s knife", "correct": true}, {"label": "D", "text": "Finochietto knife", "correct": false}], "correct_answer": "C. Humby’s knife", "question_images": ["https://image.prepladder.com/content/2MZGNp29FtA9ypW6uSt01710480746.png"], "explanation_images": ["https://image.prepladder.com/content/R56RogWkVXlQjt1WwOoJ1710480768.png", "https://image.prepladder.com/content/ykry9zUzweUgV3OaXggK1710480778.png"], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Humby's knife</strong></p>\n</td>\n<td>\n<p><strong>Electric Dermatome</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>To harvest the skin graft</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Advantage: Can be used to calibrate the <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of skin <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> and harvesting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><img src=\"https://image.prepladder.com/content/R56RogWkVXlQjt1WwOoJ1710480768.png\" style=\"height:400px; width:400px\"/></p>\n</td>\n<td>\n<p><img src=\"https://image.prepladder.com/content/ykry9zUzweUgV3OaXggK1710480778.png\" style=\"height:400px; width:400px\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most suitable approach to minimize the likelihood of keloid recurrence?", "options": [{"label": "A", "text": "Intralesional steroids", "correct": true}, {"label": "B", "text": "Surgery", "correct": false}, {"label": "C", "text": "Cryotherapy", "correct": false}, {"label": "D", "text": "Electrocoagulation", "correct": false}], "correct_answer": "A. Intralesional steroids", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What will be the diagnosis of an infant exhibiting the following condition, after a pharyngeal infection ?", "options": [{"label": "A", "text": "Staphylococcal scalded skin syndrome", "correct": true}, {"label": "B", "text": "Epidermolysis bullosa simplex", "correct": false}, {"label": "C", "text": "Impetigo contagiosa", "correct": false}, {"label": "D", "text": "Pemphigus foliaceus", "correct": false}], "correct_answer": "A. Staphylococcal scalded skin syndrome", "question_images": ["https://image.prepladder.com/content/xzTJCFbZ0PPLoawMbu6l1713956183.png"], "explanation_images": [], "explanation": "<p>Correct Option A - \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the penile lesion shown in the image:", "options": [{"label": "A", "text": "Genital wart", "correct": false}, {"label": "B", "text": "Pearly penile papule", "correct": true}, {"label": "C", "text": "Balanitis", "correct": false}, {"label": "D", "text": "Sebaceous gland prominence", "correct": false}], "correct_answer": "B. Pearly penile papule", "question_images": ["https://image.prepladder.com/content/0Kb6hT1WMPHd7HIXso1u1714027644.PNG"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The Lesions shown below are the characteristic of :", "options": [{"label": "A", "text": "Molluscum contagiosum", "correct": true}, {"label": "B", "text": "Chicken pox", "correct": false}, {"label": "C", "text": "Pemphigus", "correct": false}, {"label": "D", "text": "Common warts", "correct": false}], "correct_answer": "A. Molluscum contagiosum", "question_images": ["https://image.prepladder.com/content/LOCj6uDj91hSv052K1iy1747771625.png"], "explanation_images": ["https://image.prepladder.com/content/2lcQoXBN1rIgoNRo9rXl1710486109.png"], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Lesion appearance</strong></td>\n<td>Smooth, dome-shaped papules with central dimple</td>\n</tr>\n<tr>\n<td><strong>Colour</strong></td>\n<td>Flesh-colored, pink, or pearly-white</td>\n</tr>\n<tr>\n<td><strong>Size</strong></td>\n<td>Typically 2–5 mm in diameter</td>\n</tr>\n<tr>\n<td><strong>Common in</strong></td>\n<td>Children, sexually active adults, immunocompromised</td>\n</tr>\n<tr>\n<td><strong>Location</strong></td>\n<td>Face, trunk, axillae, <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> area</td>\n</tr>\n<tr>\n<td><strong>Cause</strong></td>\n<td>Molluscum contagiosum virus (MCV, a poxvirus)</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The narrowest part of airway in an infant is:", "options": [{"label": "A", "text": "Supraglottis", "correct": false}, {"label": "B", "text": "Glottis", "correct": false}, {"label": "C", "text": "Subglottis", "correct": true}, {"label": "D", "text": "Epiglottis", "correct": false}], "correct_answer": "C. Subglottis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nwMjEVhYQ38RXnQrUSq31714479476.png"], "explanation": "<p>Correct Option C - Subg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 15-year-old male patient who has a nasal mass extending to the cheek, causing one-sided obstruction and occasional nosebleeds?", "options": [{"label": "A", "text": "Angiofibroma", "correct": true}, {"label": "B", "text": "Nasal polyp", "correct": false}, {"label": "C", "text": "Nasopharyngeal Carcinoma", "correct": false}, {"label": "D", "text": "Inverted Papilloma", "correct": false}], "correct_answer": "A. Angiofibroma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following scenarios is high tracheostomy performed?", "options": [{"label": "A", "text": "Laryngeal papilloma", "correct": false}, {"label": "B", "text": "Carcinoma larynx", "correct": true}, {"label": "C", "text": "Bilateral vocal folds palsy", "correct": false}, {"label": "D", "text": "Laryngomalacia", "correct": false}], "correct_answer": "B. Carcinoma larynx", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jezCndfGVWaHhGRLdaVn1714479637.png"], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are parts of the Hypopharynx except:", "options": [{"label": "A", "text": "Posterior pharyngeal wall", "correct": false}, {"label": "B", "text": "Pyriform Sinus", "correct": false}, {"label": "C", "text": "Post cricoid area", "correct": false}, {"label": "D", "text": "Vallecula", "correct": true}], "correct_answer": "D. Vallecula", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 3-year-old child, who has severe Sensorineural deafness and does not show any improvement with hearing aids, but has intact auditory nerve function, which procedure is recommended as the first choice?", "options": [{"label": "A", "text": "Hearing Aids", "correct": false}, {"label": "B", "text": "BAHA", "correct": false}, {"label": "C", "text": "Cochlear implant", "correct": true}, {"label": "D", "text": "Auditory Brainstem Implant", "correct": false}], "correct_answer": "C. Cochlear implant", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Coch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with a 2 day history of fever and difficulty in swallowing. On examination there was swelling seen in the oropharynx pushing tonsil to midline and swelling over the upper part of neck . What is the most likely diagnosis:", "options": [{"label": "A", "text": "Quinsy", "correct": false}, {"label": "B", "text": "Parapharyngeal abscess", "correct": true}, {"label": "C", "text": "Retropharyngeal abscess", "correct": false}, {"label": "D", "text": "Tonsillitis", "correct": false}], "correct_answer": "B. Parapharyngeal abscess", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5jbbHDF35QGYMHrYRYca1713337125.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Deep lobe of parotid gland swelling presents at", "options": [{"label": "A", "text": "Below the ear lobe", "correct": false}, {"label": "B", "text": "Cheek", "correct": false}, {"label": "C", "text": "Temporal lobe", "correct": false}, {"label": "D", "text": "Parapharyngeal Space", "correct": true}], "correct_answer": "D. Parapharyngeal Space", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle in the larynx is essential for saving lives as it retracts the vocal cords to enable breathing?", "options": [{"label": "A", "text": "Cricothyroid", "correct": false}, {"label": "B", "text": "Posterior Cricoarytenoid", "correct": true}, {"label": "C", "text": "Lateral Cricoarytenoid", "correct": false}, {"label": "D", "text": "Transverse Arytenoid", "correct": false}], "correct_answer": "B. Posterior Cricoarytenoid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Larynx Muscle</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cricothyroid muscle</p>\n</td>\n<td>\n<p>Lengthens and tenses the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Posterior <span class=\"customMeta\" data-dictid=\"f54dba40a116927771859fc53d2f9f\">cricoarytenoid</span> muscle</p>\n</td>\n<td>\n<p>Abducts (opens) the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lateral <span class=\"customMeta\" data-dictid=\"f54dba40a116927771859fc53d2f9f\">cricoarytenoid</span> muscle</p>\n</td>\n<td>\n<p>Adducts (closes) the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Transverse <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> muscle</p>\n</td>\n<td>\n<p>Adducts (closes) the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Thyroarytenoid muscle</p>\n</td>\n<td>\n<p>Shortens and relaxes the vocal cords, contributing to vocalization</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vocalis muscle</p>\n</td>\n<td>\n<p>Controls tension and fine adjustments of the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Interarytenoid muscles (Oblique and Transverse)</p>\n</td>\n<td>\n<p>Adducts (closes) the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> part of the vocal cords</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What category of malignancy do rodent ulcers belong to?", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": false}, {"label": "B", "text": "Basal cell carcinoma", "correct": true}, {"label": "C", "text": "Malignant Melanoma", "correct": false}, {"label": "D", "text": "Adenocarcinoma", "correct": false}], "correct_answer": "B. Basal cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In patients with Nasopharyngeal Carcinoma, what is the primary cause of hearing loss?", "options": [{"label": "A", "text": "Metastasis to Temporal Bone", "correct": false}, {"label": "B", "text": "Middle ear Infection", "correct": false}, {"label": "C", "text": "Serous otitis media", "correct": true}, {"label": "D", "text": "Infiltration of Tumour middle ear", "correct": false}], "correct_answer": "C. Serous otitis media", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Serous &lt;span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\"&gt;otitis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently reported symptom in patients with Nasopharyngeal Carcinoma?", "options": [{"label": "A", "text": "Cervical lymphadenopathy", "correct": true}, {"label": "B", "text": "Hearing Loss", "correct": false}, {"label": "C", "text": "Airway Obstruction", "correct": false}, {"label": "D", "text": "Epistaxis", "correct": false}], "correct_answer": "A. Cervical lymphadenopathy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wWKoWnHf1GteR9s6aXDJ1713517379.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\"&gt;Cervical&lt;/span&gt; lymphadenopath\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the structures that are not visible during indirect laryngoscopy?", "options": [{"label": "A", "text": "Anterior Commissure", "correct": true}, {"label": "B", "text": "Tracheal rings", "correct": false}, {"label": "C", "text": "Epiglottis", "correct": false}, {"label": "D", "text": "False Vocal Cord", "correct": false}], "correct_answer": "A. Anterior Commissure", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;Anterior&lt;/span&gt; Commissu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the initial signs of vocal fold growth?", "options": [{"label": "A", "text": "Cough", "correct": false}, {"label": "B", "text": "Change of voice", "correct": true}, {"label": "C", "text": "Fatigue voice", "correct": false}, {"label": "D", "text": "Pain", "correct": false}], "correct_answer": "B. Change of voice", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Parotid gland is supplied by which nerve?", "options": [{"label": "A", "text": "Facial Nerve", "correct": false}, {"label": "B", "text": "Glossopharyngeal", "correct": true}, {"label": "C", "text": "Vagus Nerve", "correct": false}, {"label": "D", "text": "Hypoglossal Nerve", "correct": false}], "correct_answer": "B. Glossopharyngeal", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are grounds for divorce except :", "options": [{"label": "A", "text": "Adultery", "correct": false}, {"label": "B", "text": "Incurable Leprosy", "correct": false}, {"label": "C", "text": "Poverty", "correct": true}, {"label": "D", "text": "Insanity", "correct": false}], "correct_answer": "C. Poverty", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Pov\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate IPC section for the act of inducing abortion without the consent of the woman ?", "options": [{"label": "A", "text": "312", "correct": false}, {"label": "B", "text": "313", "correct": true}, {"label": "C", "text": "314", "correct": false}, {"label": "D", "text": "315", "correct": false}], "correct_answer": "B. 313", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - IPC Section 313\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In case of corrosive acid ingestion, stomach is opened along the?", "options": [{"label": "A", "text": "Lesser curvature", "correct": false}, {"label": "B", "text": "Greater curvature", "correct": true}, {"label": "C", "text": "Vertical", "correct": false}, {"label": "D", "text": "Pylorus", "correct": false}], "correct_answer": "B. Greater curvature", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Greater curvatu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Inhaling the cloth soaked in drug is:", "options": [{"label": "A", "text": "Bagging", "correct": false}, {"label": "B", "text": "Spraying", "correct": false}, {"label": "C", "text": "Huffing", "correct": true}, {"label": "D", "text": "Sniffing", "correct": false}], "correct_answer": "C. Huffing", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Huffing\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Methods of substance abuse</strong></td>\n<td style=\"text-align:center\"><strong>Explanation</strong></td>\n</tr>\n<tr>\n<td><strong>Bagging</strong></td>\n<td>Bagging refers to a method of inhaling substances by placing them inside a bag and then inhaling or breathing in the vapors. The bag is typically held over the nose and mouth, allowing the person to <span class=\"customMeta\" data-dictid=\"fa8e7de4491692777190b78c13e43a\">inhale</span> the substance contained within the bag</td>\n</tr>\n<tr>\n<td><strong>Snorting</strong></td>\n<td>Snorting involves the <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> of powdered substances, typically drugs, through the nose. The substance is crushed into a fine powder and then snorted through the nostrils using a straw, rolled-up paper, or other devices.</td>\n</tr>\n<tr>\n<td><strong>Sniffing</strong></td>\n<td>Sniffing refers to the act of inhaling or smelling substances, often <span class=\"customMeta\" data-dictid=\"656e217bb81692777202d82810ba2a\">volatile</span> or <span class=\"customMeta\" data-dictid=\"5bdef37bf01692777182f5780db753\">aromatic</span> substances.</td>\n</tr>\n<tr>\n<td><strong>Huffing</strong></td>\n<td>Huffing involves the deliberate <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> of <span class=\"customMeta\" data-dictid=\"656e217bb81692777202d82810ba2a\">volatile</span> substances or inhalants directly from their container or source. The person typically places their mouth or nose directly on the container and inhales deeply, allowing the vapors or fumes to enter their <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> system. This method is associated with the misuse of chemicals, solvents, or other <span class=\"customMeta\" data-dictid=\"656e217bb81692777202d82810ba2a\">volatile</span> substances for recreational purposes.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the responsibility of the doctor in recording the dying declaration of a victim affected by a fire ?", "options": [{"label": "A", "text": "To assess compos mentis", "correct": true}, {"label": "B", "text": "To record the statement even in the presence of magistrate", "correct": false}, {"label": "C", "text": "Cross-examine the person", "correct": false}, {"label": "D", "text": "Put the person under oath before declaration", "correct": false}], "correct_answer": "A. To assess compos mentis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - T\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Dying Declaration</strong></p>\n</td>\n<td>\n<ul>\n<li>\n<p>It is followed in India</p>\n</li>\n<li>\n<p>It is the statement given by the dying patient</p>\n</li>\n<li>\n<p>This statement can be a</p>\n<ul>\n<li>\n<p>Oral statement</p>\n</li>\n<li>\n<p>Document</p>\n</li>\n</ul>\n</li>\n<li>\n<p>It is based on the 32 IEA</p>\n</li>\n<li>\n<p>The declaration can be given by</p>\n<ul>\n<li>\n<p>Victim</p>\n</li>\n<li>\n<p>Magistrate</p>\n</li>\n<li>\n<p>Doctor</p>\n</li>\n<li>\n<p>Police</p>\n</li>\n<li>\n<p>Any person</p>\n</li>\n</ul>\n</li>\n<li>\n<p>Not recommended</p>\n<ul>\n<li>\n<p>Oath</p>\n</li>\n<li>\n<p>Cross-examination</p>\n</li>\n<li>\n<p>Leading questions</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Dying Deposition</strong></p>\n</td>\n<td>\n<ul>\n<li>\n<p>It is followed in developed countries</p>\n</li>\n<li>\n<p>It occurs in the presence of the</p>\n<ul>\n<li>\n<p>Magistrate</p>\n</li>\n<li>\n<p>Defense lawyer</p>\n</li>\n</ul>\n</li>\n<li>\n<p>Recommendations</p>\n<ul>\n<li>\n<p>Oath</p>\n</li>\n<li>\n<p>Cross examination is done (Best to protect the accused)</p>\n</li>\n<li>\n<p>Leadings questions are asked</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent statements accurately describe tremors? PD is characterized by resting tremor Tremor consist of alternate contraction of agonist and antagonist muscle in an oscillating rhythmic manner Essential tremor is an uncommon movement disorder affecting 5% of the population Normal individuals can have physiologic tremors that manifest as mild high frequency, postural or action tremors", "options": [{"label": "A", "text": "1,2,3 only", "correct": false}, {"label": "B", "text": "2,3,4 only", "correct": false}, {"label": "C", "text": "1,2,4 only", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. 1,2,4 only", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 1,2,4 only: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a medical camp established on a military base, a 20-year-old military recruit is discovered to have an HbA1C level of 6.1% and a fasting blood glucose of 120 mg/dL. The individual does not have a familial background of diabetes mellitus and displays no indications or symptoms of diabetes. The general physical examination shows no noteworthy findings. Which of the following options most accurately characterizes the blood glucose levels in this patient?", "options": [{"label": "A", "text": "Normal", "correct": false}, {"label": "B", "text": "Impaired Glucose tolerance", "correct": true}, {"label": "C", "text": "Diabetes Mellitus", "correct": false}, {"label": "D", "text": "Maturity onset diabetes in Young", "correct": false}], "correct_answer": "B. Impaired Glucose tolerance", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zBeVodjCC7HSlmvCR4FO1714456002.png", "https://image.prepladder.com/content/LcaKIScu1r9ZwShIA5R31714456002.png"], "explanation": "<p> Correct Option B - Impaired &lt;span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\"&gt;Glucose&lt;/span&gt; tolerance: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequent cause of fulminant diabetes?", "options": [{"label": "A", "text": "Viruses", "correct": true}, {"label": "B", "text": "Diabetic Ketoacidosis", "correct": false}, {"label": "C", "text": "Non-ketotic hyperosmolar coma", "correct": false}, {"label": "D", "text": "Autoimmunity", "correct": false}], "correct_answer": "A. Viruses", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Viru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following joints are commonly involved in diabetes? MC joint involved in diabetes is?", "options": [{"label": "A", "text": "Metatarsophalangeal joints", "correct": false}, {"label": "B", "text": "Knee", "correct": false}, {"label": "C", "text": "Shoulder", "correct": false}, {"label": "D", "text": "Charcot", "correct": true}], "correct_answer": "D. Charcot", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"c7eec8acc51692777192539a955090\"&gt;Metatarsophalangeal&lt;/span&gt; joints: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of insulin should be administered to manage a 32-year-old male patient with a medical history of peptic ulcer disease and diabetes mellitus, who presents to the emergency department complaining of nausea, abdominal pain, and lethargy for the past two days? The patient also reports occasional dark, tarry stools. Laboratory tests indicate elevated blood glucose levels and a high anion gap metabolic acidosis on an arterial blood gas sample.", "options": [{"label": "A", "text": "Regular insulin", "correct": true}, {"label": "B", "text": "Lispro", "correct": false}, {"label": "C", "text": "Glargine", "correct": false}, {"label": "D", "text": "Aspart", "correct": false}], "correct_answer": "A. Regular insulin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Regular insulin: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following has a slow onset of action?", "options": [{"label": "A", "text": "Glargine", "correct": true}, {"label": "B", "text": "Lispro", "correct": false}, {"label": "C", "text": "Regular", "correct": false}, {"label": "D", "text": "NPH", "correct": false}], "correct_answer": "A. Glargine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/w7lFhw1s8V3QzR4kugrA1714457625.png"], "explanation": "<p>Correct option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the main physical finding of prolactinoma that follows galactorrhea in a 19-year-old nulligravida woman who has been experiencing milk discharge from her nipples for the last 5 months and is diagnosed with prolactinoma?", "options": [{"label": "A", "text": "Bitemporal hemianopia", "correct": true}, {"label": "B", "text": "Anovulatory cycles", "correct": false}, {"label": "C", "text": "Amenorrhea", "correct": false}, {"label": "D", "text": "Infertility", "correct": false}], "correct_answer": "A. Bitemporal hemianopia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"3b17da47ce16927771831d5dde3af3\"&gt;Bitemporal&lt;/span&gt; hemianopia: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 37-year-old man is brought to the emergency room by his son. He complains of being unable to move his left arm and leg. According to his son, the patient was reading a book half an hour ago when he realized he couldn't lift his left arm to pick up another book. As he tried to move away from the table, he noticed that his left leg also became very weak. Additionally, he experienced double vision. The patient has a history of hypertension and hyperlipidemia. His body temperature is 36.1°C (97°F), blood pressure is 165/100 mmHg, pulse is 85 beats/min, and he has a respiratory rate of 16 breaths/min. During the examination, it is observed that the patient has drooping of the right eyelid and his right eye is directed downwards and to the side. When requested to smile, there is a drooping of the left corner of the mouth. The strength of the left upper and lower limbs is rated as 3 out of 5, whereas the strength of the right upper and lower limbs is rated as 5 out of 5. Which region of his brain has experienced ischemia among the following options?", "options": [{"label": "A", "text": "Inner capsule", "correct": false}, {"label": "B", "text": "Medulla", "correct": false}, {"label": "C", "text": "Midbrain", "correct": true}, {"label": "D", "text": "Occipital lobe", "correct": false}], "correct_answer": "C. Midbrain", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 73 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "What potential diagnosis should be considered for a patient admitted to the Emergency department following a road traffic accident exhibiting an altered level of consciousness and a Glasgow Coma Scale (GCS) score of 10, as depicted in the provided CT scan?", "options": [{"label": "A", "text": "Subdural hematoma", "correct": false}, {"label": "B", "text": "Intracerebral hemorrhage", "correct": false}, {"label": "C", "text": "Extradural hematoma", "correct": true}, {"label": "D", "text": "Hemorrhagic contusion", "correct": false}], "correct_answer": "C. Extradural hematoma", "question_images": ["https://image.prepladder.com/content/ga0MB8MxM2hJoMu8kO2R1746007893.png"], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"a479c9f4081692777187a3308ccd27\"&gt;Extradural&lt;/span&gt; h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with retrosternal chest pain radiating to the jaw and dysphagia. A barium swallow was performed, and the following image was shown. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Infectious esophagitis", "correct": false}, {"label": "B", "text": "Diffuse esophageal spasm", "correct": true}, {"label": "C", "text": "Barrette’s esophagus", "correct": false}, {"label": "D", "text": "Esophageal stricture", "correct": false}], "correct_answer": "B. Diffuse esophageal spasm", "question_images": ["https://image.prepladder.com/content/wioYWfJNU8OnR8vTnpy81746008993.png"], "explanation_images": [], "explanation": "<p>Correct Option B) &lt;span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\"&gt;Diffuse&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\"&gt;esophageal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The provided barium swallow indicates", "options": [{"label": "A", "text": "Achalasia cardia", "correct": true}, {"label": "B", "text": "Diffuse esophageal spasm", "correct": false}, {"label": "C", "text": "Nutcracker oesophagus", "correct": false}, {"label": "D", "text": "Hypertensive lower esophageal sphincter", "correct": false}], "correct_answer": "A. Achalasia cardia", "question_images": ["https://image.prepladder.com/content/WIDhYlmqA2V7aVhTxwOO1746009079.png"], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"b032d2af58169277718080a9060b14\"&gt;Achalasia&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions has a barium enema as shown in the picture below?", "options": [{"label": "A", "text": "Multiple colonic polyps", "correct": false}, {"label": "B", "text": "Ulcerative colitis", "correct": false}, {"label": "C", "text": "Diverticulosis", "correct": true}, {"label": "D", "text": "Irritable bowel syndrome", "correct": false}], "correct_answer": "C. Diverticulosis", "question_images": ["https://image.prepladder.com/content/q2kNu4DjiYT08F8jiOTv1747911039.png"], "explanation_images": ["https://image.prepladder.com/content/12B1ndlHSINLV7nBdiHg1746009189.png", "https://image.prepladder.com/content/iXw6SVdnZwP2u5uk4KTe1747911051.png"], "explanation": "<p>Correct answer C) Diverticulosis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diverticulosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of small, bulging pouches (diverticula) in the colon, most commonly in the <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"464\" src=\"https://image.prepladder.com/content/12B1ndlHSINLV7nBdiHg1746009189.png\" width=\"464\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diet:</strong> A low-fiber diet increases <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> pressure.</p>\n<p><strong>Age:</strong> More common in those over 60.</p>\n<p><strong>Genetics:</strong> Family history may increase risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Increased pressure:</strong> High <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> pressure causes weak spots to bulge.</p>\n<p><strong>Weak <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> wall:</strong> Weak areas, especially where blood vessels enter the mucosa, are <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to forming diverticula.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>False diverticula:</strong> Involve only the <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and submucosa.</p>\n<p><strong>Multiple and acquired: </strong>Typically multiple and not congenital.</p>\n<p><strong>Location:</strong> Most commonly in the <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> colon, along the mesenteric aspect.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often asymptomatic; may include mild <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort, bloating, and changes in <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> habits.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colonoscopy:</strong> Direct visualization.</p>\n<p><strong>CT Scan:</strong> Detailed images of the colon.</p>\n<p><strong>Barium enema:</strong> Less common, shows a characteristic sawtooth appearance</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://abdominalkey.com/diverticular-disease-of-the-colon-2/\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/iXw6SVdnZwP2u5uk4KTe1747911051.png\" width=\"3426\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diet: Increase fiber intake.</p>\n<p>Hydration: Drink plenty of fluids.</p>\n<p>Exercise: Promotes healthy <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower GI Bleed: Common cause of lower <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male patient involved in a road traffic accident was managed upon arrival at the emergency room, with a respiratory rate of 25 breaths per minute and a blood pressure of 80/45mmHg, and exhibiting hyper-resonance on the left side of the chest, what is the appropriate action based on the findings from the chest x-ray?", "options": [{"label": "A", "text": "Wide bore needle insertion in the 2nd ICS", "correct": false}, {"label": "B", "text": "Wide bore needle insertion in the 5th ICS followed by an intercostal drain in the 5th ICS", "correct": true}, {"label": "C", "text": "Aspiration of the pleural fluid", "correct": false}, {"label": "D", "text": "No intervention needed", "correct": false}], "correct_answer": "B. Wide bore needle insertion in the 5th ICS followed by an intercostal drain in the 5th ICS", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/h4wUIbQhdc3EkbZfSSjH1746009316.png", "https://image.prepladder.com/content/nwGunM4Cld58jCukrHlF1746009316.png"], "explanation": "<p>Correct answer B) Wide bore needle &lt;span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\"&gt;insertion&lt;/span&gt; in the 5th ICS followed by an &lt;span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\"&gt;intercostal&lt;/span&gt; drain in the 5th ICS\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:697px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Tension Pneumothorax</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>D/t<strong> ‘one-way valve’</strong> air leaks from the lung or chest wall.</li>\n<li>Air is sucked into the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> without any escape, collapsing and compressing the affected lung.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> shifts to the opposite side, reducing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> return and compressing the opposite lung, leading to decreased <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output and function. This can result in sudden death.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"513\" src=\"https://image.prepladder.com/content/h4wUIbQhdc3EkbZfSSjH1746009316.png\" width=\"513\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Penetrating Chest Trauma.</li>\n<li>Blunt Chest Trauma with parenchymal lung injury and persistent air leak.</li>\n<li>Iatrogenic Lung Injury (e.g., central venepuncture)</li>\n<li>Mechanical Positive-Pressure Ventilation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Tachypnea and Tachycardia</li>\n<li>Hyper-resonance and Decreased/Absent Breath Sounds</li>\n<li>Resonant Percussion with severe mediastinal/tracheal shift</li>\n<li>Cyanosis and Hypotension</li>\n<li>Chest Pain</li>\n<li>Distended Neck Veins</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Emergency Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Tension <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> is a clinical diagnosis, and treatment should never be delayed by waiting for radiological confirmation.</li>\n<li>Immediate Thoracocentesis (needle): Wide bore needle (typically a 20- or 22-gauge) in the 5th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space in the safety triangle.</li>\n<li>Decompression should be performed in the \"safe triangle.\"</li>\n</ul>\n<ul>\n<li><strong>Safe <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> Boundaries</strong>:\n\n\t\t\t\t<ul>\n<li>Posterior: Latissimus dorsi</li>\n<li>Anterior: Lateral border of the <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> major</li>\n<li>Inferior: A line drawn perpendicularly from the <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> to the back, just <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the mid-axillary line.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"430\" src=\"https://image.prepladder.com/content/nwGunM4Cld58jCukrHlF1746009316.png\" width=\"430\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>In critical situations, a finger <span class=\"customMeta\" data-dictid=\"0e733c2a0916927772001a6cd08d35\">thoracostomy</span> can be done in the same location.</li>\n</ul>\n<ul>\n<li>Nasal Oxygen for support.</li>\n<li>Intercostal Tube Placement (ICT) once stable and confirmed by chest X-ray.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Additional Care </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Antibiotics and analgesics for treatment.</li>\n<li>Ventilator Support with IPPV in severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following regulate serum calcium levels?", "options": [{"label": "A", "text": "Calcitonin", "correct": false}, {"label": "B", "text": "Parathormone", "correct": false}, {"label": "C", "text": "Vitamin D", "correct": false}, {"label": "D", "text": "All the above", "correct": true}], "correct_answer": "D. All the above", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the reason that hemoglobin cannot pass through the glomerulus in a normal physiological state?", "options": [{"label": "A", "text": "It is a large molecule bound with another protein", "correct": true}, {"label": "B", "text": "It gets attracted to the negative charge of the glomerular filtration barrier", "correct": false}, {"label": "C", "text": "Both A and B", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. It is a large molecule bound with another protein", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which hormone is responsible for the breast cramps experienced by a mother during breastfeeding her child?", "options": [{"label": "A", "text": "Progesterone", "correct": false}, {"label": "B", "text": "Estrogen", "correct": false}, {"label": "C", "text": "Prolactin", "correct": false}, {"label": "D", "text": "Oxytocin", "correct": true}], "correct_answer": "D. Oxytocin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a young patient who experienced a head injury from a road traffic accident, his family reports a change in his behavior. They describe him as being excessively curious and constantly touching objects. He also exhibits rapid forgetfulness and attempts to put various things in his mouth, including plates. Additionally, they have observed him squeezing his genitals. Based on these symptoms, which structure is most likely to be affected in this patient?", "options": [{"label": "A", "text": "Gray matter around the aqueduct of Sylvius", "correct": false}, {"label": "B", "text": "Amygdala", "correct": true}, {"label": "C", "text": "Lateral nuclei of the hypothalamus", "correct": false}, {"label": "D", "text": "Anterior cingulate gyri", "correct": false}], "correct_answer": "B. Amygdala", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person is having increased sexual activity ,increased appetite, anger and no fear, which is the structure injured?", "options": [{"label": "A", "text": "Amygdala", "correct": false}, {"label": "B", "text": "Thalamus", "correct": false}, {"label": "C", "text": "Cingulate gyrus", "correct": false}, {"label": "D", "text": "Hypothalamus", "correct": true}], "correct_answer": "D. Hypothalamus", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Corticospinal tract crosses at?", "options": [{"label": "A", "text": "Midbrain", "correct": false}, {"label": "B", "text": "Pons", "correct": false}, {"label": "C", "text": "Upper medulla", "correct": false}, {"label": "D", "text": "Lower medulla", "correct": true}], "correct_answer": "D. Lower medulla", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old man who has the following lesion over the face. He complains of bleeding while itching. The most likely diagnosis is", "options": [{"label": "A", "text": "Dermatofibrosarcoma", "correct": false}, {"label": "B", "text": "Marjolin’s ulcer", "correct": false}, {"label": "C", "text": "Basal cell carcinoma", "correct": true}, {"label": "D", "text": "Naevus", "correct": false}], "correct_answer": "C. Basal cell carcinoma", "question_images": ["https://image.prepladder.com/content/amPzf14cRNmzGcERZ5bu1746012694.png"], "explanation_images": ["https://image.prepladder.com/content/Hz77GiIUqHnHLpoxEVNN1746012738.png", "https://image.prepladder.com/content/jFaWZzQllclHSF8LxbMe1747911174.png"], "explanation": "<p>Correct answer C) B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man is brought to the casualty with severe abdominal pain radiating to the back for the past 1 day and has had 3 episodes of vomiting. The pain radiates to the back and is slightly relieved in the sitting forward position. The following signs are seen on examination and lab investigations reveal elevated lipase and amylase. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute appendicitis", "correct": false}, {"label": "B", "text": "Acute cholecystitis", "correct": false}, {"label": "C", "text": "Acute pancreatitis", "correct": true}, {"label": "D", "text": "Acute ischemic colitis", "correct": false}], "correct_answer": "C. Acute pancreatitis", "question_images": ["https://image.prepladder.com/notes/daOHYTBptx80YJZAmQTY1747728103.png"], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the lungs, which type of cells are responsible for the secretion of surfactant?", "options": [{"label": "A", "text": "Type 1 pneumocyte", "correct": false}, {"label": "B", "text": "Alveolar macrophage", "correct": false}, {"label": "C", "text": "Dust cells", "correct": false}, {"label": "D", "text": "Type 2 pneumocyte", "correct": true}], "correct_answer": "D. Type 2 pneumocyte", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding Marjolin’s ulcer is not true?", "options": [{"label": "A", "text": "It is seen in sites of chronic wounds or scars", "correct": false}, {"label": "B", "text": "It rapidly progresses to malignancy", "correct": true}, {"label": "C", "text": "It can progress to squamous cell carcinoma", "correct": false}, {"label": "D", "text": "It is radioresistant due to avascularity", "correct": false}], "correct_answer": "B. It rapidly progresses to malignancy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GokplFaeFxyFlt7NyGBg1746012905.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Marjolin’s Ulcer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low-grade Squamous Cell Carcinoma (SCC)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Sites of Development</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Post-burn scar</li>\n<li>Long-standing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> due to trauma</li>\n<li>Chronic discharging <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> sinus</li>\n<li>Post-radiation ulcer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Develops in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue due to chronic irritation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painless (no nerves in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissues)</li>\n<li>Slow growing</li>\n<li>No regional LN <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> (no lymphatics in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation of Choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> followed by a <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> cover</li>\n<li>Radiotherapy should be avoided (as it is radio-resistant and also to prevent obliterative end arteritis)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Reflex responsible for tachycardia during right atrial distension is?", "options": [{"label": "A", "text": "Bezold-Jarisch reflex", "correct": false}, {"label": "B", "text": "Bain bridge reflex", "correct": true}, {"label": "C", "text": "Cushing reflex", "correct": false}, {"label": "D", "text": "Baroreceptor reflex", "correct": false}], "correct_answer": "B. Bain bridge reflex", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure shown in the image:", "options": [{"label": "A", "text": "Beger’s procedure", "correct": false}, {"label": "B", "text": "Whipple’s procedure", "correct": true}, {"label": "C", "text": "Frey’s procedure", "correct": false}, {"label": "D", "text": "Pancreatic redivision", "correct": false}], "correct_answer": "B. Whipple’s procedure", "question_images": ["https://image.prepladder.com/content/vRfENICQHf519B9iom5r1746012946.png"], "explanation_images": ["https://image.prepladder.com/content/spfAgl5Mtn7RAigOrrT11747911307.png", "https://image.prepladder.com/content/M46lrnEGp5VvxBT2OZqY1747911315.png"], "explanation": "<p>Correct answer B) Whipple’s procedu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Whipple’s procedure </strong></p>\n<p>(pancreaticoduodenectomy)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Structures removed: Head of the pancreas, the first part of the small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> (duodenum), the gallbladder, and a portion of the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct.</p>\n<p>Types:</p>\n<ul>\n<li>Pylorus-Preserving Whipple Procedure</li>\n<li>Non–Pylorus-Preserving Whipple Procedure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreatic Cancer:</strong> Commonly treated with Whipple if cancer is <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the head of the pancreas.</p>\n<p><strong>Chronic Pancreatitis:</strong> when uncontrolled by medical management.</p>\n<p><strong>Tumors in Pancreas/Surrounding Areas:</strong> Includes duodenum, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, and <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedure Steps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor Assessment: Explore <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> to assess tumor size, location, and spread.</p>\n<p>Resection: Remove head of pancreas, duodenum, gallbladder, and part of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct; this may include partial stomach resection.</p>\n<p>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Dissection: Remove and examine nearby <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Cancer Research UK\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Diagram_showing_the_parts_removed_with_a_Whipple%27s_operation_CRUK_337.svg\" data-tags=\"\" height=\"3810\" src=\"https://image.prepladder.com/content/spfAgl5Mtn7RAigOrrT11747911307.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reconstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreaticojejunostomy:</strong> Connect remaining <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> to jejunum. <strong>Hepaticojejunostomy:</strong> Connect common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> to jejunum. <strong>Gastrojejunostomy:</strong> Connect stomach to jejunum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anastomosis Principles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tension-Free Connection:</strong> Achieve mucosa-to-mucosa connection for healing.</p>\n<p><strong>Order of Anastomoses: </strong>Pancreaticojejunostomy → <span class=\"customMeta\" data-dictid=\"db93ca9acc1692777188412df8a3d4\">Hepaticojejunostomy</span> → Gastrojejunostomy</p>\n<p><strong>Stent Placement: </strong>May use internal/external stents for small ducts.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"708\" src=\"https://image.prepladder.com/content/M46lrnEGp5VvxBT2OZqY1747911315.png\" width=\"738\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pancreatic Fistula: Major issue; managed with <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> analogues.</li>\n<li>Delayed Gastric Emptying</li>\n<li>Bleeding, wound infection</li>\n<li>Reoperation, increased mortality</li>\n<li>Dumping/Bile Reflux: Common after non-pylorus-preserving Whipple; pylorus-preserving method has uncertain benefits.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of dicrotic notch?", "options": [{"label": "A", "text": "Passive filling of blood in ventricles", "correct": false}, {"label": "B", "text": "Rapid ejection phase", "correct": false}, {"label": "C", "text": "Closure of semilunar valves", "correct": true}, {"label": "D", "text": "Isovolumic contraction", "correct": false}], "correct_answer": "C. Closure of semilunar valves", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:560px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Event</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Upstroke (Systolic Rise)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventricular <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> increases aortic pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systolic Peak</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maximum arterial pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dicrotic Notch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Semilunar <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> and <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> backflow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diastolic Decay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gradual pressure decrease as blood moves into periphery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is correct regarding Isovolumic relaxation?", "options": [{"label": "A", "text": "AV valves are closed", "correct": true}, {"label": "B", "text": "Corresponds to QT interval", "correct": false}, {"label": "C", "text": "‘C' wave of JVP", "correct": false}, {"label": "D", "text": "Semilunar valves open", "correct": false}], "correct_answer": "A. AV valves are closed", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nZjBTypN7wD1Kz8mJrX71747909373.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>AV Valves</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Semilunar Valves</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Event</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Isovolumic Contraction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventricles contract but no ejection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Ejection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood ejected into <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> &amp; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Isovolumic Relaxation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventricles relax, no <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> yet</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Filling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Open</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood flows into ventricles</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year old male with gradual progressive swelling around his wrist joint for 3 months. Image of the swelling on the x-ray film is given below. What is the probable diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing’s Sarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": true}, {"label": "D", "text": "Osteochondroma", "correct": false}], "correct_answer": "C. Osteoclastoma", "question_images": ["https://image.prepladder.com/content/hTolPO4PIjVTnJZneFbD1747907762.png", "https://image.prepladder.com/content/qzhmIFZIYuK1L2ggIRNY1747907805.png", "https://image.prepladder.com/content/JB56hTQVRRj7sC7r3Xmp1747907678.png"], "explanation_images": ["https://image.prepladder.com/content/BkFxYvoU0Tl6kmk29o9B1747907664.png", "https://image.prepladder.com/content/RcL3hmxjQvUZNHhfJjsY1747907832.png", "https://image.prepladder.com/content/QjOlVESB2ghu2WMOkng01747907916.png", "https://image.prepladder.com/content/CKo9nx01cIHFKluRSzLF1747907928.png", "https://image.prepladder.com/content/zb8hl1rDAEjRHbtH4TBf1747907939.png", "https://image.prepladder.com/content/PSe5r51UkmzsgAKQateN1747907946.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Benign but locally aggressive tumor of bone.<strong> </strong></li>\n<li>It commonly arises from epiphysis.</li>\n<li>MC Age: 20 and 45 years of age.</li>\n<li>Females &gt; males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sites affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> &gt; <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> &gt; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> &gt; sacrum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malignant transformation in &lt;1% of cases.</li>\n<li>Lungs are the most common site for metastases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Swelling, vague pain.</li>\n<li>Pathological fracture.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Raveenthiran Venkatachalam, Vincent Mangayarkarasi, Murugesan Kousalya, Periyaswamy Viswanathan, Manivachagam Dhanalakshmi, Viswanathan Anandi\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Subcutaneous-Entomophthoromycosis-of-the-right-wrist-mimicking-osteoclastoma_fig3_273785875\" data-tags=\"\" height=\"6945\" src=\"https://image.prepladder.com/content/BkFxYvoU0Tl6kmk29o9B1747907664.png\" width=\"5463\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: Expansile <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on epiphysis</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Amini B, MacManus D, Le L, et al.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/giant-cell-tumour-of-bone\" data-tags=\"\" height=\"6801\" src=\"https://image.prepladder.com/content/RcL3hmxjQvUZNHhfJjsY1747907832.png\" width=\"5208\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histo- pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Multinucleated giant cells and a background network of spindle-shaped <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> stromal cells.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Giant_cell_tumour_of_bone_-_very_high_mag.jpg\" data-tags=\"\" height=\"1098\" src=\"https://image.prepladder.com/content/QjOlVESB2ghu2WMOkng01747907916.png\" width=\"1639\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extended <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with Bone grafting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following substance, facilitate the absorption of dietary iron?", "options": [{"label": "A", "text": "Calcium", "correct": false}, {"label": "B", "text": "Vitamin C", "correct": true}, {"label": "C", "text": "Vitamin D", "correct": false}, {"label": "D", "text": "Vitamin K", "correct": false}], "correct_answer": "B. Vitamin C", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RREVSjzkDVzn2vF9gPiN1748241013.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the current stage of the disease in a patient who presents with hip pain and true shortening of the limb, and is diagnosed with tuberculosis of the hip?", "options": [{"label": "A", "text": "Stage of early arthritis", "correct": false}, {"label": "B", "text": "Stage of synovitis", "correct": false}, {"label": "C", "text": "Stage of advanced arthritis", "correct": true}, {"label": "D", "text": "Stage of arthritis without subluxation", "correct": false}], "correct_answer": "C. Stage of advanced arthritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PzXwYZwhd8vdVVLiEZ3B1747907994.png"], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>X-ray findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage I: Synovitis</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Irritable hip</li>\n<li>Increased FABER (Flexion, Abduction, External Rotation)</li>\n<li>Apparent lengthening due to <strong>FABER</strong> (Position of ease due to synovitis)</li>\n<li>Terminal movements are restricted by 25%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or haziness of the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> margins</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage II: Early Arthritis</strong></p>\n<p><strong>(Option B)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Early joint pain, stiffness</li>\n<li>Increased <strong>FADIR</strong> (Flexion, Adduction, Internal Rotation)</li>\n<li>Apparent shortening due to FADIR</li>\n<li>Gluteal and Quadriceps muscle wasting</li>\n<li>ROM restricted by 50%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osteopenia and narrowing of joint space</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage III: Late Arthritis</strong></p>\n<p><strong>(Option C)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Marked <strong>FADIR</strong></li>\n<li><strong>True shortening</strong></li>\n<li><strong>Gross restriction of movements </strong>(usually &gt;50%)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Marked <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> and destruction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage IV: Pathological Dislocation</strong></p>\n<p><strong>/severe arthritis</strong></p>\n<p><strong>(Option D)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Marked<strong> FADIR</strong></li>\n<li>Gross shortening</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe destruction and loss of joint space</li>\n<li>\"<strong>Wandering/traveling Acetabulum</strong>\": Pathological dislocation/subluxation due to gross destruction of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head or the superior acetabular margin.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Oztürkmen, Yusuf &amp; Karamehmetoğlu, Mahmut &amp; Leblebici, Cem &amp; Gokce, Alper &amp; Caniklioğlu, Mustafa.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/a-This-radiograph-demonstrates-a-travelling-acetabulum-of-the-hipThe-femoral-head-is_fig3_26841474\" data-tags=\"\" height=\"589\" src=\"https://image.prepladder.com/content/PzXwYZwhd8vdVVLiEZ3B1747907994.png\" width=\"1000\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man is brought to the emergency department following a road traffic accident. He was driving the car when the accident occurred. On examination, it is noted that the injured leg is shortened. The image of the pelvis radiograph is shown below. Which of the following nerves is most commonly injured in the given condition?", "options": [{"label": "A", "text": "Sciatic nerve", "correct": true}, {"label": "B", "text": "Posterior femoral cutaneous nerve", "correct": false}, {"label": "C", "text": "Inferior gluteal nerve", "correct": false}, {"label": "D", "text": "Superior gluteal nerve", "correct": false}], "correct_answer": "A. Sciatic nerve", "question_images": ["https://image.prepladder.com/content/kuXN5UZvn3tiJ2e9eG3O1746014661.png"], "explanation_images": ["https://image.prepladder.com/content/2O92YI4o3wyQgDSA8kUo1746014700.png", "https://image.prepladder.com/content/P4daVjkN47O0lI1RLTdn1746014700.png", "https://image.prepladder.com/content/HEZHlTFAagT384K9zfsm1746014700.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong><br/>\n\t\t\tCaused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<p>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<p>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nerve injury: <strong>common</strong>, <strong>sciatic nerve</strong> is injured.</li>\n<li>Arterial injury: rare</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nerve injury: rare</li>\n<li><strong>Arterial injury:</strong> relatively more <strong>common</strong>, <strong>Femoral artery</strong> is injured</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"\" height=\"506\" src=\"https://image.prepladder.com/content/2O92YI4o3wyQgDSA8kUo1746014700.png\" width=\"347\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub\" data-tags=\"\" height=\"355\" src=\"https://image.prepladder.com/content/P4daVjkN47O0lI1RLTdn1746014700.png\" width=\"363\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Samir Benoudina\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/central-fracture-dislocation-of-the-acetabulum-2\" data-tags=\"\" height=\"388\" src=\"https://image.prepladder.com/content/HEZHlTFAagT384K9zfsm1746014700.png\" width=\"310\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cholesterol is synthesized from?", "options": [{"label": "A", "text": "Acetyl coA", "correct": true}, {"label": "B", "text": "Phenylalanine", "correct": false}, {"label": "C", "text": "Malonyl coA", "correct": false}, {"label": "D", "text": "Oxaloacetate", "correct": false}], "correct_answer": "A. Acetyl coA", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure shown in the image below.", "options": [{"label": "A", "text": "Gastrojejunostomy", "correct": false}, {"label": "B", "text": "Pancreaticojejunostomy", "correct": true}, {"label": "C", "text": "Pancreatic Ileostomy", "correct": false}, {"label": "D", "text": "Duodenojejunostomy", "correct": false}], "correct_answer": "B. Pancreaticojejunostomy", "question_images": ["https://image.prepladder.com/content/78H6WpweVHHLlWRUI2Lq1747911381.png"], "explanation_images": [], "explanation": "<p>Correct answer B) Pancreaticojeju\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Enzyme deficient in Gaucher disease :", "options": [{"label": "A", "text": "Betagalacto cerebrosidase", "correct": false}, {"label": "B", "text": "Glucose-6-phosphate", "correct": false}, {"label": "C", "text": "Betaglucocerebrosidase", "correct": true}, {"label": "D", "text": "Alpha glucocerebrosidase", "correct": false}], "correct_answer": "C. Betaglucocerebrosidase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DbUPGoW6CfiU5QQMuAm51746015342.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient experiences an inability to extend their wrist upon waking up after sleeping with their arm hanging over the back of a chair. This condition is caused by", "options": [{"label": "A", "text": "Neurotmesis", "correct": false}, {"label": "B", "text": "Neurolysis", "correct": false}, {"label": "C", "text": "Axonotmesis", "correct": false}, {"label": "D", "text": "Neuropraxia", "correct": true}], "correct_answer": "D. Neuropraxia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cDuO5qUzddAugcduJJMY1747908090.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:568px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurapraxia</strong></p>\n<p><strong>(Grade I)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temporary <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> block, <span class=\"customMeta\" data-dictid=\"47fec911a316927771933b7607bdf0\">myelin</span> damage only.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"11117a474a1692777193044082d47a\">neuroma</span> and no degeneration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recovery is complete within 6 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Axonotmesis</strong></p>\n<p><strong>(Grade II)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Axonal damage, <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue intact.</li>\n<li>Neuroma in continuity.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recovery can take up to months</li>\n<li>Complete recovery may not occur.</li>\n<li>Motor march present</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurotmesis</strong></p>\n<p><strong>(Grade III)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Complete nerve disruption.</li>\n<li>End or side neuroma.</li>\n<li>Degeneration: Proximally+distally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Spontaneous recovery never occurs.</li>\n<li>Repair is required (poor recovery)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The splint depicted below is", "options": [{"label": "A", "text": "Foot abduction orthosis", "correct": true}, {"label": "B", "text": "DiMeglio splint", "correct": false}, {"label": "C", "text": "Ponseti cast", "correct": false}, {"label": "D", "text": "Pirani cast", "correct": false}], "correct_answer": "A. Foot abduction orthosis", "question_images": ["https://image.prepladder.com/content/6wuOnSFABQGfmP0AhrKK1746015445.png"], "explanation_images": ["https://image.prepladder.com/content/eYbYRetvAeMb3ssyGcYx1746015506.png", "https://image.prepladder.com/content/8OBToeJmyfWL5bgzmGjX1746015507.png", "https://image.prepladder.com/content/LaYfW9BnptYow1zlReqm1746015506.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Preferred Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ponseti technique: </strong></p>\n<ul>\n<li>Ideally to be started as soon as possible after birth</li>\n<li><strong>Correction sequence:</strong> <strong>Adduction→Varus (inversion)→Equinus</strong> (last &amp; difficult to correct)</li>\n<li>Success rate: 15-80%</li>\n<li>If success achieved,\n\t\t\t\t<ul>\n<li><strong>6-18 months:</strong> <strong>Day time Phelp’s brace</strong> &amp; <strong>Night time Dennis brown splint</strong></li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Chandrasekaran Kuppusamy, Senthil Selvam, Sandhiya Manohar, Madhumathi Kuppuraj, Sharmila Subramani, Karthikeyan Shanmugam, Jayaseelan Vijayalakshmi Kunaseelan, Manjula Subramanian\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Dennis-brown-splint_fig1_374832041\" data-tags=\"\" height=\"233\" src=\"https://image.prepladder.com/content/eYbYRetvAeMb3ssyGcYx1746015506.png\" width=\"289\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>18 months-4 years:</strong> CTEV shoes</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"259\" src=\"https://image.prepladder.com/content/8OBToeJmyfWL5bgzmGjX1746015507.png\" width=\"219\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1-3 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Turco’s <span class=\"customMeta\" data-dictid=\"b1b0b6b9c716927771966dfdac754d\">posteromedial</span> soft tissue release</strong></li>\n<li>McKay’s <span class=\"customMeta\" data-dictid=\"b1b0b6b9c716927771966dfdac754d\">posteromedial</span> soft tissue release</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3-5 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dillwyn Evans</strong> procedure (resection &amp; <span class=\"customMeta\" data-dictid=\"129c645fde1692777182cf1d3e1ecc\">arthrodesis</span> of calcaneo-cuboid joint)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5-8 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dwyer’s</strong> <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> (wedge shaped <span class=\"customMeta\" data-dictid=\"6d82ed3c231692777183a2635ae3d7\">calcaneum</span> resection)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"354\" src=\"https://image.prepladder.com/content/LaYfW9BnptYow1zlReqm1746015506.png\" width=\"303\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>8-10 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Davis <span class=\"customMeta\" data-dictid=\"d1ed4aacdf1692777194c9aa2fc2ac\">osteotomy</span> <strong>(wedge tarsectomy)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt;10 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Triple arthrodesis:</strong> <strong>Talocalcaneal-Calcaneocuboid-Talonavicular</strong> (TC-CC-TN)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The subcellular organelle which is associated with the killing of viruses and bacteria is?", "options": [{"label": "A", "text": "Peroxisome", "correct": false}, {"label": "B", "text": "Mitochondria", "correct": false}, {"label": "C", "text": "Lysosome", "correct": true}, {"label": "D", "text": "Golgi apparatus", "correct": false}], "correct_answer": "C. Lysosome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wAWhanerkLA0YGdY5LbQ1746015555.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options is correct with respect to a fed state? 1. Insulin secretion is more 2. Glucagon secretion is less 3. Insulin secretions is less 4. Glucagon secretion is more", "options": [{"label": "A", "text": "Only 1", "correct": false}, {"label": "B", "text": "Only 3", "correct": false}, {"label": "C", "text": "Option 1 and 2 are correct", "correct": true}, {"label": "D", "text": "Option 3 and 4 are correct", "correct": false}], "correct_answer": "C. Option 1 and 2 are correct", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fed or <span class=\"customMeta\" data-dictid=\"3e0d247aa916927771812684526ac0\">anabolic</span> state occurs immediately after a meal when the energy of nutrients (carbohydrate, protein, or fat) is transferred to high energy compounds for immediate use or for storage. <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">Peripheral</span> tissues (predominantly skeletal muscle) <span class=\"customMeta\" data-dictid=\"9d374d494a169277718337f2820f3a\">buffer</span> ingested <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> by storing it as glycogen.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fasted or catabolic state occurs later when the level of available nutrients decreases in the blood, and the stored reserves (initially glycogen) are mobilized to perform work or to generate heat. During prolonged fasting, fat <span class=\"customMeta\" data-dictid=\"224ea8a9e41692777194e81be113d8\">oxidation</span> and <span class=\"customMeta\" data-dictid=\"296c955ad216927771900bf1905f13\">ketone</span> bodies are used to meet whole body energy requirements.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young boy presented with fissured tongue, lips, and lesions in the angle of the mouth.On investigation, he had low RBC glutathione reductase activity. Which vitamin is deficient here?", "options": [{"label": "A", "text": "Vitamin B12", "correct": false}, {"label": "B", "text": "Vitamin B3", "correct": false}, {"label": "C", "text": "Biotin", "correct": false}, {"label": "D", "text": "Riboflavin", "correct": true}], "correct_answer": "D. Riboflavin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Thermogenin protein is mainly found in:", "options": [{"label": "A", "text": "Golgi complex", "correct": false}, {"label": "B", "text": "Mitochondria", "correct": true}, {"label": "C", "text": "Endoplasmic reticulum", "correct": false}, {"label": "D", "text": "Nucleus", "correct": false}], "correct_answer": "B. Mitochondria", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with acute swelling in the big toe, and his serum uric acid levels were increased. The doctor prescribed medicine to manage this acute condition. What is the mechanism of this drug?", "options": [{"label": "A", "text": "Pyrimidine antimetabolite", "correct": false}, {"label": "B", "text": "Uricosuric drug", "correct": false}, {"label": "C", "text": "Xanthine oxidase inhibitor", "correct": false}, {"label": "D", "text": "Neutrophil chemotaxis prevention", "correct": true}], "correct_answer": "D. Neutrophil chemotaxis prevention", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\"&gt;Neutrophil&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"131fe589f71692777184dc879b32db\"&gt;chemotaxis&lt;/span&gt; prevention</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attack of gout</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DOC- NSAIDS (All types) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Except for <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> and paracetamol</li>\n<li>Anti-inflammatory</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colchicine (spindle poison)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>MOA: <span class=\"customMeta\" data-dictid=\"ef00bb99bd1692777192dbc816b3d4\">Microtubule</span> inhibitor</strong></li>\n<li>Used in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks of <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> and <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> Mediterranean fever and is also the <span class=\"customMeta\" data-dictid=\"357ecf18f2169277718661a76111ea\">DOC</span> for karyotyping</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corticosteroids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intra <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> injections, avoid oral route</li>\n<li>Immunosuppressive and anti-inflammatory</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs for chronic gout</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Xanthine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> inhibitors (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drugs include<strong> <span class=\"customMeta\" data-dictid=\"6337926de316927771812a6842721f\">Allopurinol</span> (DOC)</strong>, Oxipurinol, <strong>Febuxostat</strong></li>\n<li><strong>MOA: Blocks <span class=\"customMeta\" data-dictid=\"c9a23eabc41692777202d1d98467d5\">xanthine</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> → Inhibits the conversion of <span class=\"customMeta\" data-dictid=\"304c30e55316927771895062b17e8b\">hypoxanthine</span> to <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid in the liver.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uric acid <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drugs include <strong>Pegloticase </strong>and Rasburicase</li>\n<li><strong>MOA: <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">Uric</span> acid is converted to <span class=\"customMeta\" data-dictid=\"eae976dfa31692777181804c2b20e7\">allantoin</span> and excreted in urine</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uricosuric agents (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drugs include Probenecid, Benzbromaron, Sulfinpyrazone, <strong>Lesinurad</strong></li>\n<li><strong>MOA:</strong> <strong>Inhibit OATP transporter/URAT-1 in the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> → inhibits <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid → increased <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid.</strong></li>\n</ul>\n<p> </p>\n<p>(OATP - Organic <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> transport protein, URAT-1 - <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">Uric</span> acid transporter)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Menke's disease is due to a deficiency of:", "options": [{"label": "A", "text": "Zinc", "correct": false}, {"label": "B", "text": "Copper", "correct": true}, {"label": "C", "text": "Iron", "correct": false}, {"label": "D", "text": "Magnesium", "correct": false}], "correct_answer": "B. Copper", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which enzyme deficiency causesVon Gierke's disease?", "options": [{"label": "A", "text": "Liver phosphorylase", "correct": false}, {"label": "B", "text": "Lysosomal glucosidase", "correct": false}, {"label": "C", "text": "Hepatic glycogen synthase", "correct": false}, {"label": "D", "text": "Glucose 6-phosphatase", "correct": true}], "correct_answer": "D. Glucose 6-phosphatase", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Von Gierke's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glucose-6-phophatase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pompe's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acid maltase/ <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> glucosidase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cori's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Debranching enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anderson's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Branching enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>McArdle's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle Phosphorylase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hers Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver phosphorylase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tarui's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phosphoructokinase- I</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What treatment can be administered to a patient brought to the emergency department with symptoms of diarrhea, sweating, excessive lacrimation, salivation, a garlicky odor, a pulse rate of 55/min, and a plasma cholinesterase level of 50 U/mL?", "options": [{"label": "A", "text": "Neostigmine", "correct": false}, {"label": "B", "text": "Atropine", "correct": true}, {"label": "C", "text": "Epinephrine", "correct": false}, {"label": "D", "text": "Benztropine", "correct": false}], "correct_answer": "B. Atropine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Atropine</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<thead>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Organophosphate poisoning</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common exposures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pesticide: Farmer/field worker, <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> ingestion, suicide attempt</li>\n<li>Nerve agent: Multiple patients presenting with similar symptoms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Manifestations</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Muscarinic <strong>(DUMBBELSS) :</strong></p>\n<ul>\n<li><strong>D-</strong>Diarrhea</li>\n<li><strong>U-</strong>Urination</li>\n<li><strong>M-</strong>Miosis</li>\n<li><strong>B-</strong>Bronchospasms, bronchorrhea, bradycardia</li>\n<li><strong>E-</strong>Excitation, Emesis</li>\n<li><strong>L-</strong>Lacrimation</li>\n<li><strong>S-</strong>Salivation, sweating</li>\n</ul>\n<p>Nicotinic:</p>\n<ul>\n<li>Muscle weakness, paralysis, fasciculations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Decontamination</li>\n<li>Atropine reverses <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> symptoms</li>\n<li>Pralidoxime reverses <span class=\"customMeta\" data-dictid=\"c10496dcc416927771937d7280d782\">nicotinic</span> and <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> symptoms (reactivates cholinesterase)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The co-factor for glutathione peroxidase is:", "options": [{"label": "A", "text": "Manganese", "correct": false}, {"label": "B", "text": "Selenium", "correct": true}, {"label": "C", "text": "Copper", "correct": false}, {"label": "D", "text": "Magnesium", "correct": false}], "correct_answer": "B. Selenium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old lactating mother presents with pain in her left breast and a fever. On examination of the affected side, there is localised erythema, warmth, and point tenderness, and the fluctuation test is positive. Mild axillary lymphadenopathy is on the affected side, and the contralateral breast is normal. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Lactational mastitis", "correct": false}, {"label": "B", "text": "Breast carcinoma", "correct": false}, {"label": "C", "text": "Breast abscess", "correct": true}, {"label": "D", "text": "Fibroadenoma", "correct": false}], "correct_answer": "C. Breast abscess", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Breast abscess</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Breast Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pus-filled <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> within the breast tissue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Types</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Lactational Abscess: </strong>Associated with breastfeeding.</li>\n<li><strong>Non-Lactational Abscess: </strong>Occurs in non-lactating women, e.g., <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">periductal</span> mastitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes and Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lactation:\n\t\t\t\t<ul>\n<li>Incidence: 3% to 20% in lactating mothers.</li>\n<li>Common pathogen: <strong>Staphylococcus aureus </strong>(methicillin-resistant strains in hospital settings).</li>\n<li>Entry points: <strong>Cracked/retracted nipple, blocked <span class=\"customMeta\" data-dictid=\"8ef2f22a3f1692777191d43bb00fb2\">lactiferous</span> ducts.</strong></li>\n</ul>\n</li>\n<li>Non-Lactation:\n\t\t\t\t<ul>\n<li>Often in<strong> <span class=\"customMeta\" data-dictid=\"341daa40bb169277719303fbd1ce1a\">nulliparous</span> women or post-lactation.</strong></li>\n<li>Conditions:<strong> <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">Periductal</span> mastitis, <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> mastitis, <span class=\"customMeta\" data-dictid=\"daf5ee63361692777201129f498a4d\">tubercular</span> mastitis.</strong></li>\n<li><strong>Smoking and diabetes </strong>as risk factors.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Signs and symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fever, leukocytosis, erythema, pain and tenderness, swelling, malaise, difficulty feeding, enlarged and tender axillary nodes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ultrasonography:\n\t\t\t\t<ul>\n<li>Detects cellulitis, and <span class=\"customMeta\" data-dictid=\"8170dc8ad81692777191ec56a3f27c\">liquefaction</span> necrosis.</li>\n<li>Confirms <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> size, location, and loculation.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lactational Mastitis:\n\t\t\t\t<ul>\n<li>Antibiotics: Anti-staphylococcal (e.g., cloxacillin, flucloxacillin, erythromycin).</li>\n<li>Breast emptying: Frequent <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> or pumping.</li>\n<li>Support: Breast support garment, cold compresses, analgesia.</li>\n<li>Drainage: Ultrasound-guided is preferred over <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> incision.</li>\n<li>Follow-up: Regular clinical and ultrasonographic reviews, and culture-based <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> modification.</li>\n</ul>\n</li>\n<li><strong>Non-Lactational Mastitis:</strong>\n<ul>\n<li>Broad-spectrum antibiotics for <span class=\"customMeta\" data-dictid=\"ba2454588016927771996f5f346221\">subareolar</span> infections.</li>\n<li>Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> for <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> drainage.</li>\n<li>Major milk <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for complications like <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> or fistula.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following medications does not require dosage adjustment for individuals with chronic kidney disease?", "options": [{"label": "A", "text": "Linagliptin", "correct": true}, {"label": "B", "text": "Saxagliptin", "correct": false}, {"label": "C", "text": "Repaglinide", "correct": false}, {"label": "D", "text": "Glyburide", "correct": false}], "correct_answer": "A. Linagliptin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Linagliptin</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>Increase <span class=\"customMeta\" data-dictid=\"148de0e6a61692777190372a1432f0\">Incretin</span> Levels</strong>: Prevents <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> of <span class=\"customMeta\" data-dictid=\"148de0e6a61692777190372a1432f0\">incretin</span> hormones (GLP-1 and GIP)</li>\n<li><strong>Enhance <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> Secretion</strong> from the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> in response to meals. (no risk of hypoglycemia)</li>\n<li><strong>Reduce <span class=\"customMeta\" data-dictid=\"c4d90ebfde1692777188e3689c1753\">Glucagon</span> Secretion</strong></li>\n<li>Maintain neutral weight</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">hypoglycemic</span> drug (type-2 diabetes)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Linagliptin</strong>: <strong>Safe in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</strong></li>\n<li>Teneligliptin: Safe in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Vildagliptin: Hepatotoxic</li>\n<li>Alogliptin</li>\n<li>Sitagliptin</li>\n<li>Saxagliptin:\n\t\t\t\t<ul>\n<li>Metabolised by CYP3A4, it has more drug interactions.</li>\n<li>Requires dose adjustment in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment.</li>\n<li>Risk of congestive heart failure.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (most common)</li>\n<li><strong>Pancreatitis</strong> (lesser than GLP-1)</li>\n<li>Risk of pancreatic and <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer (lesser than GLP-1)</li>\n<li>Arthritis, Nasopharyngitis:\n\t\t\t\t<ul>\n<li>Increase interleukins and cytokines levels (similar structure to CD26)</li>\n</ul>\n</li>\n<li>Hypersensitivity reactions: Steven-Johnson syndrome, angioedema</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old lady presented with a swelling in her neck. She had an exposure to radiation in the past. Identify the type of disease, image of FNAC is given below:", "options": [{"label": "A", "text": "Papillary carcinoma", "correct": true}, {"label": "B", "text": "Follicular carcinoma", "correct": false}, {"label": "C", "text": "Medullary carcinoma", "correct": false}, {"label": "D", "text": "Anaplastic carcinoma", "correct": false}], "correct_answer": "A. Papillary carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\"&gt;Papillary&lt;/span&gt; Carcinoma</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (80–85%) with excellent prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Childhood radiation exposure, BRAF &amp; RET/PTC mutations, family history.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphatic spread</strong> (cervical <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes commonly affected).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> nodule, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> lymphadenopathy, <span class=\"customMeta\" data-dictid=\"a0cba39e531692777187f51570565d\">euthyroid</span> state.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Orphan Annie eye nuclei, <span class=\"customMeta\" data-dictid=\"af21cbfa5f169277719652e0a79441\">Psammoma</span> bodies, Nuclear grooves, <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">Papillary</span> structures with <span class=\"customMeta\" data-dictid=\"a415391b321692777202ff36543c1c\">fibrovascular</span> cores.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. <strong>Ultrasound</strong> – Microcalcifications, <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> nodule, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> margins. 2. <strong>FNAC</strong> – First-line test.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. <strong>Total thyroidectomy</strong> (&gt;1 cm, multifocal, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement). 2. <strong>Lobectomy</strong> (&lt;1 cm, no metastasis). 3. <strong>RAI therapy</strong> (for <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> disease or metastasis). 4. <strong>TSH <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> therapy</strong> (Levothyroxine).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Excellent</strong> (&gt;95% 10-year survival). Worse with older age, distant metastasis, large tumor size, BRAF mutation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 36-year-old man presents with dull aching epigastric pain. He gives a history of acute abdominal pain following a binge of alcohol 5 weeks back, which was managed conservatively. On examination, he appeared icteric, and a firm mass was palpable in the epigastrium. His CT scan is given below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Pancreatic pseudocyst", "correct": true}, {"label": "B", "text": "Large choledochal cyst", "correct": false}, {"label": "C", "text": "Gastric duplication cyst", "correct": false}, {"label": "D", "text": "Mesenteric cyst", "correct": false}], "correct_answer": "A. Pancreatic pseudocyst", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) Pancreatic pseu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following medications utilized in the immediate treatment of asthma does not exert its effects by widening the bronchial airways?", "options": [{"label": "A", "text": "Salbutamol", "correct": false}, {"label": "B", "text": "Ipratropium", "correct": false}, {"label": "C", "text": "Deriphylline", "correct": false}, {"label": "D", "text": "Hydrocortisone", "correct": true}], "correct_answer": "D. Hydrocortisone", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PGnYACzY8q6bhiBZMkUX1746017113.png"], "explanation": "<p>Correct Answer D - H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A gross specimen of the colon obtained from a 14-year-old boy is shown below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Crohn's disease", "correct": false}, {"label": "B", "text": "Familial adenomatous polyposis (FAP)", "correct": true}, {"label": "C", "text": "Lynch syndrome", "correct": false}, {"label": "D", "text": "Juvenile polyposis syndrome", "correct": false}], "correct_answer": "B. Familial adenomatous polyposis (FAP)", "question_images": ["https://image.prepladder.com/content/jF5GWd9ziLkdthtqIBg41746017128.png"], "explanation_images": ["https://image.prepladder.com/content/qUC9ieDlGQhwT6koeP6K1746017155.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-month-old male baby presented with an empty scrotum. Ultrasonography revealed that the right testis was found in the right inguinal canal, while the left testis was found in the perineum. Comment on the diagnosis of this baby.", "options": [{"label": "A", "text": "Bilateral undescended testis", "correct": false}, {"label": "B", "text": "Bilateral ectopic testis", "correct": false}, {"label": "C", "text": "Right-side undescended testis and left-sided ectopic testis", "correct": true}, {"label": "D", "text": "Right side ectopic testis and left side undescended testis", "correct": false}], "correct_answer": "C. Right-side undescended testis and left-sided ectopic testis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DhufrYvgU4pd5EZvuLpW1746017229.png"], "explanation": "<p>Correct Option C) Right-side undescended &lt;span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\"&gt;testis&lt;/span&gt; and left-sided &lt;span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\"&gt;ectopic&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Dopamine at low doses causes:", "options": [{"label": "A", "text": "Increases in cardiac contractility", "correct": false}, {"label": "B", "text": "Vasoconstriction", "correct": false}, {"label": "C", "text": "Tachycardia", "correct": false}, {"label": "D", "text": "Increases renal blood flow", "correct": true}], "correct_answer": "D. Increases renal blood flow", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Increases &lt;span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\"&gt;renal&lt;/span&gt; blood flow.</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Dopamine Dose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Receptor Activation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>&lt; 2 µg/kg/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>D1 receptors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> blood flow; <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> and mesenteric vessels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>2-10 µg/kg/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>β1 receptors (heart)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Increases heart rate (positive chronotropic) and <span class=\"customMeta\" data-dictid=\"3d46029a83169277718580263882c3\">contractility</span> (positive inotropy)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>&gt; 10 µg/kg/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>α1 receptors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vasoconstriction (increased <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance) and increased blood pressure</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which PDE-5 inhibitor has the longest duration of action among the options provided?", "options": [{"label": "A", "text": "Sildenafil", "correct": false}, {"label": "B", "text": "Tadalafil", "correct": true}, {"label": "C", "text": "Vardenafil", "correct": false}, {"label": "D", "text": "Avanafil", "correct": false}], "correct_answer": "B. Tadalafil", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is true about the dose-response curve?", "options": [{"label": "A", "text": "Drug B is the most efficacious", "correct": false}, {"label": "B", "text": "Drug B is the most potent", "correct": true}, {"label": "C", "text": "Drug C is more efficacious than drug D", "correct": false}, {"label": "D", "text": "Drug A is more potent than drug B", "correct": false}], "correct_answer": "B. Drug B is the most potent", "question_images": ["https://image.prepladder.com/content/vqEbprgVkHxCWoefsIN51747909299.png"], "explanation_images": ["https://image.prepladder.com/content/H8AVqzp8JHeQkqAjJZBN1747922392.png", "https://image.prepladder.com/content/qdPDi52GVQhqGF3BPLLl1747922415.png"], "explanation": "<p>Correct Answer B - Drug B is th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 14-year-old boy who is experiencing sudden scrotal pain, where physical examination reveals a swollen and red scrotum with the right testes being retracted, absent cremasteric reflex, and negative Prehn's sign?", "options": [{"label": "A", "text": "Right-sided hydrocele", "correct": false}, {"label": "B", "text": "Strangulated inguinal hernia", "correct": false}, {"label": "C", "text": "Right testicular torsion", "correct": true}, {"label": "D", "text": "Right epididymo orchitis", "correct": false}], "correct_answer": "C. Right testicular torsion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Right testicu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Direction of Rotation</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Right Testis: Rotates clockwise</li>\n<li>Left Testis: Rotates counterclockwise</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Predisposing Factors</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inversion of the Testis</li>\n<li>High Investment in <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">Tunica</span> Vaginalis</li>\n<li>Gap Between <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> and Epididymis</li>\n<li>Heavy Straining</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age Group: Common in children and adolescents</li>\n<li>Symptoms: Sudden onset of pain in the scrotum, groin, and lower abdomen; <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> due to pylorospasm</li>\n<li>Signs: Tenderness, redness, and <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> of the scrotal skin</li>\n<li>Deming's Sign: Affected <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is positioned high due to twisting and <span class=\"customMeta\" data-dictid=\"e082e05dc416927771853d8fbe8044\">cremaster</span> muscle spasm</li>\n<li>Angell's Sign: Opposite <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> lies horizontally due to the presence of mesorchium</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>WBC Count: Elevated levels</li>\n<li>Doppler Study: To assess testicular <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> pulsation</li>\n<li>Ultrasound Abdomen</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Emergency Exploration: <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">Scrotum</span> exploration and untwisting of the testis. The <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> of the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is checked.</li>\n<li>Fixation: If viable, the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is fixed to the scrotal <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> with 2-3 <span class=\"customMeta\" data-dictid=\"fb9eb5785916927771900fcb6718d4\">interrupted</span> nonabsorbable sutures (Prolene).</li>\n<li>Timing: If surgery occurs within 12-24 hours, <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> may be retained. Any delay can lead to gangrene, requiring orchidectomy.</li>\n<li>Orchidectomy Consideration: If in doubt, the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> can be retained temporarily, with <span class=\"customMeta\" data-dictid=\"97af60ca4a16927771940d71c8f0fc\">orchidectomy</span> postponed to assess viability.</li>\n<li>Postoperative Care: A repeat <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> study confirms viability. The opposite <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> should also be fixed to prevent torsion.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patients receiving which of the following antimicrobial drugs are least likely to develop seizures?", "options": [{"label": "A", "text": "Beta-lactam compounds", "correct": false}, {"label": "B", "text": "Quinolones", "correct": false}, {"label": "C", "text": "Macrolides", "correct": true}, {"label": "D", "text": "Isoniazid", "correct": false}], "correct_answer": "C. Macrolides", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following antidepressant drugs acts by inhibiting the reuptake of both serotonin and norepinephrine?", "options": [{"label": "A", "text": "Fluoxetine", "correct": false}, {"label": "B", "text": "Venlafaxine", "correct": true}, {"label": "C", "text": "Paroxetine", "correct": false}, {"label": "D", "text": "Dapoxetine", "correct": false}], "correct_answer": "B. Venlafaxine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Venlafaxine</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>SSRI (Selective <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">Serotonin</span> <span class=\"customMeta\" data-dictid=\"42c441fad11692777197258f322307\">Reuptake</span> Inhibitors)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Fluoxetine <strong>(Option A)</strong></li>\n<li>Paroxetine <strong>(Option C)</strong></li>\n<li>Sertralin</li>\n<li>Citalopram</li>\n<li>Escitalopram</li>\n<li>Dapoxetine <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>SNRI (Serotonin-Norepinephrine <span class=\"customMeta\" data-dictid=\"42c441fad11692777197258f322307\">Reuptake</span> Inhibitors)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Venlafaxine</li>\n<li>Duloxetine</li>\n<li>Desvenlafaxine</li>\n<li>Milnacipran</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>TCA (Tricyclic Antidepressants)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<ul>\n<li>Amitriptyline</li>\n<li>Nortriptyline</li>\n<li>Imipramine</li>\n<li>Clomipramine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is used in the closure of patent ductus arteriosus?", "options": [{"label": "A", "text": "Magnesium sulfate", "correct": false}, {"label": "B", "text": "Alprostadil", "correct": false}, {"label": "C", "text": "Indomethacin", "correct": true}, {"label": "D", "text": "Paracetamol", "correct": false}], "correct_answer": "C. Indomethacin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Indomethacin</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uses of NSAIDs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>NSAIDs are avoided in</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Analgesic (in all types of pain except neuropathic pain)</li>\n<li>Antipyretic</li>\n<li>Anti-inflammatory</li>\n<li>Antiplatelet</li>\n<li>Tocolytic</li>\n<li><strong>Closure of PDA</strong></li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pregnancy (as it causes <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus)</li>\n<li>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease (IBD)</li>\n<li>Safest <span class=\"customMeta\" data-dictid=\"b924074dfe16927771933b6d50eaac\">NSAID</span> in these cases is <strong>paracetamol.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</thead>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred medication for managing ventricular arrhythmia caused by digoxin?", "options": [{"label": "A", "text": "Procainamide", "correct": false}, {"label": "B", "text": "Lignocaine", "correct": true}, {"label": "C", "text": "Atropine", "correct": false}, {"label": "D", "text": "Propranolol", "correct": false}], "correct_answer": "B. Lignocaine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Lig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For the treatment of thyroid cancer, which radioactive iodine isotope among the options listed below is used?", "options": [{"label": "A", "text": "Iodine -125", "correct": false}, {"label": "B", "text": "Iodine-131", "correct": true}, {"label": "C", "text": "Iodine-127", "correct": false}, {"label": "D", "text": "Iodine-123", "correct": false}], "correct_answer": "B. Iodine-131", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Iodine-13\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child, after disturbing a bee hive, experienced several stings. A few minutes later, the child developed breathing difficulty and hypotension. What is the drug of choice for managing this child?", "options": [{"label": "A", "text": "Dobutamine", "correct": false}, {"label": "B", "text": "Adrenaline", "correct": true}, {"label": "C", "text": "Noradrenaline", "correct": false}, {"label": "D", "text": "Dopamine", "correct": false}], "correct_answer": "B. Adrenaline", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Adrenaline</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Uses of Epinephrine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Dilution/Concentration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Route of Administration</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>Anaphylaxis</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>First-line treatment for severe allergic reactions</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>1:1000 (1 mg/mL)</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Intramuscular (IM)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>Cardiac arrest</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>To restore <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> rhythm and blood pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>1:10,000 (0.1 mg/mL)</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Intravenous (IV)</li>\n<li>Intraosseous (IO)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>Asthma</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>Treatment of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> severe <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> attacks</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>1:1000 (1 mg/mL)</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Inhalation via nebulizer</li>\n<li>Intramuscular (IM)</li>\n<li>subcutaneous (SC)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>Hypotension</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>To increase blood pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>1:100,000 (0.01 mg/mL)</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Intravenous (IV) infusion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>Local anesthesia</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>Enhance duration and intensity of the local anaesthetic effect</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p>1:200,000 to 1:100,000 (0.005 to 0.01 mg/mL)</p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<ul>\n<li>Local injection</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female presents with muscle weakness, blurred vision after exertion, and ptosis, which improves after undergoing the edrophonium test. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Lambert Eaton syndrome", "correct": false}, {"label": "B", "text": "Myasthenia gravis", "correct": true}, {"label": "C", "text": "Guillain-Barré syndrome", "correct": false}, {"label": "D", "text": "Bronchial asthma", "correct": false}], "correct_answer": "B. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"6fa809ad22169277719323eaa30f1e\"&gt;Myasthenia&lt;/span&gt; grav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old man who had travelled to Assam recently presents with fever, chills, seizures, and altered sensorium. On examination, his blood pressure is 70/50 mm Hg, and laboured breathing is observed. A blood smear reveals Plasmodium falciparum . What is the drug of choice in this condition?", "options": [{"label": "A", "text": "Chloroquine", "correct": false}, {"label": "B", "text": "Quinine", "correct": false}, {"label": "C", "text": "Intravenous artesunate", "correct": true}, {"label": "D", "text": "Artemether", "correct": false}], "correct_answer": "C. Intravenous artesunate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\"&gt;Intravenous&lt;/span&gt; artesunate</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Scenario</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Uncomplicated P. Vivax malaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chloroquine </strong>25 mg/kg over 3 days (10-10-5) + <strong>Primaquine </strong>oral 0.25 mg/kg for 14 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complicated malaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parenteral ACT-Artesunate</strong> IV given for 2 days, <strong>followed by a full course of oral ACT.</strong></p>\n<p> </p>\n<p>(OR)</p>\n<p> </p>\n<p><strong>Parenteral quinine</strong> IV given for 2 days, and oral <span class=\"customMeta\" data-dictid=\"e19b9eeec016927771979899edd580\">quinine</span> given for 5 days. Add on oral doxycycline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mixed infection<br/>\n\t\t\t(P. vivax/ovale/falciparum)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ACT+ Primaquine</strong> for 14 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1st trimester: <strong>Parenteral quinine</strong></p>\n<p>2nd and 3rd trimester: <strong>Parenteral artemisinin</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following medications is most suitable for treating cryptorchidism (undescended testes)?", "options": [{"label": "A", "text": "Pulsatile GnRH", "correct": true}, {"label": "B", "text": "Non-pulsatile GnRH", "correct": false}, {"label": "C", "text": "Testosterone", "correct": false}, {"label": "D", "text": "Estrogen", "correct": false}], "correct_answer": "A. Pulsatile GnRH", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\"&gt;Pulsatile&lt;/span&gt; GnRH\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which neurotransmitter is primarily responsible for the condition observed in a 55-year-old male who presents with rigidity, frequent falls, slowness in movements, tremors, and a short stepping gait?", "options": [{"label": "A", "text": "GABA", "correct": false}, {"label": "B", "text": "Acetylcholine", "correct": false}, {"label": "C", "text": "Dopamine", "correct": true}, {"label": "D", "text": "Serotonin", "correct": false}], "correct_answer": "C. Dopamine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A student complains of developing urticaria following the consumption of seafood. Considering the need for non-sedating medication due to an upcoming exam, which of the following drugs would you choose to prescribe?", "options": [{"label": "A", "text": "Chlorpheniramine", "correct": false}, {"label": "B", "text": "Diphenhydramine", "correct": false}, {"label": "C", "text": "Hydroxyzine", "correct": false}, {"label": "D", "text": "Fexofenadine", "correct": true}], "correct_answer": "D. Fexofenadine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Fexofenadine</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Generation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Generalised Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1st Generation</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diphenhydramine </strong>(<strong>Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sedation, drowsiness, dry mouth, blurred vision</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allergy symptoms, Insomnia, Motion sickness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chlorpheniramine </strong>(<strong>Option A)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sedation, drowsiness, dry mouth</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allergy symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hydroxyzine </strong>(<strong>Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anxiety, <span class=\"customMeta\" data-dictid=\"aa1288c36b16927771814fa5aa84eb\">Allergy</span> symptoms, Pruritus</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2nd Generation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Loratadine </strong></p>\n<p> </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimal sedation, dry mouth</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allergy symptoms, Urticaria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cetirizine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allergy symptoms, Itchiness, Urticaria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fexofenadine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-sedating, minimal side effects</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allergy symptoms, Chronic <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> urticaria</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options below acts as a selective alpha-1 receptor antagonist in medical practice?", "options": [{"label": "A", "text": "Phenoxybenzamine", "correct": false}, {"label": "B", "text": "Phentolamine", "correct": false}, {"label": "C", "text": "Prazosin", "correct": true}, {"label": "D", "text": "Idazoxan", "correct": false}], "correct_answer": "C. Prazosin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Prazosin</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Classification of Alpha-blockers based on their <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> binding</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types</strong></p>\n</td>\n<td colspan=\"4\" rowspan=\"1\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-<br/>\n\t\t\tcompetitive + <span class=\"customMeta\" data-dictid=\"ee77d507701692777190bfcf47b497\">irreversible</span> type</strong></p>\n</td>\n<td colspan=\"4\" rowspan=\"1\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Phenoxybenzamine</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Competitive + <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> type</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-selective</strong></p>\n<p> </p>\n<p> </p>\n<p> </p>\n</td>\n<td colspan=\"3\" rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phentolamine</strong></p>\n<p>Ergotamine</p>\n<p>Ergotoxine</p>\n<p>Chlorpromazine</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Alpha 1 selective</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha 1 a</strong></p>\n<p>Tamsulosin</p>\n<p>Silodosin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Internal Urethral Sphincter</p>\n<p>Iris</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ejaculation failure/retrograde ejaculation, miosis, increased <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> outflow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha 1 b</strong></p>\n<p>Alfuzosin</p>\n<p>Doxazosin</p>\n<p><strong>Prazosin</strong></p>\n<p>Terazosin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vascular Smooth Muscle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vasodilatation, <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> tachycardia, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> (thus leading to <span class=\"customMeta\" data-dictid=\"15d91786931692777197c8932c8000\">RAAS</span> activation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha 2 selective</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yohimbine</strong></p>\n<p>Idoxazon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central Nervous System</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Penile <span class=\"customMeta\" data-dictid=\"322d94cd5816927771872f3d8d132b\">erection</span> (used in depression with sexual dysfunction)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prazosin is a highly selective ɑ1 blocker.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Postural <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> (first dose effect) - due to <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> 1b <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> <span class=\"customMeta\" data-dictid=\"70d039f1401692777183bb2f23a21a\">blockade</span> on <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> smooth muscles</li>\n<li>Retrograde ejaculation: Due to <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> 1a receptors <span class=\"customMeta\" data-dictid=\"70d039f1401692777183bb2f23a21a\">blockade</span> on internal urethral sphincter</li>\n<li>Floppy <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">iris</span> syndrome: Due to the <span class=\"customMeta\" data-dictid=\"70d039f1401692777183bb2f23a21a\">blockade</span> of the <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> 1a <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> on the iris</li>\n<li>Reflex <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> occurs due to vasodilation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypertension</li>\n<li>Benign prostatic hyperplasia</li>\n<li>Raynaud’s disease</li>\n<li>Scorpion Bite.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a routine check-up, an elderly male was discovered to have a rectal mass during a digital rectal examination, indicating the possibility of rectal carcinoma. Despite normal bowel habits, the next course of action for managing this patient should be:", "options": [{"label": "A", "text": "CT scan of the abdomen", "correct": false}, {"label": "B", "text": "Rigid sigmoidoscopy and biopsy", "correct": false}, {"label": "C", "text": "Full colonoscopy and biopsy", "correct": true}, {"label": "D", "text": "Barium enema", "correct": false}], "correct_answer": "C. Full colonoscopy and biopsy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) Full &lt;span class=\"customMeta\" data-dictid=\"0c22b22aab169277718457c4c8d6c3\"&gt;colonoscopy&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presented with a low-grade fever of 1-week duration associated with loss of appetite and weight loss. Barium meal follow-through image of the patient is given below. What is the probable diagnosis?", "options": [{"label": "A", "text": "Ileocaecal TB", "correct": true}, {"label": "B", "text": "Ulcerative colitis", "correct": false}, {"label": "C", "text": "Crohn’s disease", "correct": false}, {"label": "D", "text": "Carcinoma caecum", "correct": false}], "correct_answer": "A. Ileocaecal TB", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) Ileocaecal TB</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> affecting the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> region, the most common site of <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> TB.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Why the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">Ileocecal</span> Region?</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rich in <span class=\"customMeta\" data-dictid=\"32599f889a169277719169e3483e62\">lymphoid</span> tissue, slow transit time, and increased <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> of <span class=\"customMeta\" data-dictid=\"4e55f7e0e6169277720158750ed95c\">tubercle</span> bacilli.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right lower <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> (RLQ) pain, weight loss, fever, diarrhoea/constipation, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> mass.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnoses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crohn’s disease, appendicitis, <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer, lymphoma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>RLQ tenderness, <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass, signs of <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (in severe cases).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound/CT scan</strong>: <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> wall thickening, lymphadenopathy, ascites, strictures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endoscopic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colonoscopy</strong>: Ulcers, nodularity, strictures in the <span class=\"customMeta\" data-dictid=\"6f7908953b1692777189fa3a1a9655\">ileocecal</span> region.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caseating granulomas, <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB) on Ziehl-Neelsen stain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definitive Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>AFB culture, <span class=\"customMeta\" data-dictid=\"fa67319b42169277719498abc93db6\">PCR</span> for <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> tuberculosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anti-TB Therapy (ATT)</strong>: <strong>Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (2 months), followed by <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">Rifampicin</span> + <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> (4 months).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications for Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bowel obstruction, perforation, abscess, stricture, and unresponsiveness to ATT.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limited <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (if necessary), <span class=\"customMeta\" data-dictid=\"7c91935f971692777199558dedd3cb\">stricturoplasty</span> (for non-resectable strictures).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 42-year-old woman who came with symptoms of fever, vomiting, and right hypochondriac pain, which radiates to the neck? She has experienced similar episodes in the past, and a positive Murphy's sign was observed during the examination.", "options": [{"label": "A", "text": "Acute cholecystitis", "correct": true}, {"label": "B", "text": "Carcinoma gallbladder", "correct": false}, {"label": "C", "text": "Peptic ulcer", "correct": false}, {"label": "D", "text": "Acute appendicitis", "correct": false}], "correct_answer": "A. Acute cholecystitis", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:558px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tokyo Guidelines for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"180ce1a7c416927771844825c616f4\">Cholecystitis</span> (2013/2018)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A) Local Signs of Inflammation</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Murphy's sign</strong></li>\n<li>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> (RUQ) pain/ <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> or a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> mass.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B) <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> Signs of Inflammation:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Elevated CRP</li>\n<li>Elevated WBC</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C) <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Findings:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gallbladder wall thickening (&gt;3 mm)</li>\n<li>Pericholecystic fluid,</li>\n<li>Ultrasonographic Murphy's sign.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man arrives at the emergency department with a concern of vomiting blood. He mentions a recent pattern of excessive alcohol consumption. Upon examination, his vital signs are steady, and he has a pale appearance. There are no indications of ongoing bleeding. The results of his liver function tests are within the normal range. To further assess the situation, an upper gastrointestinal endoscopy is scheduled. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Esophageal varices", "correct": false}, {"label": "B", "text": "Gastric ulcer", "correct": false}, {"label": "C", "text": "Mallory-Weiss tear", "correct": true}, {"label": "D", "text": "Alcoholic gastritis", "correct": false}], "correct_answer": "C. Mallory-Weiss tear", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gmxacvUbYNClv5tqhrAX1747911490.png"], "explanation": "<p>Correct answer C) Mallory-W\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following accurately represents Bormann's classification for gastric carcinoma?", "options": [{"label": "A", "text": "Type I: Polypoid tumor with a small ulcerated component", "correct": true}, {"label": "B", "text": "Type II: Ulcerated tumor with infiltrative margins", "correct": false}, {"label": "C", "text": "Type III: Diffusely infiltrative tumor with linitis plastica appearance", "correct": false}, {"label": "D", "text": "Type IV: Mucinous carcinoma with extensive peritoneal metastases", "correct": false}], "correct_answer": "A. Type I: Polypoid tumor with a small ulcerated component", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) Type I: &lt;span class=\"customMeta\" data-dictid=\"a3c898fa9e1692777196b39e3bf93c\"&gt;Polypoid&lt;/span&gt; tumor with a small ulcerated component:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bormann Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Macroscopic Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I (Polypoid type)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polypoid or fungating mass</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Well-defined borders</strong>, grow into the lumen, minimal invasion into the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> wall, mand ay have a <strong>small ulcerated component</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II (Ulcerated tumor with distinct borders)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ulcerated <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with raised margins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clearly defined <span class=\"customMeta\" data-dictid=\"3107ad472c16927771900477b8dae0\">infiltrative</span> edges</strong>, but <strong>not deeply penetrating</strong> into surrounding tissues. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III (Ulceroinfiltrative type)</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"50f4196df6169277720181ef605c33\">ulceration</span> with <span class=\"customMeta\" data-dictid=\"3107ad472c16927771900477b8dae0\">infiltrative</span> margins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Irregular and poorly defined borders</strong>, penetrate deeper into the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> wall, more aggressive than Type II.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV (Diffuse/Infiltrative type – <span class=\"customMeta\" data-dictid=\"00eec64d051692777191b76ee079b7\">Linitis</span> Plastica)</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diffuse thickening of the stomach wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infiltrative growth without a <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> mass</strong>, causes <strong>\"a leather bottle stomach\"</strong> appearance, commonly associated with <strong>signet-ring cell carcinoma</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents to the emergency department with abdominal pain and vomiting. He reports a 2-day history of constipation and bloating. On examination, he appears uncomfortable, and his abdomen is distended with high-pitched bowel sounds. X-ray reveals dilated loops of the small bowel. What is the most likely cause of his symptoms?", "options": [{"label": "A", "text": "Colonic malignancy", "correct": false}, {"label": "B", "text": "Small bowel obstruction", "correct": true}, {"label": "C", "text": "Acute pancreatitis", "correct": false}, {"label": "D", "text": "Gastric ulcer", "correct": false}], "correct_answer": "B. Small bowel obstruction", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) Small &lt;span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\"&gt;bowel&lt;/span&gt; obstruction</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:596px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (SBO)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Adhesions<strong> (Most common)</strong></li>\n<li>Malignancy</li>\n<li>Metastasis</li>\n<li>Peritoneal carcinomatosis</li>\n<li>Hernia</li>\n<li>Crohn's Disease</li>\n<li>Tb</li>\n<li>PID</li>\n<li>Post radiotherapy</li>\n<li>Cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgeries with High Risk of <span class=\"customMeta\" data-dictid=\"396cb274df16927771803e151a1109\">Adhesive</span> Small <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">Bowel</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (SBO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pelvic surgeries (Highest risk)</strong></li>\n<li>Lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgeries</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> surgeries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancies Responsible for SBO</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metastasis</li>\n<li>Peritoneal carcinomatosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following findings of colonoscopy is highly malignant?", "options": [{"label": "A", "text": "Multiple flat polyps about 100", "correct": true}, {"label": "B", "text": "Single pedunculated polyp", "correct": false}, {"label": "C", "text": "Multiple pedunculated polyps", "correct": false}, {"label": "D", "text": "Solitary flat polyp", "correct": false}], "correct_answer": "A. Multiple flat polyps about 100", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NAMyjJuOEbJEbkT5Eo7M1746076108.png"], "explanation": "<p>Correct answer A) Multiple flat &lt;span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\"&gt;polyp&lt;/span&gt; abou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes McBurney's point in cases of acute appendicitis?", "options": [{"label": "A", "text": "McBurney point is located in the left lower quadrant of the abdomen.", "correct": false}, {"label": "B", "text": "McBurney point corresponds to the site of maximal tenderness in acute appendicitis.", "correct": true}, {"label": "C", "text": "McBurney point is used to assess rebound tenderness in acute appendicitis.", "correct": false}, {"label": "D", "text": "McBurney point is located at the umbilicus in acute appendicitis.", "correct": false}], "correct_answer": "B. McBurney point corresponds to the site of maximal tenderness in acute appendicitis.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer B) McBurney point corresponds to the site of &lt;span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\"&gt;maximal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\"&gt;tenderness&lt;/span&gt; in &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;acute&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a patient who has been experiencing fever and pain in the lower right abdomen for the past 5 days, with the presence of a tender mass in the right iliac fossa and an elevated leukocyte count?", "options": [{"label": "A", "text": "Appendicitis", "correct": true}, {"label": "B", "text": "Hydronephrosis", "correct": false}, {"label": "C", "text": "Tuberculosis", "correct": false}, {"label": "D", "text": "Carcinoma colon", "correct": false}], "correct_answer": "A. Appendicitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a female patient who presents with a mass in the inguinal area that can be reduced from the deep inguinal ring accompanied by a gurgling sound?", "options": [{"label": "A", "text": "Direct inguinal hernia", "correct": false}, {"label": "B", "text": "Indirect inguinal hernia", "correct": true}, {"label": "C", "text": "Femoral hernia", "correct": false}, {"label": "D", "text": "Pantaloon hernia", "correct": false}], "correct_answer": "B. Indirect inguinal hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZTRDM4mXL1kd8FgzzUe11746077174.png"], "explanation": "<p>Correct answer B) &lt;span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\"&gt;Indirect&lt;/span&gt; inguinal h\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indirect Inguinal Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Direct Inguinal Hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Young adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It enters through the deep inguinal ring, traverses the inguinal canal, and exits via the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> inguinal ring.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protrudes directly through Hesselbach's triangle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">Spermatic</span> Cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location of Neck of Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> tubercle.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lies within the Hesselbach's triangle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to Scrotum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Descends into the scrotum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Does not Descend</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bubonocele:</strong> Confined to inguinal canal</li>\n<li><strong>Funicular:</strong> Processus vaginalis closed above epididymis, <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> content distinct from testis</li>\n<li><strong>Complete/Scrotal:</strong> <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> in the lower part of the hernia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><strong>—</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for an elderly male patient who has come to the hospital with lower back pain, a movable mass in the lower back that becomes more prominent when breathing in and a general feeling of weakness? The lab tests show the presence of red blood cells in the urine, with no sign of pus cells.", "options": [{"label": "A", "text": "Polycystic kidney disease", "correct": false}, {"label": "B", "text": "Hydronephrosis", "correct": false}, {"label": "C", "text": "Renal cell carcinoma", "correct": true}, {"label": "D", "text": "Chronic pyelonephritis", "correct": false}], "correct_answer": "C. Renal cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer C) &lt;span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\"&gt;Renal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 60-year-old male who is experiencing lower back pain and has sclerotic lesions in the vertebrae?", "options": [{"label": "A", "text": "Carcinoma prostate", "correct": true}, {"label": "B", "text": "Tuberculosis", "correct": false}, {"label": "C", "text": "Renal cell carcinoma", "correct": false}, {"label": "D", "text": "Carcinoma colon", "correct": false}], "correct_answer": "A. Carcinoma prostate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prostate cancer spreads <strong>hematogenously to bones</strong>, commonly affecting the <strong>spine, pelvis, ribs, and femur</strong>. <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">Metastases</span> are <strong>osteoblastic (sclerotic)</strong> due to increased <span class=\"customMeta\" data-dictid=\"8e55f8d71d1692777194a10c3d3d9d\">osteoblast</span> activity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lower back pain</strong>, <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fractures, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> symptoms (hesitancy, frequency), and <strong>neurological deficits if <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> occurs</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PSA – Elevated</strong>, <strong>ALP – Elevated</strong> (bone involvement), <strong>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">Calcium</span> – Normal/mildly elevated</strong> (osteoblastic <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> do not cause severe hypercalcemia).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sclerotic (osteoblastic) lesions</strong> in vertebrae, pelvis, and long bones.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bone Scan (Tc-99m)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shows <strong>increased <span class=\"customMeta\" data-dictid=\"c5a32dfd6e1692777197db92b6aea1\">radiotracer</span> uptake</strong> in metastatic sites (best for early detection).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MRI Spine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detects <strong>spinal cord <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> infiltration</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Pelvis/Spine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defines <strong>bone <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> and local spread</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Confirmatory Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TRUS-guided <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> biopsy</strong> (Transrectal <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> Biopsy).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Androgen <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">Deprivation</span> Therapy (ADT)</strong> (GnRH agonists like Leuprolide), <strong>Bisphosphonates for bone health</strong>, Radiation for <strong>spinal metastases</strong>, and <strong>Surgical <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> if cord <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> occurs</strong>.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 67-year-old diabetic patient presented with swelling around the knee, restriction of movement and minimal or no pain. The x-ray of the knee is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Rheumatoid arthropathy", "correct": false}, {"label": "B", "text": "Osteoarthritis", "correct": false}, {"label": "C", "text": "Charcot arthropathy", "correct": true}, {"label": "D", "text": "Psoriatic arthropathy", "correct": false}], "correct_answer": "C. Charcot arthropathy", "question_images": ["https://image.prepladder.com/content/7gvhwo5HUzUSnRCwcGUa1747908126.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Common Joint Involved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diabetes mellitus (Most common cause) (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Peripheral <span class=\"customMeta\" data-dictid=\"2d9476094c16927771933bcb162f19\">neuropathy</span> leads to altered pain sensation and proprioception</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Foot</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Syphilis (Tabes dorsalis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Neurological deficits affecting joint function</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Knee</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Syringomyelia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Dilatation of the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord; may lead to <span class=\"customMeta\" data-dictid=\"4eac1cd2f016927771990c099e203d\">syringobulbia</span> (if it extends to the Brainstem)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Shoulder</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Leprosy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Neuropathy leading to loss of sensation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hand and Foot</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Meningomyelocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Neurological deficits impacting joint function</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Variable, but often lower limbs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of trauma has a ruptured bulbar urethra. What is the location for the accumulation of urine?", "options": [{"label": "A", "text": "Superficial pouch", "correct": true}, {"label": "B", "text": "Deep pouch", "correct": false}, {"label": "C", "text": "Rectouterine pouch", "correct": false}, {"label": "D", "text": "Uterovesical pouch", "correct": false}], "correct_answer": "A. Superficial pouch", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/12ysO49oDxKPf0uKSZuX1746078174.png", "https://image.prepladder.com/content/tWQ4dHuHQiDivlKSZcPe1746078174.png", "https://image.prepladder.com/content/JN795bQlLwnZi76dFDHh1746078174.png"], "explanation": "<p>Correct answer A) &lt;span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\"&gt;Superficial&lt;/span&gt; pouch</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:662px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior Urethral Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posterior Urethral Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (most common)</li>\n<li>Penile urethra</li>\n</ul>\n<p> </p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"378\" src=\"https://image.prepladder.com/content/tWQ4dHuHQiDivlKSZcPe1746078174.png\" width=\"378\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (bulbomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> most common)</li>\n<li>Prostatic urethra</li>\n</ul>\n<p> </p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"381\" src=\"https://image.prepladder.com/content/JN795bQlLwnZi76dFDHh1746078174.png\" width=\"381\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Straddle injuries</li>\n<li>Direct trauma</li>\n<li>Iatrogenic injuries (catheterization, cystoscopy)</li>\n<li>Penetrating trauma (stab/gunshot wounds)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pelvic fractures (often due to motor vehicle accidents)</li>\n<li>Blunt trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hematuria (blood in urine)</li>\n<li>Penile/perineal bruising (butterfly-shaped hematoma)</li>\n<li>Perineal pain</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> or difficulty voiding</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> or <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> due to hematoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood at the meatus</li>\n<li>Inability to void</li>\n<li>High-riding <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> on rectal exam</li>\n<li>Perineal or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> pain</li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> associated with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU)</strong>: Gold standard, shows the extent and location of the injury</li>\n<li>Voiding Cystourethrography (VCUG): Used to assess urethral <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> post-repair</li>\n<li>Ultrasound: Can detect <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or associated injuries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU): Gold standard for initial assessment</li>\n<li>CT Urethrography: Useful in evaluating complex injuries</li>\n<li>Pelvic CT Scan: Important for associated <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Cystoscopy: Sometimes performed for further evaluation</li>\n<li>If injury at Prostatomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> - High lying <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> → On IVP- Pie in-sky appearance</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a newborn male with an undeveloped scrotum, the testis was observed to be located near the peritoneum. Which of the following factors aids in the descent of the testis into the scrotum?", "options": [{"label": "A", "text": "GnRH Analogues", "correct": true}, {"label": "B", "text": "Testosterone", "correct": false}, {"label": "C", "text": "Cold Compressions", "correct": false}, {"label": "D", "text": "Manually bring the testis down to the bottom of scrotum.", "correct": false}], "correct_answer": "A. GnRH Analogues", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) GnRH Analogu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> (Cryptorchidism) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cryptorchidism is a condition where one or both <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> fail to descend into the <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> from the abdomen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inguinal/Palpable undescended testis: 80%</li>\n<li>Abdominal/Non-Palpable undescended testis: 20%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes and Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Developmental and Genetic Factors:</strong> Conditions like <span class=\"customMeta\" data-dictid=\"8e151ee847169277719083d35bdd10\">Klinefelter syndrome</span> and <span class=\"customMeta\" data-dictid=\"e54a6646c1169277720031d162bd75\">testosterone</span> imbalances can impair testicular descent.</li>\n<li><strong>Prematurity and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">Maternal</span> Factors:</strong> <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">Premature</span> birth and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> issues like diabetes or medication exposure can lead to undescended testes.</li>\n<li><strong>Mechanical and Physical Factors: </strong>Obstructions in the inguinal canal, scrotum, or related conditions such as inguinal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> can prevent normal testicular descent.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(SATHI Mnemonic):</strong></p>\n<ul>\n<li><strong>S: <span class=\"customMeta\" data-dictid=\"61755425bd1692777199771cd3fa1e\">Sterility</span> -</strong> Elevated <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> temperature can impair <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> production, leading to potential <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> if untreated.</li>\n<li><strong>A: <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">Atrophy</span> -</strong> Prolonged exposure to heat can cause the <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> to shrink or become non-functional.</li>\n<li><strong>T: Trauma, Tumor, <span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\">Torsion</span> </strong>- Increased risk of testicular torsion, which can cause severe pain and potentially result in testicular loss. The most common tumor associated is seminoma, with the highest risk of tumor development in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> testes.</li>\n<li><strong>H: <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">Hernia</span> - </strong>Over 90% of cases are associated with a patent <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">processus</span> vaginalis, increasing the risk of inguinal hernia.</li>\n<li><strong>I: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> - </strong>The undescended <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is more <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> conditions.</li>\n</ul>\n<p><strong>Note: </strong>Leydig cells are unaffected, maintaining secondary sexual characteristics, while Sertoli cells are impaired, affecting spermatogenesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Palpable undescended testis:</strong> Inguinal exploration.</li>\n<li><strong>Non-Palpable undescended testis:</strong> <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> laparoscopy.</li>\n<li><strong>Imaging:</strong> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">Ultrasound</span> or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> may be utilised to locate the testis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical <span class=\"customMeta\" data-dictid=\"5913e35df9169277719717f79fbae7\">Repositioning</span> (Orchidopexy):</strong> Usually performed when the child is between 6-12 months old.</p>\n<p><strong>Types of Orchidopexy</strong></p>\n<ul>\n<li>Ombridannes</li>\n<li>Keetley-Torek</li>\n<li>Stephen-Fowler</li>\n<li>Ladd &amp; Gross</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presents with scrotal enlargement. His LDH levels are notably elevated, while HCG and alpha-fetoprotein levels remain within normal ranges. Upon histopathological examination, the findings are as shown below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Leydig cell tumor", "correct": false}, {"label": "B", "text": "Embryonal carcinoma", "correct": false}, {"label": "C", "text": "Seminoma", "correct": true}, {"label": "D", "text": "Teratoma", "correct": false}], "correct_answer": "C. Seminoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TPjNQFn0qAVpPNvuOrVd1747911666.png", "https://image.prepladder.com/content/EdeuL4S0J7LN6VVgZBcs1747911657.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seminoma, the most common pure testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumour in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> aged 25-45</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Germinal <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> of the <span class=\"customMeta\" data-dictid=\"1406286c02169277719897928fb9f1\">seminiferous</span> tubules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless, firm <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or mass in the testicle, typically unilateral. Accounts for 50% of all testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumors. 10% have secondary hydrocele, 5% have gynecomastia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>AFP: Normal</p>\n<p>hCG: Normal or mildly elevated</p>\n<p>LDH: Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ultrasound: Homogeneous, <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> mass</p>\n<p>Histology: Sheets of <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> cells with clear cytoplasm, large <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> with prominent <span class=\"customMeta\" data-dictid=\"829d67cd9816927771800b7303f9cc\">acidophilic</span> nucleoli</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Alex_brollo\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Testis_seminoma_3.jpg\" data-tags=\"\" height=\"3301\" src=\"https://image.prepladder.com/content/TPjNQFn0qAVpPNvuOrVd1747911666.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"0\" src=\"https://image.prepladder.com/content/EdeuL4S0J7LN6VVgZBcs1747911657.png\" width=\"0\"/></p>\n<p>FNAC: Contraindicated due to the risk of tumour cell seeding and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary: High Inguinal Radical Orchidectomy</p>\n<p>Adjuvant: Radiation therapy or <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> for positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male underwent lumbar sympathectomy, and bilateral L1 ganglions were removed. What will be the most common side effect?", "options": [{"label": "A", "text": "Impotence", "correct": false}, {"label": "B", "text": "Retrograde ejaculation", "correct": true}, {"label": "C", "text": "Bladder dysfunction", "correct": false}, {"label": "D", "text": "Incontinence", "correct": false}], "correct_answer": "B. Retrograde ejaculation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B) &lt;span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\"&gt;Retrograde&lt;/span&gt; ejacu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statements below is not true regarding the condition depicted in the image?", "options": [{"label": "A", "text": "Less chances of recurrence", "correct": true}, {"label": "B", "text": "Transillumination positive", "correct": false}, {"label": "C", "text": "Can be surgically excised", "correct": false}, {"label": "D", "text": "Seen on the dorsal and volar aspects of the wrist", "correct": false}], "correct_answer": "A. Less chances of recurrence", "question_images": ["https://image.prepladder.com/content/ZWRoEbnEOGOEb23LyKNH1746078027.png"], "explanation_images": ["https://image.prepladder.com/content/FDsjcNfWTP7SfFxXG9qP1746078202.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the wrist</li>\n<li>Arises from the <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> fluid of joint/tendon sheath</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common: <strong>Dorsal &gt; <span class=\"customMeta\" data-dictid=\"8e0bd6da651692777202f38aeec153\">volar</span> aspects of wrist (Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Usually seen in young adults</li>\n<li>Well-defined, cystic, <strong>non-tender</strong> swelling</li>\n<li>Smooth, <strong>fluctuant</strong> and <strong>transillumination positive (Option B)</strong></li>\n<li>Mucous containing cysts are associated with nail changes</li>\n<li>Rarely can cause <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kulzerwi\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Ueberbein2.jpg\" data-tags=\"\" height=\"388\" src=\"https://image.prepladder.com/content/FDsjcNfWTP7SfFxXG9qP1746078202.png\" width=\"458\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asymptomatic cases do not require treatment, spontaneously undergoes regression.</li>\n<li>USG-guided <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> or <strong>Surgical excision</strong> is done in <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> cases and for <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> indications <strong>(Option C)</strong></li>\n<li><strong>Recurrence - common (Option A)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent surgery, for which she was immobilised. Patient started complaining of leg pain on the 5th postoperative day. On examination , Homan’s sign is positive. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Deep Venous thrombosis", "correct": true}, {"label": "B", "text": "Urinary sepsis", "correct": false}, {"label": "C", "text": "Peripheral vascular disease", "correct": false}, {"label": "D", "text": "Lymphangitis", "correct": false}], "correct_answer": "A. Deep Venous thrombosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct answer A) Deep &lt;span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\"&gt;Venous&lt;/span&gt; thrombosis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Localized tenderness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specific for DVT; indicates <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> along the vein.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asymmetrical calf swelling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common but not specific to DVT.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erythema and warmth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suggestive of <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> or thrombosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pain in the affected limb</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can occur with or without movement; can indicate <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dilated <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> veins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May indicate <span class=\"customMeta\" data-dictid=\"8c77461be01692777184e67e678209\">compensatory</span> <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> due to deep <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Homans' sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-specific; <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">Passive</span> forceful <span class=\"customMeta\" data-dictid=\"5c4883591b16927771863aa94323f0\">dorsiflexion</span> of the foot with extended knee will cause <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the calf.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mose’s sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painful response to gentle squeezing of the lower calf from side-to-side.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuhof's Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thickening and deep <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the calf muscles upon palpation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phlegmasia <span class=\"customMeta\" data-dictid=\"455facf7ef169277718133da1f91e2\">Alba</span> Dolens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>DVT of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> causes painful <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> of the leg with lymphangitis, which further increases <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (white leg).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phlegmasia Caerulea Dolens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extensive <span class=\"customMeta\" data-dictid=\"7b6c3bb2611692777186e94c623ac9\">DVT</span> in <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> and <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> veins leading to a blue leg with possible <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> or infarction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After a surgical procedure, the patient demonstrates a particular clinical sign. Which specific nerve is likely to be damaged in this case?", "options": [{"label": "A", "text": "Radial nerve", "correct": false}, {"label": "B", "text": "Median nerve", "correct": true}, {"label": "C", "text": "Ulnar nerve", "correct": false}, {"label": "D", "text": "Radial artery", "correct": false}], "correct_answer": "B. Median nerve", "question_images": ["https://image.prepladder.com/content/x2EjaLeRCn8tJ7K6EYPr1747908176.png"], "explanation_images": ["https://image.prepladder.com/content/39un6TuO7j8k5ggpdr9g1747908181.png", "https://image.prepladder.com/content/tvU6PSTZDk4H38NiSJBO1746078684.png", "https://image.prepladder.com/content/wo3AeDPj4k9iz63MFsne1746078684.png", "https://image.prepladder.com/content/PuG6wfgmQVhNU4Qry6M11746078684.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Muscle tested and action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pen test:</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"211\" src=\"https://image.prepladder.com/content/tvU6PSTZDk4H38NiSJBO1746078684.png\" width=\"198\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> Abductor pollicis brevis</li>\n<li><strong>Action:</strong> Abduction of thumb</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oschner <span class=\"customMeta\" data-dictid=\"7d9fedb3a5169277718426c475e8e8\">clasp</span> test:</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"220\" src=\"https://image.prepladder.com/content/wo3AeDPj4k9iz63MFsne1746078684.png\" width=\"172\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> digitorum <span class=\"customMeta\" data-dictid=\"d3c34e683916927771998a3426c3a6\">superficialis</span> &amp; <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum profundus</li>\n<li><strong>Action:</strong> Flexion of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2 digits</li>\n<li><strong>Pointing index</strong> sign seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thumb opposition:</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"233\" src=\"https://image.prepladder.com/content/PuG6wfgmQVhNU4Qry6M11746078684.png\" width=\"162\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> Opponens pollcis</li>\n<li><strong>Action: </strong>Opposition of thumb</li>\n<li><strong>O-sign</strong> is seen in normal patients</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How is empyema thoracis treated?", "options": [{"label": "A", "text": "Antibiotics alone", "correct": false}, {"label": "B", "text": "Chest tube drainage and antibiotics", "correct": true}, {"label": "C", "text": "ICD alone", "correct": false}, {"label": "D", "text": "Wait and watch", "correct": false}], "correct_answer": "B. Chest tube drainage and antibiotics", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Diagnosis of Gout is confirmed by which test?", "options": [{"label": "A", "text": "Serum uric acid level", "correct": false}, {"label": "B", "text": "Synovial fluid analysis", "correct": true}, {"label": "C", "text": "Urine uric acid levels", "correct": false}, {"label": "D", "text": "X-ray changes", "correct": false}], "correct_answer": "B. Synovial fluid analysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which enzyme is likely to be deficient in a 4-year-old child who presents with a habit of biting their lips and fingers, and has a missing portion of fingers on their left hand? Further evaluation shows delayed developmental milestones. The parents report that two male cousins on the mother's side have similar symptoms and have been diagnosed with a genetic disorder. Laboratory reports indicate hyperuricemia.", "options": [{"label": "A", "text": "Purine nucleoside phosphorylase", "correct": false}, {"label": "B", "text": "Hypoxanthine -guanine phosphoribosyl transferase.", "correct": true}, {"label": "C", "text": "Adenine phosphoribosyl transferase", "correct": false}, {"label": "D", "text": "Adenosine deaminase", "correct": false}], "correct_answer": "B. Hypoxanthine -guanine phosphoribosyl transferase.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/B91bsIcb1BI4AOCpCt7i1747901224.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the underlying cause of the presenting symptoms in a 21-year-old individual with chronic alcoholism who is admitted to the emergency department with confusion, tremors, ataxia, and ophthalmoplegia?", "options": [{"label": "A", "text": "Vitamin B12", "correct": false}, {"label": "B", "text": "Vitamin B9", "correct": false}, {"label": "C", "text": "Vitamin B1", "correct": true}, {"label": "D", "text": "Vitamin B3", "correct": false}], "correct_answer": "C. Vitamin B1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>WERNICKE-KORSAKOFF SYNDROME (CEREBRAL BERI-BERI)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wernicke Encephalopathy:</strong></p>\n<p>Symptoms: Ophthalmoplegia, nystagmus, cerebellar ataxia, global confusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Korsakoff Psychosis:</strong></p>\n<p>Symptoms: <span class=\"customMeta\" data-dictid=\"6f04a43a8c16927771816dd61a4f17\">Anterograde</span> and <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> amnesia, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> agnosia, and confabulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes of <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">Thiamine</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> in Alcoholics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> requirements due to alcohol consumption. Alcohol is a source of empty calories.</li>\n<li>Inhibition of intestinal <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> by alcohol.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Implications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Impaired conversion of <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> to acetyl-CoA.</li>\n<li>Accumulation of <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> and <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> in the blood.</li>\n<li>Potential for life-threatening <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progression and Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Progression from Wernicke <span class=\"customMeta\" data-dictid=\"b37b211cbc169277718725f07b5473\">encephalopathy</span> to <span class=\"customMeta\" data-dictid=\"a01c754c6916927771907990bfb979\">Korsakoff psychosis</span> if untreated.</li>\n<li>Associated with severely compromised nutritional status, often due to chronic alcoholism.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symmetrical T2/FLAIR signal increase in the <span class=\"customMeta\" data-dictid=\"06d33302e016927771911f7ef71255\">mammillary</span> bodies, dorsomedial thalami, tectal plate, <span class=\"customMeta\" data-dictid=\"c51baf41771692777195b4b3432d4b\">periaqueductal</span> area, and around the third ventricle.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which antioxidant deficiency can cause the symptoms of iron-deficiency anemia, painful and tender joints, and bleeding manifestations in a 34-year-old woman who primarily consumes packaged and reheated meals?", "options": [{"label": "A", "text": "Glutathione", "correct": false}, {"label": "B", "text": "ß-carotene", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": true}, {"label": "D", "text": "Zinc", "correct": false}], "correct_answer": "C. Vitamin C", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "To evaluate a deficiency of vitamin B2 (riboflavin), one can assess the activity of:", "options": [{"label": "A", "text": "Transketolase", "correct": false}, {"label": "B", "text": "Pyruvate dehydrogenase", "correct": false}, {"label": "C", "text": "Glutathione reductase", "correct": true}, {"label": "D", "text": "Isocitrate dehydrogenase", "correct": false}], "correct_answer": "C. Glutathione reductase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A known alcoholic patient is brought to the emergency in a disoriented state. He complains of seeing snakes and insects crawling on his skin. Which of the following should be given to this patient?", "options": [{"label": "A", "text": "Haloperidol + thiamine", "correct": false}, {"label": "B", "text": "Lorazepam only", "correct": false}, {"label": "C", "text": "Lorazepam + thiamine", "correct": true}, {"label": "D", "text": "Haloperidol only", "correct": false}], "correct_answer": "C. Lorazepam + thiamine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"4398b2978c16927771915937fed503\"&gt;Lorazepam&lt;/span&gt; + th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following symptoms is least likely to be associated with a panic attack?", "options": [{"label": "A", "text": "Palpitations", "correct": false}, {"label": "B", "text": "Fear of dying", "correct": false}, {"label": "C", "text": "Chest discomfort", "correct": false}, {"label": "D", "text": "Suicide attempt", "correct": true}], "correct_answer": "D. Suicide attempt", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Suicide attempt:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Panic attacks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Unexpected, i.e., not restricted to any particular situation.</li>\n<li>Usually last for 20 to 30 minutes, rarely, they may last more than one hour.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiopulmonary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Feeling short of breath</li>\n<li>Palpitations <strong>(Option A ruled out) </strong></li>\n<li>Chest discomfort <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastrointestinal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea</li>\n<li>GI discomfort</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin and systemic</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sweating</li>\n<li>Chills</li>\n<li>Feeling flushed</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurologic</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tremors</li>\n<li>Dizziness</li>\n<li>Numbness and <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> sensation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psychiatric</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Derealisation</li>\n<li>Depersonalisation</li>\n<li>Fear of losing control</li>\n<li>Fear of dying <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the initial indication of alcohol withdrawal?", "options": [{"label": "A", "text": "Tremors", "correct": true}, {"label": "B", "text": "Delirium tremens", "correct": false}, {"label": "C", "text": "Seizures", "correct": false}, {"label": "D", "text": "Hallucinations", "correct": false}], "correct_answer": "A. Tremors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Tremors</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features of Alcohol Withdrawal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Onset after last drink</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mild withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild anxiety</li>\n<li>Tremulousness</li>\n<li>Nausea</li>\n<li>Headache</li>\n<li>Palpitations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6-8 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderate (Alcoholic hallucinosis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visual, auditory, or <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> hallucinations</li>\n<li>Intact orientation</li>\n<li>Normal vital signs</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8- 12 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe (Withdrawal seizures)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> seizures</li>\n<li>Usually brief and self-limited</li>\n<li>Also known as <strong>rum fits</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>12-24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Life-threatening (Delirium tremens)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe agitation</li>\n<li>Confusion and disorientation</li>\n<li>Hallucinations (often visual)</li>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"2e780c7fd416927771895c61217c12\">hyperactivity</span> (tachycardia, hypertension, fever)</li>\n<li>Profound sweating</li>\n<li>Tremors</li>\n<li>Insomnia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within 72 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What deficiency is responsible for cognitive impairment in the elderly?", "options": [{"label": "A", "text": "Vitamin C", "correct": false}, {"label": "B", "text": "Vitamin B12", "correct": true}, {"label": "C", "text": "Vitamin B6", "correct": false}, {"label": "D", "text": "Vitamin B1", "correct": false}], "correct_answer": "B. Vitamin B12", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Vitamin B12\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended treatment for a recently diagnosed female patient with mild depression?", "options": [{"label": "A", "text": "Cognitive behavioural therapy", "correct": true}, {"label": "B", "text": "Cognitive behavioural therapy and antidepressants", "correct": false}, {"label": "C", "text": "Mild antidepressants", "correct": false}, {"label": "D", "text": "Vagus nerve stimulation", "correct": false}], "correct_answer": "A. Cognitive behavioural therapy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Cognitive behavioural therapy</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Combination Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pharmacotherapy + Psychotherapy</li>\n<li>Combines medications (e.g., antidepressants) with <span class=\"customMeta\" data-dictid=\"f3f884992516927771965b324c2faf\">psychotherapy</span> for a higher response rate.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate to severe depression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Single Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Psychotherapy alone may be sufficient for mild cases.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild depression</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Psychotherapy Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Somatic Treatments</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cognitive Behavioral Therapy (CBT)</li>\n<li>Interpersonal Therapy (IPT)</li>\n<li>Family Therapy</li>\n<li>Psychoanalytically Oriented Therapy</li>\n<li>Behavior Therapy</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Electroconvulsive Therapy (ECT)</li>\n<li>Transcranial Magnetic <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">Stimulation</span> (TMS)</li>\n<li>Vagal Nerve <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">Stimulation</span> (VNS)</li>\n<li>Deep Brain <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">Stimulation</span> (DBS)</li>\n<li>Phototherapy</li>\n<li>Sleep Deprivation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All the following are features of polycystic disease of kidneys except:", "options": [{"label": "A", "text": "Hematuria", "correct": false}, {"label": "B", "text": "Hypertension", "correct": false}, {"label": "C", "text": "Renal failure", "correct": false}, {"label": "D", "text": "Erythrocytosis", "correct": true}], "correct_answer": "D. Erythrocytosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PgjovjIDIRXXI0cP7yj71746081832.png", "https://image.prepladder.com/content/xvqFm2KfO8bpdIS4YvHM1746081832.png", "https://image.prepladder.com/content/0FUr6KcfY80aK2y9QeJ91746081832.png", "https://image.prepladder.com/notes/vrGrdC8Qgre17m3jap8F1747728835.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hematuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of cysts into the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> collecting system</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Result of <strong>renin-angiotensin system (RAS) activation</strong> due to <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> from <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> compression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Progressive <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> expansion leads to <span class=\"customMeta\" data-dictid=\"32562f5afa1692777193c891837db9\">nephron</span> loss, causing <strong>chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease (CKD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erythrocytosis (Absent)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CKD leads to <strong>decreased <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">erythropoietin</span> (EPO)</strong>, resulting in <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> rather than polycythemia</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>ADPKD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>ARPKD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Affected age group</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Children</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cysts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Are present in both outer and inner surfaces</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present only on the inner surface.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involved gene</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>PKD 1 on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 16</li>\n<li>PKD 2 on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 4</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PKHD on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 6</p>\n<p>(Statement 2)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protein affected</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>polycystin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fibrocystin (Statement 3)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Histology</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Polycystic_kidney_disease_--_2_-_high_mag.jpg\" data-tags=\"\" height=\"214\" src=\"https://image.prepladder.com/content/PgjovjIDIRXXI0cP7yj71746081832.png\" width=\"320\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Patrick Walker, MD.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://aspneph.org/autosomal-recessive-polycystic-kidney-disease-arpkd/\" data-tags=\"\" height=\"208\" src=\"https://image.prepladder.com/content/xvqFm2KfO8bpdIS4YvHM1746081832.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Coronary or <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> heart disease (40%). <strong>(Statement 4)</strong></li>\n<li>Infection (25%).</li>\n<li>Ruptured <span class=\"customMeta\" data-dictid=\"92ff33318a16927771828d959514b8\">berry</span> <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> or <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> <span class=\"customMeta\" data-dictid=\"c7f167b8df1692777190bcd90fe428\">intracerebral</span> haemorrhage (15%).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neonatal period:\n\t\t\t\t<ul>\n<li>Respiratory failure due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypoplasia.</li>\n<li>Renal failure.</li>\n</ul>\n</li>\n<li>Childhood and adolescence:\n\t\t\t\t<ul>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure leading to ESRD.</li>\n<li>Complications of CKD.</li>\n<li>Complications from <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> fibrosis.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Images</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC/ Dr. Edwin P. Ewing, Jr.\" data-hash=\"\" data-license=\"Public domain\" data-source=\"https://commons.wikimedia.org/wiki/File:Polycystic_kidneys,_gross_pathology_CDC_PHIL.png\" data-tags=\"\" height=\"271\" src=\"https://image.prepladder.com/content/0FUr6KcfY80aK2y9QeJ91746081832.png\" width=\"319\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"ADPKD gross\" data-author=\"NA\" data-hash=\"13066\" data-license=\"NA\" data-source=\"NA\" data-tags=\"May2025\" height=\"248\" src=\"https://image.prepladder.com/notes/vrGrdC8Qgre17m3jap8F1747728835.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are true about Crohn’s disease except", "options": [{"label": "A", "text": "Rectum is involved", "correct": true}, {"label": "B", "text": "Serpiginous ulcers are formed", "correct": false}, {"label": "C", "text": "Transmural involvement", "correct": false}, {"label": "D", "text": "Recurrence is more common", "correct": false}], "correct_answer": "A. Rectum is involved", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KwiGOR3Rc2e1QMrfFoWl1746081925.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmural involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inflammation extends through the entire <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serpiginous ulcers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep, <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> ulcers give a <strong>cobblestone appearance</strong> to the mucosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skip lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Areas of <strong>normal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> interspersed</strong> with diseased segments</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Recurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More common than <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> colitis, even after surgery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rectal sparing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unlike <strong>ulcerative colitis</strong>, Crohn’s disease rarely affects the rectum</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the tarsal bone labeled in the image below.", "options": [{"label": "A", "text": "Calcaneus", "correct": false}, {"label": "B", "text": "Cuboid", "correct": false}, {"label": "C", "text": "Navicular", "correct": true}, {"label": "D", "text": "Talus", "correct": false}], "correct_answer": "C. Navicular", "question_images": ["https://image.prepladder.com/content/Hk9nHxwpHZs6d19pVoFi1747900519.png"], "explanation_images": ["https://image.prepladder.com/content/AS3Yl31bPJQbk6Op8QGk1746081827.png", "https://image.prepladder.com/content/CWS18YWbc0J2dHOYSqv91747900536.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Bone Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Bones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Description &amp; Function</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"19\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Tarsals</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Provide mechanical support and structure to the foot.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Proximal Group</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Talus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Transmits body weight to the foot.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Articulates at three joints:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Superiorly: <span class=\"customMeta\" data-dictid=\"27b1d5d7f916927771821f94581a42\">Ankle joint</span> (tibia/fibula)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Inferiorly: Subtalar joint (calcaneus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Anteriorly: Talonavicular joint (navicular)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Calcaneus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Largest <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> bone, forms the heel.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Articulates at two joints:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Superiorly: Subtalar joint (talus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Anteriorly: Calcaneocuboid joint (cuboid)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Intermediate Group</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Navicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Boat-shaped; articulates with talus, cuneiforms, and cuboid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Has a <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> for <span class=\"customMeta\" data-dictid=\"7d3a7e876e1692777200a1e15f025f\">tibialis</span> <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> attachment.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Distal Group</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Cuboid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lateral; articulates with <span class=\"customMeta\" data-dictid=\"c8b77c76861692777183e8bcbc3c5a\">calcaneus</span> and fourth/fifth metatarsals.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Features a <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> for <span class=\"customMeta\" data-dictid=\"c3aedca1e41692777202041463429b\">fibularis</span> <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> tendon.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Cuneiforms (3)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Medial, intermediate, lateral; wedge-shaped.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Help <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> arch; attach to various muscles.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Metatarsals</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>I-V (1-5)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Connect tarsals to phalanges; numbered <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to lateral.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Have a head, neck, shaft, and base; facilitate movement and support.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Phalanges</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Great Toe: 2 (proximal, distal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Toes 2-5: 3 each (proximal, intermediate, distal).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Each <span class=\"customMeta\" data-dictid=\"e9451cd23d1692777195fe471f486e\">phalanx</span> has a base, shaft, and head; provide structure to toes.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which patient has better prognosis in breast cancer?", "options": [{"label": "A", "text": "Her2+", "correct": true}, {"label": "B", "text": "Triple negative", "correct": false}, {"label": "C", "text": "Luminal B", "correct": false}, {"label": "D", "text": "Luminal A", "correct": false}], "correct_answer": "A. Her2+", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Receptor Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment Response</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminal A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ER+, PR+, HER2-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Best prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good response to <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> therapy (Tamoxifen, <span class=\"customMeta\" data-dictid=\"b249ba1c6a16927771821b83b1fd9b\">Aromatase</span> inhibitors)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminal B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ER+, PR±, HER2±</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intermediate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Responds to <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> therapy but has higher <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> than <span class=\"customMeta\" data-dictid=\"fbb10919e516927771917a9afcb633\">Luminal</span> A</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HER2+ (non-luminal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ER-, PR-, HER2+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poorer prognosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires <strong>Trastuzumab (Herceptin)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Triple-negative (Basal-like)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ER-, PR-, HER2-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Worst prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chemotherapy is the only option; high recurrence</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presenting with an unsteady gait, forgetfulness, labile moods, and Kayser-Fleischer rings was diagnosed with Wilson’s disease. Which of the following options correctly indicates the gene mutated in this condition and its location?", "options": [{"label": "A", "text": "ATP7B gene on chromosome 13", "correct": true}, {"label": "B", "text": "ATP7A gene on chromosome 13", "correct": false}, {"label": "C", "text": "ATP7B gene on chromosome 17", "correct": false}, {"label": "D", "text": "ATP7A gene on chromosome 17", "correct": false}], "correct_answer": "A. ATP7B gene on chromosome 13", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wlNxVmFnTZ6M1ajwpuRi1746082444.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The prevention of lateral dislocation of the patella during knee flexion is by-", "options": [{"label": "A", "text": "Vastus medialis", "correct": true}, {"label": "B", "text": "Patellar ligament", "correct": false}, {"label": "C", "text": "Gracilis", "correct": false}, {"label": "D", "text": "Rectus femoris", "correct": false}], "correct_answer": "A. Vastus medialis", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Role in Patellar Stability</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vastus <span class=\"customMeta\" data-dictid=\"36527a0c691692777192ead7040c14\">Medialis</span> (VMO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exerts a <strong>medial pull</strong> on the patella, preventing <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> displacement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Patellar Ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Connects the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> to the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> but does <strong>not prevent <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> dislocation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gracilis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> thigh muscle responsible for hip adduction, <strong>not involved in patellar stability</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rectus Femoris</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A major knee extensor, but <strong>does not prevent <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> displacement</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old girl was brought to the outpatient department by her mother saying she noted some abnormality in her genital area. On examination, there was the presence of pubic and axillary hair. Which of the following is the least likely diagnosis?", "options": [{"label": "A", "text": "17-hydroxylase deficiency", "correct": false}, {"label": "B", "text": "21-hydroxylase deficiency", "correct": true}, {"label": "C", "text": "11 B-hydroxylase deficiency", "correct": false}, {"label": "D", "text": "3 beta hydroxy steroid dehydrogenase deficiency", "correct": false}], "correct_answer": "B. 21-hydroxylase deficiency", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ambiguous <span class=\"customMeta\" data-dictid=\"a6a00bd30e169277718892b3a6076c\">genitalia</span> in female</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Under <span class=\"customMeta\" data-dictid=\"6f0308f1301692777202568e634059\">virilization</span> in Males</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>With <span class=\"customMeta\" data-dictid=\"a32272481a1692777198059baa2fd8\">salt wasting</span> &amp;</strong></p>\n<p><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>21 <span class=\"customMeta\" data-dictid=\"0b592280091692777189e27f90a885\">hydroxylase</span> deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> <span class=\"customMeta\" data-dictid=\"147defe59f16927771894a7addb83d\">hydroxy</span> <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>With Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>11 <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">Beta</span> <span class=\"customMeta\" data-dictid=\"0b592280091692777189e27f90a885\">hydroxylase</span> deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>17- <span class=\"customMeta\" data-dictid=\"0b592280091692777189e27f90a885\">hydroxylase</span> deficiency</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child, upon disturbing a bee hive, had several stings. After a few minutes, the child developed symptoms of shock, respiratory failure, and vascular collapse. Which of the following is the principal mediator of this reaction?", "options": [{"label": "A", "text": "Adrenaline", "correct": false}, {"label": "B", "text": "Histamine", "correct": true}, {"label": "C", "text": "Dopamine", "correct": false}, {"label": "D", "text": "Substance P", "correct": false}], "correct_answer": "B. Histamine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xL8gq0DZ0t3q0hqdkIGq1746082644.png"], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Early phase reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Late phase reaction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate (within minutes of <span class=\"customMeta\" data-dictid=\"7396dd35a41692777181bd7038fa9b\">allergen</span> exposure).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delayed (several hours after exposure) and can last for days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cells involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mast cells, basophils.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eosinophils, T lymphocytes.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cellular events</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Activation of <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells and basophils.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recruitment and <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of leukocytes, especially eosinophils.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mediators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histamine</strong>, leukotrienes (LTB4, LTC4, LTD4), prostaglandins (PGD2) and Platelet-activating factor (PAF).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytokines (e.g., IL-4, IL-5, TNF), chemokines (e.g., eotaxin).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initiating event</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exposure to <span class=\"customMeta\" data-dictid=\"7396dd35a41692777181bd7038fa9b\">allergen</span> triggers <span class=\"customMeta\" data-dictid=\"2cf4952c63169277718543a0883583\">cross-linking</span> of IgE on <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells/basophils.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recurrent inflammation, sustained by recruited leukocytes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effect on tissues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vasodilation, increased <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> permeability, smooth muscle contraction.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sustained <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and tissue damage due to <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> infiltration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allergic <span class=\"customMeta\" data-dictid=\"a8dad7cd171692777197e6d4ac2a1c\">rhinitis</span> (hay fever), <span class=\"customMeta\" data-dictid=\"7e814d15c31692777201fe0d9c1a61\">urticaria</span> (hives), Angioedema bronchoconstriction.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allergic <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> exacerbation, persistent inflammation, and tissue damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Therapeutic Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antihistamines for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> relief.</p>\n<p>Adrenaline in anaphylactic shock.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Broad-spectrum anti-inflammatory drugs (e.g., steroids) to suppress <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and prevent tissue damage.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A COVID patient required oxygen therapy. Which of the following cylinders should be used to provide oxygen for this patient? [", "options": [{"label": "A", "text": "1", "correct": true}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "A. 1", "question_images": ["https://image.prepladder.com/content/5Ce9YYejfR7LnXLJsLuz1747900119.png"], "explanation_images": ["https://image.prepladder.com/content/xYLTdWkrbzA5HRe6M9r71747900259.png", "https://image.prepladder.com/content/ioi2v49hVrG2FbbESR1S1746082798.png", "https://image.prepladder.com/content/KGAyNEd8dh5JEMddBnV21746082798.png", "https://image.prepladder.com/content/E0Kkx0CzXaSDm1dkgAiU1746082798.png", "https://image.prepladder.com/content/WK1qV82BGCMLwEQzkleS1746082798.png", "https://image.prepladder.com/content/KCJOAdNNQanqdqJ94SZe1746082798.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:660px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cylinder color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>PIN Index system</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Air</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Black body with black &amp; white shoulder</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"124\" src=\"https://image.prepladder.com/content/xYLTdWkrbzA5HRe6M9r71747900259.png\" width=\"53\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1,5</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oxygen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Black body with white shoulder</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"124\" src=\"https://image.prepladder.com/content/ioi2v49hVrG2FbbESR1S1746082798.png\" width=\"124\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2,5</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2O</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blue</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"124\" src=\"https://image.prepladder.com/content/KGAyNEd8dh5JEMddBnV21746082798.png\" width=\"124\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3,5</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carbon dioxide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grey</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"124\" src=\"https://image.prepladder.com/content/E0Kkx0CzXaSDm1dkgAiU1746082798.png\" width=\"124\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1,6 (&gt; 7.5%) ; 2,6 (&lt; 7.5%)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Entonox</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blue body with white shoulders</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"124\" src=\"https://image.prepladder.com/content/WK1qV82BGCMLwEQzkleS1746082798.png\" width=\"124\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>7</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cyclopropane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Orange</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"124\" src=\"https://image.prepladder.com/content/KCJOAdNNQanqdqJ94SZe1746082798.png\" width=\"124\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3,6</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the arrow-marked chamber.", "options": [{"label": "A", "text": "Right atrium", "correct": false}, {"label": "B", "text": "Left atrium", "correct": true}, {"label": "C", "text": "Right ventricle", "correct": false}, {"label": "D", "text": "Left ventricle", "correct": false}], "correct_answer": "B. Left atrium", "question_images": ["https://image.prepladder.com/content/WmW3YXL08NZPIaFuIExn1748163949.png"], "explanation_images": ["https://image.prepladder.com/content/rEalzlnbWs4zRyj9ZMGs1747900619.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Right Atrium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Right Ventricle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Left Atrium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Left Ventricle</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right, anterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right, inferior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left, posterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left, inferior</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Receives deoxygenated blood from <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> cava</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pumps deoxygenated blood to the lungs via <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Receives oxygenated blood from <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> veins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pumps oxygenated blood to the body via aorta</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wall Thickness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thickest</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Valves Associated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tricuspid Valve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary Valve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mitral Valve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aortic Valve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Structures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crista terminalis, <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> ovalis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trabeculae carneae, moderator band</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary veins opening, <span class=\"customMeta\" data-dictid=\"365b082ebb1692777190be7beb5c86\">interatrial</span> septum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Papillary muscles, <span class=\"customMeta\" data-dictid=\"fe7835b0b81692777184173c09d7a5\">chordae</span> tendineae</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the class of immunoglobulin shown in the image below.", "options": [{"label": "A", "text": "IgA", "correct": true}, {"label": "B", "text": "IgG", "correct": false}, {"label": "C", "text": "IgM", "correct": false}, {"label": "D", "text": "IgE", "correct": false}], "correct_answer": "A. IgA", "question_images": ["https://image.prepladder.com/content/4ONZUZ4gfdg1ZvwsxctG1747904311.png"], "explanation_images": ["https://image.prepladder.com/content/JwWsJhQYFM8RIAr9ciks1746083304.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 18-year-old boy is rushed to the ER after having choked on a bone while eating. He is responsive but unable to speak. What is to be done next?", "options": [{"label": "A", "text": "Bag and mask ventilation", "correct": false}, {"label": "B", "text": "Endoscopic removal", "correct": false}, {"label": "C", "text": "Deliver 5 back slaps and 5 chest compressions", "correct": false}, {"label": "D", "text": "Perform Heimlich maneuver", "correct": true}], "correct_answer": "D. Perform Heimlich maneuver", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fKSmGIbCtya2iQcuxpJr1746083395.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The dermatome of the area marked in the given below image is-", "options": [{"label": "A", "text": "L4", "correct": true}, {"label": "B", "text": "L5", "correct": false}, {"label": "C", "text": "S1", "correct": false}, {"label": "D", "text": "S2", "correct": false}], "correct_answer": "A. L4", "question_images": ["https://image.prepladder.com/content/dW4YA03Mk9igH9n5RKqd1747900653.png"], "explanation_images": ["https://image.prepladder.com/content/adwun5KC8pEjJjkSiyVK1746083433.png", "https://image.prepladder.com/content/jHOMAnOXS8Vsnrqftdf01746083433.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:353px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Dermatome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Region Supplied</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inguinal region</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior thigh</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> thigh and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> knee</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial leg and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> malleolus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral leg, <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of foot, great toe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral foot, sole, little toe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior thigh and leg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S3-S5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perineum and anal region</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the vertical plane that separates the body into anterior and posterior sections?", "options": [{"label": "A", "text": "Coronal plane", "correct": true}, {"label": "B", "text": "Transverse plane", "correct": false}, {"label": "C", "text": "Axial plane", "correct": false}, {"label": "D", "text": "Median plane", "correct": false}], "correct_answer": "A. Coronal plane", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YuwPynQSE9rNoxcMKB7k1747900710.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Plane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Division</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Relevance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coronal (Frontal) Plane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vertical plane passing side to side</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior and Posterior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in chest X-rays and CT scans</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sagittal (Median) Plane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vertical plane passing front to back</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left and Right</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MRI brain imaging, midline structures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transverse (Axial) Plane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Horizontal plane</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superior and Inferior</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in CT and MRI scans</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oblique Plane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagonal plane</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in specialized imaging</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which malignancy is most commonly associated with asbestosis?", "options": [{"label": "A", "text": "Mesothelioma", "correct": true}, {"label": "B", "text": "Anthracosis", "correct": false}, {"label": "C", "text": "Hepatocellular carcinoma", "correct": false}, {"label": "D", "text": "Renal cell carcinoma", "correct": false}], "correct_answer": "A. Mesothelioma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ax2VjdEBw5wZgkZ4DnBJ1747908446.png", "https://image.prepladder.com/content/hpSdQo7FPfBbfPDOmwfC1746083705.png", "https://image.prepladder.com/content/uV3Yjm471NRqc08fGxWE1747908457.png", "https://image.prepladder.com/content/28gI2xt3OViMauU7IuME1747908464.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the virus given in the image below.", "options": [{"label": "A", "text": "HIV", "correct": true}, {"label": "B", "text": "EBV", "correct": false}, {"label": "C", "text": "CMV", "correct": false}, {"label": "D", "text": "Coronavirus", "correct": false}], "correct_answer": "A. HIV", "question_images": ["https://image.prepladder.com/content/ArLVTwqXzcUsdeEqC8Vq1746083417.png"], "explanation_images": ["https://image.prepladder.com/content/x6fpYdEFHNDeYieM3Sei1746083672.png", "https://image.prepladder.com/content/AULtIXhETFs6r69R9P7F1746083707.png", "https://image.prepladder.com/content/mUsbLFBGTM4pU7tdhuu61746083724.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A disorder is characterized by recurrent hair-pulling resulting in noticeable hair loss. Which of the following statements about this disorder is not accurate? [", "options": [{"label": "A", "text": "Impulse control disorder", "correct": false}, {"label": "B", "text": "The onset is typically in adolescence or early adulthood", "correct": false}, {"label": "C", "text": "Associated with feelings of pleasure or relief after hair-pulling", "correct": false}, {"label": "D", "text": "Caused by a bacterial infection of the scalp", "correct": true}], "correct_answer": "D. Caused by a bacterial infection of the scalp", "question_images": ["https://image.prepladder.com/content/4kRCwK23wlJvrVlrwEVV1747901359.png"], "explanation_images": ["https://image.prepladder.com/content/BFnfxvsm1jfMTESRiy8R1747901386.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a patient who presents with a swelling in the midline of the neck, based on the biopsy findings, which reveal orphan Annie's eye nuclei as depicted in the image provided?", "options": [{"label": "A", "text": "Follicular carcinoma", "correct": false}, {"label": "B", "text": "Papillary carcinoma", "correct": true}, {"label": "C", "text": "Toxic nodular goiter", "correct": false}, {"label": "D", "text": "Medullary carcinoma", "correct": false}], "correct_answer": "B. Papillary carcinoma", "question_images": ["https://image.prepladder.com/content/xZfbNS3NUCe6Av5EI3VM1746083891.png"], "explanation_images": ["https://image.prepladder.com/content/tmySiIXWGIvGH7epfFAz1746083925.png", "https://image.prepladder.com/content/eu7mbfKr5V5Xltn4ImLz1747908550.png", "https://image.prepladder.com/content/A02sEs0AqYyOLQcUQHnO1746083925.png", "https://image.prepladder.com/content/LTVz2nzcHNtYvrDMd1x31747922252.png", "https://image.prepladder.com/content/Y7wz3urTYRV7HQqLlKCo1746083925.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old college student presents with small, depigmented lesions which have been there for over 2 years now as shown in the image below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Melasma", "correct": false}, {"label": "B", "text": "Vitiligo", "correct": true}, {"label": "C", "text": "Psoriasis", "correct": false}, {"label": "D", "text": "Dermatitis herpetiformis", "correct": false}], "correct_answer": "B. Vitiligo", "question_images": ["https://image.prepladder.com/content/zdk5xPvqOC06KWS1Z1CC1747901431.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the first primary tooth to erupt?", "options": [{"label": "A", "text": "Upper central incisor", "correct": false}, {"label": "B", "text": "Lower central incisor", "correct": true}, {"label": "C", "text": "Upper canine", "correct": false}, {"label": "D", "text": "Lower canine", "correct": false}], "correct_answer": "B. Lower central incisor", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary <span class=\"customMeta\" data-dictid=\"76e17c45ef16927771851bc19cfc04\">Dentition</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Time of <span class=\"customMeta\" data-dictid=\"e8c6da34eb169277718752e1060128\">eruption</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lower <span class=\"customMeta\" data-dictid=\"c4e7f8b0af169277718441693484da\">central incisor</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>6 months</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Upper <span class=\"customMeta\" data-dictid=\"c4e7f8b0af169277718441693484da\">central incisor</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">7 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Upper <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> incisor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">8 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Lower <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> incisor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">9 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1st Molar</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1 year</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Canine (Option C &amp; D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1.5 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2nd Molar</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2 years</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which artery is being palpated in the image shown below?", "options": [{"label": "A", "text": "Anterior tibial artery", "correct": false}, {"label": "B", "text": "Posterior tibial artery", "correct": true}, {"label": "C", "text": "Dorsalis pedis artery", "correct": false}, {"label": "D", "text": "Popliteal artery", "correct": false}], "correct_answer": "B. Posterior tibial artery", "question_images": ["https://image.prepladder.com/content/4LQbg50HEZ2VJw811BrE1747900747.png"], "explanation_images": ["https://image.prepladder.com/content/neL6xOMOe67e0XZQ1u1r1746083790.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Palpation Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Importance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">Tibial</span> Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Popliteal artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Runs <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> malleolus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Behind <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> malleolus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Evaluated in PAD (absent in <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> diseases)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">Tibial</span> Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Popliteal artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Passes through <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">interosseous</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> to <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> leg</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Difficult to <span class=\"customMeta\" data-dictid=\"5aabcb1ee8169277719447f2dd6c2c\">palpate</span> directly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supplies <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> of the leg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dorsalis Pedis Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Continuation of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Runs along <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of foot</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral to <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> hallucis <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> tendon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Commonly used in <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> assessments</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Popliteal Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Continuation of <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Located in popliteal fossa</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep in the popliteal fossa</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can be affected in popliteal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"025e317c8116927771870f34a94b56\">entrapment</span> syndrome</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman has been experiencing left knee pain for one month. The knee is tender to touch, and an X-ray reveals a 5cm mass in the distal femoral epiphysis with a \"soap bubble\" appearance. Microscopy findings are provided below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Chondroblastoma", "correct": false}, {"label": "B", "text": "Osteoclastoma", "correct": true}, {"label": "C", "text": "Osteosarcoma", "correct": false}, {"label": "D", "text": "Osteochondroma", "correct": false}], "correct_answer": "B. Osteoclastoma", "question_images": ["https://image.prepladder.com/content/T83Lh8ZWvSsf9ibJG0JF1746084170.png"], "explanation_images": ["https://image.prepladder.com/content/8Gb9FLRg7ZdHlEhYxoh81747908659.png", "https://image.prepladder.com/content/C1EdIbxYKwTT70D1htth1747922328.png", "https://image.prepladder.com/content/GIX4cwo81BKr3GFjnTYm1746084273.png", "https://image.prepladder.com/content/lM41pZgm2HLtEjx72Dmc1747908669.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman delivered a healthy baby and to control her postpartum hemorrhage an artery was ligated. Then later she developed pain under her gluteus muscle. Which was the artery ligated ?", "options": [{"label": "A", "text": "Uterine artery", "correct": false}, {"label": "B", "text": "Superior gluteal artery", "correct": false}, {"label": "C", "text": "Inferior gluteal artery", "correct": false}, {"label": "D", "text": "Internal iliac artery", "correct": true}], "correct_answer": "D. Internal iliac artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/89jJXW2kVwoOo6C9iYHO1747922039.png", "https://image.prepladder.com/content/TY6i1nPhCc9A83mmvmPM1747922057.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Major Branches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Internal <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">Iliac</span> Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> divisions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pelvic organs, <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> region, perineum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ligation used in PPH management</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uterine Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior division of internal iliac</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anastomoses with ovarian artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uterus, cervix, vagina</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Commonly ligated in hysterectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">Gluteal</span> Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior division of internal iliac</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Branches to <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> muscles</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gluteus medius, minimus, and <span class=\"customMeta\" data-dictid=\"72dbd9ec8716927772005127a031ac\">tensor</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> lata</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Injury can cause Trendelenburg gait</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inferior <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">Gluteal</span> Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior division of internal iliac</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supplies deeper <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gluteus maximus, <span class=\"customMeta\" data-dictid=\"1cb6159469169277719843ab627a07\">sciatic</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Injury affects hip extension</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the presence of painless sores on the vulval area indicate?", "options": [{"label": "A", "text": "Genital herpes", "correct": false}, {"label": "B", "text": "Condylomata acuminata", "correct": true}, {"label": "C", "text": "Gonococcal vulvovaginitis", "correct": false}, {"label": "D", "text": "Condyloma lata", "correct": false}], "correct_answer": "B. Condylomata acuminata", "question_images": ["https://image.prepladder.com/content/lVZs4Mk24PaYcf0QIpL91747901472.png"], "explanation_images": ["https://image.prepladder.com/content/j4lXcbzboYfYn59HfZAb1747901503.png", "https://image.prepladder.com/content/MDMp7SdAUWIu5EKGvHIH1747901497.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:562px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Oncogenic potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HPV types</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plantar warts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common skin warts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2, 4, 27, 57</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epidermodysplasia verrucosa</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mostly benign, rarely progresses to malignancy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5, 8, 9, 12, 17</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anogenital warts</p>\n<p>Laryngeal papilloma</p>\n<p>Intraepithelial neoplasia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 11</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Palmar warts in butchers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carcinomas of the <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> &amp; other <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> mucosa/larynx/oesophagus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16, 18, 31, 33, 45, 51, 52, 56, 58, 59, 68</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a 5-year-old boy who has weight loss, fever, and a painless swelling in his jaw area, with anaemia and lymphocytosis revealed by a CBC and biopsy findings shown in the accompanying image?\\", "options": [{"label": "A", "text": "Hodgkin’s disease", "correct": false}, {"label": "B", "text": "Acute lymphocytic leukemia", "correct": false}, {"label": "C", "text": "Chloroma", "correct": false}, {"label": "D", "text": "Burkitt’s lymphoma", "correct": true}], "correct_answer": "D. Burkitt’s lymphoma", "question_images": ["https://image.prepladder.com/content/HwuY4Tk5oUvl5jsAQu4a1746084393.png"], "explanation_images": ["https://image.prepladder.com/content/cPoBkFWnmU6FmHQ2WAyX1747908715.png", "https://image.prepladder.com/content/FlxFSeUgBVh986towXoU1746084421.png", "https://image.prepladder.com/content/f1MQGKhB3YaMjUbmLxQA1746084421.png", "https://image.prepladder.com/content/zS8qyVojC7LHmxhYD82w1746084421.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following cartilage do not calcify with age?", "options": [{"label": "A", "text": "Thyroid", "correct": false}, {"label": "B", "text": "Arytenoid", "correct": false}, {"label": "C", "text": "Epiglottis", "correct": true}, {"label": "D", "text": "Cricoid", "correct": false}], "correct_answer": "C. Epiglottis", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Calcification with Age</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thyroid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyaline</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protects vocal cords, supports larynx</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes, calcifies and ossifies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cricoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyaline</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides structural support to the airway</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes, calcifies and ossifies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arytenoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyaline (except vocal process, which has <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> cartilage)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Controls vocal cord movement</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes, except vocal process</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epiglottis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Elastic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prevents food from entering airway</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>No, remains flexible</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child who is exclusively fed rice water presents with a swollen abdomen and a pale, unenergetic expression, and shows signs of malnourishment with decreased serum protein and albumin levels. What is the probable diagnosis?", "options": [{"label": "A", "text": "Kwashiorkor", "correct": true}, {"label": "B", "text": "Marasmus", "correct": false}, {"label": "C", "text": "Indian childhood cirrhosis", "correct": false}, {"label": "D", "text": "Kawasaki disease", "correct": false}], "correct_answer": "A. Kwashiorkor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oPXP9UfQF6aG5i39qt1g1746084333.png", "https://image.prepladder.com/content/02a3FMA4U8wX18EkqdVK1746084336.png"], "explanation": "<p>Correct Answer A - Kwashiorkor</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3 style=\"text-align:center\"><strong>Kwashiorkor</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3 style=\"text-align:center\"><strong>Marasmus </strong><strong>(Option B)</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pitting Edema:</strong> Characterized by <strong>swelling</strong>, often starting in the legs and feet, leaving a persistent <span class=\"customMeta\" data-dictid=\"cdb5523e491692777190f8bc3775ff\">indentation</span> when pressed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe Wasting:</strong> The child appears extremely thin, with prominent bones and little body fat.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sugar Baby Appearance:</strong> The child may look deceptively healthy due to oedema, despite being malnourished.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monkey Facies:</strong> A sunken appearance of the cheeks due to loss of fat, giving an aged look.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscle Wasting:</strong> Despite the swollen appearance, muscle loss is present, leading to weakness and hypotonia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Baggy Pants Appearance:</strong> Loose, sagging skin around the <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> caused by significant muscle and fat loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mental and Neurological Symptoms:</strong> The child is apathetic, irritable, and may have <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> difficulties.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alertness: </strong>Children with <span class=\"customMeta\" data-dictid=\"122de6274d169277719141ab2c8004\">marasmus</span> remain mentally alert.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hair Changes:</strong> Hair may lose colour, become thin, and show <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> bands of colour <strong>(\"flag sign\").</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Absence of Edema:</strong> Unlike kwashiorkor, <span class=\"customMeta\" data-dictid=\"122de6274d169277719141ab2c8004\">marasmus</span> does not involve <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or oedema.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin Changes:</strong> Includes hyperpigmentation, peeling skin<strong> (\"flaky paint\" appearance),</strong> and colour changes, particularly in the buttocks, perineum, and thighs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypoglycemia Risk:</strong> The liver's <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> capacity to produce <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> increases the risk of low blood sugar.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastrointestinal Issues:</strong> Anorexia, vomiting, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension. <strong>Anaemia </strong>is present due to nutritional deficiencies.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypothermia Risk:</strong> The child may struggle to maintain <span class=\"customMeta\" data-dictid=\"4a7581c8b01692777183819f38c633\">body temperature</span> due to energy depletion.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dr. Lyle Conrad, \" data-hash=\"\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Starved_girl.jpg\" data-tags=\"\" height=\"544\" src=\"https://image.prepladder.com/content/oPXP9UfQF6aG5i39qt1g1746084333.png\" width=\"285\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Open access\" data-hash=\"\" data-license=\"Content Providers(s): CDC/ Don Eddins,\" data-source=\"https://commons.wikimedia.org/wiki/File:Starved_child.jpg\" data-tags=\"\" height=\"524\" src=\"https://image.prepladder.com/content/02a3FMA4U8wX18EkqdVK1746084336.png\" width=\"330\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the scenario of a man who fell into a manhole and sustained perineal injury, leading to difficulty in urination and presence of blood at the urethral tip, a diagnosis of bulbar urethral injury was determined. In this particular case, where would the urine accumulation be the least expected?", "options": [{"label": "A", "text": "Perineum", "correct": false}, {"label": "B", "text": "Anterior abdominal wall", "correct": false}, {"label": "C", "text": "The medial portion of thigh", "correct": true}, {"label": "D", "text": "Root of scrotum", "correct": false}], "correct_answer": "C. The medial portion of thigh", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Urethral Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Common Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Urine Accumulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Areas Restricted</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bulbar urethral injury (Spongy <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> rupture)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Straddle injury</strong> (e.g., falling on a hard object)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perineum, scrotum, penis, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thigh (due to <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> of Colles' fascia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Membranous urethral injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pelvic fractures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Retropubic space, perineum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scrotum and <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> (if Buck’s <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> remains intact)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Penile urethral injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blunt trauma or catheterization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confined within Buck’s <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> if intact, or <span class=\"customMeta\" data-dictid=\"ea5dd28db71692777195ee64c2f690\">perineum</span> if ruptured</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None if Buck’s <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> is disrupted</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with easy fatigability, back pain, and multiple lytic lesions in the skull. The bone marrow biopsy finding is given below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "CML (Chronic Myelogenous Leukemia)", "correct": false}, {"label": "B", "text": "CLL (Chronic Lymphocytic Leukemia)", "correct": false}, {"label": "C", "text": "Multiple Myeloma", "correct": true}, {"label": "D", "text": "Hairy Cell Leukemia", "correct": false}], "correct_answer": "C. Multiple Myeloma", "question_images": ["https://image.prepladder.com/content/MSHEQaEhh9wfR1Th3OrQ1747908773.png"], "explanation_images": ["https://image.prepladder.com/content/kPTyA7skoNKIniJdWWBX1746084612.png", "https://image.prepladder.com/content/F5qpOTOZpWIGG4GG8mH51746084612.png", "https://image.prepladder.com/content/u8UfltRr3XrSkD7rMpMl1746084612.png", "https://image.prepladder.com/content/YsPuaoJATxZvSdXOZoU91747908834.png", "https://image.prepladder.com/content/6U8W06w9UL1WD6QHHb9r1747908843.png", "https://image.prepladder.com/content/KdtRSdKA0h8sCJM9QVtK1747908854.png", "https://image.prepladder.com/content/jQGiq8wOoyEH2S9sCZ7y1746084652.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Inclusion Bodies seen in Multiple Myeloma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Russel bodies:</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Russell_bodies_2_high_mag_mini.jpg\" data-tags=\"\" height=\"2625\" src=\"https://image.prepladder.com/content/YsPuaoJATxZvSdXOZoU91747908834.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Location:</strong> Intracytoplasmic</li>\n<li><strong>Composition:</strong> Intracytoplasmic, eosinophilic, round inclusions formed by dilated <span class=\"customMeta\" data-dictid=\"c01a5a8c221692777187daa368ab62\">endoplasmic reticulum</span> <span class=\"customMeta\" data-dictid=\"11900fa000169277718475f5b54b45\">cisternae</span> filled with condensed immunoglobulins.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dutcher bodies</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gabriel Caponetti\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dutcher_and_Russell_bodies.jpg\" data-tags=\"\" height=\"3265\" src=\"https://image.prepladder.com/content/6U8W06w9UL1WD6QHHb9r1747908843.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Location:</strong> Intranuclear.</li>\n<li><strong>Composition:</strong> Globular inclusions containing accumulated immunoglobulin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\"><strong>Plasma cell Variants in Multiple Myeloma</strong></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mott cells</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Prof. Osaro Erhabor\" data-hash=\"\" data-license=\"CC0 \" data-source=\"https://commons.wikimedia.org/wiki/File:Mott_Cell.jpg\" data-tags=\"\" height=\"2751\" src=\"https://image.prepladder.com/content/KdtRSdKA0h8sCJM9QVtK1747908854.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contain Grape-like cytoplasmic droplets.</li>\n<li><strong>Composition: </strong>Inclusion bodies, fibrils, <span class=\"customMeta\" data-dictid=\"35b1a3c6191692777185a1e2376fc0\">crystalline</span> rods, and globules.</li>\n</ul>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Flame cells</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"University of Alberta\" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://pressbooks.openeducationalberta.ca/mlsci/chapter/plasma-cell-myeloma-multiple-myeloma/,\" data-tags=\"\" height=\"310\" src=\"https://image.prepladder.com/content/jQGiq8wOoyEH2S9sCZ7y1746084652.png\" width=\"390\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Appearance</strong>: Fiery red cytoplasm.</li>\n<li><strong>Cause</strong>: High concentration of <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> as bright red granules within the cytoplasm.</li>\n<li>Often seen in<strong> </strong><strong>IgA subtype myeloma.</strong></li>\n</ul>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a farmer who has a swollen foot and multiple discharging sinuses, as depicted in the image below?", "options": [{"label": "A", "text": "Mycetoma", "correct": true}, {"label": "B", "text": "Squamous cell carcinoma", "correct": false}, {"label": "C", "text": "Nocardia", "correct": false}, {"label": "D", "text": "Sporotrichosis", "correct": false}], "correct_answer": "A. Mycetoma", "question_images": ["https://image.prepladder.com/content/Yi7D1v6OuxkjkM39c39f1747901597.png"], "explanation_images": ["https://image.prepladder.com/content/liD6vNoJ0ltJppx3NKxe1747901616.png", "https://image.prepladder.com/content/Bfxvl08vlltkvJEfc6cX1747901605.png", "https://image.prepladder.com/content/67fQcQvJe4TVo22PB9fo1747901627.png", "https://image.prepladder.com/content/pdGJyb3iYq7v8xKmGEgI1747901663.png", "https://image.prepladder.com/content/fJN3a5EJPaLHqL3wMhDy1747901671.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causative Agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Microscopic Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eumycetoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><em>Madurella mycetomatis</em>, <em>Curvularia lunata</em>, <em>Scedosporium spp.</em>, <em>Acremonium spp.</em></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyphae or thick-walled grains (black/white).</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ahmed, Amel &amp; Sande, Wendy &amp; Fahal, Ahmed.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/KOH-wet-mount-direct-microscopic-examination-of-M-mycetomatis-grains-showing-its-hyphal_fig3_319282387\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/pdGJyb3iYq7v8xKmGEgI1747901663.png\" width=\"3624\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li>Histology shows <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> granulomas with neutrophils.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Actinomycetoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><em>Actinomadura madurae</em>, <em>Nocardia</em> spp.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thin, branching filaments visible with Gram staining. Similar granulomas to <span class=\"customMeta\" data-dictid=\"8b892faf591692777187882c62c510\">eumycetoma</span> but distinct morphology.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Bonnet, Emilie &amp; Flecher, Xavier &amp; Parratte, Sebastien &amp; Argenson, Jean-Noël &amp; Raoult, Didier &amp; Fournier, Pierre-Edouard.\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/Actinomadura-meyerae-colonies-A-A-meyerae-cultivated-from-our-patients-bone-biopsy-on_fig1_49787479\" data-tags=\"\" height=\"3382\" src=\"https://image.prepladder.com/content/fJN3a5EJPaLHqL3wMhDy1747901671.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment Approach</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eumycetoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with antifungals (itraconazole, ketoconazole). High <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Actinomycetoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy (e.g., trimethoprim-sulfamethoxazole, dapsone) along with <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old child presents with a persistent cough for 15 days. Upon examination, cervical lymphadenopathy is observed. A lymph node biopsy image is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Tuberculosis", "correct": true}, {"label": "B", "text": "Leprosy", "correct": false}, {"label": "C", "text": "Sarcoidosis", "correct": false}, {"label": "D", "text": "Syphilis", "correct": false}], "correct_answer": "A. Tuberculosis", "question_images": ["https://image.prepladder.com/content/2ysuojgF1iHKW971LxnV1747908912.png"], "explanation_images": ["https://image.prepladder.com/content/LH23zPIr3o3TXLyFUT4n1747908921.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Type of Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Caseating Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Tuberculosis, Histoplasmosis, Coccidioidomycosis, <strong>Syphilis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Non-caseating Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Sarcoidosis</strong>, Crohn’s disease, <strong>Leprosy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Foreign Body Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Silicosis, Asbestos-related diseases, Foreign body reactions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Immune Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Wegener’s granulomatosis, Giant cell arteritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Durck’s Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Cerebral malaria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Stellate Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Cat scratch disease</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes of <span class=\"customMeta\" data-dictid=\"2334b7498b1692777188fa8b2eee36\">granuloma</span> formation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infectious causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-infectious causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>TB (Caseating and non-caseating granuloma)</li>\n<li>Leprosy</li>\n<li>Syphilis</li>\n<li>Malaria <strong>(Durck granuloma)</strong></li>\n<li>Cat-scratch disease and Lymphogranuloma venerum <strong>(Stellate granuloma)</strong></li>\n<li>Q fever (Doughnut granuloma/ Fibrin ring granuloma)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Sarcoidosis (Naked granuloma)</strong></li>\n<li>Giant cell arteritis</li>\n<li>Crohn’s disease</li>\n<li>Churg-Strauss syndrome <strong>(Eosinophilic granuloma)</strong></li>\n<li>Berylliosis (Foreign body granuloma)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy has non-blanching rashes on the legs and buttocks. He also complains of joint pains, abdominal pain, vomiting, and blood in the stool. Lab investigations revealed normal platelet count and urine analysis shows haematuria +++ and proteinuria +. What is the diagnosis?", "options": [{"label": "A", "text": "Systemic lupus erythematosus (SLE)", "correct": false}, {"label": "B", "text": "Henoch Schonlein purpura (HSP)", "correct": true}, {"label": "C", "text": "Immune thrombocytopenic purpura (ITP)", "correct": false}, {"label": "D", "text": "Polyarteritis nodosa (PAN)", "correct": false}], "correct_answer": "B. Henoch Schonlein purpura (HSP)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>The exact cause is unknown.</li>\n<li>Immune-mediated vasculitis, often following an upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infection.</li>\n<li>Genetic predisposition, with HLA-B34 and DRB1, was observed in some cases.</li>\n<li>Most common in Males<strong>.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p><strong>Pathology and Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inflammation of small blood vessels affecting skin, joints, intestines, and kidneys.</li>\n<li>Triggered by immune system response to infections.</li>\n<li>Leakage of fluid and blood cells into tissues.</li>\n<li>Immune complex deposition, particularly <strong>IgA</strong>, in affected vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Palpable Purpura:</strong> Raised, purplish-red rash, mainly on lower limbs and buttocks.</li>\n<li><strong>Joint Involvement: </strong>Joint swelling, commonly in knees and ankles.</li>\n<li><strong>Abdominal Pain: </strong>Often severe, may include vomiting, diarrhoea, <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding, or intussusception<strong> </strong></li>\n<li><strong>Renal Involvement: </strong>Less common, presents as Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Criteria:</strong></p>\n<ul>\n<li><strong>Palpable <span class=\"customMeta\" data-dictid=\"0acd34c758169277719644923511e5\">purpura</span> plus at least one of:</strong>\n<ul>\n<li>Diffuse <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Arthritis or arthralgia</li>\n<li>Biopsy-proven <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">IgA</span> deposition</li>\n<li>Renal involvement (hematuria &amp;/ proteinuria)</li>\n</ul>\n</li>\n</ul>\n<p><br/>\n<strong>Laboratory involvement:</strong></p>\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"49069760291692777187e0e72db819\">ESR</span> or <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> indicates inflammation.</li>\n<li>Platelet Counts are normal.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intussusception.</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Failure due to Long-term <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage, in severe cases.</li>\n<li>Neurological Complications: Rare; may include seizures, headaches, or <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild Cases: Rest, hydration, and pain relievers.</li>\n<li>Moderate to Severe Cases: Corticosteroids (e.g., prednisone) to reduce inflammation.</li>\n<li>Severe or Resistant Cases: Additional <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> medications may be required.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Full recovery in most cases.</li>\n<li>Variable based on <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> involvement.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked in the diagram showing the development of ovarian follicles.", "options": [{"label": "A", "text": "Primary follicle", "correct": false}, {"label": "B", "text": "Antral follicle", "correct": true}, {"label": "C", "text": "Primordial follicle", "correct": false}, {"label": "D", "text": "Corpus luteum", "correct": false}], "correct_answer": "B. Antral follicle", "question_images": ["https://image.prepladder.com/content/POVfpvdAQxVvnkR9vYXX1747900880.png"], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primordial follicle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oocytes surrounded by a single layer of <strong>flattened <span class=\"customMeta\" data-dictid=\"ac2dfd97cd16927771888be9de7ded\">granulosa</span> cells</strong>. Dormant until puberty.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary follicle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Granulosa cells become cuboidal</strong>, <span class=\"customMeta\" data-dictid=\"ce703232dd1692777202121148f8ee\">zona</span> pellucida begins forming around the oocyte. No antrum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary follicle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Multiple layers of <span class=\"customMeta\" data-dictid=\"ac2dfd97cd16927771888be9de7ded\">granulosa</span> cells</strong> and <span class=\"customMeta\" data-dictid=\"2ae158b0bc1692777200039e41de96\">theca</span> cells form. Early <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> development but <strong>no antrum</strong> yet.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antral follicle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluid-filled <span class=\"customMeta\" data-dictid=\"96976bc5fc1692777181dc8403015a\">antrum</span> appears</strong>, <span class=\"customMeta\" data-dictid=\"ac2dfd97cd16927771888be9de7ded\">granulosa</span> and <span class=\"customMeta\" data-dictid=\"2ae158b0bc1692777200039e41de96\">theca</span> cells differentiate. Prepares for ovulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Graafian follicle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fully matured, <strong>large antrum</strong>, ready for ovulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corpus luteum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Formed after ovulation, secretes <span class=\"customMeta\" data-dictid=\"183d374ac91692777196c63c850299\">progesterone</span> to support pregnancy. If there is no fertilization, it degenerates.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Supravital stains are used in the identification of all except?", "options": [{"label": "A", "text": "Reticulocytes", "correct": false}, {"label": "B", "text": "Copper in tissue", "correct": true}, {"label": "C", "text": "Heinz bodies", "correct": false}, {"label": "D", "text": "Ribosomal RNA", "correct": false}], "correct_answer": "B. Copper in tissue", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JWbEVmMCa1mbFi4KA9Lv1746084794.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 35-year-old male who is experiencing hair loss, based on the provided examination findings?", "options": [{"label": "A", "text": "Tinea capitis", "correct": false}, {"label": "B", "text": "Kerion", "correct": false}, {"label": "C", "text": "Alopecia areata", "correct": true}, {"label": "D", "text": "Androgenic alopecia", "correct": false}], "correct_answer": "C. Alopecia areata", "question_images": ["https://image.prepladder.com/content/2Cf7HxYbHLODcWozOzBJ1747901775.png", "https://image.prepladder.com/content/IJrIKi6rL3PPEhkOmCu61747901793.png"], "explanation_images": ["https://image.prepladder.com/content/v0xw11WQsJMJjpaO4iIc1747901815.png", "https://image.prepladder.com/content/d6mIA9TCg2KElHLot6mh1747901801.png", "https://image.prepladder.com/content/qdPb4a7j2tm0pNaz6MCw1747901825.png", "https://image.prepladder.com/content/emNrIwPmF9WwXxbf4OR01747901840.png", "https://image.prepladder.com/content/xWB4bwBbyh5q9zrmqjlg1747901849.png", "https://image.prepladder.com/content/kluamES3rco6fZJ9n49X1747901856.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\":Thirunavukkarasye-Raveendran,\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Alopecia_areata_1.jpg\" data-tags=\"\" height=\"3846\" src=\"https://image.prepladder.com/content/emNrIwPmF9WwXxbf4OR01747901840.png\" width=\"3835\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p>Non-scarring alopecia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Antonella Tosti\" data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/Alopecia-areata-yellow-dots-and-exclamation-mark-hairs_fig1_51563330\" data-tags=\"\" height=\"2904\" src=\"https://image.prepladder.com/content/xWB4bwBbyh5q9zrmqjlg1747901849.png\" width=\"3796\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p>Exclamation mark hair</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Rallis, Efstathios &amp; Kintzoglou, Stephanos &amp; Verros, Constantinos. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Onycholysis-oil-drop-discoloration-nail-bed-hyperkeratosis-and-pitting-of-the-right_fig1_47794433\" data-tags=\"\" height=\"3106\" src=\"https://image.prepladder.com/content/kluamES3rco6fZJ9n49X1747901856.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p>Regular nail pitting</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 78-year-old male presents with fatigue, breathlessness, and palpitations. On examination, he has pedal oedema, with a pulse rate of 55 bpm, BP of 100/70 mmHg, and oxygen saturation of 94%. ECG is normal, and echocardiography reveals restrictive cardiomyopathy. A cardiac biopsy stained with Congo red shows apple-green birefringence under polarised light. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Heart failure", "correct": false}, {"label": "B", "text": "Cardiac amyloidosis", "correct": true}, {"label": "C", "text": "Hemosiderosis", "correct": false}, {"label": "D", "text": "Dystrophic calcification", "correct": false}], "correct_answer": "B. Cardiac amyloidosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/X8ugAuoAiWWfijDq8o511746084855.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Type of Amyloidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Amyloid Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"959f3344b116927771815235718f3d\">Amyloidosis</span> (AL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Amyloid Light Chain (AL)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Plasma cell disorders (e.g., multiple myeloma)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Secondary <span class=\"customMeta\" data-dictid=\"959f3344b116927771815235718f3d\">Amyloidosis</span> (AA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Amyloid-Associated (AA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> (e.g., <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis, IBD)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Hereditary Amyloidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Transthyretin (TTR)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Familial <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> polyneuropathies (e.g., <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> Mediterranean fever)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Hemodialysis-Associated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>β2-Microglobulin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Long-term hemodialysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Senile <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> Amyloidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Transthyretin (TTR)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Ageing, mutations in TTR</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Localised Amyloidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Varies (often AL type)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Specific organs (e.g., tongue, lung, skin, bladder)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Endocrine Amyloidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (Acal)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Endocrine tumours (e.g., <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma, pancreatic <span class=\"customMeta\" data-dictid=\"769b87740c16927771907f5a83b1f8\">islet</span> tumours)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An HIV patient presents with persistent diarrhea. Microscopic examination of the stool reveals oocyst of size 4 to 8 µm as shown below. Identify the causative organism. ", "options": [{"label": "A", "text": "Cryptosporidium", "correct": true}, {"label": "B", "text": "Cyclospora", "correct": false}, {"label": "C", "text": "Microspora", "correct": false}, {"label": "D", "text": "Cystoisospora", "correct": false}], "correct_answer": "A. Cryptosporidium", "question_images": ["https://image.prepladder.com/content/vfEzErY8rTTGVktWj7ac1747904407.png"], "explanation_images": ["https://image.prepladder.com/content/a7aANv67u32huyeFuRvg1746084725.png", "https://image.prepladder.com/content/QN8LmtiVSUccZp3kNk7P1746084744.png", "https://image.prepladder.com/content/c6WkspzhQXZrexMpQ0eU1746084777.png", "https://image.prepladder.com/content/ZvHdJ7J89z7UVQ9oeQhN1746084794.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cryptosporidium (Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cyclospora (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystoisospora (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ingestion of contaminated food/water, autoinfection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ingestion of contaminated food/water</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ingestion of sporulated oocysts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infective form</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sporulated oocyst</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sporulated oocyst</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sporulated oocyst</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic form</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sporulated oocyst</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unsporulated oocyst</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unsporulated oocyst</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation Period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-14 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-7 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1-4 days</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oocyst shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Round</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Round</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oval</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oocyst size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4-6 µm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8-10 µm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>20–33 µm</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sporulated oocyst</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Four sporozoites</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two sporocysts, each having two sporozoites</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two sporocysts, each having four sporozoites</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acid-fastness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uniformly acid-fast</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable acid-fast</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uniformly acid-fast</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autofluorescence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>–</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>++</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>+/-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Resistance to chlorination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>+</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>–</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>–</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sporulation of the oocyst</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inside the host cells (enterocytes)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>soil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>soil</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zoonotic potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncertain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nitazoxanide</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cotrimoxazole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cotrimoxazole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Punlop Anusonpornperm\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Cryptosporidium_parvum_02.jpg\" data-tags=\"\" height=\"133\" src=\"https://image.prepladder.com/content/a7aANv67u32huyeFuRvg1746084725.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sonia Almeria, Hediye N. Cinar and Jitender P. Dubey\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Oocists_de_Cyclospora_cayetanensis.png\" data-tags=\"\" height=\"182\" src=\"https://image.prepladder.com/content/QN8LmtiVSUccZp3kNk7P1746084744.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"UFRGS\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://en.wikipedia.org/wiki/Cystoisospora_belli#/media/File:Isospora_belli.jpg\" data-tags=\"\" height=\"180\" src=\"https://image.prepladder.com/content/c6WkspzhQXZrexMpQ0eU1746084777.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 8-year-old boy presented with dark-coloured urine, oliguria, hypertension, and facial puffiness for 3 days. The urine test is positive for albumin. He had a history of throat infection 2 weeks back. On microscopic examination, enlarged, pale glomeruli and epithelial humps are seen. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Post-staphylococcal glomerulonephritis", "correct": false}, {"label": "B", "text": "Post-streptococcal glomerulonephritis", "correct": true}, {"label": "C", "text": "Nephrotic syndrome", "correct": false}, {"label": "D", "text": "IgA nephropathy", "correct": false}], "correct_answer": "B. Post-streptococcal glomerulonephritis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Post-streptococcal glomerulonephritis</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Post-streptococcal <span class=\"customMeta\" data-dictid=\"d3658e1af116927771887bc5b8a57e\">glomerulonephritis</span> (PSGN)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute nephritic syndrome: Hematuria, oliguria, edema, hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Proteinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>(1+ to 2+) levels of proteinuria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hematuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common, with cola-colored <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> due to gross hematuria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urinary Casts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Red blood cell casts (indicating <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> inflammation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Albumin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually normal unless severe <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">Urea</span> and Creatinine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated due to impaired <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">Complement</span> C3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low in 90% of cases, returns to normal in 8-12 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cholesterol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No significant hypercholesterolemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ASO/Anti-DNase B Titers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"3e7108fe871692777182786921689e\">ASO</span> titers (pharyngitis) or anti-DNase B (skin infection)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 30-year-old woman who has lacy lesions in her mouth and genital area, while her proximal nail fold has extended onto the nail bed?", "options": [{"label": "A", "text": "Pityriasis rubra pilaris", "correct": false}, {"label": "B", "text": "Psoriasis", "correct": false}, {"label": "C", "text": "Pityriasis rosea", "correct": false}, {"label": "D", "text": "Lichen planus", "correct": true}], "correct_answer": "D. Lichen planus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vWcu4ZspobmbftiA1aNB1747901917.png", "https://image.prepladder.com/content/kbqM77SgbwcGk37k9J2C1747901922.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is correct about ABO and Rh incompatibility leading to erythroblastosis fetalis?", "options": [{"label": "A", "text": "Cytotoxic", "correct": true}, {"label": "B", "text": "Cell-mediated hypersensitivity", "correct": false}, {"label": "C", "text": "Antigen-antibody reaction", "correct": false}, {"label": "D", "text": "Immune complex", "correct": false}], "correct_answer": "A. Cytotoxic", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BG6QDhmvgImJHLBwt1Ak1746085166.png"], "explanation": "<p>Correct Answer A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old child was brought to her paediatrician for routine well-child care. Her physical examination is normal except for a systolic murmur and a widely split-second heart sound that does not vary with respiration. She has no family history of heart disease. Which among the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Total anomalous pulmonary venous connection", "correct": false}, {"label": "B", "text": "Ventricular septal defect", "correct": false}, {"label": "C", "text": "Atrial septal defect", "correct": true}, {"label": "D", "text": "Pulmonic stenosis", "correct": false}], "correct_answer": "C. Atrial septal defect", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Atrial septal defect</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left-to-Right Shunting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oxygenated blood flows from the left to right atrium; the degree of shunting varies with <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> size and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right Heart Volume <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">Overload</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> causes <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> and ventricle, and <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> artery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May increase with time, after remaining low during childhood, and lead to <span class=\"customMeta\" data-dictid=\"82343f61171692777197b4a08bc719\">reversal</span> of <span class=\"customMeta\" data-dictid=\"950826ab361692777198366a25dfbf\">shunt</span> and cyanosis.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asymptomatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Many children are asymptomatic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Failure to Thrive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poor growth and weight gain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Exercise Intolerance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Difficulty with physical activity.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Widely Split and Fixed S2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"ddbe945c10169277719841fa6a7fa2\">second heart sound</span> is split and fixed due to increased right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> diastolic volume.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systolic <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">Ejection</span> Murmur</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Soft <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> at the left upper sternal border, caused by increased flow across the right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> outflow tract.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mid-Diastolic Murmur</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rumbling <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> at the lower left sternal border due to increased flow across the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Dystrophin protein is absent completely in which of the following diseases?", "options": [{"label": "A", "text": "Becker’s Muscular Dystrophy", "correct": false}, {"label": "B", "text": "Duchenne Muscular Dystrophy", "correct": true}, {"label": "C", "text": "Myasthenia gravis", "correct": false}, {"label": "D", "text": "Lambert Eaton myasthenic syndrome", "correct": false}], "correct_answer": "B. Duchenne Muscular Dystrophy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Duchenne &lt;span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\"&gt;Muscular&lt;/span&gt; Dystrophy</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Duchenne <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> <span class=\"customMeta\" data-dictid=\"04568e3d19169277718672d9da94fd\">Dystrophy</span> (DMD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Becker <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> <span class=\"customMeta\" data-dictid=\"04568e3d19169277718672d9da94fd\">Dystrophy</span> (BMD) (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of Mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frameshift mutations lead to a disrupted reading frame</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In-frame mutations that preserve the reading frame</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dystrophin Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dystrophin deficient</strong></li>\n<li>Truncated and unstable (&lt; 3% of normal)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abnormal dystrophin</li>\n<li>Partially functional (20–90% of normal)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe, early onset, rapid progression</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Milder, later onset, slower progression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inheritance Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X-linked recessive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X-linked recessive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age of onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early childhood (Before 5 years)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Later childhood (After 5-7 years)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is incorrect about colostrum?", "options": [{"label": "A", "text": "It is the breastmilk that is seen in the initial 3-4 days", "correct": false}, {"label": "B", "text": "It is yellow", "correct": false}, {"label": "C", "text": "It contains a large number of antibodies", "correct": false}, {"label": "D", "text": "It contains a high amount of lactose and low amounts of protein", "correct": true}], "correct_answer": "D. It contains a high amount of lactose and low amounts of protein", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - It contains a high amount of &lt;span class=\"customMeta\" data-dictid=\"0aa69e4ec11692777191c26eff3504\"&gt;lactose&lt;/span&gt; and low amounts of protein</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Milk Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Time of Production</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Quantity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Key Components</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Colostrum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Initial 3-4 days after delivery (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Yellow </strong>and thick</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Small</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>It is high in antibodies</strong> <strong>(Option</strong> <strong>C)</strong>, immune-competent cells, and vitamins A, D, E, and K.</li>\n<li><strong>Rich in immunoglobulins and proteins</strong>.</li>\n<li><strong>Low in <span class=\"customMeta\" data-dictid=\"0aa69e4ec11692777191c26eff3504\">lactose</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Transitional Milk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>From 3-4 days until two weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Thinner than colostrum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Decreased immunoglobulins and proteins.</li>\n<li><strong>Increased fat and sugar.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mature Milk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Follows transitional milk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Thinner and watery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Variable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Consistent in nutrient composition</li>\n<li>Balanced in nutrients essential for growth</li>\n<li><strong>Higher <span class=\"customMeta\" data-dictid=\"0aa69e4ec11692777191c26eff3504\">lactose</span> content.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 31-year-old lady with diabetes mellitus delivers a term neonate. Which of the following problems may be associated with the baby born to this lady?", "options": [{"label": "A", "text": "Hyperglycemia", "correct": false}, {"label": "B", "text": "Tetralogy of Fallot", "correct": false}, {"label": "C", "text": "Hypercalcemia", "correct": false}, {"label": "D", "text": "Hypoglycemia", "correct": true}], "correct_answer": "D. Hypoglycemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/J8xlyykfMuLqPIw1aLXW1746086095.png"], "explanation": "<p>Correct Answer D - Hypoglycemia</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Macrosomia/Large for Date Baby</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Increased risk of <span class=\"customMeta\" data-dictid=\"53b6b8be0a1692777183606471098d\">birth trauma</span> if <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> are used in obstructed labour.</li>\n<li>Increased chances of <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">perinatal</span> <span class=\"customMeta\" data-dictid=\"bc3e3350401692777182edb342a55b\">asphyxia</span> in prolonged labour.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Metabolic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hypoglycemia (vs Option A)</strong></li>\n<li><strong>Hypocalcemia (vs Option C)</strong></li>\n<li>Hypomagnesemia</li>\n<li>Polycythemia</li>\n<li>Neonatal jaundice</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CVS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <strong>most common</strong> <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in infants of <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> mothers (IDM) is <strong>congenital heart disease (CHD).</strong></li>\n<li>The <strong>most common</strong> <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart disease in IDM is <strong>ventricular septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> (VSD). (vs Option B)</strong></li>\n<li>The <strong>most specific </strong>congenital heart disease in IDM is the <strong>transposition of the great arteries (TGA).</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Respiratory System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome or <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">hyaline</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> disease due to delayed <span class=\"customMeta\" data-dictid=\"76948f718016927771924774ade7e9\">maturation</span> of surfactant.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CNS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>The most common</strong> <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> neurologic <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in IDM: <strong>Neural tube defects.</strong></li>\n<li><strong>Most specific</strong> neurologic <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> in IDM: <strong>Sacral <span class=\"customMeta\" data-dictid=\"133b86a0a516927771809ea08682e8\">agenesis</span> or <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> syndrome.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Renal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Renal <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n<li>Renal agenesis</li>\n<li>Duplication of ureter</li>\n<li>Hydroureteronephrosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>GI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Duodenal atresia</li>\n<li>Lazy/small left <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Long Term Problems</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blindness</li>\n<li>Obesity</li>\n<li>Nonketotic hypoglycemia</li>\n<li>Deafness</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a child presenting with febrile seizures, which is the first-line drug used to control the seizures?", "options": [{"label": "A", "text": "Sodium valproate", "correct": false}, {"label": "B", "text": "Phenytoin", "correct": false}, {"label": "C", "text": "Midazolam", "correct": true}, {"label": "D", "text": "Phenobarbitone", "correct": false}], "correct_answer": "C. Midazolam", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-day-old male neonate who has not yet passed meconium developed abdominal distension. There is no history of fever. On rectal examination, forceful expulsion of stool was observed. A barium enema is performed; the findings are shown in the image below. Which of the following is the gold standard for the diagnosis of the above condition?", "options": [{"label": "A", "text": "Ultrasonography", "correct": false}, {"label": "B", "text": "MRI abdomen", "correct": false}, {"label": "C", "text": "Rectal biopsy", "correct": true}, {"label": "D", "text": "Anorectal manometry", "correct": false}], "correct_answer": "C. Rectal biopsy", "question_images": ["https://image.prepladder.com/content/7AvElgx06O14mpcOzjhH1746086402.png"], "explanation_images": [], "explanation": "<p>Correct Answer C - R\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is brought to the paediatrician with short stature. On evaluation, growth hormone levels are found to be high and insulin-like growth factor (IGF-1) levels are low. Which among the following could be the abnormality here?", "options": [{"label": "A", "text": "GH deficiency", "correct": false}, {"label": "B", "text": "GHRH deficiency", "correct": false}, {"label": "C", "text": "GH receptor anomaly", "correct": true}, {"label": "D", "text": "IGF-1 deficiency", "correct": false}], "correct_answer": "C. GH receptor anomaly", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - GH &lt;span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\"&gt;receptor&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old male with a known history of asthma developed sudden onset breathlessness and wheezing. He was rushed to the emergency, where the preliminary assessment was done. The pulse is 140/min, respiratory rate 28/min, and the FEV1 is 40% of the predicted value. Which of the following is the best next step in treatment in this case?", "options": [{"label": "A", "text": "A high concentration of oxygen should be given by a face mask + Salbutamol nebulization", "correct": true}, {"label": "B", "text": "High doses of SABA to be given by a nebulizer only", "correct": false}, {"label": "C", "text": "Sedatives should be added to alleviate anxiety", "correct": false}, {"label": "D", "text": "Nebulized anticholinergics to be added immediately as the mainstay of treatment", "correct": false}], "correct_answer": "A. A high concentration of oxygen should be given by a face mask + Salbutamol nebulization", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - A high concentration of oxygen should be given by a face mask + &lt;span class=\"customMeta\" data-dictid=\"479585b1c81692777198b4f752d734\"&gt;Salbutamol&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"f50b51347c1692777193840d147b98\"&gt;nebulization&lt;/span&gt; </p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Life-Threatening <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">Asthma</span> Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Overview</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most severe <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> exacerbations require immediate attention.</li>\n<li>Indicators: Cyanosis, silent chest, poor <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> effort, exhaustion, altered mental state, <span class=\"customMeta\" data-dictid=\"705006a9b9169277719549f3620da6\">PEF</span> &lt;30%, <span class=\"customMeta\" data-dictid=\"b98c3a8ea216927771949889d9505f\">oxygen saturation</span> &lt;90%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Immediate Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Oxygen Therapy</strong>: Administer for hypoxemia.</li>\n<li><strong>Systemic Bronchodilators</strong>: Terbutaline or <span class=\"customMeta\" data-dictid=\"35b6a8aeb416927771805fcc2e7dfb\">adrenaline</span> subcutaneously; <strong>inhaled bronchodilators </strong>(<strong>salbutamol</strong>, ipratropium).</li>\n<li>Systemic Corticosteroids: IV <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">hydrocortisone</span> (5 mg/kg).</li>\n<li>ICU Transfer: For monitoring and advanced care.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ICU Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Continuous Monitoring: Vital signs, oxygen saturation, PEF.</li>\n<li>If Improvement Noted:\n\t\t\t\t<ul>\n<li>Continue inhaled bronchodilators (salbutamol/terbutaline) every 20-30 minutes.</li>\n<li>Maintain <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">hydrocortisone</span> at 2-3 mg/kg every 6-8 hours until the patient can take oral medication.</li>\n</ul>\n</li>\n<li>If No Improvement or Deterioration:\n\t\t\t\t<ul>\n<li>Consider slow <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> of <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">sulfate</span> (50 mg/kg).</li>\n<li>Alternatively, administer a <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> dose of theophylline.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>If these measures fail, prepare for mechanical ventilation.</li>\n</ul>\n<ul>\n<li>Address Underlying Causes: Check for acidosis, pneumothorax, <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> imbalance, and infection.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-month-old child undergoes treatment for diarrhoea with hypokalemia but the child does not respond to the treatment appropriately and on examination muscular weakness is noted, what is the most likely cause of treatment failure?", "options": [{"label": "A", "text": "Hypomagnesemia", "correct": true}, {"label": "B", "text": "Hyponatremia", "correct": false}, {"label": "C", "text": "Hypermagnesemia", "correct": false}, {"label": "D", "text": "Hypernatremia", "correct": false}], "correct_answer": "A. Hypomagnesemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Hypomagnesemia</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Severe <span class=\"customMeta\" data-dictid=\"d196d1af63169277718961a27bf8c4\">hypomagnesemia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Parenteral magnesium</li>\n<li>Dose: 25-50 mg/kg</li>\n<li>Slow IV <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> (IM in neonates)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Long term therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral administration</li>\n<li>Magnesium gluconate</li>\n<li>Magnesium oxide</li>\n<li>Magnesium sulfate</li>\n<li>IM injections (minimize diarrhoea)</li>\n<li>Nighttime <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> (minimise diarrhoea)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old male patient presents with anaemia. Both his father and paternal aunt experienced similar illnesses and were effectively treated with splenectomy. The patient's peripheral blood smear resembles the one depicted in the accompanying illustration, showing spherocytes. What other abnormalities can be anticipated?", "options": [{"label": "A", "text": "Decreased osmotic fragility", "correct": false}, {"label": "B", "text": "Decreased reticulocytes", "correct": false}, {"label": "C", "text": "Heinz bodies", "correct": false}, {"label": "D", "text": "Howell-Jolly bodies", "correct": true}], "correct_answer": "D. Howell-Jolly bodies", "question_images": ["https://image.prepladder.com/content/2G8CkGGSLgjUJTzSb56Z1746087359.png"], "explanation_images": ["https://image.prepladder.com/content/a7ghizppD28lqALjeQWB1746087415.png", "https://image.prepladder.com/content/CXyCDGVe3Kl4N1mZsHKh1746087386.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 10-year-old boy with Down syndrome who presents with a mediastinal mass (SVC-like syndrome), based on the provided bone marrow histology shown below?", "options": [{"label": "A", "text": "AML (Acute Myeloid Leukemia)", "correct": false}, {"label": "B", "text": "Aplastic anemia", "correct": false}, {"label": "C", "text": "ALL (Acute Lymphoblastic Leukemia)", "correct": true}, {"label": "D", "text": "Juvenile Myelomonocytic Leukemia (JMML)", "correct": false}], "correct_answer": "C. ALL (Acute Lymphoblastic Leukemia)", "question_images": ["https://image.prepladder.com/content/EsQrmMLk54UGawCyzAdG1746091051.png"], "explanation_images": ["https://image.prepladder.com/content/0fUPNKRgO0RA9V8qyx3w1746091109.png", "https://image.prepladder.com/content/7PuQyBN0Wpwj5cviZp591746091109.png", "https://image.prepladder.com/content/wLAiInxbg4NHzXJhTBMP1746091109.png", "https://image.prepladder.com/content/Z8HoAeyGAqAybIEnzaAo1746091109.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"VashiDonsk\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Acute_leukemia-ALL.jpg\" data-tags=\"\" height=\"331\" src=\"https://image.prepladder.com/content/0fUPNKRgO0RA9V8qyx3w1746091109.png\" width=\"443\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute Lymphoblastic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (ALL)</strong></p>\n<ul>\n<li><strong>Lymphoblasts in <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> &gt;=20%</strong></li>\n<li><strong>Cytoplasmic vacuolations</strong></li>\n<li>They contain fat (Oil Red O Positive)</li>\n<li><strong>Hand mirror-shaped cells</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"The Armed Forces Institute of Pathology\" data-hash=\"\" data-license=\"Public domain\" data-source=\"https://commons.wikimedia.org/wiki/File:Faggot_cell_in_AML-M3.jpg\" data-tags=\"\" height=\"344\" src=\"https://image.prepladder.com/content/7PuQyBN0Wpwj5cviZp591746091109.png\" width=\"407\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute Myeloid <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (AML) </strong></p>\n<ul>\n<li>Blasts ≥ 20%</li>\n<li><strong>Myeloblasts with AuerRods </strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"The Armed Forces Institute of Pathology\" data-hash=\"\" data-license=\"Public domain\" data-source=\"https://commons.wikimedia.org/wiki/File:B-cell_chronic_lymphocytic_leukemia_(B-CLL).jpg\" data-tags=\"\" height=\"347\" src=\"https://image.prepladder.com/content/wLAiInxbg4NHzXJhTBMP1746091109.png\" width=\"433\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic Lymphocytic <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (CLL):</strong></p>\n<ul>\n<li><strong>Smudge cells</strong> (or parachute/basket cell): Due to the <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> of lymphocytes during slide preparation</li>\n<li><strong>Convent Girl Appearance:</strong> Lot of homogenous, small, mature-like, round lymphocytes with scant cytoplasm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Paulo Henrique Orlandi Mourao\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Chronic_myelogenous_leukemia#/media/File:Chronic_Myeloid_Leukemia_smear_2009-04-09.JPG\" data-tags=\"\" height=\"351\" src=\"https://image.prepladder.com/content/Z8HoAeyGAqAybIEnzaAo1746091109.png\" width=\"412\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic Myeloid <span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\">Leukemia</span> (CML)</strong></p>\n<ul>\n<li>Leukocytosis</li>\n<li>Cell Types: Neutrophils( multilobed nucleus), metamyelocytes (indented nucleus), myelocytes (D-shaped nucleus), and eosinophils (orange cells)</li>\n<li><strong>College girl/garden party appearance: </strong>Due to the variety of cell appearances</li>\n<li><strong>Shift to the Left:</strong> Presence of <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> cell types, mainly <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> neutrophils, in the blood.</li>\n</ul>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female presents with a lump in the upper outer part of her breast. Histopathological analysis of the mass reveals a signet ring appearance. What is the probable diagnosis?", "options": [{"label": "A", "text": "Colloid carcinoma", "correct": true}, {"label": "B", "text": "Papillary carcinoma", "correct": false}, {"label": "C", "text": "Medullary carcinoma", "correct": false}, {"label": "D", "text": "Phyllodes tumour", "correct": false}], "correct_answer": "A. Colloid carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VanP4601G90ayFPgHd1Z1747909106.png", "https://image.prepladder.com/content/7CZRbLACQxKHs3U2y8uK1747909115.png", "https://image.prepladder.com/content/ChHohyWJdMkkImiyD4rl1747909125.png", "https://image.prepladder.com/content/JyEXfsn1ZlekyUwFvwje1747909141.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with abdominal pain and distension. An x-ray was taken which showed dilated bowel loops as given in the image below. Identify the segment involved.", "options": [{"label": "A", "text": "Jejunum", "correct": true}, {"label": "B", "text": "Ileum", "correct": false}, {"label": "C", "text": "Duodenum", "correct": false}, {"label": "D", "text": "Transverse colon", "correct": false}], "correct_answer": "A. Jejunum", "question_images": ["https://image.prepladder.com/content/oySy6WgR07r2Kuzy6GZj1747909771.png"], "explanation_images": ["https://image.prepladder.com/content/bxrBjifLiVkA2mfN0RfF1747909784.png", "https://image.prepladder.com/content/kIGwDXUazZXOegTPZ68R1747909794.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Radiological Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Jejunum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><em>Valvulae conniventes</em> (plicae circulares) seen throughout the bowel, giving a <strong>stacked coin</strong> or <strong>coiled spring</strong> appearance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ileum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less prominent <span class=\"customMeta\" data-dictid=\"775b64181b1692777201c6ab88b10e\">valvulae</span> conniventes, <strong>fewer folds</strong>, and a <strong>featureless</strong> appearance compared to the jejunum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duodenum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilated <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> in <strong>proximal obstruction</strong>, \"double bubble\" sign in <strong>duodenal atresia</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transverse Colon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Haustral markings</strong> (do not completely cross the lumen), <strong>wider spacing</strong> than jejunal folds.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Small Bowel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Large Bowel</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Number of loops</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Many loops visible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Few loops visible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Position of loops</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central abdomen</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral (framing the small bowel)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wall/Mucosal pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Valvulae conniventes</strong> (complete <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> folds)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Haustra </strong>(incomplete bands)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;3 cm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;6 cm (Caecum &gt;9 cm)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gas Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple air-fluid levels, <strong>\"string of beads\"</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distended colon, air-fluid levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Upright_abdominal_X-ray_demonstrating_a_bowel_obstruction.jpg\" data-tags=\"\" height=\"4047\" src=\"https://image.prepladder.com/content/bxrBjifLiVkA2mfN0RfF1747909784.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:LargeBowelObsFlat2008.jpg\" data-tags=\"\" height=\"3634\" src=\"https://image.prepladder.com/content/kIGwDXUazZXOegTPZ68R1747909794.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During wound healing, the cells that appear first, due to chemotaxis, at the site of the wound are:", "options": [{"label": "A", "text": "Neutrophils", "correct": true}, {"label": "B", "text": "Monocytes", "correct": false}, {"label": "C", "text": "Macrophages", "correct": false}, {"label": "D", "text": "Lymphocytes", "correct": false}], "correct_answer": "A. Neutrophils", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UOoNzy03a4ImwzOvfjYJ1746091319.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:583px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Events in wound healing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Platelets and Fibrin <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> blood clots.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> remains and <strong>recruitment of neutrophils</strong> (acute inflammation).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood clots remain; neutrophils accumulate, followed by the formation of a thin epithelial layer.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> sets in, and <strong>macrophages </strong>replace neutrophils.</p>\n<p>Granulation tissue begins (blood vessel formation starts)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Maximum <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue (Maximum neovascularisation)</li>\n<li>Collagen <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> starts</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Day 21(3rd Week)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maximum <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition (Type I collagen.)</p>\n</td>\n</tr>\n</tbody>\n\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary intention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Secondary intention</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary intention <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> involves rapid <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of a clean, surgically closed wound with minimal tissue loss, resulting in a small scar.</p>\n<p>E.g., <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> scar.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Secondary intention <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> occurs when a wound is left open to granulate and epithelialise, often resulting in a larger <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> and longer <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> time.</p>\n<p>Associated with wound contraction. e.g., Road traffic accidents.</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old girl presents with a severe headache, photophobia, and a high fever of 101°F. On examination, papilledema and nuchal rigidity were present. Kernig’s and Brudzinski's signs were positive. CSF examination shows reduced glucose, increased protein, and increased leukocytes with a predominance of neutrophils. Gram staining of the CSF is shown below. The causative organism is:", "options": [{"label": "A", "text": "Haemophilus influenzae type B", "correct": false}, {"label": "B", "text": "Neisseria meningitidis", "correct": true}, {"label": "C", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "D", "text": "Listeria monocytogenes", "correct": false}], "correct_answer": "B. Neisseria meningitidis", "question_images": ["https://image.prepladder.com/content/GUYj9tVHctEAJBv3j4Xc1746091192.png"], "explanation_images": ["https://image.prepladder.com/content/Mhw00L9FCyXisCntSRIG1746091532.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cerebrospinal Fluid (CSF) Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Appearance</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cloudy or purulent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>White Blood Cell Count (WBC)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated (pleocytosis), typically &gt;1,000 cells/µL, with predominance of neutrophils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Protein</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elevated</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Glucose</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decreased</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gram Stain</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presence of <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">gram-negative</span> diplococci</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Microman12345 - Own work\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Neisseria_meningitidis#/media/File:Neisseria_meningitidis_CSF_Gram_1000.jpg\" data-tags=\"\" height=\"138\" src=\"https://image.prepladder.com/content/Mhw00L9FCyXisCntSRIG1746091532.png\" width=\"219\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Culture</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth of Neisseria meningitidis on chocolate <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> or Thayer-Martin agar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Polymerase Chain Reaction (PCR)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detection of Neisseria meningitidis DNA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Latex Agglutination Test</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive for Neisseria meningitidis antigens</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Tests</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Culture</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Growth of Neisseria meningitidis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>White Blood Cell Count</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\">leukocytosis</span> with left shift</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bacterial Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Viral (Aseptic) Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fungal Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tuberculous Meningitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cloudy or purulent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clear or slightly cloudy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clear or slightly cloudy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clear or slightly cloudy, Cob web coagulum</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>White Blood Cell Count</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated (usually &gt;1,000 cells/µL)</li>\n<li>Predominantly neutrophils (≥80%)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated (usually 50-1,000 cells/µL)</li>\n<li>Predominantly lymphocytes</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated (usually 20-500 cells/µL)</li>\n<li>Predominantly lymphocytes</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated (usually 50-500 cells/µL)</li>\n<li>Predominantly lymphocytes</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated (100-500 mg/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mildly elevated or normal (50-100 mg/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated (100-500 mg/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated (100-500 mg/dL)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased (&lt;40 mg/dL or &lt;2.2 mmol/L)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or slightly decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF/Blood Glucose Ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;0.6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal or slightly elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gram Stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive for bacteria (gram-negative diplococci, etc.)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common cause of berry aneurysm?", "options": [{"label": "A", "text": "Endothelial injury of the vessel due to hypertension", "correct": false}, {"label": "B", "text": "Muscle intimal elastic lamina layer defect", "correct": true}, {"label": "C", "text": "Muscle and adventitial layer defect", "correct": false}, {"label": "D", "text": "Adventitia defect", "correct": false}], "correct_answer": "B. Muscle intimal elastic lamina layer defect", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Obliteration of the right cardiac border on chest X-ray indicated pathology involving which of the following structures? [", "options": [{"label": "A", "text": "Right lower lobe", "correct": false}, {"label": "B", "text": "Right Atrium", "correct": false}, {"label": "C", "text": "Right middle lobe", "correct": true}, {"label": "D", "text": "Right ventricle", "correct": false}], "correct_answer": "C. Right middle lobe", "question_images": ["https://image.prepladder.com/content/ivpLRRQ1HRUHXJTHifak1747909870.png"], "explanation_images": ["https://image.prepladder.com/content/PZ39Pc2Uq4FVWAP6mudU1746091606.png", "https://image.prepladder.com/content/RmadEwdvGDXK130n36gt1747909882.png", "https://image.prepladder.com/content/NSfdtxKi5kJNhizQYkQM1747909893.png", "https://image.prepladder.com/content/lvYBQDxZqmVcRofThvPG1747909927.png", "https://image.prepladder.com/content/oH7MbNIs21n9ug6wICAo1747909941.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:453px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Obliterated <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Border</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Likely Affected Lobe</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> border</strong> (Right atrium)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right Middle Lobe</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right hemidiaphragm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right Lower Lobe</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> border</strong> (Left ventricle)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lingula (Left Upper Lobe)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left hemidiaphragm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left Lower Lobe</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient who has been working in a factory for the past 20 years presents with breathlessness. HRCT of the chest shows pleural thickening and fibrosis. What is the person suffering from?", "options": [{"label": "A", "text": "Asbestosis", "correct": true}, {"label": "B", "text": "Coal worker pneumoconiosis", "correct": false}, {"label": "C", "text": "Silicosis", "correct": false}, {"label": "D", "text": "Berylliosis", "correct": false}], "correct_answer": "A. Asbestosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:733px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Occupational Lung Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Associated Agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diagnostic Tools</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Preventive Measures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asbestosis</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asbestos fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Characterised by progressive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis. Symptoms include dyspnea, non-productive cough, and chest pain. Often associated with <span class=\"customMeta\" data-dictid=\"e9d028795c169277719520dc71ae4b\">pleural plaques</span> and increased risk of <span class=\"customMeta\" data-dictid=\"9f56633f181692777192f07ed38b1a\">mesothelioma</span> and lung cancer.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HRCT, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> function tests, occupational history</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Use of protective gear, proper ventilation, <span class=\"customMeta\" data-dictid=\"92cc1e1acb1692777182aee908c1fd\">asbestos</span> <span class=\"customMeta\" data-dictid=\"66108506de1692777180d0d83fa26b\">abatement</span> programs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Silicosis</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crystalline <span class=\"customMeta\" data-dictid=\"4fc6d603f016927771985e818db6f2\">silica</span> (quartz dust)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presents with <span class=\"customMeta\" data-dictid=\"bfa856c77716927771939978c5afd0\">nodular</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis, primarily in the upper lobes. Increased risk of TB and other <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infections. <span class=\"customMeta\" data-dictid=\"bf11df6de316927771845ac371b9b6\">Chronic exposure</span> can lead to progressive massive fibrosis.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chest X-ray, HRCT, occupational history</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dust control measures, respirators, regular health check-ups</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coal Worker's <span class=\"customMeta\" data-dictid=\"67bf7be75e16927771951318e1670e\">Pneumoconiosis</span> (CWP)</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coal dust</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Also known as \"black lung disease.\" Features similar to <span class=\"customMeta\" data-dictid=\"a06a8ebae41692777198013abbc10d\">silicosis</span> but usually affect the upper lungs with coal dust deposition and fibrosis, without the silicotic nodules.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chest X-ray, HRCT, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> function tests</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dust control, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> protective equipment, regular monitoring</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Byssinosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cotton, flax, hemp dust</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>\"Monday fever\" describes worsening symptoms at the beginning of the workweek. Symptoms include chest tightness and wheezing, predominantly in textile workers.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical evaluation, occupational history</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Improved ventilation, dust suppression, health education</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Berylliosis</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Beryllium and its compounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute or chronic lung disease caused by beryllium. Chronic <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> mimics <span class=\"customMeta\" data-dictid=\"1bea5cbf1d16927771988b19241f4c\">sarcoidosis</span> with <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms and <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> inflammation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lung biopsy, <span class=\"customMeta\" data-dictid=\"d8970d6c401692777182ef5e543622\">beryllium</span> <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> test (BeLPT), imaging</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limiting exposure, personal protective equipment, medical surveillance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Farmer's Lung</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moldy hay, crops, and compost dust</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A type of <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> <span class=\"customMeta\" data-dictid=\"5a679034841692777196d988b49eb5\">pneumonitis</span> caused by inhaling organic dust, presenting with malaise, cough, and breathlessness that may become chronic.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HRCT, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> function tests, specific <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> testing for antigens</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory protective equipment, proper storage of agricultural products</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 19-year-old male, chronic smoker, presented with fever, a painful lump over his left cheek just below the ear, and difficulty in swallowing or talking. The patient also complained of mild testicular pain. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cervical tuberculosis", "correct": false}, {"label": "B", "text": "Diphtheria", "correct": false}, {"label": "C", "text": "Mumps", "correct": true}, {"label": "D", "text": "Lymphoma", "correct": false}], "correct_answer": "C. Mumps", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6wrVd2KZv8VrAmEfs0QH1747902363.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mumps</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mumps virus (Paramyxoviridae family)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5-9 years mostly</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory droplets</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Period of communicability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>7 days before to 7 days after the onset of symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-grade<strong> fever,</strong> Headache, <strong>Parotitis (Often Bilateral), <span class=\"customMeta\" data-dictid=\"cc5721398816927771943c33d367a6\">orchitis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most Common <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> in child : Aseptic Meningitis</li>\n<li>Most Common <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> in<strong> Adult : Orchitis</strong> ( does not lead to <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> )</li>\n<li>Oophoritis, pancreatitis, myocarditis, arthritis, <span class=\"customMeta\" data-dictid=\"df0e1364a11692777200ed67550c12\">thyroiditis</span> &amp; conjunctivitis.</li>\n<li>Mumps during early pregnancy <strong>increases <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> wastage but not malformations.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurological Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Meningitis (Most Common) -</strong> 10-30% of cases.</li>\n<li>Encephalitis, <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> myelitis, and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> are less common.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Self-limiting</strong></li>\n<li>Management focuses on symptom relief - pain reduction, hydration, and antipyretics.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following MRI imaging techniques is shown in the image below?", "options": [{"label": "A", "text": "T1 MRI", "correct": false}, {"label": "B", "text": "T2 MRI", "correct": true}, {"label": "C", "text": "STIR", "correct": false}, {"label": "D", "text": "FLAIR", "correct": false}], "correct_answer": "B. T2 MRI", "question_images": ["https://image.prepladder.com/content/pj5zcRlSg8l3GzamfD771747909997.png"], "explanation_images": ["https://image.prepladder.com/content/0fIC1ybK33yDxdIi86Bk1746092579.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>MRI Sequence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CSF Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fat Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Use Cases</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1-weighted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dark</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bright</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anatomy, fat-containing lesions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2-weighted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bright</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Darker</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Edema, inflammation, tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>FLAIR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dark</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dark</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White matter lesions, <span class=\"customMeta\" data-dictid=\"a71c8cfa8216927771955861218d80\">periventricular</span> pathology</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>STIR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dark</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dark</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suppresses fat signal, good for <span class=\"customMeta\" data-dictid=\"09b955b4f91692777193bd4080e7fc\">musculoskeletal</span> imaging</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "McNaughten's rule is?", "options": [{"label": "A", "text": "IPC 82", "correct": false}, {"label": "B", "text": "IPC 83", "correct": false}, {"label": "C", "text": "IPC 84", "correct": true}, {"label": "D", "text": "IPC 85", "correct": false}], "correct_answer": "C. IPC 84", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - IPC 84\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The magnetic field in MRI machines is measured in which of the following units?", "options": [{"label": "A", "text": "Tesla", "correct": true}, {"label": "B", "text": "HU", "correct": false}, {"label": "C", "text": "KHz", "correct": false}, {"label": "D", "text": "Hg", "correct": false}], "correct_answer": "A. Tesla", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Unit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Symbol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Measurement Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Application</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tesla</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Magnetic field strength</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in <strong>MRI</strong> to measure <span class=\"customMeta\" data-dictid=\"c731b7ca621692777191324e5d32e7\">magnetic field</span> intensity (e.g., 1.5T, 3T, 7T <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> scanners)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gauss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>G</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Magnetic field strength</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Older unit for <span class=\"customMeta\" data-dictid=\"c731b7ca621692777191324e5d32e7\">magnetic field</span> strength (1T = 10,000G)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absorbed dose of radiation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Measures energy absorbed per unit mass in <strong>radiotherapy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sievert</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sv</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Biological effect of radiation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in <strong>radiation safety</strong> to assess exposure risk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hounsfield Unit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tissue density in CT</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in <strong>CT scans</strong> to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> tissues (e.g., bone = +1000 HU, air = -1000 HU)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Becquerel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bq</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radioactive <span class=\"customMeta\" data-dictid=\"6a867651ba1692777185bb15ba2f9c\">decay</span> rate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in <strong>nuclear medicine</strong> to measure radioactivity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Curie</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ci</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radioactivity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Older unit (1 Ci = 3.7 × 10¹⁰ Bq), used in <strong>nuclear imaging</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Roentgen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>R</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ionization in air</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in older radiation exposure measurements</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Millisievert</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>mSv</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radiation dose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used for <strong>radiation protection</strong>, <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> doses are often measured in mSv</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Electron Volt</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>eV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Energy of X-rays/Gamma rays</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in <strong>radiation physics</strong> to measure <span class=\"customMeta\" data-dictid=\"8da14408b216927771952175d1d0b0\">photon</span> energy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Kiloelectron Volt</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>keV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X-ray <span class=\"customMeta\" data-dictid=\"8da14408b216927771952175d1d0b0\">photon</span> energy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Important in <strong>X-ray and CT imaging</strong> for beam quality</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are grounds for divorce except :", "options": [{"label": "A", "text": "Adultery", "correct": false}, {"label": "B", "text": "Incurable Leprosy", "correct": false}, {"label": "C", "text": "Poverty", "correct": true}, {"label": "D", "text": "Insanity", "correct": false}], "correct_answer": "C. Poverty", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most radiosensitive tissue in our body?", "options": [{"label": "A", "text": "Skin", "correct": false}, {"label": "B", "text": "Muscles", "correct": false}, {"label": "C", "text": "Bone marrow", "correct": true}, {"label": "D", "text": "Nervous tissue", "correct": false}], "correct_answer": "C. Bone marrow", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Radiosensitivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reason</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bone marrow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Highly radiosensitive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contains rapidly dividing stem cells for blood cell production</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphoid tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Highly radiosensitive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid cell turnover, easily damaged by radiation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastrointestinal mucosa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderately radiosensitive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epithelial cells divide rapidly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Basal layer is sensitive, but outer layers provide some protection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radioresistant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cells do not divide frequently</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nervous tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Highly radioresistant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurons are non-dividing cells and less affected by radiation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are paired cartilages except?", "options": [{"label": "A", "text": "Arytenoid", "correct": true}, {"label": "B", "text": "Thyroid", "correct": false}, {"label": "C", "text": "Cuneiform", "correct": false}, {"label": "D", "text": "Corniculate", "correct": false}], "correct_answer": "A. Arytenoid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iabudEum9o0aOo23XxVg1747900930.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Paired/Unpaired</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Unpaired</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thyroid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Unpaired</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Forms the <span class=\"customMeta\" data-dictid=\"f70d828cb81692777191d1f0c6e91f\">laryngeal prominence</span> (Adam’s apple), provides structural support.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cricoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Unpaired</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complete ring, supports larynx, <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> site for muscles.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epiglottis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Unpaired</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leaf-shaped, prevents food from entering the trachea.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paired</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arytenoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paired</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Controls vocal cord movement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corniculate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paired</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sits on top of arytenoids, helps with voice modulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cuneiform</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paired</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides structural support to the laryngeal inlet.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man comes with complaints of fever and increasing fatigue for the past week. On examination, he is febrile, hypotensive, and tachycardic. The findings of microscopic examination of his peripheral blood smear are given below. What is the causative agent?", "options": [{"label": "A", "text": "Plasmodium vivax", "correct": false}, {"label": "B", "text": "Plasmodium falciparum", "correct": true}, {"label": "C", "text": "Plasmodium ovale", "correct": false}, {"label": "D", "text": "Plasmodium malariae", "correct": false}], "correct_answer": "B. Plasmodium falciparum", "question_images": ["https://image.prepladder.com/content/2Y2ebCgHLyJmPiA0LDYe1746091795.png"], "explanation_images": ["https://image.prepladder.com/content/lcHlPLqL8lGsLkdqAA9l1747904504.png", "https://image.prepladder.com/content/viOT5YhjW8GsVTzeIxEi1746092704.png", "https://image.prepladder.com/content/S81M7b2LDMwgous1zOhS1747904509.png", "https://image.prepladder.com/content/MSueEuGKLcFoFK5A4i1o1746092835.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vivax </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Falciparum </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malariae </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ovale </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RBC size </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged with frayed margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pigments </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellowish brown</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dark brown</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schizont </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large (9-10 μm)</p>\n<p>Fills the RBC</p>\n<p>Contains 12-24 merozoite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not seen in the periphery</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small (6 μm), almost fills the RBC and contains 8 merozoites</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gametocytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spherical (Option A)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dr. Mae Melvin\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://pixnio.com/science/microscopy-images/malaria-plasmodium/this-photomicrograph-shows-a-red-blood-cell-being-infected-by-plasmodium-vivax-in-its-schizont-stage-magnified-1000x\" data-tags=\"\" height=\"2572\" src=\"https://image.prepladder.com/content/lcHlPLqL8lGsLkdqAA9l1747904504.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crescentic </strong></p>\n<p>Larger than RBC</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Macrogametocyte_of_the_parasite_Plasmodium_falciparum_PHIL_2701_lores.jpg\" data-tags=\"\" height=\"193\" src=\"https://image.prepladder.com/content/viOT5YhjW8GsVTzeIxEi1746092704.png\" width=\"286\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spherical (Option C and D)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dr. Melvin, Steven Glenn, USCDCP\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://pixnio.com/science/microscopy-images/malaria-plasmodium/this-giemsa-stained-thin-film-blood-smear-micrograph-depicts-a-band-form-plasmodium-malariae-trophozoite\" data-tags=\"\" height=\"2668\" src=\"https://image.prepladder.com/content/S81M7b2LDMwgous1zOhS1747904509.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ring <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5 μm</p>\n<p>Occupies ⅙ of RBC size</p>\n<p>It may be</p>\n<ul>\n<li>Multiple forms</li>\n<li>Accole (attached to RBC membrane)</li>\n<li>Double dot/headphone shaped with fragment nucleus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Band form</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In Plasmodium falciparum, only <span class=\"customMeta\" data-dictid=\"36514f2a4416927771881b27e74758\">gametocyte</span> and ring forms are demonstrated in the PBS, as later stages of the <span class=\"customMeta\" data-dictid=\"7d53fd92541692777187195e87ab70\">erythrocytic</span> cycle occur in deep vessels and not in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Comment on the diagnosis of CT chest shown below.", "options": [{"label": "A", "text": "Aortic dissection", "correct": true}, {"label": "B", "text": "Pulmonary embolism", "correct": false}, {"label": "C", "text": "Cardiac myxoma", "correct": false}, {"label": "D", "text": "Aortic aneurysm", "correct": false}], "correct_answer": "A. Aortic dissection", "question_images": ["https://image.prepladder.com/content/T2g1oiqmxxOcmORb1wYA1747910070.png"], "explanation_images": ["https://image.prepladder.com/content/ECnNOl2vtoTACpqfcPDl1746092976.png", "https://image.prepladder.com/content/E03c1F9KafB4FopQDgmV1747910085.png", "https://image.prepladder.com/content/ZY3aezFfpS45MYEzHMF31748163825.png", "https://image.prepladder.com/content/tqQkbJJqMskBbrHE0OxE1748163840.png", "https://image.prepladder.com/content/Ds2tqJcnYKAokJyOJ5p71747910205.png", "https://image.prepladder.com/content/VVATh3MaTWhePONAIzgT1747910212.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An intern observed that a patient in the ward was unresponsive, and an ECG which was performed urgently showed a rhythm as depicted below. DC shock was delivered but the arrhythmia persisted and the patient is still unresponsive. What is the next best step in the management of this patient?", "options": [{"label": "A", "text": "Synchronized cardioversion", "correct": false}, {"label": "B", "text": "Start CPR", "correct": true}, {"label": "C", "text": "Deliver another DC shock", "correct": false}, {"label": "D", "text": "1 mg epinephrine", "correct": false}], "correct_answer": "B. Start CPR", "question_images": ["https://image.prepladder.com/content/zUm1noJfbEur7xuK0Gjd1747902373.png"], "explanation_images": ["https://image.prepladder.com/content/Ukf6Kwl4ZULAe0H2hYSC1746093027.png", "https://image.prepladder.com/content/7IaSrFIpY8c9m2jhdRb31746093027.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pulsus paradoxus is seen in:", "options": [{"label": "A", "text": "Coronary artery disease", "correct": false}, {"label": "B", "text": "Severe Asthma or Chronic Obstructive Pulmonary Disease", "correct": true}, {"label": "C", "text": "Atrial Fibrillation", "correct": false}, {"label": "D", "text": "Right ventricular myocardial infarction", "correct": false}], "correct_answer": "B. Severe Asthma or Chronic Obstructive Pulmonary Disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pulsus Paradoxus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A fall in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> &gt;10 mmHg during inspiration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exaggerated <span class=\"customMeta\" data-dictid=\"769fa5be3616927771906f8ae8b053\">interventricular</span> <span class=\"customMeta\" data-dictid=\"01be542e8e16927771861e861ab536\">dependence</span> → Increased right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> during inspiration shifts the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> leftward, reducing left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> output and causing a more pronounced drop in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> pressure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Conditions:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pericardial <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> (classic association)</strong>\n<ul>\n<li>External pressure on the heart limits filling</li>\n<li>Inspiration compresses the RV, preventing normal inspiratory RV filling</li>\n<li>Interventricular <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> shifts left, restricting LV <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> and output → Marked fall in BP</li>\n</ul>\n</li>\n<li>Massive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism</li>\n<li>Hemorrhagic shock</li>\n<li><strong>Severe obstructive lung disease (e.g., asthma, COPD)</strong></li>\n<li>Tension pneumothorax</li>\n<li>Effusive <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">Constrictive</span> Pericarditis</li>\n<li>Restrictive Cardiomyopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Measurement:</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Auscultatory method:\n\t\t\t\t<ul>\n<li>Identify the <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> pressure <strong>during <span class=\"customMeta\" data-dictid=\"2cbabc42d21692777187c451566867\">expiration</span> </strong>and <strong>independent of respiration.</strong></li>\n<li>The <strong>difference between these two </strong>is the <strong>pulsus paradoxus</strong>.</li>\n<li>If the difference exceeds 15 mmHg, <span class=\"customMeta\" data-dictid=\"a507417e891692777196a900bd7993\">pulsus</span> paradoxus may be <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> at the <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> or <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery.</li>\n</ul>\n</li>\n<li>Tachycardia, atrial fibrillation, <span class=\"customMeta\" data-dictid=\"28f03e93ee1692777200dd8ea97b29\">tachypnea</span> will make it difficult to measure.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:493px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Inspiration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Expiration</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Falls</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rises</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood pressure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Falls (up to 10 mmHg)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rises</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heart rate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Accelerates</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slows</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Second heart sound (S2)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Splits*</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fuses*</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate IPC section for the act of inducing abortion without the consent of the woman?", "options": [{"label": "A", "text": "312", "correct": false}, {"label": "B", "text": "313", "correct": true}, {"label": "C", "text": "318", "correct": false}, {"label": "D", "text": "317", "correct": false}], "correct_answer": "B. 313", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - 313\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55 year old male patient presented with complaints of dyspnea with congestive heart failure. The clinician wants to know whether it's HF with preserved EF or reduced EF. Which of the below investigation is used for calculation of ejection fraction?", "options": [{"label": "A", "text": "MUGA", "correct": true}, {"label": "B", "text": "SPECT using thallium", "correct": false}, {"label": "C", "text": "PET myocardial perfusion imaging", "correct": false}, {"label": "D", "text": "Sestamibi scan with pharmacological stress", "correct": false}], "correct_answer": "A. MUGA", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/h2RwDGIc7m882BAGN5zA1747910599.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:618px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Scan types</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>For Myocardial <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Assess ischemia</li>\n<li><strong>Cold spot: </strong>decreased <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in ischemic areas.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Thallium scan (Commonly used) <strong>(Option B)</strong></li>\n<li>Tetrofosmin</li>\n<li>Sestamibi scan <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>For Myocardial Infarction </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Assess infarct</li>\n<li><strong>Hot spot</strong> in <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> area as <span class=\"customMeta\" data-dictid=\"53da8f40b5169277719620504e0cb9\">pyrophosphate</span> accumulates and is not metabolized.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>99m Tc - <span class=\"customMeta\" data-dictid=\"53da8f40b5169277719620504e0cb9\">Pyrophosphate</span> scan.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>For <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Function </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Evaluate <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> fraction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>MUGA</strong> (Multiple Gated Acquisition) scan (AKA nuclear ventriculography)\n\t\t\t\t<ul>\n<li>Radiolabeled RBCs are used</li>\n</ul>\n</li>\n<li>Most accurate for <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> function - <strong>Cardiac MRI</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>For Myocardial <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">Viability</span> </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Assess the <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> of myocardium</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>PETscan </strong>- Best investigation for myocardial viability. <strong>(Option C)</strong>\n<ul>\n<li><strong>Perfusion</strong> and<strong> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> mismatch</strong> are observed in the PET scan.</li>\n<li><strong>Perfusion Agents</strong>:N-13 <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> and Rubidium chloride.</li>\n<li><strong>Metabolism Agent</strong>: FDG-PET is used for <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> metabolism.\n\t\t\t\t\t<ul>\n<li>No FDG <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> indicates a <strong>normal heart</strong> or an<strong> infarct.</strong></li>\n<li>FDG <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> is present: In the <strong>Ischemic Myocardium</strong></li>\n</ul>\n</li>\n<li>FDG-PET is combined with <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for comprehensive assessment.\n\t\t\t\t\t<ul>\n<li>Uptake in PET with low <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> indicates <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (suggestive of <strong>hibernation</strong>).</li>\n<li>Irreversible <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> indicates the presence of <strong>scar tissue</strong>.</li>\n</ul>\n</li>\n<li><strong>Note:</strong> Hibernating <span class=\"customMeta\" data-dictid=\"c64e23ddb8169277719344010b3fc0\">myocardium</span> is ischemic but viable.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In case of corrosive acid ingestion, stomach is opened along the?", "options": [{"label": "A", "text": "Lesser curvature", "correct": false}, {"label": "B", "text": "Greater curvature", "correct": true}, {"label": "C", "text": "Vertical", "correct": false}, {"label": "D", "text": "Pylorus", "correct": false}], "correct_answer": "B. Greater curvature", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Greater curvatu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Organ</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dissection Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Features </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Brain </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cerebrum</strong></p>\n<ul>\n<li>It is separated from the <span class=\"customMeta\" data-dictid=\"a9c41a58d816927771847775d63d96\">cerebellum</span> and <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> with a <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> cut.</li>\n<li>Sliced coronally at 1 cm intervals.</li>\n<li>Fixed brains sliced through <span class=\"customMeta\" data-dictid=\"06d33302e016927771911f7ef71255\">mammillary</span> bodies, then coronally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asymmetry, brain shift, old infarcts, <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> lesions, <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> dilation, <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> shrinkage, fat emboli, petechial hemorrhage, and edema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cerebellum</strong></p>\n<ul>\n<li>Horizontally dissected in a ‘fan’ shape.</li>\n<li>Middle slice through the <span class=\"customMeta\" data-dictid=\"e0c09f9e461692777185212f4de159\">dentate</span> nucleus.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Structural abnormalities such as hemorrhages and lesions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Brainstem</strong></p>\n<ul>\n<li>Sliced perpendicular to its <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> at 5 mm intervals.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hemorrhages, softening, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> degeneration, and tumors.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Heart </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inflow-outflow</strong></p>\n<ul>\n<li>Open the right atrium, <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve, and <span class=\"customMeta\" data-dictid=\"5ebe3b1fbd1692777196b3ced12100\">pulmonic</span> valve.</li>\n<li>Open left atrium, <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve, and aortic valve.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Best for <span class=\"customMeta\" data-dictid=\"686725cf89169277719994d7d523d1\">systematic</span> chamber and <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> evaluation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Slicing</strong></p>\n<ul>\n<li>First, slice 3 cm from the apex.</li>\n<li>Parallel slices 1 cm apart.</li>\n<li>Rest opened along with blood flow.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Useful for suspected ischemic myocardial disease, shows <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> distribution.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sandwich Technique</strong></p>\n<ul>\n<li>The knife slices the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> muscle.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"c64e23ddb8169277719344010b3fc0\">myocardium</span> opened like a book.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Exposes infarcts or fibrotic plaques in the myocardium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spinal Cord </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior Approach</strong></p>\n<ul>\n<li>Long midline incision, <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> skin and muscle outward.</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> cut with a saw.</li>\n<li>Remove <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> processes and laminae.</li>\n<li>Open <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> and cut nerves for <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord removal.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lesions along the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord and surrounding tissues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intestine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The entire length is dissected.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Injuries, <span class=\"customMeta\" data-dictid=\"b437be3f051692777196d06a1fa93d\">poison</span> reactions, foreign bodies (bullets), <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> colitis-like lesions (mercuric <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> poisoning).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Liver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Remove and weigh.</li>\n<li>Multiple <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> sections 1–2 cm apart.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hepatomegaly (inflammation, neoplasia) or shrunken liver (cirrhosis). <span class=\"customMeta\" data-dictid=\"1f51bf91811692777188d929c8e851\">Gallbladder</span> <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> (stones, inflammation).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Safety pin appearance is seen in:", "options": [{"label": "A", "text": "Haemophilus influenzae", "correct": false}, {"label": "B", "text": "Burkholderia pseudomallei", "correct": true}, {"label": "C", "text": "Pseudomonas aeruginosa", "correct": false}, {"label": "D", "text": "Burkholderia cepacia", "correct": false}], "correct_answer": "B. Burkholderia pseudomallei", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UcIWTB5Du3ArXwI54Bgb1747904569.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Inhaling the cloth soaked in drug is:", "options": [{"label": "A", "text": "Bagging", "correct": false}, {"label": "B", "text": "Spraying", "correct": false}, {"label": "C", "text": "Huffing", "correct": true}, {"label": "D", "text": "Sniffing", "correct": false}], "correct_answer": "C. Huffing", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Huffing\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Biceps brachii functions as which type of muscle for lifting the forearm ?", "options": [{"label": "A", "text": "Synergistic", "correct": false}, {"label": "B", "text": "Fixator", "correct": false}, {"label": "C", "text": "Antagonist", "correct": false}, {"label": "D", "text": "Primary mover", "correct": true}], "correct_answer": "D. Primary mover", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Term</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Example in <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">Forearm</span> Flexion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"6a3d83b16a16927771925091c30287\">Mover</span> (Agonist)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Main muscle responsible for movement.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Biceps brachii</strong> flexes the elbow.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antagonist</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Muscle that opposes the primary mover.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Triceps brachii</strong> extends the elbow, opposing the biceps.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Synergist</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assists the primary <span class=\"customMeta\" data-dictid=\"6a3d83b16a16927771925091c30287\">mover</span> by adding force or stability.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Brachialis</strong> helps the <span class=\"customMeta\" data-dictid=\"6b395fd7b21692777183cf78e12920\">biceps</span> in flexion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fixator</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stabilizes the origin of the primary mover.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rotator <span class=\"customMeta\" data-dictid=\"074fda92471692777185c9d613a2ea\">cuff</span> muscles</strong> stabilize the <span class=\"customMeta\" data-dictid=\"f0cdc42a0c1692777198f54a380826\">shoulder joint</span> during flexion.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the causative organism of bull neck?", "options": [{"label": "A", "text": "Corynebacterium diphtheriae", "correct": true}, {"label": "B", "text": "Corynebacterium jeikeium", "correct": false}, {"label": "C", "text": "Corynebacterium minutissimum", "correct": false}, {"label": "D", "text": "Corynebacterium urealyticum", "correct": false}], "correct_answer": "A. Corynebacterium diphtheriae", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Sore throat</li>\n<li><strong>Swelling of neck due to <span class=\"customMeta\" data-dictid=\"344bcb4e391692777191307c1e0074\">lymphadenopathy</span> and edema, bull's neck</strong></li>\n<li>Difficulty <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> (dysphagia)</li>\n<li>Low-grade fever</li>\n<li><strong>Pseudomembrane formation in the throat</strong></li>\n<li><strong>Non-healing ulcers covered by grey <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> on the skin</strong></li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<ul>\n<li>Myocarditis</li>\n<li>Neurological complications (e.g., paralysis, neuropathy)</li>\n<li>Renal failure</li>\n<li>Airway obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the responsibility of the doctor in recording the dying declaration of a victim affected by a fire?", "options": [{"label": "A", "text": "To assess compos mentis", "correct": true}, {"label": "B", "text": "To record the statement even in the presence of magistrate", "correct": false}, {"label": "C", "text": "Cross-examine the person", "correct": false}, {"label": "D", "text": "Put the person under oath before declaration", "correct": false}], "correct_answer": "A. To assess compos mentis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following muscles is an abductor of the vocal cord?", "options": [{"label": "A", "text": "Lateral cricoarytenoid", "correct": false}, {"label": "B", "text": "Posterior cricoarytenoid", "correct": true}, {"label": "C", "text": "Thyroarytenoid", "correct": false}, {"label": "D", "text": "Vocalis", "correct": false}], "correct_answer": "B. Posterior cricoarytenoid", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior cricoarytenoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Abducts vocal cords</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only abductor, opens <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> during inspiration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral cricoarytenoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adducts vocal cords</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Closes <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> for phonation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thyroarytenoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relaxes vocal cords</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lowers pitch of voice.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vocalis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tenses vocal cords</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fine control of voice modulation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 72-year-old farmer was presented in the hospital with pinpoint pupil &amp;amp; increased secretions. The diagnosis is", "options": [{"label": "A", "text": "Alcohol poisoning", "correct": false}, {"label": "B", "text": "Opioid poisoning", "correct": false}, {"label": "C", "text": "Organophosphorus poisoning", "correct": true}, {"label": "D", "text": "Datura poisoning", "correct": false}], "correct_answer": "C. Organophosphorus poisoning", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2Seiz0MxilDLlKwZAkm61746093763.png"], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"8e1f460230169277719463930573a7\"&gt;Organophosphorus&lt;/span&gt; poisoning</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Muscarinic: </strong>Lethargy, Salivation, Diarrhea, Lacrimation, Urination, Miosis, Muscle weakness, Bronchorrhea, Bronchospasm, Bradycardia, Emesis (Mnemonic: DUMBBELLS)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Nicotinic: </strong>Muscle weakness, Fasciculation, Areflexia, Muscle paralysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>CNS: </strong>Headache, Tremor, Confusion, Slurred speech, Coma, Convulsion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Laboratory Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>RBC/True Cholinesterase</strong> (specific)</li>\n<li><strong>Plasma/Pseudocholinesterase</strong> (Most common)\n\t\t\t\t<ul>\n<li>Falls rapidly with <span class=\"customMeta\" data-dictid=\"8e1f460230169277719463930573a7\">organophosphorus</span> poisoning</li>\n<li>Inexpensive, sensitive)</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Atropine test</strong>: If 2 mg of <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">Atropine</span> relieves symptoms, it confirms OP poisoning</li>\n<li><strong>P-nitro <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> test</strong> for confirmation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Resuscitative measures (Airway-Breathing-Circulation)</li>\n<li>Decontamination</li>\n<li>Gastric <span class=\"customMeta\" data-dictid=\"b625b3e881169277719169ef4e1af3\">lavage</span> with 1:5000 KMnO4</li>\n<li>Activated charcoal</li>\n<li><strong>Atropine sulfate</strong> (2-4 mg IV every 10-15 minutes until atropinization)</li>\n<li><strong>Signs of atropinization:</strong> Heart rate&gt;80 beats/min, pupils no longer pinpoint, clear chest on <span class=\"customMeta\" data-dictid=\"b2f0dbabe516927771821b0ec5ba85\">auscultation</span> with no wheeze, <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP&gt;80mmHg, Dry axillae</li>\n<li>Oximes (Pralidoxime) to decrease <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> and CNS symptoms\n\t\t\t\t<ul>\n<li>removes <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> group</li>\n<li>reduces <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> requirement</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Cause of Death</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Respiratory Muscle <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">Paralysis</span> (RMP)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Takayasu arteritis most commonly involves:", "options": [{"label": "A", "text": "Pulmonary artery", "correct": false}, {"label": "B", "text": "Coronary arteries", "correct": false}, {"label": "C", "text": "Abdominal aorta", "correct": false}, {"label": "D", "text": "Arch of aorta", "correct": true}], "correct_answer": "D. Arch of aorta", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable condition for a 6-year-old child who has not received immunization, presented to the Emergency Room by a concerned mother, experiencing symptoms such as fever, cough, and difficulty breathing? Physical examination reveals the presence of a pseudo membrane on the tonsils that bleeds upon attempted removal, as well as a swollen neck giving a bull-neck appearance.", "options": [{"label": "A", "text": "Infectious mononucleosis", "correct": false}, {"label": "B", "text": "Tonsillitis", "correct": false}, {"label": "C", "text": "Diphtheria", "correct": true}, {"label": "D", "text": "Candidiasis", "correct": false}], "correct_answer": "C. Diphtheria", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Given below is a histological section of the thyroid gland. Which of the following is secreted by the cell marked ‘X’ in the image?", "options": [{"label": "A", "text": "Thyroxine", "correct": false}, {"label": "B", "text": "Calcitonin", "correct": true}, {"label": "C", "text": "PTH", "correct": false}, {"label": "D", "text": "SerotoninX", "correct": false}], "correct_answer": "B. Calcitonin", "question_images": ["https://image.prepladder.com/content/LeIWsoUYIPRkJhITt5Kd1747900967.png"], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cell Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hormone Secreted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Follicular cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Line the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> follicles</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thyroxine (T3, T4)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regulates metabolism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parafollicular (C) cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between follicles</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcitonin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lowers blood <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> by inhibiting osteoclasts.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 64-year-old man presents with complaints of palpitations and syncope. He has a history of inferior-wall myocardial infarction a year ago. Holter study was done and his 24 hour ECG strip obtained is given below. What is the long-term treatment for this condition?", "options": [{"label": "A", "text": "Amiodarone", "correct": false}, {"label": "B", "text": "Atropine only", "correct": false}, {"label": "C", "text": "Permanent pacemaker", "correct": true}, {"label": "D", "text": "Atropine and isoproterenol", "correct": false}], "correct_answer": "C. Permanent pacemaker", "question_images": ["https://image.prepladder.com/content/7vn6rvojPMNKqsiwOM7T1746093839.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sinus <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sinus <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">bradycardia</span> is a <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> rhythm with normal <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> but a <strong>rate &lt; 60 bpm.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ECG showing <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> rhythm at a rate lower than 60 bpm.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Etiologies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Normal in athletes</li>\n<li>Medications (beta-blockers, <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blockers, digoxin)</li>\n<li>Hypothyroidism, hypothermia</li>\n<li><strong>Sick <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> syndrome,</strong> myocardial infarction</li>\n<li>Vagal <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> (e.g., <span class=\"customMeta\" data-dictid=\"8b7ff268db16927772018672ed7531\">vasovagal</span> syncope)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asymptomatic (in many patients)</li>\n<li>Fatigue</li>\n<li><strong>Dizziness</strong> or lightheadedness</li>\n<li>Exercise intolerance</li>\n<li>Syncope or presyncope</li>\n<li>Cognitive slowing</li>\n<li>Worsening <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> or <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> symptoms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Assess <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> stability</li>\n<li>ECG to confirm <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> rhythm</li>\n<li>Review medication list for <span class=\"customMeta\" data-dictid=\"23a27ffd991692777183b72a8abd5e\">bradycardic</span> agents</li>\n<li>Evaluate for comorbidities (e.g., hypothyroidism, myocardial infarction)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>If Hemodynamically Unstable:</strong>\n<ul>\n<li>IV <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> 0.5 mg every 3-5 minutes (max 3 mg)</li>\n<li>If there is no improvement, consider a temporary pacemaker</li>\n</ul>\n</li>\n<li><strong>If Stable, for long term mamagement:</strong>\n<ul>\n<li>Treat underlying causes</li>\n<li>Withdraw bradycardia-inducing medications</li>\n<li><strong>Permanent pacemaker</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following conditions does not result in the development of a grey-white membrane over the tonsils?", "options": [{"label": "A", "text": "Streptococcal tonsillitis", "correct": false}, {"label": "B", "text": "Diphtheria", "correct": false}, {"label": "C", "text": "Ludwig’s angina", "correct": true}, {"label": "D", "text": "Infectious mononucleosis", "correct": false}], "correct_answer": "C. Ludwig’s angina", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Nb3Ln9G0EPZYcKe1cbQ31747902010.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ludwig’s angina- Anatomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Spaces</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It involves three spaces around the mandible: the sublingual, submandibular, and <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> spaces.</p>\n<ul>\n<li><strong>Sublingual space</strong>: Infections here typically arise from the premolars and first molar.</li>\n<li><strong>Submandibular space</strong>: It contains the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, and connects to both the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> and <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> spaces.</li>\n<li><strong>Submental space</strong>: Infections in the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> space can easily spread to the <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> and <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> spaces.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary Spaces</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The secondary spaces, known collectively as the masticator space, surround the muscles involved in <span class=\"customMeta\" data-dictid=\"7beec9567a1692777191ec123e0989\">mastication</span> (masseter, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> pterygoid, and temporalis).</li>\n<li>These spaces can become involved due to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> spread of infection from the primary spaces or from a <span class=\"customMeta\" data-dictid=\"8881e191391692777200888db48f0f\">third molar</span> infection.</li>\n<li>The primary clinical feature of masticator space infection is <strong>significant trismus.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which anatomical plane contains the neurovascular structures supplying the abdominal wall, located below the rectus abdominis muscle and above the transversalis fascia?", "options": [{"label": "A", "text": "Between the internal oblique and external oblique", "correct": false}, {"label": "B", "text": "Deep to transversus abdominis", "correct": false}, {"label": "C", "text": "Between the internal oblique and rectus abdominis", "correct": false}, {"label": "D", "text": "Between the internal oblique and transversus abdominis", "correct": true}], "correct_answer": "D. Between the internal oblique and transversus abdominis", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Layer of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> Wall</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Structures Present</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Between skin and external oblique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial fascia, <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerves.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Between <span class=\"customMeta\" data-dictid=\"787b0ec4661692777187c06c757e51\">external oblique</span> and internal oblique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No major <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> structures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Between <span class=\"customMeta\" data-dictid=\"50a310ef2e16927771907de8547137\">internal oblique</span> and <span class=\"customMeta\" data-dictid=\"b4b7ff709c1692777200a120b1b991\">transversus</span> abdominis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurovascular plane (intercostal nerves, <span class=\"customMeta\" data-dictid=\"46ff8ef1ee16927771996bb1697129\">subcostal</span> nerve, <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> branches, and <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> arteries).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Deep to <span class=\"customMeta\" data-dictid=\"b4b7ff709c1692777200a120b1b991\">transversus</span> abdominis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transversalis fascia, <span class=\"customMeta\" data-dictid=\"1f0a3237f21692777187669004cf0a\">extraperitoneal</span> fat, peritoneum.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with Pink color skin &amp;amp; mucosa, a bitter almond smell from breath, and frothy discharge. The cause of death is:", "options": [{"label": "A", "text": "H2S poisoning", "correct": false}, {"label": "B", "text": "CO poisoning", "correct": false}, {"label": "C", "text": "HCN poisoning", "correct": true}, {"label": "D", "text": "OPC poisoning", "correct": false}], "correct_answer": "C. HCN poisoning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - HCN poisoning</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cyanide poisoning</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Physical Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gaseous state- <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">Hydrogen</span> <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> (HCN)</li>\n<li>Liquid form- <span class=\"customMeta\" data-dictid=\"ed92a2be6e1692777189f821a720bd\">Hydrocyanic acid</span> or Prussic acid</li>\n<li>Solid state- salt forms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sources of poisoning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Electroplating</strong>, <strong>photographic</strong> processes, rubber, and plastic manufacturing industries</li>\n<li>Insecticide and rodenticide</li>\n<li>Drug toxicity: Sodium nitroprusside</li>\n<li>Military chemical warfare agents</li>\n<li><strong>Burning of plastic furniture, silk, or wool</strong></li>\n<li>Cigarette smoking</li>\n<li><strong>Bitter almonds, peach, apricot, plum, apple, pear, cassava</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mode of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> across both skin and <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membrane</li>\n<li>Cyanide salts combine with <span class=\"customMeta\" data-dictid=\"c6cd3307e0169277718936624365e5\">hydrochloric acid</span> in the stomach to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> HCN that is absorbed</li>\n<li><strong>Inhibition of <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> </strong>causes <span class=\"customMeta\" data-dictid=\"9c1068c4ed16927771892ed05b11d6\">histotoxic</span> anoxia</li>\n<li><strong>Neurotoxicity</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inhalation: Dizziness, vertigo, and <span class=\"customMeta\" data-dictid=\"4880e9b3761692777185e64eba797c\">constriction</span> of the throat</li>\n<li>Ingestion: Nausea, headache, loss of <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> power, hypotension, <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> failure, and convulsion</li>\n<li><strong>Skin: Brick-red color of skin and <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes</strong></li>\n<li>Anion gap <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> and <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lee-Jones test</li>\n<li>Serum <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> level</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> (pH &lt; 7.1): Administer sodium bicarbonate</li>\n<li>Antidotal therapy<strong> (Eli Lilly <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> kit approach)</strong>\n<ul>\n<li>First step: <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">Inhalation</span> of <span class=\"customMeta\" data-dictid=\"5406cdc5f9169277718107b60b7619\">Amyl</span> nitrite</li>\n<li>Second step: Sodium <span class=\"customMeta\" data-dictid=\"8866b36aa016927771938ffb10b429\">nitrite</span> (3% solution) IV</li>\n<li>Third step: Sodium <span class=\"customMeta\" data-dictid=\"c7e95d7fc4169277720098ae4b326f\">thiosulfate</span> (25% solution) IV</li>\n</ul>\n</li>\n<li>Other Antidotes\n\t\t\t\t<ul>\n<li>4-dimethylaminophenol (4-DMAP)</li>\n<li>Hydroxocobalamin (Vitamin B12): Combines with <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> cyanocobalamin, which is excreted in the urine</li>\n<li>Hyperbaric oxygen</li>\n</ul>\n</li>\n<li>Note: <span class=\"customMeta\" data-dictid=\"f1f83adcbd1692777192944952fb13\">Methylene</span> blue is NOT an <span class=\"customMeta\" data-dictid=\"5e612ce1381692777181adc76f11e6\">antidote</span> for <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> and must NOT be used</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autopsy Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bitter almond’s odour </strong></li>\n<li><strong>Brick-red color of skin and <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes </strong></li>\n<li><strong>Cyanosis of extremities </strong></li>\n<li>Hemorrhagic gastritis</li>\n<li>Disseminated <span class=\"customMeta\" data-dictid=\"8fad605541169277719552afc9ebac\">petechiae</span> in brain, meninges, pleura, lungs, and pericardium</li>\n<li>Pulmonary and cerebral edema</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate approach to treat a child who is attending school and has a repeated occurrence of infections in the upper respiratory tract, difficulty in breathing through the nose, and hearing problems, along with the observation of a palate that is significantly raised in shape?", "options": [{"label": "A", "text": "Tonsillectomy", "correct": false}, {"label": "B", "text": "Adenoidectomy", "correct": false}, {"label": "C", "text": "Adenoidectomy with grommet insertion", "correct": true}, {"label": "D", "text": "Myringotomy with grommet insertion", "correct": false}], "correct_answer": "C. Adenoidectomy with grommet insertion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In this image of basal ganglia, all of the following are correctly labeled except?", "options": [{"label": "A", "text": "1-Caudate nucleus", "correct": false}, {"label": "B", "text": "2-Globus pallidus", "correct": false}, {"label": "C", "text": "3-Putamen", "correct": false}, {"label": "D", "text": "4-Internal capsule", "correct": true}], "correct_answer": "D. 4-Internal capsule", "question_images": ["https://image.prepladder.com/content/Q3sgdlIKhaZAoocMUDMD1747901006.png"], "explanation_images": ["https://image.prepladder.com/content/ZrGkiCMje06JRa91JK8A1746094002.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Caudate nucleus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motor processes, learning, associative functions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral to <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> ventricle, near thalamus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Putamen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regulates movements, influences learning</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Part of the striatum, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to <span class=\"customMeta\" data-dictid=\"86c230abe316927771889bbef8df5d\">globus</span> pallidus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Globus pallidus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibitory control of movements</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial to putamen, part of <span class=\"customMeta\" data-dictid=\"b053edc5951692777191ef548602ef\">lentiform</span> nucleus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Internal capsule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contains motor and <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> pathways</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"1d14ed8c1216927771832ccea0c79f\">caudate</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> and <span class=\"customMeta\" data-dictid=\"b053edc5951692777191ef548602ef\">lentiform</span> nucleus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thalamus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sensory relay station</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial to <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia, near third ventricle</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which poisoning is caused by a bullet retained inside the body?", "options": [{"label": "A", "text": "Iron", "correct": false}, {"label": "B", "text": "Phosphorus", "correct": false}, {"label": "C", "text": "Nitrocellulose", "correct": false}, {"label": "D", "text": "Lead", "correct": true}], "correct_answer": "D. Lead", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following findings from a pleural fluid aspirate will suggest an exudative pleural effusion? Normal values Total S. Protein: 6-8 gm% S.LDH: 140-280 IU S. glucose: 140-200", "options": [{"label": "A", "text": "Pleural: Serum protein ratio &amp;gt; 0.5, pleural: Serum LDH ratio &amp;gt; 0.6 or pleural LDH &amp;gt; ⅔ of serum LDH", "correct": true}, {"label": "B", "text": "Pleural fluid protein = 4.5 gm% and glucose = 30 mg%", "correct": false}, {"label": "C", "text": "Pleural fluid LDH = 90IU and glucose = 30 mg%", "correct": false}, {"label": "D", "text": "Pleural fluid protein = 3.5gm% and glucose = 90 mg%", "correct": false}], "correct_answer": "A. Pleural: Serum protein ratio &gt; 0.5, pleural: Serum LDH ratio &gt; 0.6 or pleural LDH &gt; ⅔ of serum LDH", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Radiological investigation</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray:</strong></p>\n<ul>\n<li><strong>200 mL</strong> of fluid is needed for <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> on the <span class=\"customMeta\" data-dictid=\"ea1ec2d35e16927771962a17599e25\">posteroanterior</span> (PA) view.</li>\n<li><strong>50 mL</strong> of fluid may lead to <span class=\"customMeta\" data-dictid=\"6fd1f7611516927771836db4e712a1\">blunting</span> of the <span class=\"customMeta\" data-dictid=\"03b5b4a6ef1692777185c8ff0d80d2\">costophrenic</span> angle on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> view.</li>\n<li>A <strong>homogeneous opacity</strong> with <span class=\"customMeta\" data-dictid=\"e5922b669a169277719487f8bbabd3\">obliteration</span> of the<strong> <span class=\"customMeta\" data-dictid=\"03b5b4a6ef1692777185c8ff0d80d2\">costophrenic</span> angle</strong> is typical.</li>\n<li>This appearance is marked by a <strong>curved upper border</strong>, known as the <strong>Ellis S-shaped curve</strong>.</li>\n<li>Obliteration of cardiophrenic angle<strong>.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound: </strong>More effective than <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> in detecting fluid presence, showing a clear <strong>hypoechoic space</strong> indicative of <strong>transudate</strong> and moving densities suggesting exudate.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pleural fluid Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Light's Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiates transudative from <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> pleural effusions based on <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> and protein levels in pleural fluid.</p>\n<ul>\n<li>An <strong>exudative pleural effusion</strong> meets at least<strong> one</strong> of the following:\n\n\t\t\t\t<ol>\n<li>Pleural fluid protein/serum protein &gt; 0.5</li>\n<li>Pleural fluid LDH/serum <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt; 0.6</li>\n<li>Pleural fluid <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> exceeds two-thirds of the normal upper limit for serum.</li>\n</ol>\n</li>\n<li>~25% of transudates may be misidentified as exudates.</li>\n<li>If <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> criteria are <span class=\"customMeta\" data-dictid=\"fffe8d8cdd169277719212053c343d\">met</span> but a transudative condition is suspected, measure protein difference; if &gt;31 g/L (3.1 g/dL), likely transudative.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Additional Tests for <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">Exudative</span> Effusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Appearance description</li>\n<li>Glucose level, If<strong> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">Glucose</span> &lt;60 mg/dL</strong> Consider:\n\t\t\t\t<ul>\n<li>Malignancy</li>\n<li>Bacterial infections (empyema)</li>\n<li>Rheumatoid pleuritis</li>\n</ul>\n</li>\n<li>Differential cell count</li>\n<li>Microbiologic studies</li>\n<li>Cytology</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Standard Peculiarities </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Heart Failure</strong>: <strong>NT-proBNP</strong> level &gt; 1500 pg/mL indicates <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> due to congestive heart failure</li>\n<li><strong>Parapneumonic Effusion</strong>: Key criteria include:\n\t\t\t\t<ul>\n<li>Loculated pleural fluid</li>\n<li><strong>Pleural fluid pH &lt; 7.20</strong></li>\n<li>Pleural fluid <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt; 3.3 mmol/L <strong>(&lt; 60 mg/dL) ( Option B, C)</strong></li>\n<li>Positive <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">Gram</span> <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> or culture results</li>\n<li>Presence of visible pus</li>\n</ul>\n</li>\n<li><strong>Tuberculous Pleuritis</strong>: Diagnosis confirmed by high TB markers in pleural fluid <strong>(adenosine <span class=\"customMeta\" data-dictid=\"8da63c3e5316927771852b78bac0ba\">deaminase</span> </strong>&gt; 40 IU/L<strong> </strong>or i<strong>nterferon γ </strong>&gt; 140 pg/mL)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image given below is from a chronic smoker’s oral examination. Identify the lesion given.", "options": [{"label": "A", "text": "Erythroplakia", "correct": false}, {"label": "B", "text": "Leukoplakia", "correct": true}, {"label": "C", "text": "Fordyce’s granules", "correct": false}, {"label": "D", "text": "Koplik’s spots", "correct": false}], "correct_answer": "B. Leukoplakia", "question_images": ["https://image.prepladder.com/content/jRDTI7MxpAxxkyd0IUk91747902021.png"], "explanation_images": ["https://image.prepladder.com/content/miibFcYrflq8RsAoDqbl1747902058.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:556px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>White patch on oral mucosa, defined clinically, excluding conditions like <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> planus, candidiasis, etc.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Smoking, tobacco chewing</strong></li>\n<li>Alcohol abuse (especially with smoking)</li>\n<li>Chronic trauma (ill-fitting dentures, cheek bites)</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"b49bba8e8a16927771997b281fd66a\">submucous</span> fibrosis, hyperplastic candidiasis, Plummer-Vinson syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Buccal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (most common in India)</li>\n<li>Oral commissures, floor of mouth, tongue, gingivobuccal sulcus, lip mucosa</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age &amp; Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Men in their 40s are 2-3 times more affected than females.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Homogenous</strong>: Smooth or wrinkled white patch, lower <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n<li><strong>Nodular (speckled)</strong>: White patches on an erythematous base, higher <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n<li><strong>Erosive (erythroleukoplakia)</strong>: Interspersed with red patches, fissures, highest <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignant potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>1-17.5% risk, average 5% <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation</li>\n<li>Higher risk in <span class=\"customMeta\" data-dictid=\"fd29b16a0e1692777186324bd9a553\">dysplastic</span> lesions and certain locations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Remove <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> factors</strong>: Spontaneous <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> in some cases.</li>\n<li><strong>Biopsy</strong>: For lesions with high <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential.</li>\n<li><strong>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> or laser/cryotherapy</strong>: For suspicious or small lesions</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the GCS of a patient with a head injury who opens her eyes in response to a loud voice, localizes pain and is confused and disoriented but can answer questions?", "options": [{"label": "A", "text": "E3 M5 V4", "correct": true}, {"label": "B", "text": "E3 M6 V5", "correct": false}, {"label": "C", "text": "E4 M4 V5", "correct": false}, {"label": "D", "text": "E3 M5 V5", "correct": false}], "correct_answer": "A. E3 M5 V4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:426px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Head Injury Severity: Clinical Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minor head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 15 with no LOC (loss of consciousness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 14 or 15 with LOC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 9 - 13</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 3 - 8</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:297px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pupils Unreactive to Light</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pupil <span class=\"customMeta\" data-dictid=\"d4b70f945316927771972d75389cf0\">Reactivity</span> Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both Pupils</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>One Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neither Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In an autopsy of suspected poisoning, which organ, along with the stomach, part of the intestine, and liver, is preserved?", "options": [{"label": "A", "text": "Kidney", "correct": true}, {"label": "B", "text": "Lungs", "correct": false}, {"label": "C", "text": "Muscle", "correct": false}, {"label": "D", "text": "Heart", "correct": false}], "correct_answer": "A. Kidney", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - K\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the parasite.", "options": [{"label": "A", "text": "Giardia lamblia", "correct": true}, {"label": "B", "text": "Trichomonas vaginalis", "correct": false}, {"label": "C", "text": "Trypanosoma", "correct": false}, {"label": "D", "text": "Cyclospora", "correct": false}], "correct_answer": "A. Giardia lamblia", "question_images": ["https://image.prepladder.com/content/1JuwxT2a4pLE1Zx4WSxa1746093743.png"], "explanation_images": ["https://image.prepladder.com/content/CbtKf1lbKyxOiDpjjNen1746093954.png", "https://image.prepladder.com/content/juVlaJn3KPp5Fm7RMWMv1746094005.png", "https://image.prepladder.com/content/Bezp4ktAubtCHH8MhmzH1746094047.png", "https://image.prepladder.com/content/ZtzF3l3SRHw049cSvIVM1746094078.png", "https://image.prepladder.com/content/B7uEfr3x52BBWJrPlUpH1746094094.png", "https://image.prepladder.com/content/32vV86jDl7KNblj6nBEq1746094112.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female presents to the emergency department with the following arterial blood gas (ABG) results: pH 7.55, PaCO 2 40 mmHg, HCO 3 - 32 mEq/L. Which of the following conditions is most likely responsible for these findings?", "options": [{"label": "A", "text": "Metabolic acidosis", "correct": false}, {"label": "B", "text": "Metabolic alkalosis", "correct": true}, {"label": "C", "text": "Respiratory acidosis", "correct": false}, {"label": "D", "text": "Respiratory alkalosis", "correct": false}], "correct_answer": "B. Metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5 year old child has flexible fingers and can even touch the back of his hand with his wrist extended. The child also demonstrates the sign shown in the image below. On auscultation, a click is heard after S1, followed by a late systolic murmur. What is the probable diagnosis?", "options": [{"label": "A", "text": "Ehlers-Danlos syndrome", "correct": true}, {"label": "B", "text": "Marfan’s syndrome", "correct": false}, {"label": "C", "text": "Loeys-Dietz syndrome", "correct": false}, {"label": "D", "text": "Osteogenesis imperfecta", "correct": false}], "correct_answer": "A. Ehlers-Danlos syndrome", "question_images": ["https://image.prepladder.com/content/ZWQFAeTmSChl1EqCfxNG1747902471.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classical (cEDS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>COL5A1, COL5A2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperextensible skin, atrophic scars,<strong> joint hypermobility</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vascular (vEDS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>COL3A1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thin skin, visible veins, arterial/organ rupture,</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypermobile (hEDS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unknown</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Joint hypermobility</strong>, chronic pain, POTS, <strong>mitral <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> prolapse</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Kyphoscoliotic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PLOD1, FKBP14</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe scoliosis, hypotonia, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> rupture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arthrochalasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>COL1A1, COL1A2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital hip dislocation, severe joint hypermobility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dermatosparaxis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ADAMTS2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe skin fragility, sagging skin, large hernias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Periodontal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C1R, C1S</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"09980563461692777188b0de904031\">gum</span> disease, tooth loss, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> fragility</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what level does the spinal cord end in infants?", "options": [{"label": "A", "text": "L1", "correct": false}, {"label": "B", "text": "L2", "correct": false}, {"label": "C", "text": "L3", "correct": true}, {"label": "D", "text": "L4", "correct": false}], "correct_answer": "C. L3", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Spinal Cord <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">Termination</span> Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Relevance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fetus (24 weeks)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extends to <strong>S1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> development stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Newborn (Infants)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ends at <strong>L3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Important for <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> site selection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ends at <strong>L1-L2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Safe <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> site is <strong>L3-L4 or L4-L5</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most appropriate position for placement of single lead pacemaker ?", "options": [{"label": "A", "text": "Right ventricle", "correct": true}, {"label": "B", "text": "Left atrium", "correct": false}, {"label": "C", "text": "Left ventricle", "correct": false}, {"label": "D", "text": "Superior vena cava", "correct": false}], "correct_answer": "A. Right ventricle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/j3xsjbUkbimputFbM5Xs1746094446.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the examination of injury, hair bulbs are noted to be crushed. The probable type of wound is:", "options": [{"label": "A", "text": "Abrasion", "correct": false}, {"label": "B", "text": "Laceration", "correct": true}, {"label": "C", "text": "Stab injury", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "B. Laceration", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/l1mgThTkJ0FW57EH9xyG1746094319.png"], "explanation": "<p>Correct Answer B - L\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stellate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\">Round objects (e.g., hammer).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Crescentic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Objects with edges.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Linear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Long, thin objects (e.g., pipes)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Irregular/Y-shaped</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Flat-surfaced objects</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Accidental</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\">Found on exposed body parts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Homicidal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Found on non-accessible areas, typically the head.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Suicidal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Rare, usually on exposed parts, on the same side of the body.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In nasopharyngeal carcinoma, which of the following is a component of trotter's triad?", "options": [{"label": "A", "text": "Conductive hearing loss, ipsilateral temporoparietal neuralgia, palatal paralysis", "correct": true}, {"label": "B", "text": "Sensorineural hearing loss, contralateral temporoparietal neuralgia, palatal paralysis", "correct": false}, {"label": "C", "text": "Sensorineural hearing loss, ipsilateral temporoparietal neuralgia, palatal paralysis", "correct": false}, {"label": "D", "text": "Conductive hearing loss, contralateral temporoparietal neuralgia, palatal paralysis", "correct": false}], "correct_answer": "A. Conductive hearing loss, ipsilateral temporoparietal neuralgia, palatal paralysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on the given image, which of the following specimens would not contain filarial worms, considering the presented disease?", "options": [{"label": "A", "text": "Blood", "correct": false}, {"label": "B", "text": "Saliva", "correct": true}, {"label": "C", "text": "Urine", "correct": false}, {"label": "D", "text": "Hydrocele fluid", "correct": false}], "correct_answer": "B. Saliva", "question_images": ["https://image.prepladder.com/content/rXKoy0oAXKvMt04U0lw31746094802.png"], "explanation_images": ["https://image.prepladder.com/content/ZWGGizWRXQ6NzSh7S7NW1746094944.png", "https://image.prepladder.com/content/vpS0PpTBEtPP3uQ1PzIS1746094950.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis of filariasis</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1.</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thick blood film</strong><br/>\n<strong>(Investigation of choice)</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nocturnal microfilariae are seen in blood between 10 PM to 2 AM</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphatic filariasis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brugian/Malayan filariasis</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large, smooth (graceful) curve with countable nuclei</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ullah, Muhammad &amp; Al Balushi, Ahmed &amp; Aliyani, Nader &amp; Kalarikkal, Biju &amp; Miranda, Reeher &amp; Mohamed, Sherif &amp; Habsi, Ahmed &amp; Saidi, Eman &amp; Anver, Adil &amp; Qassem, Nouraldeen.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Full-Size-Microfilaria-Wuchereria-Bancrofti-seen-on-thick-blood-smear-stained-with_fig1_340704206\" data-tags=\"\" height=\"351\" src=\"https://image.prepladder.com/content/ZWGGizWRXQ6NzSh7S7NW1746094944.png\" width=\"351\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small, kinked at an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> angle with a long head and uncountable nuclei</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://picryl.com/media/brugia-malayi-de356c\" data-tags=\"\" height=\"391\" src=\"https://image.prepladder.com/content/vpS0PpTBEtPP3uQ1PzIS1746094950.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid Detection Test</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also called the <strong>filarial strip test</strong></li>\n<li>Used for <strong>monitoring</strong>, mapping, and evaluation activities</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Membrane filter concentration method</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most sensitive methods for detecting low-density microfilaraemia</li>\n<li>Require specialized equipment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DEC <span class=\"customMeta\" data-dictid=\"80806f031b1692777196a8db8c148e\">provocation</span> test:</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A single oral dose of 100mg DEC followed by blood <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> after 1 hour</li>\n<li>Microfilariae can appear in the daytime.</li>\n<li><strong>Highest <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serological tests</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between past and present infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mass blood survey</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thick blood films for epidemiological Survey</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary source of arterial supply for the palatine tonsils among the options provided?", "options": [{"label": "A", "text": "Tonsillar branch of the facial artery", "correct": true}, {"label": "B", "text": "Descending palatine branch of maxillary artery", "correct": false}, {"label": "C", "text": "Buccal branch of maxillary artery", "correct": false}, {"label": "D", "text": "Ascending palatine branch of facial artery", "correct": false}], "correct_answer": "A. Tonsillar branch of the facial artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NGiRwiedCD3SBllzFaGk1746095021.png", "https://image.prepladder.com/content/SSBIYgIMU7EB5POXYC4G1746095021.png", "https://image.prepladder.com/content/WmhotZrqcAXsa9fPq3bG1746095021.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anatomy of <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">Palatine</span> tonsils</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral wall of the <span class=\"customMeta\" data-dictid=\"4356afe522169277719436b593e4b1\">oropharynx</span> between the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pillars.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surface Extensions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upwards into the soft palate, downwards into the base of the tongue, and anteriorly into the <span class=\"customMeta\" data-dictid=\"e9ece0007c1692777194ca3031b229\">palatoglossal</span> arch.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medial Surface Epithelium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Stratified <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> with crypts. </strong></li>\n<li>Crypta magna, or <span class=\"customMeta\" data-dictid=\"d567f07dd1169277719021eebd8d64\">intratonsillar</span> cleft, is located near the upper part of the tonsil.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"223\" src=\"https://image.prepladder.com/content/NGiRwiedCD3SBllzFaGk1746095021.png\" width=\"223\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral Surface</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is covered by a <strong>fibrous <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> separated from the <span class=\"customMeta\" data-dictid=\"2f64b606f6169277720080acdb1d3d\">tonsil</span> bed by loose areolar tissue. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tonsil Bed Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Formed by the <strong>superior constrictor</strong> and <strong>styloglossus muscles.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"236\" src=\"https://image.prepladder.com/content/SSBIYgIMU7EB5POXYC4G1746095021.png\" width=\"236\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arterial Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Tonsillar branch of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> </strong>(main supply)</li>\n<li>Ascending pharyngeal artery</li>\n<li>Ascending <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> artery</li>\n<li>Dorsal <span class=\"customMeta\" data-dictid=\"2d8e6d84411692777191ec7303c17d\">linguae</span> branches of the <span class=\"customMeta\" data-dictid=\"f7c3ba6f1c1692777191e58e8571b0\">lingual</span> artery</li>\n<li>Descending <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> branch of the maxillary artery.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"236\" src=\"https://image.prepladder.com/content/WmhotZrqcAXsa9fPq3bG1746095021.png\" width=\"236\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Venous Drainage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It drains into the <strong>paratonsillar vein</strong>, which joins the common <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> and the pharyngeal <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> plexus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphatic Drainage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flows into the <strong>upper deep <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> nodes.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sensory Nerve Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lesser <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> branches of the <span class=\"customMeta\" data-dictid=\"cc57caf4a21692777199191e19c935\">sphenopalatine</span> <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> (CN V)</strong> and the <strong>glossopharyngeal nerve.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 23-year-old male who has been experiencing eye pain, sensitivity to light, and redness for the last two days, following an injury caused by brushing his eyes against leaves and thorns while gardening?", "options": [{"label": "A", "text": "Simplex keratitis", "correct": false}, {"label": "B", "text": "Bacterial keratitis", "correct": false}, {"label": "C", "text": "Fungal keratitis", "correct": true}, {"label": "D", "text": "Acanthamoeba keratitis", "correct": false}], "correct_answer": "C. Fungal keratitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Causative organism: <strong>Aspergillus fumigatus</strong> &gt;&gt; Fusarium</li>\n<li>Predisposing factor: <strong>Vegetative matter injury</strong> (trauma) <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>SIGNS &gt;&gt; symptoms</strong></li>\n<li>Pain &amp; Foreign Body Sensation</li>\n<li>Watering/ Photophobia</li>\n<li>Blurred Vision, Redness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Corneal Ulcer:</strong> <strong>Greyish-white</strong>, dry, elevated, rolled-out margins</li>\n<li><strong>Pigmented Ulcer:</strong> Brownish, <span class=\"customMeta\" data-dictid=\"0f22e5402f16927771853bb4b7b234\">dematiaceous</span> fungi</li>\n<li><strong>Feathery Extensions:</strong> Finger-like projections in stroma</li>\n<li><strong>Sterile Immune Ring: </strong>Yellow line of demarcation</li>\n<li><strong>Satellite Lesions: </strong>Small lesions around the main ulcer</li>\n<li><strong>Hypopyon:</strong> <strong>Large, immobile, non-sterile</strong>, even in small ulcer</li>\n<li>Perforation: Rare but possible</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal Scraping: For microbiological examination</li>\n<li><strong>Wet KOH Mount:</strong> <span class=\"customMeta\" data-dictid=\"c7247fbd3a1692777202a138609acb\">Filamentous</span> <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> or yeast-like <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> (Candida)</li>\n<li>Culture: <strong>Sabouraud's agar</strong> for fungal culture</li>\n<li>PCR: For rapid identification of pathogens</li>\n<li>Corneal Biopsy: For deep stromal <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> or negative cultures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Topical <span class=\"customMeta\" data-dictid=\"c929a2b71516927771812a8b7b7ec3\">Antifungal</span> Agents:</strong> <strong>Natamycin 5%</strong>, Voriconazole, Amphotericin-B, Nystatin</li>\n<li><strong>Oral <span class=\"customMeta\" data-dictid=\"c929a2b71516927771812a8b7b7ec3\">Antifungal</span> Agents:</strong> Ketoconazole, <strong>Voriconazole</strong> (for severe ulcers)</li>\n<li><strong>Surgical Management:</strong>\n<ul>\n<li>Repeated Scraping: Removal of necrotic material</li>\n<li><strong>Cauterization Options:</strong> <span class=\"customMeta\" data-dictid=\"6d1f123ee21692777183f3fcf75999\">Carbolic acid</span> (100%), <span class=\"customMeta\" data-dictid=\"8c99460f21169277720025f264451b\">Trichloroacetic acid</span> (10%–20%), <span class=\"customMeta\" data-dictid=\"b9fa570d89169277719506ba2ad67e\">Povidone-iodine</span> (5%)</li>\n<li>Therapeutic Keratoplasty: Corneal transplantation</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>BACTERIAL <span class=\"customMeta\" data-dictid=\"f1711947d41692777190ce56ef2f7d\">KERATITIS</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>FUNGAL KERATITIS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>S. aureus (worldwide)</li>\n<li>S. epidermidis (India)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Aspergillus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fluorescein <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> positive ulcer</li>\n<li><strong>Hypopyon (sterile)</strong></li>\n<li><strong>Stromal edema</strong></li>\n<li>Descemet’s <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> folds</li>\n<li>Keratic precipitates due to <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> uveitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Signs &gt;&gt;&gt; symptoms</li>\n<li>Dry/rough ulcer</li>\n<li>Has projecting ends</li>\n<li><strong>Thick immobile unsterile hypopyon</strong></li>\n<li><strong>Satellite nodules</strong> are <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> and have immune reaction- <strong>Wessley ring</strong></li>\n<li>IOP is high</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Empirical monotherapy: Moxifloxacin, gatifloxacin, besifloxacin</li>\n<li>Duo therapy: <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">Gram</span> positive + <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> negative. Combination of <span class=\"customMeta\" data-dictid=\"74e05b271916927771848ff58d86f9\">Cefazolin</span> with <span class=\"customMeta\" data-dictid=\"ca244a562f16927771884ac81c7d2e\">Gentamicin</span> or <span class=\"customMeta\" data-dictid=\"ccdefe2f7e169277718419d6bb8958\">Cefuroxime</span> with Gentamicin.</li>\n<li>Cycloplegics and mydriatics</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Antifungals: <strong>Natamycin 5%</strong>, amphotericin B</li>\n<li>Steroids are contraindicated</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent laryngeal cartilages is least prone to calcification?", "options": [{"label": "A", "text": "Thyroid", "correct": false}, {"label": "B", "text": "Cricoid", "correct": false}, {"label": "C", "text": "Arytenoid", "correct": false}, {"label": "D", "text": "Epiglottis", "correct": true}], "correct_answer": "D. Epiglottis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Y7exBiF0bMc31K66GITu1747902112.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:581px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Type of Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Paired Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Unpaired Cartilage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hyaline Cartilage</strong></p>\n<p>(Calcifies with age)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Arytenoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Thyroid, Cricoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Elastic Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Corniculate, Cuneiform</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Epiglottis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve is accountable for causing ear pain following a tonsillectomy procedure among the options provided?", "options": [{"label": "A", "text": "Glossopharyngeal nerve", "correct": true}, {"label": "B", "text": "Facial nerve", "correct": false}, {"label": "C", "text": "Trigeminal nerve", "correct": false}, {"label": "D", "text": "Vagus nerve", "correct": false}], "correct_answer": "A. Glossopharyngeal nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a neonate who presents with symptoms of photophobia and excessive tearing, along with a clinical examination showing a normal tear passage and a clear, but abnormally large cornea, and the presence of Haab's striae in the eye image below?", "options": [{"label": "A", "text": "Buphthalmos", "correct": true}, {"label": "B", "text": "Keratoconus", "correct": false}, {"label": "C", "text": "Trachoma", "correct": false}, {"label": "D", "text": "Keratoglobus", "correct": false}], "correct_answer": "A. Buphthalmos", "question_images": ["https://image.prepladder.com/content/3RwoNiAYiyFcJ2DUyRZE1746095439.png"], "explanation_images": ["https://image.prepladder.com/content/r0e9Xb3NXO4nNEhBc4qv1747905513.png", "https://image.prepladder.com/content/TYypjtljdoCf48zJS7a11747905528.png", "https://image.prepladder.com/content/OlPpJLeI5PQpWyK556xN1747905540.png", "https://image.prepladder.com/content/Ib5udK2wwRgGYYNXq1bs1747922202.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>Newborn glaucoma/ True <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> glaucoma:</strong> Elevated <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> pressure is present during <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> life, resulting in <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> at birth. Typically presents within the first month of life.</li>\n<li><strong>Infantile:</strong> ≤ 3 yrs of age</li>\n<li><strong>Juvenile:</strong> &gt; 3 yrs of age</li>\n</ul>\n<p> </p>\n<p>(<strong>Buphthalmos:</strong> meaning \"bull-like eyes,\" is a condition characterized by the <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the eyeball. It typically manifests before the age of 3 years and results from the accumulation and <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> of <span class=\"customMeta\" data-dictid=\"0f0067663b16927771818fe253b3b9\">aqueous</span> humor.)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trabeculodysgenesis</li>\n<li>Angle Recess Absence</li>\n<li>Iris Insertion Types\n\t\t\t\t<ul>\n<li>Flat Insertion: Reveals the <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> body and scleral spur.</li>\n<li>Concave Insertion: Obscures the <span class=\"customMeta\" data-dictid=\"d523549f091692777198f5ec70ed9e\">scleral spur</span> and <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> body.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"S. Senthil, S. Badakere, Jonnadula Ganesh, Rashmi Krishnamurthy, Siddharth Dikshit, N. Choudhari, C. Garudadri, A. Mandal\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://www.semanticscholar.org/paper/Profile-of-childhood-glaucoma-at-a-tertiary-center-Senthil-Badakere/bc27a485cc916e6c96e909f8d28a97ba8737b151\" data-tags=\"\" height=\"1627\" src=\"https://image.prepladder.com/content/TYypjtljdoCf48zJS7a11747905528.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Classic Triad:</strong> Lacrimation, photophobia, and blepharospasm; often accompanied by eye rubbing.</li>\n<li><strong>Corneal Signs:</strong>\n<ul>\n<li>Oedema: Early sign, may progress to permanent opacity.</li>\n<li>Enlargement: Corneal <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> &gt;13 mm confirms enlargement; &gt;16 mm indicates poor prognosis.</li>\n</ul>\n</li>\n<li><strong>Haab’s Striae:</strong> Tears in Descemet's membrane, visible as <span class=\"customMeta\" data-dictid=\"1b8aa0db391692777194178f73c98c\">opaque</span> lines.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Maxwell, Giorgina &amp; Souzeau, Emmanuelle.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Ocular-signs-of-childhood-glaucoma-A-Megalocornea-and-corectopia-B-Haab-striae_fig2_383522893\" data-tags=\"\" height=\"3528\" src=\"https://image.prepladder.com/content/OlPpJLeI5PQpWyK556xN1747905540.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Additional Features:\n\t\t\t\t<ul>\n<li><strong>Deep <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> Chamber:</strong> Indicates elevated IOP.</li>\n<li>Optic Disc Changes: Variable <span class=\"customMeta\" data-dictid=\"4d57ccd00f1692777185c371df0426\">cupping</span> and atrophy.</li>\n<li><strong>Raised IOP:</strong> Elevated but not acute.</li>\n<li><strong>Axial Myopia:</strong> Due to increased <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> length.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Direct Goniotomy followed by Trabeculotomy</strong> - preferred management for <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> Glaucoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man presents with a painless genital ulcer, as shown below. A microscopy of a sample from the lesion is also shown below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Granuloma inguinale", "correct": true}, {"label": "B", "text": "Lymphogranuloma venereum", "correct": false}, {"label": "C", "text": "Chancroid", "correct": false}, {"label": "D", "text": "Gonorrhoea", "correct": false}], "correct_answer": "A. Granuloma inguinale", "question_images": ["https://image.prepladder.com/content/sUY9ze9cgYDjRPnbDpxm1746095235.png", "https://image.prepladder.com/content/N08hFctIeZ2qZxaP2Xm91746095251.png"], "explanation_images": ["https://image.prepladder.com/content/y038twajz1N43HLCiY3A1746095496.png", "https://image.prepladder.com/content/dmXj4DZWZrtOsJ5R2yKn1746095505.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Klebsiella granulomatis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Granuloma inguinale</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms:<strong> </strong><strong>Painless, beefy-red genital</strong> or anal ulcers, tissue granulation, <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from lesions</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Donovanosis.JPG\" data-tags=\"\" height=\"263\" src=\"https://image.prepladder.com/content/y038twajz1N43HLCiY3A1746095496.png\" width=\"281\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Microscopy:<strong> Donovan bodies</strong> are seen, they are <span class=\"customMeta\" data-dictid=\"45e0bd1529169277719054d85830ce\">intracytoplasmic</span> inclusions found in macrophages and are a <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> feature of this condition.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC/ Susan Lindsley\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Donovan_bodies_%28Klebsiella_granulomatis%29_PHIL18899.png\" data-tags=\"\" height=\"240\" src=\"https://image.prepladder.com/content/dmXj4DZWZrtOsJ5R2yKn1746095505.png\" width=\"325\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "AKIN and RIFLE criteria is used for classification of which of the folowing coditions?", "options": [{"label": "A", "text": "Acute kidney injury", "correct": true}, {"label": "B", "text": "Chronic kidney failure", "correct": false}, {"label": "C", "text": "Acute glomerulonephritis", "correct": false}, {"label": "D", "text": "Nephrotic syndrome", "correct": false}], "correct_answer": "A. Acute kidney injury", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>SCr/GFR Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Urine Output (UO) Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>R</strong>isk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> × 1.5 or ↓ <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> &gt; 25%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.5 mL/kg/h for 6 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>I</strong>njury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> × 2 or ↓ <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> &gt; 50%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.5 mL/kg/h for 12 hours</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>F</strong>ailure</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> × 3 or ↓ <span class=\"customMeta\" data-dictid=\"1c745475f51692777188c744487e6f\">GFR</span> &gt; 75%</p>\n<p style=\"text-align: center;\">or</p>\n<p style=\"text-align: center;\">Baseline <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> ≥ 353.6 μmol/L (≥ 4 mg/dL) +</p>\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> &gt; 44.2 μmol/L (&gt; 0.5 mg/dL)</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.3 mL/kg/h for 24 hours</p>\n<p style=\"text-align: center;\">or</p>\n<p style=\"text-align: center;\">Anuria for 12 hours</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>L</strong>oss of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Function</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Complete loss of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function for &gt; 4 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>E</strong>nd-Stage <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Complete loss of <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> function for &gt; 3 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Serum <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">Creatinine</span> (SCr) Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Urine Output (UO) Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> ≥ 26.5 μmol/L (≥ 0.3 mg/dL)</p>\n<p style=\"text-align: center;\">or</p>\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> 150–200% (1.5–2 times)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.5 mL/kg/h for &gt; 6 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> &gt; 200–300% (&gt; 2–3 times)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.5 mL/kg/h for &gt; 12 hours</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>3</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Baseline <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> ≥ 353.6 μmol/L (≥ 4 mg/dL) +</p>\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> ≥ 44.2 μmol/L (≥ 0.5 mg/dL)</p>\n<p style=\"text-align: center;\">or</p>\n<p style=\"text-align: center;\">↑ <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> &gt; 300% (&gt; 3 times)</p>\n<p style=\"text-align: center;\">or</p>\n<p style=\"text-align: center;\">Patients requiring <strong>Renal Replacement Therapy (RRT)</strong>, regardless of <span class=\"customMeta\" data-dictid=\"7bb80a07e016927771983c6199892f\">SCr</span> or UO at the time of initiation.</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 0.3 mL/kg/h for 24 hours or</p>\n<p style=\"text-align: center;\">Anuria for 12 hours</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a female patient, aged 65, who visits the outpatient department with symptoms of breathlessness and fatigue? During examination, the patient's neck veins were engorged, and her jugular venous pulse displayed a swift X and Y descent.", "options": [{"label": "A", "text": "Constrictive pericarditis", "correct": true}, {"label": "B", "text": "Cardiac tamponade", "correct": false}, {"label": "C", "text": "Dilated cardiomyopathy", "correct": false}, {"label": "D", "text": "Restricted cardiomyopathy", "correct": false}], "correct_answer": "A. Constrictive pericarditis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Elevated JVP with rapid y descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reflects <strong>rapid early diastolic filling</strong> of the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> due to pressure gradient.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Fatigue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by the heart’s inability to meet <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> demands.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Rapid, low-volume pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Restricted <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> limits stroke volume, weakening the pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pericardial knock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <strong>loud early S3 from the thickened pericardium</strong> during diastolic filling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Kussmaul’s sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paradoxical rise in JVP during inspiration.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hepatomegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> due to i<strong>ncreased <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abdominal fluid accumulation due to <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Peripheral oedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling in the extremities from <strong>fluid retention.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pulsus paradoxus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A fall in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP (10mm Hg) during inspiration, potentially <span class=\"customMeta\" data-dictid=\"8ee21101ac1692777189434bcef126\">impalpable</span> pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Atrial fibrillation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common due to atrial <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> and dilation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following instruments are sterilized by gamma radiation?", "options": [{"label": "A", "text": "Syringes, needles, and catheters", "correct": true}, {"label": "B", "text": "Contaminated clothes and animal carcasses", "correct": false}, {"label": "C", "text": "Gloves and aprons", "correct": false}, {"label": "D", "text": "Bacterial vaccines and intravenous solutions", "correct": false}], "correct_answer": "A. Syringes, needles, and catheters", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ionising</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Features:</p>\n<ul>\n<li><strong>High <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> power</strong></li>\n<li><strong>Sporicidal action +</strong></li>\n<li>Known as <strong>Cold radiation </strong>(do not increase surface heat)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Examples: <span class=\"customMeta\" data-dictid=\"49be0416121692777188dc8944b7bc\">Gamma</span> rays, X-rays, Cosmic rays</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses:</p>\n<ul>\n<li><strong>Plastics, syringes, catheters</strong></li>\n<li><strong>Catgut sutures - <span class=\"customMeta\" data-dictid=\"49be0416121692777188dc8944b7bc\">Gamma</span> (γ) rays</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-ionising</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Features:</p>\n<ul>\n<li>Low <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> power</li>\n<li>Only <span class=\"customMeta\" data-dictid=\"501eeb4a9716927771827a72cc5476\">bactericidal</span> action +</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Examples: UV rays, <span class=\"customMeta\" data-dictid=\"82df9c600116927771907b7977a3b4\">infrared</span> rays</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses:</p>\n<ul>\n<li>Plastics, syringes, catheters</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>DNA damage by <strong>Dimer formation</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quality control agent </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Bacillus pumilus</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A comatose elderly patient with a weight of approximately 70 kilograms is presented to the emergency department. During examination, it was determined that the patient's serum glucose levels were 500mg/dL, arterial pH is 7.30, and there is an elevation in plasma ketones levels. However, the serum potassium levels are within the normal range. In order to treat this patient, which of the following should be added to the saline solution?", "options": [{"label": "A", "text": "Insulin", "correct": true}, {"label": "B", "text": "Bicarbonate", "correct": false}, {"label": "C", "text": "Potassium", "correct": false}, {"label": "D", "text": "14 units of regular insulin intravenously", "correct": false}], "correct_answer": "A. Insulin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tTxJc7cnhWxiv2511b0C1747922138.png", "https://image.prepladder.com/content/bI5u3cHWKaHgf88fN9GD1747922152.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the deformity depicted in the image:", "options": [{"label": "A", "text": "Swan neck deformity", "correct": false}, {"label": "B", "text": "Boutonniere deformity", "correct": true}, {"label": "C", "text": "Z line deformity", "correct": false}, {"label": "D", "text": "Mallet finger deformity", "correct": false}], "correct_answer": "B. Boutonniere deformity", "question_images": ["https://image.prepladder.com/content/zh10VG1RDKkjVP5MrMnV1747902629.png"], "explanation_images": ["https://image.prepladder.com/content/6XxOGLtm1EjCHrwz2v981747902685.png", "https://image.prepladder.com/content/vMlsCGqS8xY50ON9420U1747902638.png", "https://image.prepladder.com/content/04XcG5xEAgrhHLIOTNxL1747902678.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Articular <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> and changes in <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Articular changes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autoimmune <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> mediates <span class=\"customMeta\" data-dictid=\"388a4ccfbf1692777194a8f6a2d3b4\">pannus</span> formation, eroding the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and bone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metacarpophalangeal joint<strong> (MCP)</strong>, <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> <strong>(PIP) </strong>joint and <strong>wrist</strong> joint are involved</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"9\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Deformities</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Swan neck <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Option A)</strong></p>\n<ul>\n<li>Extension at <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint (<strong>PIP</strong>)</li>\n<li>Flexion at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint (<strong>DIP</strong>): The DIP joint is not involved; <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> occurs due to tension on the tendons attached to the base of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> phalanges</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Boutonniere deformity</strong></p>\n<ul>\n<li>Flexion<strong> </strong>at PIP and extension at DIP</li>\n<li>Both swan neck and boutonniere <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> can occur in different fingers of the same hand.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Z-line <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Option C)</strong></p>\n<ul>\n<li><strong>Subluxation </strong>of the first <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> joint.</li>\n<li>Hyperextension of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Rollcloud,\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Z-shaped_deformity.jpg\" data-tags=\"\" height=\"2817\" src=\"https://image.prepladder.com/content/6XxOGLtm1EjCHrwz2v981747902685.png\" width=\"2550\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"3441\" src=\"https://image.prepladder.com/content/vMlsCGqS8xY50ON9420U1747902638.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with flaccid bullous lesions as shown in the image below involving the entire trunk and oral cavity. Acantholytic cells are seen on Tzank smear. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Pemphigus foliaceus", "correct": false}, {"label": "B", "text": "Pemphigus vulgaris", "correct": true}, {"label": "C", "text": "Dermatitis herpetiformis", "correct": false}, {"label": "D", "text": "Bullous pemphigoid", "correct": false}], "correct_answer": "B. Pemphigus vulgaris", "question_images": ["https://image.prepladder.com/content/jfXkgf42MivxktLgzgqc1747902808.png"], "explanation_images": ["https://image.prepladder.com/content/ZHJcfCx33LnxXqzAssTD1747902819.png", "https://image.prepladder.com/content/rMmG72lpCWUuRaZbAxBF1747902828.png", "https://image.prepladder.com/content/chZf4J2ScgRnRaLjiHWd1747902835.png", "https://image.prepladder.com/content/kS9NjW3DgE7F3KXBbg3m1747902890.png", "https://image.prepladder.com/content/NEC724BLFQ1Yso6GWwL51747902901.png", "https://image.prepladder.com/content/v5eLHhCWu62kcQYIJ8YW1747903024.png", "https://image.prepladder.com/content/NJmM5DcMrqbBuNIlgH4R1747970593.png", "https://image.prepladder.com/content/S3PuptMJg3ESe9oZSQf71747903066.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Antigen affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Immunobullous disease-associated</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmoglein 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pemphigus <span class=\"customMeta\" data-dictid=\"dfc66a833816927772038da4307e01\">foliaceous</span> (Subcorneal split)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmoglein 3 &gt; 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pemphigus <span class=\"customMeta\" data-dictid=\"a038b675ea169277720227edae8451\">Vulgaris</span> (Suprabasal split)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmocolin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgA pemphigus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmoplakin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paraneoplastic pemphigus</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pemphigus vulgaris</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pemphigus foliaceus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suprabasal split</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcorneal splits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>DSG 3&gt; 1 is target antigen</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>DSG 1 is target antigen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mucosa involved</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mucosa not involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pemphigus vegetans is the variant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pemphigus Erythematosus ( Senear Usher Syndrome) is a <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> (a/w SLE)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinically present with <span class=\"customMeta\" data-dictid=\"d28003a82c1692777202475273e346\">flaccid</span> blisters and erosions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinically present with erosions and rarely blisters</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:768px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Chronic Bullous Disorder of Childhood</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Dermatitis Herpetiformis</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pemphigus Vulgaris</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pemphigus Foliaceus</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bullous Pemphigoid</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cutaneous Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">Tense</span> vesicles on normal/ urticarial patches</p>\n<p>• <strong>String of pearls </strong>appearance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Polymorphic (small vesicles, erythematous papules, and urticarial plaques) - erosions</p>\n<p>• Crusts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Flaccid blisters • Painful/ persistent erosions and crusts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Exfoliative dermatitis</p>\n<p>• Arcuate, circinate, or <span class=\"customMeta\" data-dictid=\"ce3cc4c1bd16927771967fba44f261\">polycyclic</span> lesions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Large, <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">tense</span> blisters that may be hemorrhagic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Most Common Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Face, Extremities, Genital area, Trunk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extensor surfaces of limbs, Buttocks, Shoulders, Nape of neck, Scalp</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scalp, Face, Upper torso, <strong>Oral <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> only</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Head and neck</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acral (palms and soles),<strong> Flexural areas</strong> (inner thighs, axillae, and groin)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pruritus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>±</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>++++</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>± to +++</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mucosal Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequent and severe</p>\n<p><strong>(oral <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> mostly)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Target antigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LAD 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epidermal <span class=\"customMeta\" data-dictid=\"8da830779416927772004eec86224b\">trans</span> <span class=\"customMeta\" data-dictid=\"0f74dab81916927771887fc3d3c5aa\">glutaminase</span> 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dsg 1, 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dsg 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BPAG2/ BPAG1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HLA DQ2, DQ8.</strong></p>\n<p>Commonly associated with <strong>gluten sensitive enteropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ ve nikolsky sign,</p>\n<p>Bulla spread sign: <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> angulated margins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>- ve nikolsky sign, Bulla spread sign: regular round margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• <strong>Subepidermal blisters </strong></p>\n<p>• Inflammatory <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> with eosinophils and neutrophils</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Subepidermal blisters with <span class=\"customMeta\" data-dictid=\"041f0e547a1692777193350b3f7d39\">neutrophilic</span> microabscesses within <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> papillae</p>\n<p>• Fibrin deposition • Granular deposits of IgA within <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> papillae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Acantholysis</p>\n<p>(Suprabasal split)</p>\n<p>• <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">Dermal</span> <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> (lymphocytes, eosinophils and neutrophils)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Subtle acantholysis</p>\n<p>• <strong>Subcorneal </strong>separation</p>\n<p>• <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">Dermal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> ± eosinophils</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>• Subepidermal blisters with eosinophilia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Direct Immunofluorescence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Linear <strong>IgA </strong>along <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> junction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Granular deposits of IgA within <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> papillae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgG deposition around keratinocytes (fish net or <span class=\"customMeta\" data-dictid=\"b8938475cf1692777185ca43d57b41\">crazy paving</span> pattern)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deposition of IgG around keratinocytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Linear deposits of IgG or C3 at basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> zone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Díaz, M.S. &amp; Morita, L. &amp; Ferrari, Bruno &amp; Sartori, S. &amp; Greco, M.F. &amp; Bonells, L. &amp; González-Enseñat, M.A. &amp; Villa, M.A. &amp; Larralde, Margarita. \" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/Direct-immunofluorescence-findings-in-linear-IgA-bullous-dermatosis-Note-the-linear-IgA_fig3_335686136\" data-tags=\"\" height=\"607\" src=\"https://image.prepladder.com/content/kS9NjW3DgE7F3KXBbg3m1747902890.png\" width=\"846\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Michael Occidental, M.D., Randie H. Kim, M.D., Ph.D.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/imgau/skinnontumordermatitisherpetiformisKim02.jpg\" data-tags=\"\" height=\"3016\" src=\"https://image.prepladder.com/content/NEC724BLFQ1Yso6GWwL51747902901.png\" width=\"4015\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Reunala, Timo &amp; Salmi, Teea &amp; Hervonen, Kaisa &amp; Kaukinen, Katri &amp; Collin, Pekka. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/publication/325122702/figure/fig1/AS:11431281211273433@1702371758088/Dermatitis-herpetiformis-Typical-scratched-papules-and-macules-on-the-elbows-A-and-on.tif\" data-tags=\"\" height=\"2359\" src=\"https://image.prepladder.com/content/v5eLHhCWu62kcQYIJ8YW1747903024.png\" width=\"3928\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jeffrey N. Li ∙ Parth Patel ∙ Cristian Gonzalez ∙ Travis Vandergriff ∙ Heather Goff\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.jaadcasereports.org/article/S2352-5126(21)00141-7/fulltext\" data-tags=\"\" height=\"3778\" src=\"https://image.prepladder.com/content/NJmM5DcMrqbBuNIlgH4R1747970593.png\" width=\"3526\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Liza Mohapatra,Kallolinee Samal,Prasenjeet Mohanty,Siddhartha Dash\" data-hash=\"\" data-license=\"CC BY-NC-SA\" data-source=\"https://www.researchgate.net/figure/Bullous-pemphigoid-Direct-immunofluorescence-study-showing-linear-immunoglobulin-G-and_fig1_334253361\" data-tags=\"\" height=\"907\" src=\"https://image.prepladder.com/content/S3PuptMJg3ESe9oZSQf71747903066.png\" width=\"1198\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First-line Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dapsone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dapsone, Gluten-free diet (<strong>B</strong>arley, <strong>R</strong>ye, <strong>O</strong>ats, <strong>W</strong>heat)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High dose <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> corticosteroids,</p>\n<p><strong>Cyclophosphamide</strong> ( s/e hemorrhagic cystitis), <strong>Rituximab:</strong> <span class=\"customMeta\" data-dictid=\"4665fdd0a0169277718100f58eb0d5\">anti</span> CD 20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systemic or <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> corticosteroids</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low dose <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> corticosteroids</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most common site for head and neck cancer in India?", "options": [{"label": "A", "text": "Nasopharynx", "correct": false}, {"label": "B", "text": "Oropharynx", "correct": false}, {"label": "C", "text": "Oral cavity", "correct": true}, {"label": "D", "text": "Hypopharynx", "correct": false}], "correct_answer": "C. Oral cavity", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Addison's disease is characterized by all of the following symptoms except?", "options": [{"label": "A", "text": "Hyperglycemia", "correct": true}, {"label": "B", "text": "Hyponatremia", "correct": false}, {"label": "C", "text": "Hyperkalemia", "correct": false}, {"label": "D", "text": "Hypotension", "correct": false}], "correct_answer": "A. Hyperglycemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Autoimmune: M/C/C Worldwide\n\t\t\t\t<ul>\n<li>Sporadic</li>\n<li>Polyglandular syndromes</li>\n</ul>\n</li>\n<li>Tuberculosis: M/C/C in India</li>\n<li>Histoplasmosis</li>\n<li>HIV/AIDS</li>\n<li>Metastatic carcinoma</li>\n<li>Bilateral adrenalectomy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Glucocorticoid insufficiency:\n\t\t\t\t<ul>\n<li>Weight loss, anorexia, malaise, weakness, nausea, vomiting, <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> or constipation, postural hypotension, shock, hypoglycemia, <strong>hyponatremia (Option B) </strong>(dilutional), hypercalcemia</li>\n</ul>\n</li>\n<li>Mineralocorticoid insufficiency:\n\t\t\t\t<ul>\n<li><strong>Hypotension (Option D)</strong>, shock, hyponatremia, <strong>hyperkalemia (Option C)</strong></li>\n</ul>\n</li>\n<li>ACTH excess: Pigmentation</li>\n<li>Adrenal <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> insufficiency: Decreased body hair and loss of libido, especially in females</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 year old female patient with fever and malar rashes was found to have vegetations on either side of the heart valves. What can be the diagnosis of the patient?", "options": [{"label": "A", "text": "Infective endocarditis", "correct": false}, {"label": "B", "text": "Libman sacks endocarditis", "correct": true}, {"label": "C", "text": "Rheumatic Heart Disease", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Libman sacks endocarditis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2LR5q0qjdUq3axKFrjG31747904112.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Systemic Involvement in SLE</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulmonary system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pleuritis (most common): </strong>Prevalence (30 - 50%)</li>\n<li>Pneumonitis</li>\n<li>Atelectasis</li>\n<li>Reduced lung volume and</li>\n<li>Pulmonary fibrosis</li>\n<li>Shrinking lung syndrome, (&lt; 5%)</li>\n<li>Intra-alveolar hemorrhage</li>\n<li>Pulmonary HTN (&lt; 5 %)<strong> (Option C)</strong></li>\n<li>Acute Respiratory Distress Syndrome (ARDS) (&lt; 5%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Musculoskeletal system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is the most <strong>commonly involved system</strong></li>\n<li>Polyarthritis (<strong>symmetrical)</strong></li>\n<li>Polyarthralgia</li>\n<li><strong>Rheumatoid arthritis</strong></li>\n<li><strong>Myositis</strong></li>\n<li><strong>Jaccoud arthropathy</strong> is a <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> caused by <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> laxity, <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> fibrosis, and <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> imbalance.</li>\n<li>Axial skeletal involvement is uncommon.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"A. Najm, B. Le Goff, A. Achille, O. Espitia, C. Durant, F. Perrin, C. Agard\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/%5BThree-cases-of-Jaccoud%27s-arthropathy-during-Najm-Goff/f933e204973a6fe2477e6c41c5b29e3cac6436bd\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/2LR5q0qjdUq3axKFrjG31747904112.png\" width=\"3391\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Lupus <span class=\"customMeta\" data-dictid=\"d4d4bbdd341692777193b705a75667\">nephritis</span> (most common)</strong></li>\n<li>Proteinuria</li>\n<li>Nephrotic syndrome</li>\n<li>Rarely End-stage Renal Disease (ESRD)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nervous system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Headache, Seizures, Stroke, Polyneuropathy, TIA, Acute confusional state, Movement disorder, Aseptic meningitis, Myelopathy, Psychosis and Mood disorders.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiovascular system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease - common <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> </strong></li>\n<li>Pericarditis</li>\n<li>Coronary vasculitis</li>\n<li>Myocarditis</li>\n<li><strong>Libman sacks endocarditis</strong></li>\n<li>Accelerated atherosclerosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hematological manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anemia of chronic disease</li>\n<li>Leucopenia</li>\n<li>Lymphopenia</li>\n<li>Thrombocytopenia</li>\n<li>Autoimmune Hemolytic anemia-MCC of <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> in SLE</li>\n<li>Splenomegaly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>GI involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abdominal pain</li>\n<li>Nausea, diarrhoea</li>\n<li>Abnormal liver enzymes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ocular manifestation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sicca syndrome: <strong>Dry eyes (keratoconjunctivitis sicca) </strong>and<strong> <span class=\"customMeta\" data-dictid=\"e3afd7f63b1692777186b9a6e7824d\">dry mouth</span> (xerostomia).</strong></li>\n<li>Conjunctivitis</li>\n<li><strong>Episcleritis</strong></li>\n<li>Vasculitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a man of 45 years who arrives at the emergency department with an abrupt loss of vision and experiencing painful movements of the eye? Upon examination, a relative afferent pupillary defect is observed in the affected eye. Further visual field testing demonstrates a central scotoma in the same eye.", "options": [{"label": "A", "text": "Optic nerve glioma", "correct": false}, {"label": "B", "text": "Optic neuritis", "correct": true}, {"label": "C", "text": "Eale’s disease", "correct": false}, {"label": "D", "text": "Neuroretinitis", "correct": false}], "correct_answer": "B. Optic neuritis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/toqTtID3hNwMtocFl3TZ1746096588.png", "https://image.prepladder.com/content/eCNW1rfATWJBuPpnWiVn1746096588.png", "https://image.prepladder.com/content/dd86kU1AP9gY0sAMgiS81747905662.png", "https://image.prepladder.com/content/foI8CwDQRTiVDg14T7p71747905655.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td colspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Classification of <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> neuritis:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Papillitis </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Retrobulbar <span class=\"customMeta\" data-dictid=\"6e951a16031692777193af1c351309\">Neuritis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuroretinitis (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Optic disc</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Optic nerve behind the eyeball.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Optic disc and surrounding <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> in the <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> area.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fundoscopy reveals a blurred disc margin due to leakage and increased <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> permeability, edematous and hyperaemic disc, and <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> cup is obliterated.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Rui Zhang, Jiang Qian, Jie Guo, Yifei Yuan, Kang Xue, Han Yue, Ling Chen\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1155/2016/2797028\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/toqTtID3hNwMtocFl3TZ1746096588.png\" width=\"256\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain on eye elevation</li>\n<li><strong>RAPD (relative <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> pupillary defect)</strong> is observed.</li>\n<li>Fundoscopic examination typically reveals normal <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc, at least initially, which is why the classic phrase, “the patient sees nothing, and the doctor sees nothing” is often used to describe <span class=\"customMeta\" data-dictid=\"99ac6e31f71692777197220f87effc\">retrobulbar</span> neuritis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A <strong>macular star</strong> is seen in fundoscopy (accumulation of lipids).</li>\n<li><strong>Optic atrophy</strong> present</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Viswanath Gajula, Ravi Kamepalli, Jagadeesh K. Kalavakunta\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1002/ccr3.43\" data-tags=\"\" height=\"214\" src=\"https://image.prepladder.com/content/eCNW1rfATWJBuPpnWiVn1746096588.png\" width=\"267\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visual loss: <strong>Monocular sudden, progressive and profound visual loss</strong> is the hallmark of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuritis.</li>\n<li>Dark <span class=\"customMeta\" data-dictid=\"c623a72bdd16927771808d60122016\">adaptation</span> may be lowered.</li>\n<li>Visual obscuration in bright light is a typical symptom of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuritis.</li>\n<li>Impairment of <span class=\"customMeta\" data-dictid=\"c82cc1010816927771859bbfde816b\">color vision</span> is always present in <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuritis.</li>\n<li><strong>Uhthoff's symptom: </strong>Episodic <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> obscuration of vision on exertion and on exposure to heat, which recovers on resting or moving away from the heat, occurs in patients with isolated <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> neuritis.</li>\n<li><strong>Pulfrich's phenomenon:</strong> Depth perception may be impaired, particularly for the moving object.</li>\n<li>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> is usually <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> markedly.</li>\n<li>Visual field changes: The most common field <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> <span class=\"customMeta\" data-dictid=\"6e951a16031692777193af1c351309\">neuritis</span> is a relative central or <span class=\"customMeta\" data-dictid=\"fd318be9d4169277718460949f7037\">centrocecal</span> scotoma.</li>\n<li>Contrast sensitivity is impaired.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> neuritis:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conservative management</strong></p>\n<p>(Observation and Monitoring)</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild symptoms</li>\n<li>Known history of similar episodes</li>\n</ul>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Many cases improve spontaneously.</li>\n<li>Suitable for mild symptoms but not recommended for severe cases or first episodes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High-Dose Corticosteroids</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe vision loss</li>\n<li>No history of previous episodes</li>\n<li>MRI evidence of demyelination</li>\n</ul>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intravenous <span class=\"customMeta\" data-dictid=\"c3adf9f403169277719294351e8fb8\">methylprednisolone</span> (1 g daily for 3 days) followed by oral <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> taper as established by the ONTT trial (Optic <span class=\"customMeta\" data-dictid=\"6e951a16031692777193af1c351309\">Neuritis</span> Treatment Trial).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a 14-year-old male who has been experiencing repeated nosebleeds, without any history of injury, along with nasal blockage and excessive nasal discharge? During examination, a solid, purplish growth is observed on the back of the nasopharynx.", "options": [{"label": "A", "text": "Nasopharyngeal carcinoma", "correct": false}, {"label": "B", "text": "Rhabdomyosarcoma", "correct": false}, {"label": "C", "text": "Pyogenic granuloma", "correct": false}, {"label": "D", "text": "Juvenile nasopharyngeal angiofibroma", "correct": true}], "correct_answer": "D. Juvenile nasopharyngeal angiofibroma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Juvenile <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site of Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, near the superior margin of the <span class=\"customMeta\" data-dictid=\"cc57caf4a21692777199191e19c935\">sphenopalatine</span> foramen, where the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> and <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> bones meet.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gross Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reddish-purple, lobulated, <span class=\"customMeta\" data-dictid=\"3f6a2302971692777198a107e73204\">sessile</span> mass covered by mucosa; lacks a <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> despite being benign.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopic Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vascular Tissue: Endothelium-lined spaces with incomplete/absent muscle coats, leading to bleeding; <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> vessels are thin-walled, central vessels hyperplastic.</li>\n<li>Stromal Cells: <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">Stellate</span> or spindle-shaped cells that produce collagen, affecting tumor firmness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunohistochemistry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fibroblasts, collagen, myofibroblasts, <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells, and occasionally giant cells are present.</li>\n<li>Reactivity to smooth muscle <span class=\"customMeta\" data-dictid=\"8e023fb81e16927771802d21820404\">actin</span> and beta-catenin, suggesting beta-catenin’s role in growth.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Growth Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>JNA development likely results from a combination of hormonal influence, growth factors, and genetic factors.</li>\n<li>Androgen Receptors: Present in 75% of JNA tumors, indicating male hormone involvement.</li>\n<li>VEGF: Promotes endothelial and stromal cell growth.</li>\n<li>IGF-II: Role is less clear.</li>\n<li>Genetics: C-MYC <span class=\"customMeta\" data-dictid=\"07aa4138b11692777196389334280a\">proto-oncogene</span> found in larger tumors; may interact with <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> and beta-catenin genes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions leads to the development of wing beating tremor?", "options": [{"label": "A", "text": "Wilson’s disease", "correct": true}, {"label": "B", "text": "Huntington’s chorea", "correct": false}, {"label": "C", "text": "Parkinsonism", "correct": false}, {"label": "D", "text": "Sydenham’s chorea", "correct": false}], "correct_answer": "A. Wilson’s disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features of Wilson's Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hepatic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic Hepatitis: <strong>Jaundice,</strong> hepatomegaly, elevated liver enzymes due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in the liver.</li>\n<li>Cirrhosis: <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">Portal</span> hypertension, <strong>variceal bleeding</strong> as a result of long-term <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation and fibrosis.</li>\n<li>Acute Liver Failure<strong>: Coagulopathy,</strong> jaundice, <strong>encephalopathy.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurological Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Movement Disorders: Tremors (flapping or wind-beating tremor), </strong>dystonia, ataxia, <span class=\"customMeta\" data-dictid=\"faa6bb18b11692777186c6a26198e2\">dysarthria</span> due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</li>\n<li><strong>Parkinsonism-like symptoms :</strong> Rigidity, bradykinesia, <span class=\"customMeta\" data-dictid=\"42b8208bad1692777185be9de842a0\">cogwheel rigidity</span> from <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</li>\n<li><strong>Psychiatric:</strong> Depression, personality changes, cognitive decline.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ocular Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Kayser-Fleischer Rings:</strong> Brown/greenish rings in the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> deposition in <strong>Descemet's membrane</strong>.</li>\n</ul>\n<p> </p>\n<ul>\n<li><strong>Sunflower Cataract: </strong>Rare, (copper deposition in the lens).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">Acidosis</span> (Fanconi Syndrome): </strong>Due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubules.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hematologic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hemolytic Anemia: </strong>Copper-induced red cell damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skeletal Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Osteopenia, osteoporosis, joint arthropathy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An El Tor Vibrio was identified as the causative agent of a diarrhea epidemic. Which of the following is not a characteristic feature of this organism?", "options": [{"label": "A", "text": "Resistant to El Tor phage V", "correct": true}, {"label": "B", "text": "Intrinsic resistance to polymyxin B", "correct": false}, {"label": "C", "text": "Voges-Proskauer test is positive", "correct": false}, {"label": "D", "text": "Not susceptible to group IV phage", "correct": false}], "correct_answer": "A. Resistant to El Tor phage V", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests/Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>El Tor</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tests:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemolysis of sheep RBCs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Voges-Proskauer </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chick <span class=\"customMeta\" data-dictid=\"64e0895e441692777187dad4949f29\">erythrocyte</span> <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">agglutination</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Polymyxin B sensitivity </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensitive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resistant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Group IV <span class=\"customMeta\" data-dictid=\"d40be13a521692777194d54f866a62\">phage</span> <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Susceptible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not susceptible</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>El Tor <span class=\"customMeta\" data-dictid=\"d40be13a521692777194d54f866a62\">phage</span> 5 <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not susceptible</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Susceptible</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Others:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mortality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carrier rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young lady presented to the ENT OPD with a history of sudden onset unilateral hearing loss, tinnitus, and dizziness following an episode of acute otitis media two weeks back. Rinne’s test and fistula test were positive. She had refused treatment then and currently came with complaints of worsened hearing loss in the affected ear. On examination, the fistula test was negative. What would be the most likely finding on the Rinne test in this scenario?", "options": [{"label": "A", "text": "True positive", "correct": true}, {"label": "B", "text": "True negative", "correct": false}, {"label": "C", "text": "False positive", "correct": false}, {"label": "D", "text": "False negative", "correct": false}], "correct_answer": "A. True positive", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the most likely diagnosis for a 5-year-old boy presenting with severe itching, sensitivity to light, and sticky discharge from his eyes. Upon examination the following findings were seen?", "options": [{"label": "A", "text": "Trachoma", "correct": false}, {"label": "B", "text": "Vernal keratoconjunctivitis", "correct": true}, {"label": "C", "text": "Phlyctenular conjunctivitis", "correct": false}, {"label": "D", "text": "Xerophthalmia", "correct": false}], "correct_answer": "B. Vernal keratoconjunctivitis", "question_images": ["https://image.prepladder.com/content/OmKJLb5QGkj1j6f3k00I1746096747.png"], "explanation_images": ["https://image.prepladder.com/content/otPlf3cqIFEJfpP1Gabo1746096884.png", "https://image.prepladder.com/content/lQD9kjl93spM0gD5dRVD1747905701.png", "https://image.prepladder.com/content/B7d14GFPOTralGYrE9lT1746096884.png", "https://image.prepladder.com/content/BqMMZvcqzX1WIL2JchBK1746096884.png", "https://image.prepladder.com/content/Fp7w176wIXnUrZ6HqNxg1746096884.png", "https://image.prepladder.com/content/ZCYrlTsBu9ex7yJLvKBD1746096884.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:596px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<ul>\n<li>It is a <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"6ce77d5f5e1692777185cf7f8a67cd\">conjunctivitis</span> that tends to occur with the onset of warm weather. It primarily affects young children and adolescents, particularly boys.</li>\n<li><strong>Type I &amp; IV HSR reaction &gt; Type IV HSR</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Course </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>The condition typically starts in childhood and may resolve on its own over 5–10 years.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Burning, Itching, Photophobia (sensitivity to light), and <span class=\"customMeta\" data-dictid=\"7b8d2e6b3a1692777191cfff333306\">lacrimation</span> (excessive tearing).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Palpebral Form: Hypertrophied palpebral <span class=\"customMeta\" data-dictid=\"d168af6e7f1692777185683fea5e7f\">conjunctiva</span> with a <strong>cobblestone appearance</strong>; bluish-white color; dense <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue with thickened epithelium.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Addis H, Jeng BH\" data-hash=\"\" data-license=\"CC BY NC\" data-source=\"https://www.dovepress.com/vernal-keratoconjunctivitis-peer-reviewed-fulltext-article-OPTH\" data-tags=\"\" height=\"290\" src=\"https://image.prepladder.com/content/otPlf3cqIFEJfpP1Gabo1746096884.png\" width=\"399\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Limbal or Bulbar Form: Opacification at the limbus, <span class=\"customMeta\" data-dictid=\"be6fe9c6c316927771889dbaaf2b89\">gelatinous</span> thickening, and <strong>Horner–Trantas dots</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jodhbir Singh Mehta, Wei-Li Chen, Arthur C. K. Cheng, Le Xuan Cung, Ivo J. Dualan, Ramesh Kekunnaya, Nurliza Khaliddin, Tae-Im Kim, Douglas K. Lam, Seo Wei Leo, Florence Manurung, Nattaporn Tesavibul, Dominique Bremond-Gignac\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Horner-Trantas-dots-Peri-limbal-Horner-Trantas-dots-are-focal-white-dots-consisting-of_fig5_362403730\" data-tags=\"\" height=\"193\" src=\"https://image.prepladder.com/content/lQD9kjl93spM0gD5dRVD1747905701.png\" width=\"880\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Pseudogerontoxon/cupid’s bow </strong>(which resembles <span class=\"customMeta\" data-dictid=\"e11c93da8d1692777182758f2163d6\">arcus</span> senilis) is a grayish-white ring at the <span class=\"customMeta\" data-dictid=\"799979f3bc169277719134cd535c7c\">limbus</span> seen in severe <span class=\"customMeta\" data-dictid=\"71928251b41692777191a31e57c47f\">limbal</span> <span class=\"customMeta\" data-dictid=\"b2a2e3ba5c1692777201528ac05837\">vernal</span> <span class=\"customMeta\" data-dictid=\"8b4e6e36bb169277719032f22681c2\">keratoconjunctivitis</span> (VKC).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Seyfettin Erdem\" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Limbal-type-VKC-pseudogerontoxone-image-palpebral-papilla-64-patients-447-limbal_fig3_336972956\" data-tags=\"\" height=\"271\" src=\"https://image.prepladder.com/content/B7d14GFPOTralGYrE9lT1746096884.png\" width=\"456\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Shield ulcers</strong> are a significant <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of VKC, particularly in severe cases. These microerosions typically <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> on the upper third of the cornea.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Yusuke Matsuzaki, Hiroshi Toshida, Toshihiko Ohta, Akira Murakami\" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Slitlamp-microscopic-image-of-a-25-year-old-man-showing-corneal-shield-ulcer-at-40-days_fig1_236941145\" data-tags=\"\" height=\"359\" src=\"https://image.prepladder.com/content/BqMMZvcqzX1WIL2JchBK1746096884.png\" width=\"470\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Mixed form: Exhibits characteristics of both the <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> (palpebral) and <span class=\"customMeta\" data-dictid=\"71928251b41692777191a31e57c47f\">limbal</span> subtypes, typically presenting in only one eye.</li>\n<li><strong>Maxwell Lyon's sign</strong> is a <span class=\"customMeta\" data-dictid=\"a952f661da169277719691c48c8cbe\">pseudomembrane</span> formed due to excessive <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> deposition on the <span class=\"customMeta\" data-dictid=\"0a6b15e83616927771941190f46a83\">papilla</span> resulting in cobblestone papillae.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Alexandre Xavier Costa, José Álvaro Pereira Gomes, Leonardo Guedes Candido Marculino, Vera Lucia Liendo, Telma Pereira Barreiro, Myrna Serapião dos Santos\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Efficacy-of-supratarsal-triamcinolone-injection-after-1-week-on-the-upper-tarsal_fig1_318869687\" data-tags=\"\" height=\"291\" src=\"https://image.prepladder.com/content/Fp7w176wIXnUrZ6HqNxg1746096884.png\" width=\"364\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>In the palpebral form, hypertrophied <span class=\"customMeta\" data-dictid=\"c948d4dca7169277719474a468ff5e\">papillae</span> are observed, rich in eosinophils and other <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Topical therapy: </strong>\n<ul>\n<li>Antihistamines - Levocabastine &amp; emedastine</li>\n<li>Mast cell stabilizers - Sodium cromoglicate</li>\n<li>Mild steroids - Fluorometholone and <span class=\"customMeta\" data-dictid=\"1ef009aee816927771912e72480697\">loteprednol</span> etabonate,</li>\n<li>Acetylcysteine can control <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> mucus.</li>\n</ul>\n</li>\n<li>Local therapy: Subtarsal <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> injections and <span class=\"customMeta\" data-dictid=\"7a2baeba7416927771858fcddc798f\">cryotherapy</span> for severe cases.</li>\n<li>Surgical treatment: Excision of giant <span class=\"customMeta\" data-dictid=\"c948d4dca7169277719474a468ff5e\">papillae</span> and treatment of <span class=\"customMeta\" data-dictid=\"018fabee35169277719835cd1bf49c\">shield</span> ulcers with debridement and <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> or <span class=\"customMeta\" data-dictid=\"4f62176420169277718214bfcafae5\">bandage</span> contact lens.</li>\n<li>Cold compresses and tinted <span class=\"customMeta\" data-dictid=\"9e8e9086691692777188b5a212bcc7\">glasses</span> for comfort.</li>\n<li>Avoid eye rubbing</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes the Little's area?", "options": [{"label": "A", "text": "Keisselbach’s plexus is present in the Little’s area", "correct": true}, {"label": "B", "text": "It is situated at the posteroinferior part of the nasal septum", "correct": false}, {"label": "C", "text": "Least common site for epistaxis", "correct": false}, {"label": "D", "text": "Anastomoses of 7 major arteries occur here", "correct": false}], "correct_answer": "A. Keisselbach’s plexus is present in the Little’s area", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lWN9I33ZT5Z98f5tIIrX1746097061.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:541px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Branch of</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sphenopalatine artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maxillary artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ophthalmic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (from internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Greater <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maxillary artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"59733f304e1692777191d9deb34f10\">labial</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Facial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (from external <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the Battle sign?", "options": [{"label": "A", "text": "Mastoid ecchymosis", "correct": true}, {"label": "B", "text": "Periorbital hematoma", "correct": false}, {"label": "C", "text": "Bezold abscess", "correct": false}, {"label": "D", "text": "Perichondritis", "correct": false}], "correct_answer": "A. Mastoid ecchymosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly patient was rushed to the casualty following bouts of severe breathlessness. He reported a history of fever and cough for the past 3 days. Lab tests were done, and target sequences for the RdRp gene, E gene, N gene, and ORF1 were detected. What was the test done?", "options": [{"label": "A", "text": "CLIA", "correct": false}, {"label": "B", "text": "ELISA", "correct": false}, {"label": "C", "text": "CBNAAT", "correct": false}, {"label": "D", "text": "Real-time RT-PCR", "correct": true}], "correct_answer": "D. Real-time RT-PCR", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of fever for the past 4 days and sudden onset of breathlessness was admitted to ICU as he was deteriorating. He was unresponsive to the incremental flow rate of oxygen and his oxygen saturation was progressively decreasing. A chest x-ray was ordered and the findings are shown in the image below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Atelectasis", "correct": false}, {"label": "B", "text": "Mediastinitis", "correct": false}, {"label": "C", "text": "Pulmonary fibrosis", "correct": false}, {"label": "D", "text": "ARDS", "correct": true}], "correct_answer": "D. ARDS", "question_images": ["https://image.prepladder.com/content/CDbQauhz3glnM8DwUbqJ1746096745.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the context of medical treatment, the V-Y procedure is employed for which of the subsequent conditions?", "options": [{"label": "A", "text": "Entropion", "correct": false}, {"label": "B", "text": "Ectropion", "correct": true}, {"label": "C", "text": "Blepharophimosis", "correct": false}, {"label": "D", "text": "Ptosis", "correct": false}], "correct_answer": "B. Ectropion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Ectropion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Involutional Ectropion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Most common; age-related</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Horizontal laxity</li>\n<li>Canthal <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> laxity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Epiphora</li>\n<li>Tarsal thinning</li>\n<li>Lagophthalmos</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medial <span class=\"customMeta\" data-dictid=\"08ad217507169277718520a894eb90\">conjunctivoplasty</span> for mild cases.</li>\n<li>Horizontal lid shortening for moderate cases.</li>\n<li><strong>Byron Smith's modified Kuhnt-Szymanowski operation</strong> for severe cases.</li>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> strip technique for generalized ectropion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cicatricial Ectropion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Scarring of <strong>anterior </strong>lamella</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trauma/surgery</li>\n<li>Scarring conditions (e.g., blepharitis)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Scarring</li>\n<li>Skin fibrosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild cases: <strong>V-Y operation. (Option B)</strong></li>\n<li>Mild to moderate cases: Z-plasty (Elschnig's operation).</li>\n<li>Severe cases: <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> of <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue and full-thickness skin grafting.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paralytic Ectropion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Facial nerve <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> (Bell’s)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bell’s palsy</strong></li>\n<li>Trauma/surgery</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Exposure keratopathy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temporary measures: <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">Topical</span> lubricants, <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> taping, <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> tarsorrhaphy.</li>\n<li>Permanent measures (if needed): <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">Horizontal</span> lid tightening with/without middle <span class=\"customMeta\" data-dictid=\"95dc7047f41692777191f225afb261\">lamellar</span> buttress, palpebral <span class=\"customMeta\" data-dictid=\"5e2a7b127c1692777198f4895cc7c0\">sling</span> operation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanical Ectropion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mass or <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> pushing eyelid</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tumors</li>\n<li>Conjunctival growths</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eyelid displacement</li>\n<li>Conjunctival chemosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Treat the underlying mechanical causes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Congenital Ectropion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Present at birth</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tarsal plate atrophy</li>\n<li><strong>Down syndrome</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Associated <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> malformation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild cases may not require treatment.</li>\n<li>Moderate or severe cases: <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">Horizontal</span> lid tightening and full-thickness skin graft.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred medication for treating Hyperthyroidism during the second trimester of pregnancy?", "options": [{"label": "A", "text": "Propyl Thiouracil", "correct": false}, {"label": "B", "text": "Carbimazole", "correct": true}, {"label": "C", "text": "Sodium iodide", "correct": false}, {"label": "D", "text": "Radioactive iodine", "correct": false}], "correct_answer": "B. Carbimazole", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"df46bcd43116927771892090901263\">Hyperthyroidism</span> in Pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First Trimester:</strong></p>\n<ul>\n<li>Propylthiouracil 100-300mg/day (three times daily)</li>\n<li>Mechanism: Inhibits hormone <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> + <span class=\"customMeta\" data-dictid=\"22d375381416927772009663d54998\">Thyroxine</span> to Triiodothyronine conversion</li>\n</ul>\n<p><strong>Second/Third Trimester:</strong></p>\n<ul>\n<li>Methimazole 5-15mg/day (once daily)</li>\n</ul>\n<p><strong>Monitoring:</strong></p>\n<ul>\n<li>Thyroid Function Tests every 2-4 weeks</li>\n<li>Thyroid Stimulating Hormone <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Antibodies: 18-22 weeks, 30-34 weeks</li>\n<li>Target: <span class=\"customMeta\" data-dictid=\"47e1c1b38d1692777203e28eaf2e19\">Free Thyroxine</span> upper normal, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> Stimulating Hormone slightly low</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thyroid Storm Protocol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Propanolol</li>\n<li>Potassium Iodide/Lugol's solution (60 minutes post-antithyroid drugs)</li>\n<li>Propylthiouracil/Methimazole administration</li>\n<li>Glucocorticoids</li>\n<li>Intensive care support</li>\n<li>Mortality: 20-30% if untreated</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Teratogenicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Methimazole Embryopathy:</strong></p>\n<ul>\n<li>Aplasia cutis</li>\n<li>Choanal/esophageal atresia</li>\n<li>Dysmorphic facies</li>\n</ul>\n<p><strong>PTU Associated:</strong></p>\n<ul>\n<li>Isolated anomalies</li>\n<li>Situs inversus</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> malformations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Radioactive iodine</li>\n<li>First <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> thyroidectomy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fetal Surveillance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ultrasound markers:</strong></p>\n<ul>\n<li>Thyroid dimensions</li>\n<li>Fetal heart rate (&gt;160/min significant)</li>\n<li>Growth parameters</li>\n<li>Hydrops features</li>\n<li>Bone maturation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A COVID patient presented with fever, nasal congestion, and unilateral headache. Later, he developed facial pain and numbness, along with a blackish lesion. On Sabouraud Dextrose Agar (SDA), a cotton-wooly growth is seen. H&amp;amp;E staining shows non-septate hyphae branching at right angles/obtuse angles. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Aspergillosis", "correct": false}, {"label": "B", "text": "Bacterial orbital cellulitis", "correct": false}, {"label": "C", "text": "Mucormycosis", "correct": true}, {"label": "D", "text": "Cavernous sinus thrombosis", "correct": false}], "correct_answer": "C. Mucormycosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QHvIFs5fnS2yQMhR8gG11746097672.png", "https://image.prepladder.com/content/qnAb4fsVt4hswf06osnM1746097777.png", "https://image.prepladder.com/content/xihAHEEeYdv0mThvhaVF1746097781.png", "https://image.prepladder.com/content/xfcU9y6dmUAkDoDDxOgG1746097801.png", "https://image.prepladder.com/content/nUY62v5N4QSjZmJGouEY1746097814.png", "https://image.prepladder.com/content/pywQRYVkaQ5m1Nd8NNBe1746097821.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mucormycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is an <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> disease caused by zygomycetes (phycomycetes) - Rhizopus, <span class=\"customMeta\" data-dictid=\"2cd8f411371692777193c9fa32b32c\">Mucor</span> and Absidia. <strong>Rhizopus Arrhizus </strong>is the most common pathogen</p>\n<p><strong>Rhizopus:</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Timleo\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Rhizopus\" data-tags=\"\" height=\"253\" src=\"https://image.prepladder.com/content/QHvIFs5fnS2yQMhR8gG11746097672.png\" width=\"321\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> <strong>Absidia</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" CDC/Dr. Lucille K. Georg \" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Absidia\" data-tags=\"\" height=\"206\" src=\"https://image.prepladder.com/content/qnAb4fsVt4hswf06osnM1746097777.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> <strong>Mucor</strong> (Lactophenol cotton blue stained):</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" Alison Burkett, M.D., Sawanan Saitornuang, B.S., Sixto M. Leal, Jr., M.D., Ph.D.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/microbiologyzygomycetes.html\" data-tags=\"\" height=\"234\" src=\"https://image.prepladder.com/content/xihAHEEeYdv0mThvhaVF1746097781.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Begins in the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, where spores germinate and <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> mycelia → invade adjacent tissues, leading to local destruction.</p>\n<p>Fungi invade blood vessels, causing <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> and <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> in affected areas, which contributes to its high mortality rate (Angio-invasiveness)</p>\n<p><strong>Common Sites</strong></p>\n<ul>\n<li><strong>Rhinocerebral Form</strong>: Involves the nose, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> sinuses, and orbit; frequently seen in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</li>\n</ul>\n<ul>\n<li><strong>Pulmonary Infections</strong>: When the lungs are the primary site, the <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> can invade lung arteries, leading to serious complications.</li>\n</ul>\n<ul>\n<li>Others: Cutaneous mucormycosis, GI mucormycosis, Disseminated mucormycosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Clinical Features</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Rhinocerebral Zygomycosis</strong>:\n\t\t\t\t<ul>\n<li><strong>Facial swelling, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> (often black), fever, and mucosal necrosis.</strong></li>\n<li>Rapid <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> can lead to severe complications, including visual loss and neurological symptoms.</li>\n</ul>\n</li>\n<li><strong>Pulmonary Zygomycosis</strong>:\n\t\t\t\t<ul>\n<li>Symptoms may include cough, fever, and <strong>hemoptysis</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histological Examination</strong>:</p>\n<p><strong>Diagnosis is confirmed by identifying broad, non-septate (or sparsely septate) hyphae.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\"' data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"175\" src=\"https://image.prepladder.com/content/xfcU9y6dmUAkDoDDxOgG1746097801.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Culture: </strong></p>\n<ul>\n<li>After <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> for 3-4 days on Sabouraud <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> at 30-37°C, the colonies are grey-white with a thick cottony, fluffy surface.</li>\n<li>Under the microscope, nonseptate, broad hyphae with aerial sporangiophores which end in a <span class=\"customMeta\" data-dictid=\"7234e0b4e11692777199d188770525\">sporangium</span> (a <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> containing spores are seen.)</li>\n</ul>\n<p><strong>a. </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\"' data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"218\" src=\"https://image.prepladder.com/content/nUY62v5N4QSjZmJGouEY1746097814.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>b</strong>.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\"' data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"205\" src=\"https://image.prepladder.com/content/pywQRYVkaQ5m1Nd8NNBe1746097821.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>a. </strong><strong>Sabouraud's <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">dextrose</span> <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> (SDA) medium showing Rhizopus growth </strong></p>\n<p> </p>\n<p><strong>b. Microscopy of LPCB stained preparation demonstrating <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">morphology</span> of Rhizopus spp. (non-septate hyphae, sporangiophore, <span class=\"customMeta\" data-dictid=\"7234e0b4e11692777199d188770525\">sporangium</span> and spores)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intravenous amphotericin B combined, where appropriate, with <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> is the recommended treatment.</li>\n<li>Medical control of diabetes is required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "PR segment in ECG indicates:", "options": [{"label": "A", "text": "Atrial depolarization", "correct": false}, {"label": "B", "text": "Atrioventricular nodal conduction", "correct": true}, {"label": "C", "text": "Ventricular depolarization", "correct": false}, {"label": "D", "text": "Ventricular repolarization", "correct": false}], "correct_answer": "B. Atrioventricular nodal conduction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4yAFO70rGV3ZOUUOfhEA1747904175.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:632px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Normal Duration and Size </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>P wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atrial <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> is initiated by the SA node.<strong> (Option A Ruled Out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>0.08–0.11 seconds</li>\n<li>2–2.75 small boxes</li>\n<li>&lt;2.5 mm (0.25 mV) in amplitude/ height</li>\n<li>&lt;0.12 sec (120 <span class=\"customMeta\" data-dictid=\"324240732616927771930d34d9e907\">msec</span> or 3 small boxes) in width</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PR interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Time from onset of atrial <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> (P wave) to onset of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> (<strong>electrical impulse passing through AV node</strong>) <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>0.12–0.20 seconds</li>\n<li>3–5 small boxes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Q wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Initial <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> of the <span class=\"customMeta\" data-dictid=\"769fa5be3616927771906f8ae8b053\">interventricular</span> septum, directed from left to right.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>&lt;0.04 seconds</li>\n<li>&lt;1 small box</li>\n<li>Depth: &lt;1/4 of R wave or ~1–2 mm (&lt;0.5 small boxes)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>QRS complex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventricular <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> - the time taken for the electrical impulse to spread through the ventricles. <strong> (Option C Ruled Out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>&lt;0.10 seconds</li>\n<li>&lt;2.5 small boxes in width</li>\n<li>Height: 5–30 mm (1–6 big boxes)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>QT interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Time from the start of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> to the end of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> repolarization.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Duration depends on HR.</li>\n<li>HR inversely proportional QT length. Rate-corrected (QTc) 330–350 msec</li>\n<li>~11 small boxes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ST segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Represents the early part of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> repolarization. It is <span class=\"customMeta\" data-dictid=\"95f7d4c24d16927771904b4278640d\">isoelectric</span> (flat). <strong> (Option D Ruled Out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>0.08–0.12 seconds</li>\n<li>2–3 small boxes</li>\n<li>Normally <span class=\"customMeta\" data-dictid=\"95f7d4c24d16927771904b4278640d\">isoelectric</span> (flat), deviations &gt;1 small box indicate pathology</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Represents the later stage of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> repolarization.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>&lt;0.04 seconds</li>\n<li>2.5–6.25 small boxes</li>\n<li>Height: Varies. Normally &lt;5 mm (1 big box) in limb leads, &lt;10 mm (2 big boxes) in precordial leads</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>U wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unknown origin; possibly related to <span class=\"customMeta\" data-dictid=\"40451a27bd1692777197d6c276d0bc\">repolarization</span> of Purkinje fibers or <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> walls.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Not always measurable</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 11-month-old baby was brought by his mother with complaints of the left upper eyelid moving up and down while breastfeeding that disappears when the baby is not breastfeeding. She gave a history of the child being diagnosed with left eye ptosis. What is this condition called?", "options": [{"label": "A", "text": "Symblepharon", "correct": false}, {"label": "B", "text": "Blepharophimosis syndrome", "correct": false}, {"label": "C", "text": "Lagophthalmos", "correct": false}, {"label": "D", "text": "Marcus -Gunn jaw-winking", "correct": true}], "correct_answer": "D. Marcus -Gunn jaw-winking", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mb9JUOZCjWjv72pxiz0h1747905777.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the interpretation of elevated serum Calcium levels in a patient with normal serum alkaline phosphatase, PTH, and Vitamin D3 levels?", "options": [{"label": "A", "text": "Vitamin D intoxication", "correct": false}, {"label": "B", "text": "Hyperparathyroidism", "correct": false}, {"label": "C", "text": "Multiple myeloma", "correct": true}, {"label": "D", "text": "Nutritional rickets", "correct": false}], "correct_answer": "C. Multiple myeloma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following treatments is appropriate for a 3-month-old child with a mucopurulent discharge from the right puncta and a history of increased watering in the right eye, as noticed by the mother?", "options": [{"label": "A", "text": "Syringing", "correct": false}, {"label": "B", "text": "Probing with syringing", "correct": false}, {"label": "C", "text": "Sac massage with topical antibiotics", "correct": true}, {"label": "D", "text": "Dacryocystorhinostomy", "correct": false}], "correct_answer": "C. Sac massage with topical antibiotics", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:556px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>&lt; 6-9 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lacrimal <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> <span class=\"customMeta\" data-dictid=\"c515f6a71d16927771919f574f1ee9\">massage</span> with <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> antibiotics (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>9 months - 4 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bowman’s probing with syringing <strong>(Option A) (Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt; 4 years </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dacryocystorhinostomy <strong>(Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following interfere with iron absorption?", "options": [{"label": "A", "text": "Vitamin C", "correct": false}, {"label": "B", "text": "Phytates", "correct": true}, {"label": "C", "text": "Oxalate", "correct": false}, {"label": "D", "text": "Myoglobin", "correct": false}], "correct_answer": "B. Phytates", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factors Increasing Iron Absorption</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factors Decreasing Iron Absorption</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acidic stomach environment</li>\n<li>Vitamin C (ascorbic acid) <strong>(Option A Ruled Out)</strong></li>\n<li>Empty stomach</li>\n<li>Meat proteins</li>\n<li>Citric acid</li>\n<li>Haem iron sources (meat, fish)</li>\n<li>Fermented foods</li>\n<li>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> state</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reduced stomach acid</li>\n<li>Proton pump inhibitors</li>\n<li>Antacids</li>\n<li>Tetracycline (chelates iron)</li>\n<li><strong>Phytates (Option B) </strong>(in cereals, legumes)</li>\n<li>Tea and coffee (tannins)</li>\n<li>Calcium-rich foods</li>\n<li>High fiber meals</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most sensitive and specific marker for MI is?", "options": [{"label": "A", "text": "Troponin", "correct": true}, {"label": "B", "text": "Cytokeratin", "correct": false}, {"label": "C", "text": "Myoglobin", "correct": false}, {"label": "D", "text": "CPK-MM", "correct": false}], "correct_answer": "A. Troponin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/eW8jkz1Yngvrrsyn2eUh1746098509.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Preferred biochemical markers due to their sensitivity and specificity.</li><li>↳ Preferred biochemical markers due to their sensitivity and specificity.</li><li>↳ Criteria for ACS: Requires rise and/or fall in biomarker values, with at least one value above the 99th percentile upper reference limit.</li><li>↳ Criteria for ACS:</li><li>↳ Troponin T (cTnT) and Troponin I (cTnI ) increase significantly after STEMI.</li><li>↳ Troponin T (cTnT)</li><li>↳ Troponin I (cTnI</li><li>↳ Can detect concentrations &lt;1 ng/L in non-ischemic conditions.</li><li>↳ &lt;1 ng/L</li><li>↳ Troponin levels: Increase within 3-6 hours. Peak at around 36 hours. Remains elevated for 7-10 days after STEMI.</li><li>↳ Troponin levels:</li><li>↳ Increase within 3-6 hours. Peak at around 36 hours. Remains elevated for 7-10 days after STEMI.</li><li>↳ Increase within 3-6 hours.</li><li>↳ Peak at around 36 hours.</li><li>↳ Remains elevated for 7-10 days after STEMI.</li><li>↳ 7-10 days</li><li>↳ Troponin should be measured at presentation and repeated at 1-3 hours (high-sensitivity assays) or 3-6 hours (conventional assays).</li><li>↳ Further troponin tests are advised beyond 3-6 hours if AMI remains a possibility or there is diagnostic uncertainty.</li><li>↳ Causes of elevated Serum Troponin other than MI Cardiorespiratory Causes Non-Cardiorespiratory Causes Pulmonary embolism Aortic dissection Acute pulmonary edema Tachyarrhythmias Myocarditis/Myopericarditis Cardiac trauma Cardiac surgery/ablation Prolonged hypotension Severe sepsis Severe burns Stroke Subarachnoid hemorrhage End-stage renal failure</li><li>↳ Causes of elevated Serum Troponin other than MI</li><li>↳ Causes of elevated Serum Troponin other than MI</li><li>↳ Causes of elevated Serum Troponin other than MI</li><li>↳ Causes of elevated Serum Troponin other than MI</li><li>↳ Cardiorespiratory Causes Non-Cardiorespiratory Causes</li><li>↳ Cardiorespiratory Causes</li><li>↳ Cardiorespiratory Causes</li><li>↳ Cardiorespiratory Causes</li><li>↳ Non-Cardiorespiratory Causes</li><li>↳ Non-Cardiorespiratory Causes</li><li>↳ Non-Cardiorespiratory Causes</li><li>↳ Pulmonary embolism Aortic dissection Acute pulmonary edema Tachyarrhythmias Myocarditis/Myopericarditis Cardiac trauma Cardiac surgery/ablation Prolonged hypotension Severe sepsis Severe burns Stroke Subarachnoid hemorrhage End-stage renal failure</li><li>↳ Pulmonary embolism Aortic dissection Acute pulmonary edema Tachyarrhythmias Myocarditis/Myopericarditis Cardiac trauma Cardiac surgery/ablation</li><li>↳ Pulmonary embolism Aortic dissection Acute pulmonary edema Tachyarrhythmias Myocarditis/Myopericarditis Cardiac trauma Cardiac surgery/ablation</li><li>↳ Pulmonary embolism</li><li>↳ Aortic dissection</li><li>↳ Acute pulmonary edema</li><li>↳ Tachyarrhythmias</li><li>↳ Myocarditis/Myopericarditis</li><li>↳ Cardiac trauma</li><li>↳ Cardiac surgery/ablation</li><li>↳ Prolonged hypotension Severe sepsis Severe burns Stroke Subarachnoid hemorrhage End-stage renal failure</li><li>↳ Prolonged hypotension Severe sepsis Severe burns Stroke Subarachnoid hemorrhage End-stage renal failure</li><li>↳ Prolonged hypotension</li><li>↳ Severe sepsis</li><li>↳ Severe burns</li><li>↳ Stroke</li><li>↳ Subarachnoid hemorrhage</li><li>↳ End-stage renal failure</li><li>↳ Cardiac troponin levels remain elevated for several days after an acute myocardial infarction (AMI), making them unreliable for detecting reinfarction.</li><li>↳ Cardiac troponin levels remain elevated for several days after an acute myocardial infarction (AMI), making them unreliable for detecting reinfarction.</li><li>↳ unreliable for detecting reinfarction.</li><li>↳ 2. Creatine Phosphokinase (CK) and CK-MB:</li><li>↳ 2. Creatine Phosphokinase (CK) and CK-MB:</li><li>↳ CK rises within 4-8 hours. Peaks by 24 hours. Returns to normal within 48-72 hours. CK lacks specificity for STEMI since it can be elevated in skeletal muscle disease, trauma, or injections. CK-MB isoenzyme is more specific for the heart CK-MB elevated: Cardiac surgery Myocarditis Electrical cardioversion CK-MB/CK ratio &gt;2.5 suggests a myocardial source, though it's not diagnostic. CK-MB levels normalize within 48 to 72 hours , so a subsequent rise can confirm reinfarction.</li><li>↳ CK rises within 4-8 hours.</li><li>↳ Peaks by 24 hours.</li><li>↳ Returns to normal within 48-72 hours.</li><li>↳ CK lacks specificity for STEMI since it can be elevated in skeletal muscle disease, trauma, or injections.</li><li>↳ CK-MB isoenzyme is more specific for the heart</li><li>↳ CK-MB elevated: Cardiac surgery Myocarditis Electrical cardioversion</li><li>↳ CK-MB elevated:</li><li>↳ Cardiac surgery Myocarditis Electrical cardioversion</li><li>↳ Cardiac surgery</li><li>↳ Myocarditis</li><li>↳ Electrical cardioversion</li><li>↳ CK-MB/CK ratio &gt;2.5 suggests a myocardial source, though it's not diagnostic.</li><li>↳ CK-MB/CK ratio &gt;2.5</li><li>↳ CK-MB levels normalize within 48 to 72 hours , so a subsequent rise can confirm reinfarction.</li><li>↳ normalize within 48 to 72 hours</li><li>↳ confirm reinfarction.</li><li>↳ 3. Lactate Dehydrogenase (LDH):</li><li>↳ 3. Lactate Dehydrogenase (LDH):</li><li>↳ Increase in the blood 6 to 12 hours after ACS. Peak within 24 to 72 hours. Normalize within 8 to 14 days. LDH is no longer used to diagnose myocardial infarction because it is not specific to cardiac myocytes.</li><li>↳ Increase in the blood 6 to 12 hours after ACS.</li><li>↳ Peak within 24 to 72 hours.</li><li>↳ Normalize within 8 to 14 days.</li><li>↳ LDH is no longer used to diagnose myocardial infarction because it is not specific to cardiac myocytes.</li><li>↳ LDH</li><li>↳ not specific to cardiac myocytes.</li><li>↳ 4. Heart-type Fatty Acid-Binding Protein (H-FABP):</li><li>↳ 4. Heart-type Fatty Acid-Binding Protein (H-FABP):</li><li>↳ Sensitivity of H-FABP in detecting AMI within 4 hours of symptom onset was 60%, significantly higher than troponin (18.8%) and CK-MB (12.5%). But the specificity of H-FABP in detecting AMI was less than that of troponin and CK-MB.</li><li>↳ Sensitivity of H-FABP in detecting AMI within 4 hours of symptom onset was 60%, significantly higher than troponin (18.8%) and CK-MB (12.5%).</li><li>↳ But the specificity of H-FABP in detecting AMI was less than that of troponin and CK-MB.</li><li>↳ specificity</li><li>↳ in detecting AMI was less than that of troponin and CK-MB.</li><li>↳ Cytokeratin (Option B): Cytokeratin is a protein found in epithelial cells and has no role in cardiac injury detection. It is primarily used as a tumor marker for certain types of cancers and has no relevance in diagnosing myocardial infarction.</li><li>↳ Cytokeratin</li><li>↳ (Option B):</li><li>↳ Myoglobin (Option C): While myoglobin is released during muscle injury and rises earlier than troponin (2-3 hours after injury), it lacks cardiac specificity as it is found in both cardiac and skeletal muscle.</li><li>↳ Myoglobin</li><li>↳ (Option C):</li><li>↳ CPK-MM (Option D): Creatine Phosphokinase-MM is the skeletal muscle isoform of CPK. It is predominantly found in skeletal muscle. Its elevation can occur in condition causing skeletal muscle damage, making it a poor choice for specific MI diagnosis.</li><li>↳ CPK-MM (Option D):</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes of elevated Serum <span class=\"customMeta\" data-dictid=\"69d29372dc169277720014447abea8\">Troponin</span> other than MI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiorespiratory Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Cardiorespiratory Causes </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pulmonary embolism</li>\n<li>Aortic dissection</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</li>\n<li>Tachyarrhythmias</li>\n<li>Myocarditis/Myopericarditis</li>\n<li>Cardiac trauma</li>\n<li>Cardiac surgery/ablation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prolonged hypotension</li>\n<li>Severe sepsis</li>\n<li>Severe burns</li>\n<li>Stroke</li>\n<li>Subarachnoid hemorrhage</li>\n<li>End-stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is given lifelong for patient receiving prosthetic mitral valve replacement?", "options": [{"label": "A", "text": "Aspirin", "correct": false}, {"label": "B", "text": "Clopidogrel", "correct": false}, {"label": "C", "text": "Atorvastatin", "correct": false}, {"label": "D", "text": "Warfarin", "correct": true}], "correct_answer": "D. Warfarin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Warfarin Use </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Target INR Range</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atrial Fibrillation</p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>2.0 - 2.5</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Venous <span class=\"customMeta\" data-dictid=\"237b2a1dfa1692777200a074fd1072\">Thromboembolism</span> (VTE) Prophylaxis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bioprosthetic <span class=\"customMeta\" data-dictid=\"1a060c24961692777189bcbbf1d2cd\">Heart Valves</span> (first 3 months)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Post-Myocardial Infarction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment of DCT, PE, TIA</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2.5 - 3.0</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mechanical <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">Prosthetic</span> Heart Valves</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p><strong>3.0 - 3.5</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recurrent Thromboembolism</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother brought her 16-year-old daughter to the hospital with complaints of primary amenorrhea. On evaluation axillary and pubic hair were present and other secondary sexual characteristics were normal. LH and FSH levels are normal and USG showed an absence of a uterus. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Turner syndrome", "correct": false}, {"label": "B", "text": "MRKH syndrome", "correct": true}, {"label": "C", "text": "Androgen insensitivity syndrome", "correct": false}, {"label": "D", "text": "Swyer syndrome", "correct": false}], "correct_answer": "B. MRKH syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JunJqGGPdjM5qPXVhxf31746098876.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Karyotype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Menstruation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Female Internal Reproductive Organs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Laboratory Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MRKH syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>46 XX</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary amenorrhea</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lack/hypoplasia of the uterus</li>\n<li>Lack of upper 2/3 of the vagina</li>\n<li>Normal ovaries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ Testosterone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Turner Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>45 XO</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary amenorrhea</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypogonadsim</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑/normal FSH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Androgen Insensitivity Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>46 XY</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary amenorrhea</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Shortened vagina</li>\n<li>Lack of cervix</li>\n<li>Testes</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ FSH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swyer syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>46 XY</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary amenorrhea</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gonadal dysgenesis</li>\n<li>Lack ovaries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+ FSH</p>\n<p>+ Estrogen</p>\n<p>+ Progesterone</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not an indication of expectant management in unruptured ectopic gestation?", "options": [{"label": "A", "text": "Initial serum beta hCG level &amp;lt;200 mIU/mL", "correct": false}, {"label": "B", "text": "Gestational sac size &amp;gt;4 cm", "correct": true}, {"label": "C", "text": "Asymptomatic", "correct": false}, {"label": "D", "text": "Decreasing beta hCG measurement", "correct": false}], "correct_answer": "B. Gestational sac size &gt;4 cm", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criteria/Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Expectant Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Beta <span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\">hCG</span> &lt; 1,500 IU/L</li>\n</ul>\n<p>And falling subsequent levels</p>\n<ul>\n<li>No significant symptoms</li>\n<li>Strong likelihood of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> resolution</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Monitoring without intervention, relying on the natural resolution of the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Beta <span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\">hCG</span> &lt; 3,000 IU/L</li>\n<li>Adnexal mass &lt; 4 cm</li>\n<li>No <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> activity</li>\n<li>Hemodynamically stable</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Methotrexate (single dose/ multi-dose regimen) (best)</strong></li>\n<li><strong>KCl (directly in sac)</strong></li>\n<li>Mifepristone</li>\n<li>Prostaglandins</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Beta <span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\">hCG</span> &gt; 5,000 IU/L</li>\n<li>Size of <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> &gt; 4 cm</li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> activity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Linear <span class=\"customMeta\" data-dictid=\"61fda112f41692777198f6f3b8535f\">Salpingostomy</span> (best)</strong></li>\n<li>Resection Anastomosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The number of maternal deaths per 100,000 live births is called-", "options": [{"label": "A", "text": "Maternal mortality ratio", "correct": true}, {"label": "B", "text": "Under 5 Mortality Rate", "correct": false}, {"label": "C", "text": "Infant mortality rate", "correct": false}, {"label": "D", "text": "Perinatal mortality rate", "correct": false}], "correct_answer": "A. Maternal mortality ratio", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\"&gt;Maternal&lt;/span&gt; mortality ratio</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Indicator</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Formula</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>India Value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Most Common Cause</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Infant Mortality Rate (IMR) <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Infant deaths / Live Births × 1000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>33</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Low Birth Weight (LBW) &amp; Prematurity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Maternal Mortality Ratio (MMR)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Maternal deaths / Live Births × 100,000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>122</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Postpartum <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">Hemorrhage</span> (PPH)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Under 5 Mortality Rate (U5MR) <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Total Under 5 deaths / Live Births × 1000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>39</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Low Birth Weight (LBW) &amp; Prematurity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Neonatal Mortality Rate (NNR)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Neonatal deaths / Live Births × 1000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>24</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Low Birth Weight (LBW) &amp; Prematurity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Perinatal Mortality Rate (PNMR) <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Perinatal deaths / Live Births × 1000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>23</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Low Birth Weight (LBW) &amp; Prematurity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Stillbirth Rate (SBR)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Total Stillbirths / Live Births × 1000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>22</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Maternal infections / <span class=\"customMeta\" data-dictid=\"f5df620f42169277718051194dc6e4\">Abruptio</span> placentae</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For assessing the viral load in a test sample, which test utilizes the provided graph?", "options": [{"label": "A", "text": "Antigen test", "correct": false}, {"label": "B", "text": "Real-time RT PCR", "correct": true}, {"label": "C", "text": "CBNAAT", "correct": false}, {"label": "D", "text": "TruNat", "correct": false}], "correct_answer": "B. Real-time RT PCR", "question_images": ["https://image.prepladder.com/content/FgXxiTFcvhOzXqZjC5OO1748163922.png"], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"9ddd195e9a1692777197bb3f135c2e\"&gt;Real-time&lt;/span&gt; RT PCR\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the initial step when an immunization survey is being conducted?", "options": [{"label": "A", "text": "Cluster identification", "correct": true}, {"label": "B", "text": "Conducting the survey", "correct": false}, {"label": "C", "text": "Completing the cluster and summary forms", "correct": false}, {"label": "D", "text": "Calculating the total fertility rate of the area", "correct": false}], "correct_answer": "A. Cluster identification", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Clu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vaccine among the options exhibits a seroconversion rate that is quicker than the incubation period of the corresponding disease?", "options": [{"label": "A", "text": "Coronavirus", "correct": false}, {"label": "B", "text": "Measles", "correct": true}, {"label": "C", "text": "Polio", "correct": false}, {"label": "D", "text": "Mumps", "correct": false}], "correct_answer": "B. Measles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As per the guidelines for disposing of biomedical waste, what color bag should be used to discard used cotton swabs?", "options": [{"label": "A", "text": "Yellow", "correct": true}, {"label": "B", "text": "Red", "correct": false}, {"label": "C", "text": "Blue", "correct": false}, {"label": "D", "text": "Transparent", "correct": false}], "correct_answer": "A. Yellow", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Yellow</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Waste Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of bag or container to be used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Method of disposal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>All <strong>infectious </strong>waste.</li>\n<li>Human <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Animal <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste</li>\n<li><strong>Soiled </strong>waste (contaminated with blood, body fluids, dressings and swabs, <strong>blood bags</strong>).</li>\n<li>Expired or discarded medicines</li>\n<li>Chemical waste.</li>\n<li><strong>Microbiological </strong>and other <span class=\"customMeta\" data-dictid=\"3ec60edb4a16927771842bb9fd9aa4\">clinical laboratory</span> waste.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Yellow coloured <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> <span class=\"customMeta\" data-dictid=\"b0628f561616927771849023eb3a3d\">chlorinated</span> plastic bags.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incineration</li>\n<li>Plasma pyrolysis</li>\n<li>Deep burial</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Red</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Contaminated waste (recyclable)</strong>: Tubing, bottles, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> tubes and sets, catheters, <strong>urine bags</strong>, syringes (without needles), vacutainers and gloves.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Red coloured <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">non</span> <span class=\"customMeta\" data-dictid=\"b0628f561616927771849023eb3a3d\">chlorinated</span> plastic bags.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoclaving or microwaving/hydroclaving, and then sent for recycling (not to landfill).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Glassware:</strong> Broken or discarded and contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic waste.</li>\n<li><strong>Metallic body implants</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardboard boxes with blue coloured markings.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Disinfection or autoclaving/microwaving, hydroclaving and then sent to recycling.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>White</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Waste <strong>sharps </strong>including metals: Needles, syringes with fixed needles, scalpels or any other sharp object that may cause <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> and cuts.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Puncture proof and leak proof containers.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Auto or <span class=\"customMeta\" data-dictid=\"2d95ddf7b8169277718654aee27077\">dry heat</span> <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> followed by shredding and <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> or encapsulation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For a population of 10,000, what does a sex ratio of more than 1000 mean?", "options": [{"label": "A", "text": "Males are less than 500", "correct": false}, {"label": "B", "text": "Females are less than 500", "correct": false}, {"label": "C", "text": "Males are less than 5000", "correct": true}, {"label": "D", "text": "Females are less than 5000", "correct": false}], "correct_answer": "C. Males are less than 5000", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xlmXM4lArGFs0O7iiqwv1746101177.png", "https://image.prepladder.com/content/FD4l6eLAWJuaBoTehf9M1746101182.png"], "explanation": "<p>Correct Answer C - Males are less than 5000</p>\n<p><strong>References:</strong></p>\n<ul><li>↳ Importance in Demography : Crucial for understanding population dynamics.</li><li>↳ Importance in Demography</li><li>↳ Influencing Factors : Mortality differences between genders. Sex-selective migration. Sex ratio at birth.</li><li>↳ Influencing Factors</li><li>↳ Mortality differences between genders. Sex-selective migration. Sex ratio at birth.</li><li>↳ Mortality differences between genders.</li><li>↳ Sex-selective migration.</li><li>↳ Sex ratio at birth.</li><li>↳ Implications of Low Sex Ratio : Indicates a preference for male children. Results in gender inequities. This leads to neglect of girls, higher female mortality in youth, female infanticide, and foeticide. Increases maternal mortality. Bias towards males in population counts.</li><li>↳ Implications of Low Sex Ratio</li><li>↳ Indicates a preference for male children. Results in gender inequities. This leads to neglect of girls, higher female mortality in youth, female infanticide, and foeticide. Increases maternal mortality. Bias towards males in population counts.</li><li>↳ Indicates a preference for male children.</li><li>↳ Results in gender inequities.</li><li>↳ This leads to neglect of girls, higher female mortality in youth, female infanticide, and foeticide.</li><li>↳ Increases maternal mortality.</li><li>↳ Bias towards males in population counts.</li><li>↳ Males are less than 500 (Option A) : This is incorrect because the male population being so low would result in an extremely skewed sex ratio, which is unrealistic in this context.</li><li>↳ Males are less than 500 (Option A)</li><li>↳ Females are less than 500 (Option B) : This is incorrect because a sex ratio greater than 1000 implies there are more females, not fewer.</li><li>↳ Females are less than 500 (Option B)</li><li>↳ Females are less than 5000 (Option D) : This is incorrect because for the sex ratio to exceed 1000, the number of females must be more than 5000.</li><li>↳ Females are less than 5000 (Option D)</li></u\n<p><strong>References:</strong></p>\n<ul><li>↳ Female Deficit Syndrome</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In controlled tipping, the amount of land required for the trench method to be practiced for a population of 10,000 is:", "options": [{"label": "A", "text": "4 acres", "correct": false}, {"label": "B", "text": "5 acres", "correct": false}, {"label": "C", "text": "2 acres", "correct": false}, {"label": "D", "text": "1 acre", "correct": false}], "correct_answer": "Unknown", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - 1 acre</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Methods of Refuse Disposal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>1. Dumping:</strong> Unsatisfactory; becomes a nuisance.</p>\n<p><strong>2.</strong> <strong>Controlled <span class=\"customMeta\" data-dictid=\"ca71df0bba1692777200f4d0d60421\">Tipping</span> (Sanitary Landfill):</strong> Most satisfactory; achieved via trench, ramp, and area methods.</p>\n<ul>\n<li><strong>Modified <span class=\"customMeta\" data-dictid=\"601fb1538a16927771987048f6e712\">Sanitary</span> Landfill:</strong> Compacting and covering are done once or twice a week</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Methods of controlled tipping</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>a. Trench Method:</strong></p>\n<ul>\n<li>Used on level ground.</li>\n<li>Most important method</li>\n<li>Dug on level ground, 2-3 meters deep and 4-12 meters wide.</li>\n<li>For a population of 10,000, a 2-meter-deep trench requires 1 acre of land.</li>\n</ul>\n<p><strong>b.</strong> <strong>Ramp Method:</strong> For moderately sloping terrain</p>\n<p><strong>c. Area Method:</strong> Requires supplemental earth, used in depressions or quarries.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Technique in controlled tipping</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Physical, chemical, and bacteriological changes occur in buried refuse.</li>\n<li>Temperature rises to 60°C after 7 days, killing pathogens, followed by decomposition.</li>\n<li>Organic matter decomposes into <span class=\"customMeta\" data-dictid=\"f4cf2eb2351692777190992f264326\">innocuous</span> soil in 4-6 months, used as manure</li>\n<li>Cooling occurs within 2-3 weeks.</li>\n<li>Final product: Manure used in farming.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A couple has given birth to their first child. Based on the nuclear family cycle, which phase is the family entering into?", "options": [{"label": "A", "text": "Extension", "correct": true}, {"label": "B", "text": "Complete extension", "correct": false}, {"label": "C", "text": "Contraction", "correct": false}, {"label": "D", "text": "Completed contraction", "correct": false}], "correct_answer": "A. Extension", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Extension</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>No.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Phases of Family Life Cycle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Beginning of Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>End of Phase</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">I</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Formation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Marriage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Birth of 1st child</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Extension</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Birth of 1st child</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Birth of last child</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Complete Extension <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Birth of last child</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">1st child leaves home</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Contraction <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">1st child leaves home</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Last child leaves home of parents</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Completed Contraction <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Last child leaves home of parents</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">1st spouse dies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">VI</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Dissolution</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">1st spouse dies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Death of survivor (extinction)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The school health programs are managed by which of the following?", "options": [{"label": "A", "text": "Primary health centre", "correct": true}, {"label": "B", "text": "District hospital", "correct": false}, {"label": "C", "text": "Sub-centre", "correct": false}, {"label": "D", "text": "Sub-divisional hospital", "correct": false}], "correct_answer": "A. Primary health centre", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Primary health\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis of a 35-year-old male with a history of prolonged corneal ulcer who now presents with a deformed eye as shown in the image?", "options": [{"label": "A", "text": "Megalocornea", "correct": false}, {"label": "B", "text": "Conjunctivitis", "correct": false}, {"label": "C", "text": "Buphthalmos", "correct": false}, {"label": "D", "text": "Anterior staphyloma", "correct": true}], "correct_answer": "D. Anterior staphyloma", "question_images": ["https://image.prepladder.com/content/vBR98Ddin8cSbGdBmyyW1747905790.png"], "explanation_images": ["https://image.prepladder.com/content/0efx0kNGYBHTJO9IR8Vp1746101660.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of staphyloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pseudocornea (following corneal ulcer) (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intercalary </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perforating injuries of the <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> cornea, marginal corneal ulcer, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> scleritis, and <span class=\"customMeta\" data-dictid=\"516238f054169277719881ad620559\">scleromalacia</span> perforans</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ciliary </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glaucoma, scleritis, and trauma to the <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> region</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Equatorial (approx 14 mm behind the limbus) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scleritis, degenerative myopia, and chronic uncontrolled glaucoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Degenerative <strong>high <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> myopia</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Re-infection with which of the following will lead to catastrophic symptoms even in the presence of antibodies?", "options": [{"label": "A", "text": "Dengue", "correct": true}, {"label": "B", "text": "Yellow fever", "correct": false}, {"label": "C", "text": "Japanese encephalitis", "correct": false}, {"label": "D", "text": "Zika", "correct": false}], "correct_answer": "A. Dengue", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Dengu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Marsupialization is an ideal treatment of choice for condition X involving the female reproductive tract, the lesion responsible for condition X is located at?", "options": [{"label": "A", "text": "Perineal body", "correct": false}, {"label": "B", "text": "Bartholin gland", "correct": true}, {"label": "C", "text": "Vagina", "correct": false}, {"label": "D", "text": "Cervix", "correct": false}], "correct_answer": "B. Bartholin gland", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EmQtW4aPE0yhtyZu7GRW1747905018.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the likely diagnosis for a pregnant woman with high blood pressure, experiencing pain in the abdomen, vaginal bleeding, and a decrease in fetal movements?", "options": [{"label": "A", "text": "Abruptio placenta", "correct": true}, {"label": "B", "text": "Placenta previa", "correct": false}, {"label": "C", "text": "Hydramnios", "correct": false}, {"label": "D", "text": "Preterm labor", "correct": false}], "correct_answer": "A. Abruptio placenta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dMPpceM67IRYzMyzMJ121747905074.png"], "explanation": "\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Placental Abruption</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Premature separation of the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> from the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> wall</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Marginal abruption (partial detachment)</li>\n<li>Central abruption (complete detachment)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Maternal hypertension</li>\n<li>Advanced <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> age</li>\n<li>Previous history of <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> abruption</li>\n<li>Trauma or injury during pregnancy</li>\n<li>Substance abuse (e.g. cocaine, smoking)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vaginal bleeding, often accompanied by <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Uterine <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> and <span class=\"customMeta\" data-dictid=\"f97c39ea7a1692777189ea0ea68b49\">hypertonic</span> contractions</li>\n<li>Fetal <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> heart rate patterns</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical evaluation by a healthcare professional</li>\n<li>Ultrasound <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> to assess <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> location</li>\n<li>Laboratory tests (e.g. complete blood count, <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> profile)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Depends on the severity and <span class=\"customMeta\" data-dictid=\"2727bb69eb1692777188a09a87f2b8\">gestational age</span> of the fetus</li>\n<li>Close monitoring of <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> and <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> condition</li>\n<li>Bed rest and restriction of physical activity</li>\n<li>Administration of blood products if significant bleeding</li>\n<li>Delivery of the fetus, either vaginally or by <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">cesarean</span> section</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Maternal <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> and shock</li>\n<li>Fetal growth restriction and distress</li>\n<li>Preterm birth and associated complications</li>\n<li>Stillbirth or <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> death</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Postpartum care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Monitoring for <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> and infection</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the act of disseminating a specific organized belief system or political perspective through the use of information with the intention of implanting it in people's minds?", "options": [{"label": "A", "text": "Health doctrine", "correct": false}, {"label": "B", "text": "Health propaganda", "correct": true}, {"label": "C", "text": "Health education", "correct": false}, {"label": "D", "text": "Health information", "correct": false}], "correct_answer": "B. Health propaganda", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Health propaganda</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Health Education (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Propaganda</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mode of acquisition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Actively <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> knowledge and skills (active thinking).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Knowledge (may be false or exaggerated) is instilled in people's minds (facts).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Develops</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reflective behaviour.</li>\n<li>Trains people to use judgment before acting.</li>\n<li>Individuality.</li>\n<li>Personality.</li>\n<li>Self-expression.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reflexive behaviour.</li>\n<li>Aims at impulsive action.</li>\n<li>A standard pattern of attitudes and behaviours according to what would be used- a set pattern of behaviour.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Appeals to</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reason</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Emotion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Knowledge acquisition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>By self-reliant activity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spoon-fed and received</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Process centered on</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Behaviour: aims at developing favourable attitudes, habits, and skills.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Information: no changes of attitude- behaviour designed.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The usage of the given device in the picture is:", "options": [{"label": "A", "text": "Hysterosalpingography", "correct": false}, {"label": "B", "text": "Measure the length of the uterus", "correct": false}, {"label": "C", "text": "Retraction", "correct": false}, {"label": "D", "text": "Menstrual regulation/aspiration", "correct": true}], "correct_answer": "D. Menstrual regulation/aspiration", "question_images": ["https://image.prepladder.com/content/pVUVAgkfo7vRdTrAaQ6O1747905092.png"], "explanation_images": [], "explanation": "\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Karman Cannula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The Karman cannula, also known as the Karman curette, is a medical instrument used for suction-based procedures in gynecology.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Design</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a slender, flexible, <span class=\"customMeta\" data-dictid=\"3f9a320e1a169277718983ee3d1860\">hollow</span> tube with side perforations and a rounded tip for gentle insertion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mainly used for <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> regulation (early pregnancy termination), endometrial sampling, and suction-based procedures in gynecology.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. The <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> is inserted into the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> through the cervix. 2. Vacuum <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> is applied to <span class=\"customMeta\" data-dictid=\"a246c8382816927771821a267ea486\">aspirate</span> <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contents.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-invasive, suitable for early pregnancy termination, less discomfort compared to some other methods.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Active <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease, <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> abortion, <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy, certain <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> abnormalities.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Safety</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proper <span class=\"customMeta\" data-dictid=\"50ca3536ab16927771820138ef02f8\">aseptic</span> technique is crucial to prevent infection and complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risks include infection, bleeding, <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> perforation, incomplete abortion, and pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alternative Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Other methods include medical abortion (medication-induced) and <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures (dilation and curettage).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Preparation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Patient counseling, informed consent, and appropriate pain management are essential.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Post-procedure Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Monitoring for complications, providing pain relief, and advising on follow-up care.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the USG examination of a woman at 28 weeks of gestation, you observe her amniotic fluid index to be 12.8 cm. At what stage does this measurement typically reach its highest value in a healthy pregnancy?", "options": [{"label": "A", "text": "30 weeks of gestation", "correct": false}, {"label": "B", "text": "32 weeks of gestation", "correct": true}, {"label": "C", "text": "36 weeks of gestation", "correct": false}, {"label": "D", "text": "38 weeks of gestation", "correct": false}], "correct_answer": "B. 32 weeks of gestation", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of visual impairment does a person have if their vision is less than 3/60 but greater than 1/60 in their better eye, and their field of vision is limited to less than 10 degrees from the center of fixation?", "options": [{"label": "A", "text": "Curable blindness", "correct": false}, {"label": "B", "text": "Economic blindness", "correct": false}, {"label": "C", "text": "Social blindness", "correct": true}, {"label": "D", "text": "Manifest blindness", "correct": false}], "correct_answer": "C. Social blindness", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>NPCB <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Visual Impairment</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>The National Programme for Control of <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">Blindness</span> (NPCB) in India defines <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">blindness</span> as \"<strong>visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of &lt;3/60 in a better eye with best possible correction</strong>\" and <strong>central <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> &lt;10 degrees</strong>. The NPCB further categorizes visual <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> as:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Visual Acuity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Visual Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 6/18 in the better eye with available correction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Low Vision</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 6/18 to 6/60</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Economic <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">Blindness</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 6/60 to 3/60</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Social <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">Blindness</span> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 3/60 to 1/60</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Manifest <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">Blindness</span> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 1/60 to the perception of light</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Absolute Blindness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>No perception of light</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>WHO <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Visual Impairment</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>The <span class=\"customMeta\" data-dictid=\"755191f69b1692777202502ef70aaf\">World Health Organization</span> (WHO) defines <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">blindness</span> as \"<strong>visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> of less than 3/60 (Snellen) or its equivalent</strong>\".</p>\n<p>The International <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of Disease 11 (2018) classifies vision <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> into distance and near-presenting vision impairment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Visual Acuity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mild Distance Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 6/12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Moderate Distance Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 6/18</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Severe Distance Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 6/60</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Blindness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Presenting visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than 3/60</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Near Vision Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Presenting near vision <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> worse than N6 or M0.8 at 40 cm with existing correction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which method would be most effective in delivering statistical data to emphasize the significance of routine antenatal care for pregnant mothers, when educating a small, uneducated village during your rural posting?", "options": [{"label": "A", "text": "Pictogram", "correct": true}, {"label": "B", "text": "Line diagram", "correct": false}, {"label": "C", "text": "Histogram", "correct": false}, {"label": "D", "text": "Frequency polygon", "correct": false}], "correct_answer": "A. Pictogram", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BdV2tqIT4DFFFY6TXWQI1746102013.png", "https://image.prepladder.com/content/kk4RSSCJwlNJY5XDBXti1746102026.png", "https://image.prepladder.com/content/bSzc8PwJMa2DW6KJNqDj1746102034.png", "https://image.prepladder.com/content/4L2F2AW1W907LfYjrk5g1746102053.png", "https://image.prepladder.com/content/YB2eU5HEbrszzkJK4dtm1746102060.png", "https://image.prepladder.com/content/SBEOXtvUghsDFLTC15nS1746102068.png"], "explanation": "<p>Correct Answer A - Pictog\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Quantitative of variables</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Qualitative variables</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Histogram</li>\n<li>Frequency polygon</li>\n<li>Line chart or diagram</li>\n<li>Cumulative frequency curve (Ogive)</li>\n<li>Scatter diagram</li>\n<li>Box and whisker plot</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bar diagram</li>\n<li>Pie chart</li>\n<li>Pictogram</li>\n<li>Venn diagram</li>\n<li>Spot maps</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old female primigravida with a history of 3 months of amenorrhoea undergoes USG. The USG done is shown below. What is the USG suggestive of?", "options": [{"label": "A", "text": "Ectopic pregnancy", "correct": false}, {"label": "B", "text": "Hydatidiform mole", "correct": true}, {"label": "C", "text": "Multiple renal cysts in the fetus", "correct": false}, {"label": "D", "text": "Oligohydramnios", "correct": false}], "correct_answer": "B. Hydatidiform mole", "question_images": ["https://image.prepladder.com/content/HG0yAxyktqNb8AHQsXaa1747905149.png"], "explanation_images": ["https://image.prepladder.com/content/9wm6W3nedMbOZPa7PtZS1747905157.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman, who is in her 8th week of pregnancy, has come seeking medical termination of pregnancy (MTP). What would be the correct dosage of misoprostol to be given through the mucosal route?", "options": [{"label": "A", "text": "200 mcg", "correct": false}, {"label": "B", "text": "600 mcg", "correct": false}, {"label": "C", "text": "400 mcg", "correct": false}, {"label": "D", "text": "800 mcg", "correct": true}], "correct_answer": "D. 800 mcg", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was brought to the outpatient department with a history of trauma near the eye and now presents with symptoms of fever, severe pain, and swelling in the left eye. On examination, no abnormal findings were observed. What is the likely diagnosis?", "options": [{"label": "A", "text": "Orbital cellulitis", "correct": false}, {"label": "B", "text": "Endophthalmitis", "correct": false}, {"label": "C", "text": "Panophthalmitis", "correct": false}, {"label": "D", "text": "Preseptal cellulitis", "correct": true}], "correct_answer": "D. Preseptal cellulitis", "question_images": ["https://image.prepladder.com/content/ToLJvIVabct4YBQ0ip6n1746102143.png"], "explanation_images": ["https://image.prepladder.com/content/sfV271I8MqXnBx3dwS131746102217.png", "https://image.prepladder.com/content/k2PGdjWrQ1TouvHBvJNv1746102217.png", "https://image.prepladder.com/content/W1VCGRAuE5CnTPb9HY5h1746102217.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Orbital <span class=\"customMeta\" data-dictid=\"0985f5f6041692777184d2e82e558c\">cellulitis</span> is an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> infection of the soft tissues of the orbit located behind the <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> septum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sinusitis: Ethmoid <span class=\"customMeta\" data-dictid=\"3207c2541a1692777198f4af88308b\">sinusitis</span> (most common) carries a high risk of causing <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> cellulitis. (Option A)</li>\n<li>Underlying <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> problem.</li>\n<li>Dacryocystitis (inflammation of the <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> sac).</li>\n<li>Endogenous cause: Septicemia</li>\n<li>Exogenous cause: Fracture or surgery of the orbit.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Organisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Staphylococcus aureus (most common)</li>\n<li>Haemophilus influenzae (most common in children)</li>\n<li>Streptococcus pneumoniae</li>\n<li>Streptococcus pyogenes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Preseptal cellulitis:</strong> Fever, pain, swelling, <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> on the outer <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> region. <strong>(Option D)</strong></li>\n<li><strong>Orbital cellulitis: (Option A)</strong>\n<ul>\n<li>Painful, <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"4edef7912e1692777196cb0f66e35d\">Proptosis</span> (swelling and severe pain worsened by eye movement or pressure)</li>\n<li>Restriction of eye movements (due to proptosis)</li>\n<li>Decreased visual acuity</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Modified Chandler <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> system:</strong></p>\n<ul>\n<li><strong>Stage I: Preseptal cellulitis/ <span class=\"customMeta\" data-dictid=\"5b1b31d3e41692777195670afc94ca\">periorbital</span> cellulitis</strong> (limited <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> septum) <strong>(Option D)</strong></li>\n<li><strong>Stage II:</strong> Inflammatory <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> oedema/ <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> <span class=\"customMeta\" data-dictid=\"0985f5f6041692777184d2e82e558c\">cellulitis</span> (Posterior to <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> septum)</li>\n<li><strong>Stage III:</strong> Subperiosteal abscess</li>\n<li><strong>Stage IV: </strong>Orbital abscess</li>\n<li><strong>Stage V: </strong>Cavernous <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombosis</li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"608\" src=\"https://image.prepladder.com/content/W1VCGRAuE5CnTPb9HY5h1746102217.png\" width=\"608\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Antibiotics (IV): Empirical therapy treats <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> <span class=\"customMeta\" data-dictid=\"0985f5f6041692777184d2e82e558c\">cellulitis</span> by giving Ceftazidime, Vancomycin, and Metronidazole.</li>\n<li>Monitoring of <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve function</li>\n<li>Surgery: Drainage of an <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> or infected sinuses should be considered if there is a lack of response to antibiotics.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A study to determine the association between maternal smoking histories from pregnant women during their antenatal visits and then subsequently assessing the birth weight of their babies soon after delivery. What type of study is this?", "options": [{"label": "A", "text": "Prospective cohort", "correct": true}, {"label": "B", "text": "Retrospective cohort", "correct": false}, {"label": "C", "text": "Case-control", "correct": false}, {"label": "D", "text": "Cross-sectional", "correct": false}], "correct_answer": "A. Prospective cohort", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VGT64Cpww5t6sQ9JWfWI1748163902.png"], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"22b453f7d01692777196953a3c9dd0\"&gt;Prospective&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"dbb5ff6b6c1692777184160220ac92\"&gt;cohort&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following treatment options is most frequently used for recurrent pterygium?", "options": [{"label": "A", "text": "Conjunctival autograft", "correct": true}, {"label": "B", "text": "Beta-radiation", "correct": false}, {"label": "C", "text": "Observation", "correct": false}, {"label": "D", "text": "Bare sclera technique", "correct": false}], "correct_answer": "A. Conjunctival autograft", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:692px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reassurance/Observation:</strong> if not causing any visual problems <strong>(Option C)</strong></p>\n<p><strong>Medical treatment: </strong></p>\n<ul>\n<li>Tear substitutes for small <span class=\"customMeta\" data-dictid=\"531cf746021692777197c135fbce82\">regressive</span> <span class=\"customMeta\" data-dictid=\"9571debfbe1692777196de3e804df2\">pterygium</span> with dry eye</li>\n<li>Topical steroids for associated inflammation</li>\n<li>Protection from UV rays with sunglasses</li>\n</ul>\n<p><strong>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for:</strong></p>\n<ul>\n<li>Progression of <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> towards the pupillary area causing excessive <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> and visual impairment</li>\n<li>Restricted <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> movements</li>\n<li>Disfiguring</li>\n<li>Diplopia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Procedures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bare <span class=\"customMeta\" data-dictid=\"3e4400809d16927771983252fc08b1\">sclera</span> technique: (Option D)</strong>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"9571debfbe1692777196de3e804df2\">pterygium</span> is excised from the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> and conjunctiva, leaving a bare sclera</li>\n<li>Associated with a <strong>high <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate</strong></li>\n</ul>\n</li>\n<li><strong>Autoconjunctival graft: (Option A)</strong>\n<ul>\n<li>A piece of <span class=\"customMeta\" data-dictid=\"71928251b41692777191a31e57c47f\">limbal</span> conjunctival tissue from <strong>the same or the other eye </strong>or An<strong> <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> </strong>is used to cover the bare sclera</li>\n<li>Sutured at the <span class=\"customMeta\" data-dictid=\"799979f3bc169277719134cd535c7c\">limbus</span> to cover the defect</li>\n<li>Less <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate</li>\n</ul>\n</li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with <span class=\"customMeta\" data-dictid=\"95dc7047f41692777191f225afb261\">lamellar</span> <span class=\"customMeta\" data-dictid=\"8a6b591d1d16927771900a3c620d92\">keratectomy</span> and <span class=\"customMeta\" data-dictid=\"95dc7047f41692777191f225afb261\">lamellar</span> <span class=\"customMeta\" data-dictid=\"9810f0dbdb16927771908a955add6d\">keratoplasty</span> for deeply infiltrating <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> recalcitrant pterygia</li>\n<li>Old methods (not used now):\n\t\t\t\t<ul>\n<li>McRaynold’s operation</li>\n<li>Postoperative use of <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> irradiations</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Post-operative therapy and care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prevent recurrence:\n\t\t\t\t<ul>\n<li><strong>Mitomycin C 0.02% drops </strong></li>\n<li>Complications like scleral necrosis, cataracts, and <span class=\"customMeta\" data-dictid=\"0b673ec1e31692777190e88b9898af\">iritis</span> <strong> </strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The minimum requirements of a health worker job are given: should be a woman, a resident of the village, 25 to 45 years old, and have a formal education till 8th standard. What is the health worker called?", "options": [{"label": "A", "text": "Anganwadi worker", "correct": false}, {"label": "B", "text": "Nurse", "correct": false}, {"label": "C", "text": "Midwife", "correct": false}, {"label": "D", "text": "ASHA worker", "correct": true}], "correct_answer": "D. ASHA worker", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"817804153a16927771822a30e05c60\"&gt;ASHA&lt;/span&gt; worker </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>ASHA (Accredited Social Health Activist)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>ASHA is a woman (married, divorced, or widowed) resident of the village, aged 25-45 years, with education up to 8th grade.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Population Norm for ASHA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>The general norm is 1 <span class=\"customMeta\" data-dictid=\"817804153a16927771822a30e05c60\">ASHA</span> per 1000 population. In tribal, hilly, and desert areas, this may be relaxed to 1 <span class=\"customMeta\" data-dictid=\"817804153a16927771822a30e05c60\">ASHA</span> per habitation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Role and Responsibilities of ASHA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Health Activist: </strong>Create awareness and provide information on health determinants, existing services, and the importance of health and family welfare.</li>\n<li><strong>Counselor</strong>: Provide counseling on birth preparedness, safe delivery, and family planning.</li>\n<li><strong>Mobilizer:</strong> Help the community access health services, such as immunizations, sanitation, and nutrition.</li>\n<li><strong>Provider: </strong>Offer basic care for common illnesses and first-aid, and act as a <span class=\"customMeta\" data-dictid=\"25116121ed169277718644b8fe30ff\">depot</span> for essential medications.</li>\n<li><strong>Community Engagement:</strong> Work with village health committees and panchayats for planning and awareness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Specific Responsibilities of ASHA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ol>\n<li>Promote health and <span class=\"customMeta\" data-dictid=\"18aafee1a71692777198cdc688e8aa\">sanitation</span> practices.</li>\n<li>Advise on child care, immunization, and <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> health.</li>\n<li>Assist with family planning and treatment of minor ailments.</li>\n<li>Mobilize pregnant women and children to health services</li>\n<li>Provide basic medical care and support for diarrhea, fever, and <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> (under DOTS).</li>\n<li>Serve as a <span class=\"customMeta\" data-dictid=\"25116121ed169277718644b8fe30ff\">depot</span> holder for essential drugs and medical supplies.</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Role and Integration with Anganwadi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>The Anganwadi worker helps guide ASHA, particularly in organizing Health Day activities, mobilizing village women and children, and promoting <span class=\"customMeta\" data-dictid=\"05bef24e711692777193a154b462b4\">nutrition</span> and health education.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Role and Integration with ANMs (Auxiliary Nurse Midwives)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>ANMs guide <span class=\"customMeta\" data-dictid=\"817804153a16927771822a30e05c60\">ASHA</span> in areas like immunization, safe pregnancy, and health education, and assist in organizing Health Days. ANMs also help with training and monitor ASHA's performance.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "To avoid overcrowding, what is the maximum number of people allowed to live in a house with 2 rooms?", "options": [{"label": "A", "text": "2 people", "correct": false}, {"label": "B", "text": "3 people", "correct": false}, {"label": "C", "text": "4 people", "correct": true}, {"label": "D", "text": "5 people", "correct": false}], "correct_answer": "C. 4 people", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - 4 people</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Number of Rooms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Maximum Number of Persons Recommended</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">&gt; 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">10</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\">Add 2 persons for each additional room after 5</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Highest sodium content is present in which of the following foods:", "options": [{"label": "A", "text": "Sugar cane", "correct": false}, {"label": "B", "text": "Barley", "correct": false}, {"label": "C", "text": "Canned soup", "correct": true}, {"label": "D", "text": "Fresh fruit juices", "correct": false}], "correct_answer": "C. Canned soup", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Canned sou\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with carcinoma endometrium is treated with pelvic external beam irradiation to the whole pelvis. Which of the following organs is most radiosensitive in the pelvic region?", "options": [{"label": "A", "text": "Ovary", "correct": true}, {"label": "B", "text": "Vagina", "correct": false}, {"label": "C", "text": "Bladder", "correct": false}, {"label": "D", "text": "Rectum", "correct": false}], "correct_answer": "A. Ovary", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following indicators is the best to know the overall burden of disease?", "options": [{"label": "A", "text": "Quality-adjusted life years (QALY)", "correct": false}, {"label": "B", "text": "Health-adjusted life expectancy (HALE)", "correct": false}, {"label": "C", "text": "Disability-adjusted life years (DALY)", "correct": true}, {"label": "D", "text": "Disability-free life expectancy (DFLE)", "correct": false}], "correct_answer": "C. Disability-adjusted life years (DALY)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Disability-adjusted life years (DALY)</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Quality-adjusted Life Years (QALY)</strong></p>\n<p><strong>(Option A) </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Quality and quantity of life lived.</li>\n<li>Assesses number of years of life added due to the intervention and hence the benefit and value for money of the intervention</li>\n<li>QALY - 1 year of life lived in <u>perfect</u> health</li>\n<li>Positive indicator of the cost-effectiveness of an intervention.</li>\n<li>Scored between 0 (death) and 1 (perfect health).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Disability-adjusted Life Years (DALY)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>DALY= Years of life lost to <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> death + years lived with disability</li>\n<li>1 DALY: 1 year of healthy life lost</li>\n<li>It is a measure of the burden of disease and the effectiveness of intervention</li>\n</ul>\n<p><strong>Year of life lost (YLL):</strong></p>\n<ul>\n<li>Calculated from the number of deaths at each age multiplied by the expected remaining years of life according to a global standard life expectancy.</li>\n</ul>\n<p><strong>Years lost to disability (YLD):</strong></p>\n<ul>\n<li>Where the number of incident cases due to injury and illness is multiplied by the average duration of the disease and a weighting factor reflecting the severity of the disease on a scale from 0 (perfect health) to 1 (dead).</li>\n</ul>\n<p><strong>DALY = YLL + YLD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Health Adjusted Life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">Expectancy</span> (HALE) (Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>The average number of years a <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> is expected to live in full health considering the current age-specific mortality rate.<br/>\n\t\t\t\tHealthy Life Expectancy</li>\n</ul>\n<p>HALE = Life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">Expectancy</span> at birth + adjustment of time spent in poor health</p>\n<p>HALE = LE-DALY</p>\n<p><strong>Life Expectancy</strong></p>\n<ul>\n<li>Average no. of years a <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> is expected to live, considering the current age-specific mortality rate.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Sullivan’s index (or DFLE) (Option D) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Disability-free life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> (DFLE) with the current pattern of mortality and disability.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 14-year-old girl presented with cyclical abdominal pain and a midline hypogastric lump. She has not achieved menarche yet. The per vaginal examination is shown below, and a blush swelling is seen along with it. What is the likely cause of her condition?", "options": [{"label": "A", "text": "Bartholin cyst", "correct": false}, {"label": "B", "text": "Transverse vaginal septum", "correct": false}, {"label": "C", "text": "Imperforate hymen", "correct": true}, {"label": "D", "text": "Endometrioma", "correct": false}], "correct_answer": "C. Imperforate hymen", "question_images": ["https://image.prepladder.com/content/OYNR2AGrgUTCDaESZTnI1746102554.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man suffered trauma to the eye from a punch while fighting with another person. What is the most common site of fracture in orbit?", "options": [{"label": "A", "text": "Medial wall", "correct": false}, {"label": "B", "text": "Lateral wall", "correct": false}, {"label": "C", "text": "Roof", "correct": false}, {"label": "D", "text": "Floor", "correct": true}], "correct_answer": "D. Floor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KfEeenANj7pzWGGYg0Lt1746102794.png", "https://image.prepladder.com/content/tcmz0bU5JWmR8V7A6zJh1746102794.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Blow-out <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> fractures result from trauma causing backward <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"53c6bebcbb169277718777b3fe0e5c\">eyeball</span> and an increase in <span class=\"customMeta\" data-dictid=\"537708a987169277719097ee31f0eb\">intraorbital</span> pressure, leading to a resultant fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pure blow-out fractures: Not associated with involvement of the <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> rim.</li>\n<li>Impure blow-out fractures: Associated with other fractures in the middle third of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> skeleton.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Periorbital oedema</strong> and blood <span class=\"customMeta\" data-dictid=\"f0c6fefae41692777187c76a6f65f6\">extravasation</span> (e.g., <strong>subconjunctival ecchymosis</strong>)</li>\n<li>Emphysema of the eyelids, more common with <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall fractures</li>\n<li><strong>Paraesthesia</strong> and anaesthesia in the distribution of the <strong>infraorbital nerve</strong> (lower lid, cheek, side of nose, upper lip, and upper teeth)</li>\n<li>Ipsilateral <span class=\"customMeta\" data-dictid=\"26bb4e3cc81692777187ce44e530e5\">epistaxis</span> (bleeding from maxillary sinus)</li>\n<li>Proptosis, often due to <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> oedema and haemorrhage</li>\n<li><strong>Enophthalmos</strong> (due to <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> fat escape, muscle entrapment, and <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> enlargement)</li>\n<li><strong>Diplopia</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>X-ray:</strong> <strong>Water’s view</strong> shows <strong>‘hanging drop’ opacity</strong> of the superior maxillary <span class=\"customMeta\" data-dictid=\"96976bc5fc1692777181dc8403015a\">antrum</span> due to <span class=\"customMeta\" data-dictid=\"18b73c28601692777188f2aae28838\">herniated</span> <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> contents.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Cobb, A. R., Murthy, R., Saiet, J., Bailey, B., &amp; Hibbert, J.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.sciencedirect.com/science/article/abs/pii/S0266435608000417\" data-tags=\"\" height=\"700\" src=\"https://image.prepladder.com/content/KfEeenANj7pzWGGYg0Lt1746102794.png\" width=\"570\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li><strong>CT/MRI: </strong>Coronal sections show extent of the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> and herniation- <strong>hanging drop or tear drop sign</strong></li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Gooris, Peter &amp; Mourits, Maarten &amp; Mensink, Gertjan &amp; Bergsma, Jan.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Teardrop-sign-as-a-result-of-an-orbital-floor-trapdoor-fracture-OS-coronal-view_fig4_376932263\" data-tags=\"\" height=\"209\" src=\"https://image.prepladder.com/content/tcmz0bU5JWmR8V7A6zJh1746102794.png\" width=\"248\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>General Measures and Medical Treatment:</strong></p>\n<ul>\n<li>Avoid nose blowing</li>\n<li>Systemic antibiotics to prevent <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> infection</li>\n<li>Analgesics and anti-inflammatory drugs</li>\n<li>Cold compresses to decrease swelling</li>\n</ul>\n<p><strong>Surgical Management:</strong></p>\n<ul>\n<li>Optimal surgery time: <strong>10-14 days after injury</strong></li>\n<li>Surgical indications: Persistent diplopia, large herniation, tissue incarceration, <span class=\"customMeta\" data-dictid=\"1f51f462bc1692777187ffc9d3094b\">enophthalmos</span> &gt;3mm</li>\n</ul>\n<p><strong>Orbital Surgeries:</strong></p>\n<ul>\n<li>Orbitotomy: 4 approaches: anterior, lateral, transfrontal, and temporofrontal</li>\n<li>Exenteration: Removal of all <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> contents and <span class=\"customMeta\" data-dictid=\"cd7fce2afd1692777195bc79cdc10b\">periorbita</span> through an <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> along <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> margins.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Miss. Uma presents to you with complaints of mass descending per vaginum for the past 6 months. On examination, you notice a grade 3 uterovaginal prolapse and a decubitus ulcer over the prolapse. Which of the following is a cause for this decubitus ulcer and treatment?", "options": [{"label": "A", "text": "Malignancy and excision", "correct": false}, {"label": "B", "text": "Venous congestion and reduction of the prolapsed part into the vagina and daily packing with glycerine and acriflavine", "correct": true}, {"label": "C", "text": "Infection and antibiotics", "correct": false}, {"label": "D", "text": "Trauma and dressing", "correct": false}], "correct_answer": "B. Venous congestion and reduction of the prolapsed part into the vagina and daily packing with glycerine and acriflavine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GU04SrCJ8DS58tadJn801746102824.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cardiac output reverts to pre-pregnancy levels by:", "options": [{"label": "A", "text": "2 days postpartum", "correct": false}, {"label": "B", "text": "5 days post-partum", "correct": false}, {"label": "C", "text": "7 days postpartum", "correct": false}, {"label": "D", "text": "10 days postpartum", "correct": true}], "correct_answer": "D. 10 days postpartum", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hemodynamic changes during pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Change</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cardiac output (L/min)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases +40%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stroke volume (ml)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases +27%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heart rate (per minute)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases +17%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood pressure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An unaffected or mid-pregnancy drop of <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">diastolic pressure</span> by 5-10 mm Hg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Venous pressure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases +100%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Colloid <span class=\"customMeta\" data-dictid=\"5d369be246169277719451754ab37a\">oncotic</span> pressure (mmHg)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases -14%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance (SVR)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases -21%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance (PVR)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases -34%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The pregnancy test kit launched by the government is called:", "options": [{"label": "A", "text": "NISHCHAY", "correct": true}, {"label": "B", "text": "NIKSHAY", "correct": false}, {"label": "C", "text": "NIKUSTH", "correct": false}, {"label": "D", "text": "AXSHYA", "correct": false}], "correct_answer": "A. NISHCHAY", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GyIqkXfJ4upsibFMqhPd1746102978.png", "https://image.prepladder.com/content/cd52X5z1Jyhm8QxATBw41746102985.png"], "explanation": "<p>Correct Answer A - NISHCHAY</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mission Parivar Vikas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>It aims to promote family planning and reduce the population</li>\n<li><strong>Nayi pahel kit-</strong> family planning kit for newlyweds</li>\n<li><strong>Saas bahu samelan-</strong> encourages daughter-in-law and mother-in-law to discuss family planning</li>\n<li><strong>Saarthi-</strong> family planning mobile van</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>NISHCHAY</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Home testing UPT provided by ASHA</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"377\" src=\"https://image.prepladder.com/content/GyIqkXfJ4upsibFMqhPd1746102978.png\" width=\"686\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Jansankhya sthirata kosh</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Population <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> fund ADD ON: provides incentives for delaying marriage, birth spacing</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"350\" src=\"https://image.prepladder.com/content/cd52X5z1Jyhm8QxATBw41746102985.png\" width=\"686\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gather approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contraception counseling method</li>\n<li>Stands for Greet, Ask, Tell, Help, Explain, and Return</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old woman presents with a malodorous vaginal discharge that started a week earlier. On examination, the Whiff's test is positive, and the Gram stain shows the presence of clue cells. This infection is commonly treated with which of the following?", "options": [{"label": "A", "text": "Metronidazole", "correct": true}, {"label": "B", "text": "Nystatin pessary", "correct": false}, {"label": "C", "text": "Tetracycline", "correct": false}, {"label": "D", "text": "Azithromycin", "correct": false}], "correct_answer": "A. Metronidazole", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6FRmVH0vpaePzlWTHvDr1746102984.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amsel's Criteria</p>\n<ul>\n<li>Presence of clue cells (more than 20% of the total cell population)</li>\n</ul>\n<ul>\n<li>Positive whiff test</li>\n</ul>\n<ul>\n<li>Vaginal pH greater than 4.5</li>\n</ul>\n<ul>\n<li>Thin, white, <span class=\"customMeta\" data-dictid=\"d9ec45007b1692777189e3b26e44ca\">homogeneous</span> <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> discharge</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Microscopic Examination</p>\n<ul>\n<li>Detection of clue cells in <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> smear</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Molecular Methods</p>\n<ul>\n<li>Detection of ribosomal <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> of Gardnerella vaginalis using PCR</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n<p>First-Line Treatment</p>\n<ul>\n<li>Oral Metronidazole: 500 mg BD for 7 days</li>\n<li>Tinidazole 2 g orally for 3 days</li>\n</ul>\n<p>Alternative Treatment</p>\n<ul>\n<li>Clindamycin 300 mg orally BD for 7 days</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acidic pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaline pH&gt;7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaline pH&gt;7</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Candidiasis</strong></p>\n<ul>\n<li>Dimorphic fungi\n\t\t\t\t<ul>\n<li>Blastospores (sacreoids)</li>\n<li>Mycelia (invasion &amp; adherence)</li>\n</ul>\n</li>\n<li>Curdy white <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> on <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> wall on removal causes petechiae</li>\n<li>Out of proportion pruritus</li>\n<li>Complicated/uncomplicated</li>\n</ul>\n<p><strong>Uncomplicated</strong></p>\n<ul>\n<li>Seen in normal women</li>\n<li>Good prognosis</li>\n<li>Associated with allicans</li>\n</ul>\n<p><strong>Complicated</strong></p>\n<ul>\n<li>In <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> (in DM, TB, pregnancy etc)</li>\n<li>Recurrent, severe</li>\n<li>Associated with non-allicans</li>\n</ul>\n<p><strong>Treatment</strong></p>\n<ul>\n<li>Azoles\n\t\t\t\t<ul>\n<li>Oral</li>\n<li>Fluconazole</li>\n<li>Rx both male &amp; female</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bacterial Vaginosis</strong></p>\n<ul>\n<li>Hemophilus vaginalis aka Garderella vaginalis</li>\n<li><strong>Amsel's criteria</strong> for diagnosing <span class=\"customMeta\" data-dictid=\"37bea4cea61692777182730bcddd46\">bacterial vaginosis</span> require the presence of at least three out of the following five criteria</li>\n</ul>\n<p>1. Presence of clue cells (&gt;20%) on <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> examination</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mikael Häggström,\" data-hash=\"\" data-license=\"CC0 1.0\" data-source=\"https://en.wikipedia.org/wiki/Clue_cell#/media/File:Micrograph_of_a_clue_cell,_annotated.jpg\" data-tags=\"\" height=\"200\" src=\"https://image.prepladder.com/content/6FRmVH0vpaePzlWTHvDr1746102984.png\" width=\"266\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>2. <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> pH greater than 4.5</p>\n<p>3. Positive whiff test with KOH (fishy odor)</p>\n<p>4. Thin, white <span class=\"customMeta\" data-dictid=\"d9ec45007b1692777189e3b26e44ca\">homogeneous</span> <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> discharge</p>\n<p>5. Fishy odour</p>\n<p><strong>Treatment</strong></p>\n<ul>\n<li>Metronidazole</li>\n<li>Rx the women (no sexual transmission)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trichomoniasis</strong></p>\n<ul>\n<li>By Trichomonas vaginalis flagellate protozoan\n\t\t\t\t<ul>\n<li>Motile organism causes severe <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> &amp; severe pruritis</li>\n</ul>\n</li>\n<li>Colpitis Macularis (strawberry vagina)</li>\n<li>Greenish yellow, frothy discharge</li>\n</ul>\n<p><strong>Treatment</strong></p>\n<ul>\n<li>Metronidazole</li>\n<li>Rx both man &amp; women</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What dose of folic acid is recommended for a woman who wants to become pregnant but has a history of pregnancy complicated with a neural tube defect?", "options": [{"label": "A", "text": "400 mcg/day", "correct": false}, {"label": "B", "text": "1 mg/day", "correct": false}, {"label": "C", "text": "2 mg/day", "correct": false}, {"label": "D", "text": "4 mg/day", "correct": true}], "correct_answer": "D. 4 mg/day", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Dose of Folic Acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>400 μg daily</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Standard <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> supplementation for all women of <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> age to prevent <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects and support overall health.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4 mg daily</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-demand situations: Multiple pregnancies, <span class=\"customMeta\" data-dictid=\"f350ca9b3516927771814951e4c70c\">anticonvulsant</span> therapy, haemoglobinopathies, chronic infections/diseases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4 mg daily from 1 month before conception to about 12 weeks of pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prevent the <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> of <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects in women with prior affected infants.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4 mg daily for at least 4 weeks post-delivery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treat pregnancy-induced megaloblastic anaemia and replenish <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> stores after childbirth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1 mg daily with iron and a <span class=\"customMeta\" data-dictid=\"857226a62716927771933d4e26861b\">nutritious</span> diet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Improve symptoms and aid recovery from pregnancy-induced megaloblastic anaemia.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the condition characterized by painless vision loss?", "options": [{"label": "A", "text": "Central retinal arterial occlusion", "correct": false}, {"label": "B", "text": "Branched retinal artery occlusion", "correct": false}, {"label": "C", "text": "Central retinal vein occlusion", "correct": true}, {"label": "D", "text": "Branched retinal vein occlusion", "correct": false}], "correct_answer": "C. Central retinal vein occlusion", "question_images": ["https://image.prepladder.com/content/jAQcyPb9JWDbRgLgxbYF1746103041.png"], "explanation_images": ["https://image.prepladder.com/content/TlILQJuNTBM7uK9GMN2X1746103095.png", "https://image.prepladder.com/content/JgoWfy1VV7JN6GeL68dl1746103095.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Age <strong>&gt; 50 years</strong> (primary risk factor), <strong>Hypertension</strong>, Diabetes Mellitus, Hyperlipidemia, <span class=\"customMeta\" data-dictid=\"61e49875801692777188ad5edea804\">Glaucoma</span> (increased IOP), Smoking, Hypercoagulable states</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thrombosis driven by <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> stasis, endothelial damage, and hypercoagulability</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-ischemic CRVO</strong> (Venous <span class=\"customMeta\" data-dictid=\"ea73ce564216927771989ea1aa2c3d\">stasis</span> retinopathy) (75% of cases)</p>\n<ul>\n<li>Mild to moderate, <strong>unilateral blurring of vision </strong></li>\n<li>Fundus: Mild <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and tortuosity, flame-shaped hemorrhages, mild <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> edema</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ischemic CRVO</strong> (Hemorrhagic retinopathy)</p>\n<ul>\n<li>Severe, <strong>sudden visual loss</strong>, massive <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> engorgement, <strong>\"splashed-tomato\" </strong>hemorrhages, cotton <span class=\"customMeta\" data-dictid=\"eaae57387d1692777202060f299953\">wool</span> spots, <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> edema</li>\n<li>Marked <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> sheathing, collaterals, neovascularization, chronic <span class=\"customMeta\" data-dictid=\"99516d71df1692777185eb2585a44f\">cystoid</span> edema</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sagnik Sen, Mukesh Patil, Rohit Saxena\" data-hash=\"\" data-license=\"Na\" data-source=\"https://www.researchgate.net/figure/Tomato-splashed-appearance-in-CRVO_fig4_313965605\" data-tags=\"\" height=\"248\" src=\"https://image.prepladder.com/content/TlILQJuNTBM7uK9GMN2X1746103095.png\" width=\"409\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ocular Exam: Visual acuity, IOP, Slit-lamp exam (NVI), Gonioscopy (NVA)</li>\n<li><strong>Goldmann Perimetry and ERG: </strong>Differentiating ischemic vs non-ischemic CRVO</li>\n<li><strong>Fundus Fluorescein Angiography (FFA):</strong> Assess <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> perfusion</li>\n<li><strong>Optical Coherence Tomography (OCT): </strong>Assess <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> edema, sub-retinal fluid</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Systemic Management:</strong> Control of <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> conditions (hypertension, diabetes, hyperlipidemia, hyperhomocysteinemia)</li>\n<li><strong>Medical Treatment: <span class=\"customMeta\" data-dictid=\"67c9bce29d169277719036007848c0\">Intravitreal</span> anti-VEGF (e.g., Bevacizumab)</strong>, <span class=\"customMeta\" data-dictid=\"67c9bce29d169277719036007848c0\">intravitreal</span> steroids (Triamcinolone, Dexamethasone implant)</li>\n<li><strong>Laser Therapy: Panretinal <span class=\"customMeta\" data-dictid=\"10cb4498ea1692777195b60ee356a3\">photocoagulation</span> (PRP) </strong>for neovascularization</li>\n<li>Surgical: Pars <span class=\"customMeta\" data-dictid=\"2d0756b0d11692777195ef3bcd110d\">plana</span> <span class=\"customMeta\" data-dictid=\"e6aa17c07816927772024116d41015\">vitrectomy</span> for complications</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neovascular glaucoma, <span class=\"customMeta\" data-dictid=\"176e169d7a169277719341dbc83862\">Neovascularization</span> of the <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">iris</span> (NVI), Vitreous hemorrhage, Proliferative retinopathy, Chronic <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> edema</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Serial monitoring of serum beta hCG is required for which of the following conditions?", "options": [{"label": "A", "text": "Downs syndrome", "correct": false}, {"label": "B", "text": "Pregnancy-associated with Neural tube defects", "correct": false}, {"label": "C", "text": "Molar pregnancy", "correct": true}, {"label": "D", "text": "Rh negative pregnancy", "correct": false}], "correct_answer": "C. Molar pregnancy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Yqrs1kygUVw4BXo7r5mZ1746103135.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Partial Mole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete Mole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Karyotype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually 69, XXY or 69, XXX (triploid)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Usually 46, XX or 46, XY (diploid)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 paternal sets + 1 <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> set</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All paternal (empty egg + <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> duplication)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fetal tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It may be present but abnormal.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>β-hCG levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elevated, but lower than the complete mole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of persistent GTD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-10%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of choriocarcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-4%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-3%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Theca <span class=\"customMeta\" data-dictid=\"cb86764f631692777191898edd4296\">lutein</span> cysts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 8-month-old baby on examination shows signs of vitamin A deficiency. What is the dose of vitamin A to be administered to the baby?", "options": [{"label": "A", "text": "25,000 IU IM", "correct": false}, {"label": "B", "text": "25,000 IU orally", "correct": false}, {"label": "C", "text": "100,000 IU orally", "correct": true}, {"label": "D", "text": "100,000 IU IM", "correct": false}], "correct_answer": "C. 100,000 IU orally", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - 100,000 IU orally</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>&lt;6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>6 months-1 year</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>&gt; 1 year</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Day 0 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">50000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1 lakh IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2 <span class=\"customMeta\" data-dictid=\"747531de8416927771915b0ec79f73\">Lac</span> IU</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Day 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">50000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1 lakh IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2 <span class=\"customMeta\" data-dictid=\"747531de8416927771915b0ec79f73\">Lac</span> IU</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Day 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">50000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1 lakh IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2 <span class=\"customMeta\" data-dictid=\"747531de8416927771915b0ec79f73\">Lac</span> IU</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which kit would you recommend for the treatment of a 20-year-old female who has recently engaged in sexual intercourse and is experiencing vaginal discharge and lower abdominal pain when following the syndromic management approach for sexually transmitted infections at the Suraksha clinic in the local primary health center?", "options": [{"label": "A", "text": "Blue", "correct": false}, {"label": "B", "text": "Red", "correct": false}, {"label": "C", "text": "Black", "correct": false}, {"label": "D", "text": "Yellow", "correct": true}], "correct_answer": "D. Yellow", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Yellow </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Kit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medicines</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grey</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urethral discharge</li>\n<li>Cervicitis</li>\n<li>Ano-rectal discharge</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Azithromycin, cefixime</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Green</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vaginitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Secnidazole, fluconazole</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-herpetic <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> ulcers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Azithromycin, B. Penicillin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blue <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Genital ulcers</li>\n<li>Penicillin <span class=\"customMeta\" data-dictid=\"aa1288c36b16927771814fa5aa84eb\">allergy</span> +</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Azithromycin, doxycycline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Red <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Herpetic <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> ulcers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acyclovir</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yellow</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefixime metronidazole, doxycycline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Black <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inguinal bubo</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Azithromycin, doxycycline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Brown</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anorectal <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefixime, doxycycline</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a woman who has a previous infertility history and is currently undergoing HMG treatment, based on the following findings in the USG?", "options": [{"label": "A", "text": "Ovarian hyperstimulation syndrome", "correct": true}, {"label": "B", "text": "Theca lutein cyst", "correct": false}, {"label": "C", "text": "PCOD", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "A. Ovarian hyperstimulation syndrome", "question_images": ["https://image.prepladder.com/content/JlXm0Gdh4GXhIvVz3JBc1747905321.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mathur Classification of OHSS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild OHSS:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal bloating</li>\n<li>Mild <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Ovarian size &lt;8cm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate OHSS:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Moderate <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Nausea + vomiting</li>\n<li>Ultrasound evidence of ascites</li>\n<li>Increased Ovarian size (8-12 cm)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe OHSS:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical ascites/hydrothorax</li>\n<li>Oliguria (&lt;500 ml/day)</li>\n<li>Hematocrit &gt;0.45</li>\n<li>Hyponatremia (sodium &lt;134 mmol/l)</li>\n<li>Hypoosmolality (&lt;282 mOsm/kg)</li>\n<li>Hypoproteinemia (albumin &lt;35 g/l)</li>\n<li>Ovarian size &gt;12 cm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Critical OHSS:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tense ascites/large hydrothorax</li>\n<li>Hematocrit &gt;0.55</li>\n<li>WBC &gt;25000/ml</li>\n<li>Oliguria/anuria</li>\n<li>Thromboembolism</li>\n<li>ARDS</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of OHSS:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Avoid pregnancy in severe &amp; critical forms</li>\n<li>Remove fluids by tapping <span class=\"customMeta\" data-dictid=\"a1146fb9d8169277718250cf1224a8\">ascites</span> &amp; effusion</li>\n<li>Oral fluids (Mild, moderate forms)</li>\n<li>IV Fluids for replacement:\n\t\t\t\t<ul>\n<li>NaCl, DNS (crystalloids)</li>\n<li>Albumin, Dextran, <span class=\"customMeta\" data-dictid=\"24511b2ef716927771990798c3d939\">starch</span> (colloids)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is used to reduce the selection bias in a clinical trial?", "options": [{"label": "A", "text": "Selecting the population", "correct": false}, {"label": "B", "text": "Intervention", "correct": false}, {"label": "C", "text": "Randomization", "correct": true}, {"label": "D", "text": "Written informed consent", "correct": false}], "correct_answer": "C. Randomization", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Randomization</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Randomisation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>The technique where every participant will get an equal and known chance of being allocated to either the treatment group or the control group.</li>\n<li>Eliminates both known and unknown confounders.</li>\n<li><strong>Selection bias is avoided by randomisation,</strong> which arises when the participants are not representative of the target population.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>In a clinical trial, patients are randomly assigned to receive either a new drug or a placebo, balancing out <span class=\"customMeta\" data-dictid=\"fe39bb8df416927771849b06e48169\">confounding</span> variables.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of Bias</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Subject Bias</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigator Bias </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Analysis Bias</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recall bias</li>\n<li>Hawthorne bias</li>\n<li>Reporting bias</li>\n<li>Non-response bias</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Selection bias</strong>\n<ul>\n<li>Berksonian</li>\n<li>Neyman</li>\n<li>Reporting</li>\n</ul>\n</li>\n<li>Publication bias</li>\n<li>Misclassification bias</li>\n<li>Interviewer bias</li>\n<li>Pygmalion bias</li>\n<li>Golem bias (blunting of response due to demotivated observer)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Statistical bias</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions are associated with oligohydramnios?", "options": [{"label": "A", "text": "Renal agenesis", "correct": true}, {"label": "B", "text": "Neural tube defect", "correct": false}, {"label": "C", "text": "Esophageal atresia", "correct": false}, {"label": "D", "text": "Premature birth", "correct": false}], "correct_answer": "A. Renal agenesis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YOtYm09bnEeUIe8i4oqi1747905219.png"], "explanation": "\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:33px; vertical-align:top; width:131px\">\n<p style=\"text-align:center\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:33px; vertical-align:top; width:242px\">\n<p style=\"text-align:center\"><strong>Polyhydramnios</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:33px; vertical-align:top; width:233px\">\n<p style=\"text-align:center\"><strong>Oligohydramnios</strong></p>\n</td>\n</tr>\n<tr>\n<td><strong>Fetal Factors</strong></td>\n<td>\n<ul>\n<li>Fetal anomalies (e.g., anencephaly, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> atresia)</li>\n<li>Twin-to-twin <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> syndrome (TTTS)</li>\n<li>Hydrops fetalis</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Renal agenesis</li>\n<li>Post-term pregnancy</li>\n<li>Fetal growth restriction (IUGR)</li>\n<li>Amnion nodosum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Maternal Factors</strong></td>\n<td>\n<ul>\n<li>Diabetes mellitus</li>\n<li>Cardiac disease</li>\n<li>Renal disease</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Maternal hypertension</li>\n<li>Preeclampsia</li>\n<li>Placental insufficiency</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>Placental Factors</strong></td>\n<td>Chorioangioma</td>\n<td>Placental abruption</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of statistical diagram is used in the given text to illustrate the population change between 1983 and 1989 in a specific location?", "options": [{"label": "A", "text": "Histogram", "correct": false}, {"label": "B", "text": "Line diagram", "correct": false}, {"label": "C", "text": "Component bar graph", "correct": true}, {"label": "D", "text": "Multiple bar graphs", "correct": false}], "correct_answer": "C. Component bar graph", "question_images": ["https://image.prepladder.com/content/P4O6pZL13J0aZnRtD5fY1748163870.png"], "explanation_images": ["https://image.prepladder.com/content/rZgryOT4tho4uSUkbXHI1746103652.png", "https://image.prepladder.com/content/030R5jbNwd5uYC6WgIH11746103661.png", "https://image.prepladder.com/content/3NPnRo9Qa7v5fLpx9NNi1746103670.png", "https://image.prepladder.com/content/jTkxnUUMYIKJmPlhzQSx1746103679.png", "https://image.prepladder.com/content/fOy50mAKpUxbKXgTwZgX1746103688.png"], "explanation": "<p>Correct Answer C - Component bar graph</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Explanation</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"329\" src=\"https://image.prepladder.com/content/rZgryOT4tho4uSUkbXHI1746103652.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Simple Bar <span class=\"customMeta\" data-dictid=\"a445e59f7816927771864e36b1dbd3\">Diagram</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple bar diagrams represent the frequency of <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> variables like gender.</li>\n<li>Discrete variables:These variables take fewer values and no in between values.\n\t\t\t\t<ul>\n<li>Examples: Religion, Blood groups</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"246\" src=\"https://image.prepladder.com/content/030R5jbNwd5uYC6WgIH11746103661.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Compound Bar <span class=\"customMeta\" data-dictid=\"a445e59f7816927771864e36b1dbd3\">Diagram</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>There are gaps (discrete data) represented with multiple bars.</li>\n<li>It is <span class=\"customMeta\" data-dictid=\"1304db17d3169277719684a316a8c4\">qualitative</span> in the first quarter.</li>\n<li>It is a Multiple bar diagram/Compound bar diagram.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"321\" src=\"https://image.prepladder.com/content/3NPnRo9Qa7v5fLpx9NNi1746103670.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Component Bar <span class=\"customMeta\" data-dictid=\"a445e59f7816927771864e36b1dbd3\">Diagram</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Same bar has been divided into different components and each component represents its frequency.</li>\n<li>It is a frequency of <span class=\"customMeta\" data-dictid=\"635650799116927771862d7cb568f4\">discrete</span> variables.</li>\n<li>It is known as the Component bar diagram.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"458\" src=\"https://image.prepladder.com/content/jTkxnUUMYIKJmPlhzQSx1746103679.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Histogram (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>It is not a bar diagram.</li>\n<li>It represents the frequency of continuous variables or <span class=\"customMeta\" data-dictid=\"ef5cb829b8169277719603304e73cb\">quantitative</span> variables.</li>\n<li>Height is a <span class=\"customMeta\" data-dictid=\"ef5cb829b8169277719603304e73cb\">quantitative</span> or <span class=\"customMeta\" data-dictid=\"558c892bf516927771857a44d2fe91\">continuous variable</span> (can take many possible values and also in between values)</li>\n<li>It can be expressed in decimals and there is no gap in between.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During your internship, you notice the following instrument being used by the senior resident. The uses of this instrument include all the following except?", "options": [{"label": "A", "text": "To differentiate between chronic inversion and fibroid polyp", "correct": false}, {"label": "B", "text": "It is used to diagnose cervical stenosis", "correct": false}, {"label": "C", "text": "It is used in fallopian tube recanalization", "correct": true}, {"label": "D", "text": "It is used to measure the uterine cavity and the cervical length", "correct": false}], "correct_answer": "C. It is used in fallopian tube recanalization", "question_images": ["https://image.prepladder.com/content/H0uvaq3WTwmfGok9Pg9O1747905264.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old multiparous woman presented with grade II/III uterine prolapse with cystocele. She complains of passing urine on coughing and sneezing. What type of urinary incontinence is seen in this patient?", "options": [{"label": "A", "text": "Overflow incontinence", "correct": false}, {"label": "B", "text": "Urge incontinence", "correct": false}, {"label": "C", "text": "Stress incontinence", "correct": true}, {"label": "D", "text": "Neurogenic bladder", "correct": false}], "correct_answer": "C. Stress incontinence", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urinary <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> (M/C)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> control (stress incontinence).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urinary retention</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Difficulty in <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> emptying</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recurrent <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> infections</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to incomplete <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> emptying.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bowel Dysfunction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Constipation, straining, and faecal incontinence.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vaginal Ulceration</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to exposure and friction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sexual Dysfunction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pain or discomfort during intercourse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pelvic Pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain, dyspareunia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to WHO, what is the minimum number of antenatal visits?", "options": [{"label": "A", "text": "8", "correct": true}, {"label": "B", "text": "4", "correct": false}, {"label": "C", "text": "12", "correct": false}, {"label": "D", "text": "14", "correct": false}], "correct_answer": "A. 8", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which serotype of HPV is responsible for Ca Cervix?", "options": [{"label": "A", "text": "16,19,31,32", "correct": false}, {"label": "B", "text": "16,18,31,32", "correct": false}, {"label": "C", "text": "16,19,31,33", "correct": false}, {"label": "D", "text": "16,18,31,33", "correct": true}], "correct_answer": "D. 16,18,31,33", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Risk types of Human <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">Papilloma</span> Virus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6, 11, 42, 43, and 44.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70</p>\n<p><strong>16 and 18 </strong>are responsible for most cancers.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old primigravida at 10 weeks gestation comes to the ER with nausea, vomiting, and abdominal pain. Nausea and vomiting began one day back, and now the patient is unable to tolerate fluids. She complains of pain in the right upper quadrant, which started a few hours back. On examination, her temperature is 100.2 F, her pulse is 119 bpm, and her BP is 110/70 mm of Hg. She has swelling of her lower limbs up to the ankles bilaterally. Abdominal examination shows a gravid uterus corresponding to 10 weeks of gestation and tenderness in the right upper quadrant, with mild guarding and is diagnosed as acute appendicitis. What is the next step of management? Laboratory Findings: Complete blood count: Haemoglobin: 11g/dl Leukocytes: 13,000 cells/μl Platelets: 150,000 cells/μl Liver Function tests: AST: 40U/L ALT: 48U/L Urinalysis: Protein: negative Pus cells: 1-2/HPF Bacteria: none USG abdomen: Reveals a 9.7mm diameter, aperistaltic, non-compressible, dilated, blind-ending structure arising from the base of the caecum.", "options": [{"label": "A", "text": "Do appendicectomy", "correct": true}, {"label": "B", "text": "Wait till 2nd trimester", "correct": false}, {"label": "C", "text": "Conservative management", "correct": false}, {"label": "D", "text": "Reassurance", "correct": false}], "correct_answer": "A. Do appendicectomy", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:396px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>MANTRELS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M</strong>igratory pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A</strong>norexia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N</strong>ausea, Vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T</strong>enderness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>R</strong>ebound tenderness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>E</strong>levated temperature</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L</strong>eukocytosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S</strong>hift to left</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Score Interpretation:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Score of 9-10 - diagnosis is certain</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Score of 7-8 - High likely <span class=\"customMeta\" data-dictid=\"b64d7fd68c1692777189e1bae32157\">hood</span> of diagnosis</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Score of 5-6 - Equivocal (most dangerous)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CECT is indicated in cases of Equivocal MANTREL score findings to confirm the diagnosis</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Score of 1-4 - Negative for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> appendicitis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "You are a doctor in a village. A 1-year-old child who is not taking feeds presents with fever and cough for 2 days. On examination, he is calm, with a respiratory rate of 51 breaths/min, and stridor is present. According to IMNCI (integrated management of neonatal and childhood illnesses). How is he classified?", "options": [{"label": "A", "text": "Pneumonia", "correct": false}, {"label": "B", "text": "Cough and cold", "correct": false}, {"label": "C", "text": "Severe pneumonia", "correct": true}, {"label": "D", "text": "ARDS", "correct": false}], "correct_answer": "C. Severe pneumonia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RMe4avtyFz8A1PJ6piSP1746103976.png"], "explanation": "<p>Correct Answer C - Severe pneu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which filter is used in a colposcope?", "options": [{"label": "A", "text": "Black", "correct": false}, {"label": "B", "text": "Red", "correct": false}, {"label": "C", "text": "Green", "correct": true}, {"label": "D", "text": "Yellow", "correct": false}], "correct_answer": "C. Green", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ojkTPlfaILVXL1Emu3OD1746104008.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Colposcopy Basics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnostic procedure using lighted magnifying instrument (colposcope)</li>\n<li>Examines cervix, vagina, and vulva</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abnormal Pap test</li>\n<li>Visual inspection with <span class=\"customMeta\" data-dictid=\"0dd11cf9621692777180830d7825b2\">acetic</span> acid (VIA)</li>\n<li>HPV DNA positive</li>\n<li>Suspicious <span class=\"customMeta\" data-dictid=\"4ac19545431692777184956c031e64\">cervix</span> with normal PAP</li>\n<li>Post-treatment follow-up of intraepithelial/invasive carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Equipment Required</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vaginal speculum</li>\n<li>Colposcope</li>\n<li>5% <span class=\"customMeta\" data-dictid=\"0dd11cf9621692777180830d7825b2\">acetic</span> acid</li>\n<li>Lugol's solution</li>\n<li>Biopsy forceps</li>\n<li>Endocervical speculum</li>\n<li>Kevorkian curette/endocervical brush</li>\n<li>Hemostasis materials</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Technical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Functions as dissecting microscope</li>\n<li>Magnifies cervical, vaginal, vulvar tissue</li>\n<li>Multiple options available:\n\t\t\t\t<ul>\n<li>Lens types</li>\n<li>Computer-generated images</li>\n<li>Light filters</li>\n<li>Camera capabilities</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following instruments are considered the gold standard for measuring intraocular pressure?", "options": [{"label": "A", "text": "Gonioscope", "correct": false}, {"label": "B", "text": "Goldmann applanation tonometer", "correct": true}, {"label": "C", "text": "Hertel’s exophthalmometer", "correct": false}, {"label": "D", "text": "Tonopen", "correct": false}], "correct_answer": "B. Goldmann applanation tonometer", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/q1S2w36zdW9UxtcIahZT1746103323.png", "https://image.prepladder.com/content/iKBu1DdPigMeXUIbgSdH1747905936.png", "https://image.prepladder.com/content/gT8bVIvvvZ7RL8H81gzM1746103323.png", "https://image.prepladder.com/content/7Q3TQlLtGIlvabz27MPQ1746103323.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an absolute contraindication for the device shown in the image below?", "options": [{"label": "A", "text": "Anemia", "correct": false}, {"label": "B", "text": "Vaginal bleeding", "correct": true}, {"label": "C", "text": "Uterine malformations", "correct": false}, {"label": "D", "text": "Uterine fibroids", "correct": false}], "correct_answer": "B. Vaginal bleeding", "question_images": ["https://image.prepladder.com/content/7woYQOgabMZE0ivZvhkc1746104083.png"], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\"&gt;Vaginal&lt;/span&gt; bleeding\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient diagnosed with a stroke, their visual field testing indicated macula sparing homonymous hemianopia. Where is the probable location of the lesion within the optic pathway?", "options": [{"label": "A", "text": "Optic tract", "correct": false}, {"label": "B", "text": "Occipital lobe", "correct": true}, {"label": "C", "text": "Optic radiation", "correct": false}, {"label": "D", "text": "Optic chiasma", "correct": false}], "correct_answer": "B. Occipital lobe", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WAmpxGw2UN2AjdZZpjlr1746104161.png", "https://image.prepladder.com/content/KrPfXRSpXu1Bf1V6xOx61746104161.png", "https://image.prepladder.com/content/VkNgNzo5DSveHmTd2JFT1746104161.png", "https://image.prepladder.com/content/G8vscMwmc70afTFbUeoA1746104161.png", "https://image.prepladder.com/content/JSyRjIvfP5sh19HcQeO41746104161.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Visual Pathway Lesions and Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fibers Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Field Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> + Nasal Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/WAmpxGw2UN2AjdZZpjlr1746104161.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Anopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Chiasma (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral Nasal Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"297\" src=\"https://image.prepladder.com/content/KrPfXRSpXu1Bf1V6xOx61746104161.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Bitemporal Hemianopia</strong></p>\n<p style=\"text-align:center\"><strong>(Heteronymous Hemianopia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Tract/ <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Geniculate Body (LGB)/ Optic Radiation (Option A) (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + Contralateral Nasal Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/VkNgNzo5DSveHmTd2JFT1746104161.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Homonymous Hemianopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Visual <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">Cortex</span> without the involvement of tip</strong></p>\n<p><strong>(Posterior Cerebral Artery) (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + Contralateral Nasal Fibers except <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> representation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/G8vscMwmc70afTFbUeoA1746104161.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Homonymous <span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\">Hemianopia</span> with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">Macular</span> Sparing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tip of Visual Cortex</strong></p>\n<p><strong>(Middle Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Macular Representation of Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> and Contralateral Nasal Fibers.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/JSyRjIvfP5sh19HcQeO41746104161.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Macular Homonymous Hemianopia</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is responsible for maintaining the births and deaths in India?", "options": [{"label": "A", "text": "Vital registration system", "correct": true}, {"label": "B", "text": "Census", "correct": false}, {"label": "C", "text": "Death certificate", "correct": false}, {"label": "D", "text": "Lay reporting", "correct": false}], "correct_answer": "A. Vital registration system", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Vital &lt;span class=\"customMeta\" data-dictid=\"ecc2886bef169277719705c1e5adf2\"&gt;registration&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a possible cause of the salt and pepper appearance of the fundus in a patient?", "options": [{"label": "A", "text": "Rubella", "correct": false}, {"label": "B", "text": "Syphilis", "correct": false}, {"label": "C", "text": "Refsum’s disease", "correct": false}, {"label": "D", "text": "Tuberculosis", "correct": true}], "correct_answer": "D. Tuberculosis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequent association of lung malignancy?", "options": [{"label": "A", "text": "Asbestosis", "correct": true}, {"label": "B", "text": "Silicosis", "correct": false}, {"label": "C", "text": "Bagassosis", "correct": false}, {"label": "D", "text": "Byssinosis", "correct": false}], "correct_answer": "A. Asbestosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the image provided, which refractive error is observed in the depicted condition?", "options": [{"label": "A", "text": "Hypermetropia and astigmatism", "correct": false}, {"label": "B", "text": "Myopia and astigmatism", "correct": true}, {"label": "C", "text": "Myopia and hypermetropia", "correct": false}, {"label": "D", "text": "Hypermetropia", "correct": false}], "correct_answer": "B. Myopia and astigmatism", "question_images": ["https://image.prepladder.com/content/WctwV2IzTXfclEbD3l9U1746104349.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Progressive, non-inflammatory <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> ectatic corneal condition affecting the <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> part.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Involves progressive thinning and <span class=\"customMeta\" data-dictid=\"def85be6371692777186604c253b12\">ectasia</span> of the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> due to <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> of mucopolysaccharides and collagen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Defective vision due to <strong>progressive <span class=\"customMeta\" data-dictid=\"619b89f28f16927771936b1ade010c\">myopia</span> and <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> astigmatism</strong> (uncorrectable by glasses) <strong>(Option B)</strong></li>\n<li>Blurred and distorted vision, glare, and halos around lights</li>\n<li>Light sensitivity and <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> irritation</li>\n<li>Visual loss primarily from <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> and myopia, secondary loss from corneal scarring</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Distorted Window Reflex:</strong> Visual <span class=\"customMeta\" data-dictid=\"01e6fc8ce01692777190444b00e46f\">irregularity</span> on corneal reflection.</li>\n<li>Placido Disc Irregularity: <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">Irregular</span> circles.</li>\n<li><strong>Slit-Lamp Examination:</strong>\n<ul>\n<li>Thinning and <span class=\"customMeta\" data-dictid=\"def85be6371692777186604c253b12\">ectasia</span> of the central cornea.</li>\n<li>Opacity at the apex, Fleischer Ring (brownish ring around the <span class=\"customMeta\" data-dictid=\"1c42c9fe83169277718486ee5a82e9\">cone</span> due to haemosiderin in the epithelium).</li>\n<li>Folds in Descemet's and Bowman's membranes.</li>\n</ul>\n</li>\n<li><strong>Vogt Striae:</strong> Fine, <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> <span class=\"customMeta\" data-dictid=\"0509c7dd431692777199a912f7af7a\">striae</span> at the apex, disappearing with external pressure.</li>\n<li><strong>Oil Droplet Reflex: </strong>Annular dark shadow separating central and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> in distant direct ophthalmoscopy.</li>\n<li>Retinoscopy: <strong>Yawning <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> (scissor reflex)</strong> with high oblique/irregular astigmatism.</li>\n<li>Ophthalmoscope Findings: <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">Irregular</span> <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> and progressive myopia, poorly corrected by <span class=\"customMeta\" data-dictid=\"9e8e9086691692777188b5a212bcc7\">glasses</span> in later stages.</li>\n<li><strong>Munson's Sign: </strong>Localized bulging of the lower lid when looking down (seen in late stages).</li>\n<li>Keratometer Findings: Malformed, malaligned, and malfocused mires.</li>\n<li>Corneal Topography: Sensitive method for early detection, shows corneal surface shape.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spectacle Correction:</strong></p>\n<ul>\n<li>Effective in the early stages, but contact lenses are more beneficial.</li>\n<li>Less effective in later stages due to <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> astigmatism.</li>\n</ul>\n<p><strong>Contact Lenses:</strong></p>\n<ul>\n<li>Rigid gas <span class=\"customMeta\" data-dictid=\"32343a48ea1692777195585b33c764\">permeable</span> lenses improve vision in early cases.</li>\n<li>Specially designed scleral lenses (e.g., Rose-K) are useful in early to moderate cases.</li>\n</ul>\n<p><strong>Corneal <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">Collagen</span> <span class=\"customMeta\" data-dictid=\"2cf4952c63169277718543a0883583\">Cross-Linking</span> (CXL):</strong></p>\n<ul>\n<li>New treatment <span class=\"customMeta\" data-dictid=\"2333eb40ca16927771925442e26719\">modality</span> to slow disease progression.</li>\n<li>Involves <strong>Riboflavin (0.1%) <span class=\"customMeta\" data-dictid=\"fe2c08a01b1692777187011e915049\">eye drops</span> and UVA radiation</strong>.</li>\n<li>Riboflavin induces <span class=\"customMeta\" data-dictid=\"2cf4952c63169277718543a0883583\">cross-linking</span> of corneal <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> to stabilize the <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> and improve <span class=\"customMeta\" data-dictid=\"b8a7f0f92a16927771853a60b379f8\">contact lens</span> tolerance.</li>\n</ul>\n<p><strong>Keratoplasty :</strong></p>\n<ul>\n<li>Recommended if disease progresses or in cases of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"7b09c2b34916927771896ff30fcaa0\">hydrops</span> (Descemet's <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> tear).</li>\n<li>Reserved for more advanced diseases or when other treatments fail.</li>\n<li>Penetrating <span class=\"customMeta\" data-dictid=\"9810f0dbdb16927771908a955add6d\">keratoplasty</span> is common, but <strong>Deep Anterior Lamellar <span class=\"customMeta\" data-dictid=\"9810f0dbdb16927771908a955add6d\">Keratoplasty</span> (DALK)</strong> is preferred if Descemet's <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and <span class=\"customMeta\" data-dictid=\"b9a776cad316927771878445d3a99f\">endothelium</span> are intact, reducing <span class=\"customMeta\" data-dictid=\"49e378f9f71692777197bc5e458569\">rejection</span> risk.</li>\n</ul>\n<p><strong>Intracorneal Ring Segments (INTACS) :</strong></p>\n<ul>\n<li>Effective in early to moderate cases by <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">flattening</span> the cornea.</li>\n<li>Less effective in halting progression.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When quarantine was introduced in the 14th century for plague, how many days were people who were suspected to have the infection quarantined for?", "options": [{"label": "A", "text": "14 days", "correct": false}, {"label": "B", "text": "35 days", "correct": false}, {"label": "C", "text": "40 days", "correct": true}, {"label": "D", "text": "28 days", "correct": false}], "correct_answer": "C. 40 days", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - 4\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the image provided, which refractive error is observed in the depicted condition?", "options": [{"label": "A", "text": "A condensing lens is not required", "correct": false}, {"label": "B", "text": "B) It is used as close to the patient’s eye as possible. A real, inverted image is seen, Magnification is about 15 times", "correct": false}, {"label": "C", "text": "A real, inverted image is seen", "correct": false}, {"label": "D", "text": "Magnification is about 15 times", "correct": true}], "correct_answer": "D. Magnification is about 15 times", "question_images": ["https://image.prepladder.com/content/0o5ng07v1egaHTnFDhvl1746104432.png"], "explanation_images": ["https://image.prepladder.com/content/AdUbNcws3bUBqAJjTmm61746104471.png", "https://image.prepladder.com/content/k94BafnIIiBD4FGkSiz21746104471.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Direct Ophthalmoscope</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indirect Ophthalmoscope</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Virtual image, erect <strong>(Option B &amp; C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Real image, inverted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Magnification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>15x <span class=\"customMeta\" data-dictid=\"279228dffd1692777191c834a27177\">magnification</span> <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2-3x magnification</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Condensing lens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not required</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Visualization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uniocular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Binocular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Field of view</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 DD</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8 DD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Undilated pupil</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stereopsis present</li>\n<li>Entire <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> can be seen</li>\n<li>Visualization through hazy media is possible</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD \" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Ophthalmoscopy#/media/File:Ophthalmoscope_Otoscope08.JPG\" data-tags=\"\" height=\"437\" src=\"https://image.prepladder.com/content/AdUbNcws3bUBqAJjTmm61746104471.png\" width=\"198\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sun.Y.Lee \" data-hash=\"\" data-license=\"NA\" data-source=\"https://eyewiki.org/File:AA0_52689.jpg\" data-tags=\"\" height=\"288\" src=\"https://image.prepladder.com/content/k94BafnIIiBD4FGkSiz21746104471.png\" width=\"362\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which benefit does a patient receive when seeking treatment at an ESI hospital under the ESI Act?", "options": [{"label": "A", "text": "Sickness benefit", "correct": false}, {"label": "B", "text": "Medical benefit", "correct": true}, {"label": "C", "text": "Maternity benefit", "correct": false}, {"label": "D", "text": "Dependent's benefit", "correct": false}], "correct_answer": "B. Medical benefit", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Medical benefit</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Benefits of ESI (Employees State Insurance) Act</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medical Benefit</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Provides \"full medical care,\" including <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> <span class=\"customMeta\" data-dictid=\"1a8e8831bb1692777182ce2c8a751f\">at no</span> cost to insured individuals &amp; families in cases of sickness, employment injury, and maternity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sickness Benefit <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Provides <strong>70% </strong>of average daily wages in cash <strong>during medical leave </strong>for a maximum of 91 days within 365 days, as certified by the Insurance Medical Officer/Practitioner.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extended </strong>Sickness Benefit</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extended coverage for long-term diseases beyond 91 days; 34 diseases covered if employed for two years.</li>\n<li>Extended <span class=\"customMeta\" data-dictid=\"73c1caf8d11692777198b1248373d3\">sickness</span> benefit is paid at <strong>80%</strong> of the insured person's wages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Enhanced </strong>Sickness Benefit</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cash benefits (100% wages) for <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> procedures:\n\t\t\t\t<ul>\n<li>14 days for <span class=\"customMeta\" data-dictid=\"2a6989bad01692777201a73b82b799\">tubectomy</span> (women),</li>\n<li>7 days for <span class=\"customMeta\" data-dictid=\"8b8c53004d1692777201cf3df335f5\">vasectomy</span> (men).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maternity Benefit <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cash payments for childbirth, miscarriage, or pregnancy-related sickness:\n\t\t\t\t<ul>\n<li>26 weeks for childbirth,</li>\n<li>6 weeks for miscarriage, and</li>\n<li>40 days for pregnancy-related sickness.</li>\n</ul>\n</li>\n<li>Paid at 100% of the insured woman's average daily wages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disablement Benefit</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temporary Disablement Benefit (TDB):\n\t\t\t\t<ul>\n<li>90% of wages paid from day one for temporary employment injury, until recovery.</li>\n</ul>\n</li>\n<li>Permanent Disablement Benefit (PDB):\n\t\t\t\t<ul>\n<li>90% of wages paid monthly for life, based on certified loss of earning capacity.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dependent's Benefit <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependents receive 90% of the deceased's (due to employment injuries) wages as a shared pension, and they are eligible until age 18.</li>\n<li><strong>If the daughter marries before 18, the benefit is withdrawn. </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Funeral Expenses</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It offers a cash payment of up to<strong> Rs. 15,000 </strong>to cover funeral expenses upon the death of an insured individual.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rehabilitation</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Insured individuals and their families are entitled to continued medical treatment after permanent disablement or retirement.</li>\n<li>They have to pay a <span class=\"customMeta\" data-dictid=\"01cc201eb616927771937a9ae6c669\">nominal</span> fee of Rs.10 per month for this benefit.</li>\n<li>A rehabilitation <span class=\"customMeta\" data-dictid=\"f8330e788f16927771812e4f73b80c\">allowance</span> of Rs.15,000 granted.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unemployment allowance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>For eligible employees due to factory <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> or retrenchment: 50% of wage for up to two years.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the proportion of the distribution within one standard deviation of the mean in a normal curve?", "options": [{"label": "A", "text": "68%", "correct": true}, {"label": "B", "text": "34%", "correct": false}, {"label": "C", "text": "99%", "correct": false}, {"label": "D", "text": "95%", "correct": false}], "correct_answer": "A. 68%", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kQWUBYe7wPX3pQRPoPwy1746105052.png"], "explanation": "<p>Correct Answer A- </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Area under the curve </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Observation covered </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mean +/- 1 SD</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">68.3% ~ 68% of observation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mean +/- 2 SD</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">95.4% ~ 95% of observation <strong>(Option D) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mean +/- 3 SD</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">99.7% ~ 99% of observation <strong>(Option C) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Mean +/- ∞SD</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">100% of observation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "If Bajra is mixed with black seeds, what is used to separate them?", "options": [{"label": "A", "text": "20% salt water", "correct": true}, {"label": "B", "text": "Normal saline", "correct": false}, {"label": "C", "text": "10% salt water", "correct": false}, {"label": "D", "text": "Water", "correct": false}], "correct_answer": "A. 20% salt water", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - 20%\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of resistance is exhibited by the patient who is unresponsive to Isoniazid, Rifampicin, Ofloxacin, and Kanamycin?", "options": [{"label": "A", "text": "Multidrug resistance", "correct": false}, {"label": "B", "text": "Extensively drug-resistant", "correct": true}, {"label": "C", "text": "Rifampicin resistant", "correct": false}, {"label": "D", "text": "Extremely drug-resistant", "correct": false}], "correct_answer": "B. Extensively drug-resistant", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Extensively drug-resistant</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug sensitive TB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Patients are sensitive to 4 TB drugs: R,H,Z,E (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mono-resistant (MR) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resistant to one 1st line anti-TB drug only.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>H-Mono-resistant (H-MR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resistant to <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> (H) only.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rifampicin resistant (RR) (Option C) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resistant to <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">Rifampicin</span> (R) only.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Multi-drug resistant (MDR) (Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resistant to both <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">Rifampicin</span> (R) &amp; <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> (H).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Poly-Drug resistant (PDR) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resistant to 2 drugs other than <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">Rifampicin</span> (R) &amp; <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">Isoniazid</span> (H).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pre-Xtensive resistant (pre-XDR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Any <span class=\"customMeta\" data-dictid=\"3c0021ebec1692777192f766374e40\">MDR</span> patient (H+R) resistant to any fluoroquinolone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Extensive resistant (XDR) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Any <span class=\"customMeta\" data-dictid=\"3c0021ebec1692777192f766374e40\">MDR</span> patient (H+R) resistant to any <span class=\"customMeta\" data-dictid=\"f4975edd0b1692777203b54cf45c2d\">fluoroquinolone</span> and Group 4 drugs (Bedaquiline, Linezolid, Levo/Moxifloxacin).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As a Medical Officer in charge of a Primary Health Center, you intend to engage in a conversation and address health concerns specifically with Antenatal mothers. What would be the ideal number of participants you would include in the focus group discussion?", "options": [{"label": "A", "text": "4-6", "correct": false}, {"label": "B", "text": "3-5", "correct": false}, {"label": "C", "text": "6-12", "correct": true}, {"label": "D", "text": "12-15", "correct": false}], "correct_answer": "C. 6-12", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - 6-12</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Points</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Data Collection Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Focus Group Discussion (FGD) is a <span class=\"customMeta\" data-dictid=\"1304db17d3169277719684a316a8c4\">qualitative</span> method, in the <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of two-way communication<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Participants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6-12 people</strong> seated in a circle, guided by a Moderator.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Role of Moderator</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The active role of Leading the FGD by asking 10-12 open-ended, guiding questions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sociogram Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reflects the quality and interactiveness of the FGD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sociogram Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"a445e59f7816927771864e36b1dbd3\">diagram</span> or chart created by an observer to represent the interaction dynamics during the FGD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Role of Recorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A separate individual is responsible for recording the discussion, with participants’ prior permission.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Data Analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Focuses on identifying common themes emerging from the discussion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Communication Style</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The FGD is interactive and two-way (Socratic), encouraging dialogue among participants and between participants and the Moderator.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic patient comes to you for advice regarding his diet. You advise him to include foods with a low glycemic index in the diet. Which of the following would you advise him for the same?", "options": [{"label": "A", "text": "Cornflakes", "correct": false}, {"label": "B", "text": "Brown rice", "correct": false}, {"label": "C", "text": "Sucrose", "correct": false}, {"label": "D", "text": "Papaya", "correct": true}], "correct_answer": "D. Papaya", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Papaya</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>GI Index Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Low GI</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>55 or less</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Most fruits and vegetables (except potatoes, watermelon, sweetcorn), whole grains, pasta foods, beans, lentils, oats, quinoa, guava</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Medium GI</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>56-69</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sucrose, basmati rice, brown rice, dairy products <strong>(Options B, C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>High GI</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>70 and above</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Corn flakes, baked potato, some white rice varieties (e.g., jasmine), white bread, candy bar, syrupy foods <strong>(Options A)</strong></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "You are a junior resident in the ICU. A senior doctor asks you to manage a mechanically ventilated patient whose arterial blood gasses showed features of hypoventilation with respiratory acidosis. Which of the following parameters can you modulate to improve the condition of the patient?", "options": [{"label": "A", "text": "Decrease FiO2", "correct": false}, {"label": "B", "text": "Increase respiratory rate", "correct": true}, {"label": "C", "text": "Increased PEEP", "correct": false}, {"label": "D", "text": "Increase plateau pressure", "correct": false}], "correct_answer": "B. Increase respiratory rate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:364px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>ABG Abnormality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Ventilator Adjustment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>↓ PaO2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>↑ <span class=\"customMeta\" data-dictid=\"9abcb9edc11692777195dac40cd470\">PEEP</span> or ↑ FiO2</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>↓ PaCO2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>↓ <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate or ↓ <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>↑ PaCO2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>↑ <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate or ↑ <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume</p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While doing a subclavian venous catheterization, the patient suddenly desaturated and on examination of the chest, there was hyper resonance in the apical area of the right lung. What is the most likely diagnosis here?", "options": [{"label": "A", "text": "Arterial puncture", "correct": false}, {"label": "B", "text": "Pneumothorax", "correct": true}, {"label": "C", "text": "Cardiac tamponade", "correct": false}, {"label": "D", "text": "Chylothorax", "correct": false}], "correct_answer": "B. Pneumothorax", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was given halothane for a surgical procedure. After a few minutes, the anesthetist noticed that he developed rigidity and hyperthermia. Which of the following ions is the reason for the above symptoms?", "options": [{"label": "A", "text": "Sodium", "correct": false}, {"label": "B", "text": "Calcium", "correct": true}, {"label": "C", "text": "Potassium", "correct": false}, {"label": "D", "text": "Magnesium", "correct": false}], "correct_answer": "B. Calcium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:589px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Rare, life-threatening reaction to certain <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> medications (inhaled anesthetics, succinylcholine).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Often autosomal dominant with variable <span class=\"customMeta\" data-dictid=\"cd2e83c3ad1692777195dad2ab75ec\">penetrance</span> (meaning not everyone with the gene will develop the condition).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Underlying mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Mutations in the ryanodine <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> (RYR1) gene cause uncontrolled release of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> (Ca2+) from the sarcoplasmic reticulum, leading to sustained muscle <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> and heat generation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Signs/Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Severe muscle rigidity, rapid rise in <span class=\"customMeta\" data-dictid=\"4a7581c8b01692777183819f38c633\">body temperature</span> (hyperthermia), increased heart rate, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Dantrolene</strong> (a ryanodine <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> <span class=\"customMeta\" data-dictid=\"2e432a4f3c1692777181e8e244ca0e\">antagonist</span> that reduces <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> release from the sarcoplasmic <span class=\"customMeta\" data-dictid=\"1b6498ff211692777197ae0981e366\">reticulum</span> and relaxes muscles).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which inhalational agent is best suited for patients with compromised cardiac function?", "options": [{"label": "A", "text": "Halothane", "correct": false}, {"label": "B", "text": "Isoflurane", "correct": false}, {"label": "C", "text": "Desflurane", "correct": true}, {"label": "D", "text": "Sevoflurane", "correct": false}], "correct_answer": "C. Desflurane", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures are not pierced during epidural anesthesia?", "options": [{"label": "A", "text": "Supraspinous ligament", "correct": false}, {"label": "B", "text": "Interspinous ligament", "correct": false}, {"label": "C", "text": "Ligamentum flavum", "correct": false}, {"label": "D", "text": "Dura", "correct": true}], "correct_answer": "D. Dura", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CuF6Gk8BVVsxjZmWT9U31747900398.png", "https://image.prepladder.com/content/zw1FyA1TUtb01ccrKgcV1746165094.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a middle-aged man with diabetes, who has reported a decline in vision and whose fluorescein angiography displays the depicted image?", "options": [{"label": "A", "text": "Mild non proliferative diabetic retinopathy", "correct": false}, {"label": "B", "text": "Moderate non proliferative diabetic retinopathy", "correct": false}, {"label": "C", "text": "Severe non proliferative diabetic retinopathy", "correct": false}, {"label": "D", "text": "Proliferative diabetic retinopathy", "correct": true}], "correct_answer": "D. Proliferative diabetic retinopathy", "question_images": ["https://image.prepladder.com/content/KRQtAMtoNvwMD72YT24U1747905998.png"], "explanation_images": ["https://image.prepladder.com/content/TMcIWKXEQmoRR4wrVxjC1747906001.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Proliferative <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">Retinopathy</span> (NPDR):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>No <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> Retinopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in 12 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Very Mild NPDR:</strong></p>\n<p>Microaneurysms only</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review most patients in 12 months</p>\n<p>(Option D)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mild NPDR: (Option A)</strong></p>\n<p>Any or all of the: microaneurysms, <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hemorrhages, exudates, and <span class=\"customMeta\" data-dictid=\"ef5bc669a416927771854943d1cfa8\">cotton-wool</span> spots, up to the level of moderate NPDR. No <span class=\"customMeta\" data-dictid=\"871f3dc691169277719044c0f27f98\">intraretinal</span> <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> anomalies (IRMA) or significant beading.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review range 6-12 months, depending on the severity of signs, stability, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> factors, and patient's circumstances</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderate NPDR: (Option B)</strong></p>\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hemorrhages in 1-3 quadrants or mild IRMA</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"965fde0a5a1692777182ae7e8ede4b\">beading</span> can be present in no more than 1 quadrant</li>\n<li>Cotton <span class=\"customMeta\" data-dictid=\"eaae57387d1692777202060f299953\">wool</span> spots commonly present</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in approximately 6 months</p>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe NPDR: (Option C)</strong></p>\n<p>The 4-2-1 rule; is one or more of the:</p>\n<ul>\n<li>Severe hemorrhages in all 4 quadrants</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"965fde0a5a1692777182ae7e8ede4b\">beading</span> in 2 or more quadrants</li>\n<li>Moderate IRMA in 1 or more quadrants</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in 4 months</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Very severe NPDR: </strong></p>\n<p>Two or more of the criteria for severe NPDR</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in 2-3 months</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Proliferative <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">Retinopathy</span> (PDR): (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mild-moderate PDR: </strong></p>\n<p><strong>New vessels on the disc (NVD) or new vessels elsewhere (NVE)</strong>, but extent insufficient to meet the high-risk criteria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment is considered according to the severity of signs, stability, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> factors, and the patient's circumstances such as reliability of attendance for review. If not treated, review in up to 2 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High-risk PDR: </strong></p>\n<ul>\n<li>NVD greater than ⅓ disc area</li>\n<li>Any NVD with <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> hemorrhage</li>\n<li>NVE greater than ½ disc area with <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> hemorrhage</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment should be performed immediately when possible and certainly on the same day if <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> presentation with a good <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> view</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advanced <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> eye disease:</strong></p>\n<p>It is characterized by tractional <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> detachment. Significant persistent <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> and <span class=\"customMeta\" data-dictid=\"624c00049d1692777193b1a9d81379\">neovascular</span> glaucoma.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitreoretinal surgery with photocoagulation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 310 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A patient presents with swelling and tenderness in the anatomical snuffbox after sustaining a fall on their outstretched hand. The X-ray image is given below. Identify the fracture.", "options": [{"label": "A", "text": "Colles fracture", "correct": false}, {"label": "B", "text": "Scaphoid fracture", "correct": true}, {"label": "C", "text": "Smith fracture", "correct": false}, {"label": "D", "text": "Galeazzi fracture", "correct": false}], "correct_answer": "B. Scaphoid fracture", "question_images": ["https://image.prepladder.com/content/qW7q4hDYJyreJrjcP0Yj1691232761.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\"&gt;Scaphoid&lt;/span&gt; Fractu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has presented with fever and blister on the hand, followed by the development of axillary lymphadenopathy . What will you ask the patient with regard to history?", "options": [{"label": "A", "text": "History of rat bite", "correct": false}, {"label": "B", "text": "History of exposure to cat", "correct": true}, {"label": "C", "text": "History of similar complaints among family members", "correct": false}, {"label": "D", "text": "History of louse bite", "correct": false}], "correct_answer": "B. History of exposure to cat", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - History of exposu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came to the gynecology OPD with complaints of foul-smelling frothy vaginal discharge, and intense itching . On examination, the cervix appears strawberry-like . Which of the following statements is false regarding the causative organism?", "options": [{"label": "A", "text": "It exists in cyst and trophozoite forms", "correct": true}, {"label": "B", "text": "It is an obligate parasite", "correct": false}, {"label": "C", "text": "The gold standard for diagnosis is culture on CPLM", "correct": false}, {"label": "D", "text": "The treatment of choice is metronidazole", "correct": false}], "correct_answer": "A. It exists in cyst and trophozoite forms", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - It exists in &lt;span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\"&gt;cyst&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"b3ef280cda169277720014eca742f3\"&gt;trophozoite&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following methods is used to sterilize a glass petri dish?", "options": [{"label": "A", "text": "Autoclaving at 121 degrees Celsius for 30-60 minutes", "correct": false}, {"label": "B", "text": "Hot air oven at 160 degrees Celsius for 120 minutes", "correct": true}, {"label": "C", "text": "Autoclaving at 134 degrees Celsius for 3 minutes", "correct": false}, {"label": "D", "text": "Hot air oven at 121 degrees Celsius for 30-60 minutes", "correct": false}], "correct_answer": "B. Hot air oven at 160 degrees Celsius for 120 minutes", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Hot air oven at 160 degrees Celsius for 120 minu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient presented to the emergency department with pain and swelling of the right knee . A plain radiograph is shown below. What is the best treatment for this condition?", "options": [{"label": "A", "text": "Tension band wiring with K-wires", "correct": true}, {"label": "B", "text": "Tension band wiring with cancellous screws", "correct": false}, {"label": "C", "text": "Cylinder cast", "correct": false}, {"label": "D", "text": "Patellectomy", "correct": false}], "correct_answer": "A. Tension band wiring with K-wires", "question_images": ["https://image.prepladder.com/content/4LEzNAvSkXlOiBztVnii1713871798.png"], "explanation_images": ["https://image.prepladder.com/content/XKYfSZPOuu9hV3rlcvyI1714477153.png"], "explanation": "<p>Correct Option A - Tension band &lt;span class=\"customMeta\" data-dictid=\"6ef263e89e169277720230becfc5ec\"&gt;wiring&lt;/span&gt; with K\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is accurate regarding antigenic drift ?", "options": [{"label": "A", "text": "There is a gradual sequential change in antigenic structure", "correct": true}, {"label": "B", "text": "Causes a sudden increase in the number of cases", "correct": false}, {"label": "C", "text": "The new antigens formed are unrelated to the previous antigens", "correct": false}, {"label": "D", "text": "Antibodies to the predecessor viruses do not neutralize the new variants", "correct": false}], "correct_answer": "A. There is a gradual sequential change in antigenic structure", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - There is a gradual sequential change in &lt;span class=\"customMeta\" data-dictid=\"331db7d96b16927771813cfafb0985\"&gt;antigenic&lt;/span&gt; structu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Antigenic shift</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Antigenic drift</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sudden change</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gradual change</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exchange of <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> segments between <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> A Genetic reassortment</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mutation in H and N</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes major epidemics and pandemics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Does not cause epidemics or pandemics</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seen in <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seen in <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> A and B</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old IV drug abuser presents with a 1-week history of malaise, fatigue, and rigors. His temperature on admission was 38.5° C . Examination revealed a pansystolic murmur , loudest at the left sternal edge. Three sets of blood cultures were taken. Which organism is most likely to be found in his blood culture?", "options": [{"label": "A", "text": "Streptococcus sanguis", "correct": false}, {"label": "B", "text": "Enterococcus faecium", "correct": false}, {"label": "C", "text": "Coxiella burnetii", "correct": false}, {"label": "D", "text": "Staphylococcus aureus", "correct": true}], "correct_answer": "D. Staphylococcus aureus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\"&gt;Staphylococcus&lt;/span&gt; Aureus:</p>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Condition</strong></p>\n</td>\n<td>\n<p><strong>Most common organism</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Most common organism (overall)</p>\n</td>\n<td>\n<p>Staphylococcus aureus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Community-acquired native <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> endocarditis</p>\n</td>\n<td>\n<p>Streptococci</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Healthcare-associated native <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> endocarditis</p>\n</td>\n<td>\n<p>Staphylococcus aureus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Endocarditis in <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> drug users (Right side)</p>\n</td>\n<td>\n<p>Staphylococcus aureus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Endocarditis in <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> drug users (Left side)</p>\n</td>\n<td>\n<p>Enterococci and Staphylococcus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Single most common organism causing <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> endocarditis</p>\n</td>\n<td>\n<p>Staphylococcus aureus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Most common group of organisms causing early <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> (&lt;12 months after surgery)</p>\n</td>\n<td>\n<p>Coagulase-negative <span class=\"customMeta\" data-dictid=\"0520f732541692777199acffcfd9ba\">staphylococci</span> (CoNS)</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "If a sample is cultured in LJ media , what is the likely staining characteristic of the cultured organism?", "options": [{"label": "A", "text": "Negative staining", "correct": false}, {"label": "B", "text": "Gram negative", "correct": false}, {"label": "C", "text": "Acid fast", "correct": true}, {"label": "D", "text": "Non-acid fast", "correct": false}], "correct_answer": "C. Acid fast", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Acid F\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male patient presented with complaints of a gradually progressive swelling around his wrist joint for 3 months. Given below is the X-ray image of the affected wrist. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ewing’s sarcoma", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": true}, {"label": "D", "text": "Osteochondroma", "correct": false}], "correct_answer": "C. Osteoclastoma", "question_images": ["https://image.prepladder.com/content/BzWthfjQOuj8VlzEWYSs1691220180.png"], "explanation_images": [], "explanation": "<p>Correct Option C - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-month-old baby is brought to the OPD with a deformity, as shown in the image below. Which of the following is the management recommendation?", "options": [{"label": "A", "text": "Manipulation and cast", "correct": true}, {"label": "B", "text": "Posteromedial soft tissue release", "correct": false}, {"label": "C", "text": "Triple arthrodesis", "correct": false}, {"label": "D", "text": "Evan’s procedure", "correct": false}], "correct_answer": "A. Manipulation and cast", "question_images": ["https://image.prepladder.com/content/V00UfcaN2IimSGS1RuDw1691220345.png"], "explanation_images": ["https://image.prepladder.com/content/5HsH8lAUCuGRTdvvZyoV1691220514.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"fb84ef68cf1692777191f6e12eeebe\"&gt;Manipulation&lt;/span&gt; and C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male has been suffering from a progressive lower backache and early morning stiffness for the past six months. His symptoms are more severe in the morning and improve with exercise. He is a known case of ulcerative colitis. An X-ray of his lumbar spine is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pott’s spine", "correct": false}, {"label": "B", "text": "Psoriatic arthritis", "correct": false}, {"label": "C", "text": "Ankylosing spondylitis", "correct": true}, {"label": "D", "text": "Rheumatoid arthritis", "correct": false}], "correct_answer": "C. Ankylosing spondylitis", "question_images": ["https://image.prepladder.com/content/pQkVH7Gp4ykzg8kX8fF81713871879.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Ankylosing\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Ankylosing spondylitis </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Psoriatic arthritis </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Rheumatoid arthritis </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Predominant joints affected</p>\n</td>\n<td>\n<p>Spine and <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joints<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Peripheral joints<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Small joints of hands and feet</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Radiographic findings</p>\n</td>\n<td>\n<p>Sacroiliitis, erosions, or <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> of the spine<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Joint space narrowing, bone erosions, bone proliferation<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Joint space narrowing, bone erosions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Association with other comorbidities</p>\n</td>\n<td>\n<p>Inflammatory <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease</p>\n</td>\n<td>\n<p>Psoriasis, uveitis</p>\n</td>\n<td>\n<p>Sjogren's syndrome, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pattern of joint involvement</p>\n</td>\n<td>\n<p>Symmetric, may affect entire spine</p>\n</td>\n<td>\n<p>Symmetric or asymmetric, <span class=\"customMeta\" data-dictid=\"806f0389c516927771851ea84ecf34\">dactylitis</span> common</p>\n</td>\n<td>\n<p>Symmetrical involvement of small joints of hands and feet</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Anaphylaxis occurred in a boy who was eating peanut butter. This scenario exemplifies:", "options": [{"label": "A", "text": "T cell-mediated cytotoxicity", "correct": false}, {"label": "B", "text": "IgE-mediated reaction", "correct": true}, {"label": "C", "text": "IgG-mediated reaction", "correct": false}, {"label": "D", "text": "Antigen-antibody complex mediated", "correct": false}], "correct_answer": "B. IgE-mediated reaction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xkbCMtMpeb6xSYSIiK531712820711.png"], "explanation": "<p>Correct Option B - IgE-Mediated R\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is specifically found in gram-negative bacteria?", "options": [{"label": "A", "text": "Lipoproteins", "correct": false}, {"label": "B", "text": "Peptidoglycan", "correct": false}, {"label": "C", "text": "Lipopolysaccharide", "correct": true}, {"label": "D", "text": "Teichoic acid", "correct": false}], "correct_answer": "C. Lipopolysaccharide", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vHFz6N5OZ4ZXapWoLlhl1712747840.png"], "explanation": "<p>Correct Option C - Lipopolysaccharide:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Features</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gram-positive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gram-negative</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">Thickness</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100 layer thick</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-2 layer thickness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">Lipid content</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2-5%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>15-50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">Composition</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peptidoglycans</li>\n<li>Lipoproteins</li>\n<li>Teichoic acid</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lipopolysaccharide</li>\n<li>Lipoproteins</li>\n<li>Peptidoglycan</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">Periplasmic space and Porins</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">Teichoic acid</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pentapeptide cross bridge</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">NAM-NAG</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Features</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gram-positive</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gram-negative</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">Thickness</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100 layer thick</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-2 layer thickness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">Lipid content</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2-5%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>15-50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">Composition</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peptidoglycans</li>\n<li>Lipoproteins</li>\n<li>Teichoic acid</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lipopolysaccharide</li>\n<li>Lipoproteins</li>\n<li>Peptidoglycan</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">Periplasmic space and Porins</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">Teichoic acid</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pentapeptide cross bridge</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">NAM-NAG</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with vomiting to medicine OPD . He mentions eating fried rice recently. What is the most likely causative organism?", "options": [{"label": "A", "text": "Clostridium perfringens", "correct": false}, {"label": "B", "text": "Bacillus cereus", "correct": true}, {"label": "C", "text": "Staphylococcus aureus", "correct": false}, {"label": "D", "text": "Bacillus anthracis", "correct": false}], "correct_answer": "B. Bacillus cereus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tRlpHe1BAndsXapuzMY71712040138.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"461ee544961692777182696a650b05\"&gt;Bacillus&lt;/span&gt; Cereus:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Emetic type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diarrheal type </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IP</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;6 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8-16 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Food</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chinese fried rice</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Meat and milk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heat</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heat stable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heat labile</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MOA</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased cGMP</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased cAMP</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Toxins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cerulide: <span class=\"customMeta\" data-dictid=\"53c79c006f1692777201a60b8a5842\">vagomimetic</span> action</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nhe toxins: <span class=\"customMeta\" data-dictid=\"9e7aec9ff416927771984a1e3100b7\">secretory</span> diarrhea</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with abdominal pain, diarrhea, and a step-ladder pattern fever. He also complains of a headache and malaise . His symptoms gradually worsened over the past 2 weeks. Which of the following is the best diagnostic test?", "options": [{"label": "A", "text": "Widal test", "correct": true}, {"label": "B", "text": "Stool culture", "correct": false}, {"label": "C", "text": "Blood culture", "correct": false}, {"label": "D", "text": "Urine culture", "correct": false}], "correct_answer": "A. Widal test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Widal T\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-color:black; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><strong>Week of Infection</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:top\"><strong>Test</strong></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Week 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Blood culture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Week 2 </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibody test (WIDAL)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Week 3 </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stool culture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Week 4 </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urine culture</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the hormone present in the contraceptive shown in the image below?", "options": [{"label": "A", "text": "Nonoxynol 9", "correct": true}, {"label": "B", "text": "Octoxynol 8", "correct": false}, {"label": "C", "text": "Menfegol", "correct": false}, {"label": "D", "text": "Levonorgestrel", "correct": false}], "correct_answer": "A. Nonoxynol 9", "question_images": ["https://image.prepladder.com/content/Obdf6UhfHvTmWyjFvQrL1691232838.png"], "explanation_images": [], "explanation": "<p>Correct Option A: Nonoxynol 9\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the IUCD with the longest lifespan?", "options": [{"label": "A", "text": "Progestasert", "correct": false}, {"label": "B", "text": "CuT 380 A", "correct": true}, {"label": "C", "text": "Mirena", "correct": false}, {"label": "D", "text": "Nova T", "correct": false}], "correct_answer": "B. CuT 380 A", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B: CuT 380 A\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td>CuT380A</td>\n<td>10 years</td>\n</tr>\n<tr>\n<td>CuT200</td>\n<td>3 years</td>\n</tr>\n<tr>\n<td>Multiload Cu250</td>\n<td>3 years</td>\n</tr>\n<tr>\n<td>LNG IUS/Mirena</td>\n<td>5 years</td>\n</tr>\n<tr>\n<td>Progestasert</td>\n<td>1 year</td>\n</tr>\n<tr>\n<td>Nova - T</td>\n<td>5 years</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman complained of inability to conceive, dysmenorrhea, and pelvic pain. She has a history of frequent episodes of pelvic inflammatory disease. Hysterosalpingogram shows an absence of peritoneal spillage on the right side. What is the diagnosis?", "options": [{"label": "A", "text": "Tubal block", "correct": true}, {"label": "B", "text": "Endometriosis", "correct": false}, {"label": "C", "text": "Asherman syndrome", "correct": false}, {"label": "D", "text": "Bilateral hydrosalpinx", "correct": false}], "correct_answer": "A. Tubal block", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: Tubal block\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition given in the image below.", "options": [{"label": "A", "text": "Vasa previa", "correct": false}, {"label": "B", "text": "Placenta previa", "correct": true}, {"label": "C", "text": "Placenta accreta", "correct": false}, {"label": "D", "text": "Abruptio placenta", "correct": false}], "correct_answer": "B. Placenta previa", "question_images": ["https://image.prepladder.com/content/bw8GPOatHVs0YJyCNYaQ1691225606.png"], "explanation_images": ["https://image.prepladder.com/content/zQCqaqAQGHeFLnHcGTRT1711630806.png"], "explanation": "<p>Correct Option B: Placenta prev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the use of the instrument given below?", "options": [{"label": "A", "text": "Myomectomy", "correct": false}, {"label": "B", "text": "Hysterosalpingography", "correct": true}, {"label": "C", "text": "Endometrial biopsy", "correct": false}, {"label": "D", "text": "Conization of cervix", "correct": false}], "correct_answer": "B. Hysterosalpingography", "question_images": ["https://image.prepladder.com/content/aFAtztuhjZFMlzgYxoIk1715836083.png"], "explanation_images": [], "explanation": "<p>Correct Option B: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23 year old woman presented with 8th weeks of gestation following a positive UPT test . The patient is not willing to continue this pregnancy. What is the appropriate dosage of Misoprostol (administered by mucosal route)?", "options": [{"label": "A", "text": "200 mcg", "correct": false}, {"label": "B", "text": "600 mcg", "correct": false}, {"label": "C", "text": "400 mcg", "correct": false}, {"label": "D", "text": "800 mcg", "correct": true}], "correct_answer": "D. 800 mcg", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 800 mcg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "On ophthalmologic examination, the presence of Koeppe's nodules is observed in a patient diagnosed with sarcoidosis. In which area of the eye are these nodules typically observed?", "options": [{"label": "A", "text": "Cornea", "correct": false}, {"label": "B", "text": "Conjunctiva", "correct": false}, {"label": "C", "text": "Iris", "correct": true}, {"label": "D", "text": "Retina", "correct": false}], "correct_answer": "C. Iris", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/G4TceNfshIAlb4qAr1qR1714051194.png"], "explanation": "<p>Correct Option C: I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which corrective procedure yields the most favorable obstetric outcome for a 24-year-old woman who visits the infertility clinic due to recurrent abortions and is diagnosed with a septate uterus?", "options": [{"label": "A", "text": "Jones metroplasty", "correct": false}, {"label": "B", "text": "Strassmann metroplasty", "correct": false}, {"label": "C", "text": "Tompkins metroplasty", "correct": false}, {"label": "D", "text": "Transcervical resection of septum", "correct": true}], "correct_answer": "D. Transcervical resection of septum", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman who underwent dilatation and curettage following a missed abortion now presents with amenorrhoea. Her urine pregnancy test is negative. Hysterosalpingography shows the findings seen in the image below. What is your diagnosis?", "options": [{"label": "A", "text": "Sheehan syndrome", "correct": false}, {"label": "B", "text": "Endometriosis", "correct": false}, {"label": "C", "text": "Asherman syndrome", "correct": true}, {"label": "D", "text": "Pyometra", "correct": false}], "correct_answer": "C. Asherman syndrome", "question_images": ["https://image.prepladder.com/content/zJjwxKhvYWxW0vRMjhsd1715836243.png"], "explanation_images": [], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Preconceptional use of which of the following leads to reduced incidence of neural tube defects?", "options": [{"label": "A", "text": "Folic acid", "correct": true}, {"label": "B", "text": "Iron", "correct": false}, {"label": "C", "text": "Calcium", "correct": false}, {"label": "D", "text": "Vitamin A", "correct": false}], "correct_answer": "A. Folic acid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fistula labelled in the image below?", "options": [{"label": "A", "text": "Vesicocervical fistula", "correct": false}, {"label": "B", "text": "Urethrovaginal fistula", "correct": false}, {"label": "C", "text": "Ureterovaginal fistula", "correct": false}, {"label": "D", "text": "Vesicovaginal fistula", "correct": true}], "correct_answer": "D. Vesicovaginal fistula", "question_images": ["https://image.prepladder.com/content/u0lAtevLgTLeKMallKKT1691226653.png"], "explanation_images": [], "explanation": "<p>Correct Option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old woman, G2P2, presents to the emergency department with intense, sudden onset pelvic pain and profuse bleeding after giving birth at home . Diagnosis pointed towards secondary PPH. When does secondary postpartum haemorrhage develop?", "options": [{"label": "A", "text": "Within 6 hours of delivery", "correct": false}, {"label": "B", "text": "Within 24 hours of delivery", "correct": false}, {"label": "C", "text": "24 hours – 12 weeks after delivery", "correct": true}, {"label": "D", "text": "Shortly after the delivery of placenta", "correct": false}], "correct_answer": "C. 24 hours – 12 weeks after delivery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 24 hours – 12 weeks after deliv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the sign that is seen during 8 weeks of pregnancy resulting in a dusky blue color of the vagina?", "options": [{"label": "A", "text": "Palmer’s sign", "correct": false}, {"label": "B", "text": "Chadwick’s sign", "correct": true}, {"label": "C", "text": "Hegar’s sign", "correct": false}, {"label": "D", "text": "Osiander’s sign", "correct": false}], "correct_answer": "B. Chadwick’s sign", "question_images": ["https://image.prepladder.com/content/koHEf2Q7v7XLCeNGy5zo1691228589.png"], "explanation_images": ["https://image.prepladder.com/content/LqU4N2rU64Byfr2flMu91691228662.png"], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In cases of genital tuberculosis, which segment of the fallopian tube is frequently affected?", "options": [{"label": "A", "text": "Infundibulum", "correct": false}, {"label": "B", "text": "Ampulla", "correct": true}, {"label": "C", "text": "Isthmus", "correct": false}, {"label": "D", "text": "Interstitium", "correct": false}], "correct_answer": "B. Ampulla", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male arrived at the emergency ward with sudden vision loss and experiencing painful eye movements . Upon examination, the affected eye shows a relative afferent pupillary defect, a normal optic disc , and a central scotoma . What is the likely diagnosis?", "options": [{"label": "A", "text": "Optic nerve glioma", "correct": false}, {"label": "B", "text": "Optic neuritis", "correct": true}, {"label": "C", "text": "Eale’s disease", "correct": false}, {"label": "D", "text": "Optic atrophy", "correct": false}], "correct_answer": "B. Optic neuritis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Optic neu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently occurring benign tumor of the ovaries that affects both sides in women of reproductive age?", "options": [{"label": "A", "text": "Epithelial cell tumor", "correct": false}, {"label": "B", "text": "Follicular cysts", "correct": true}, {"label": "C", "text": "Sex cord stromal tumor", "correct": false}, {"label": "D", "text": "Benign teratoma", "correct": false}], "correct_answer": "B. Follicular cysts", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B. &lt;span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\"&gt;Follicular&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When selecting the strength of an intraocular lens (IOL) for a child under 1 year old, what factors should be considered?", "options": [{"label": "A", "text": "Myopic shift", "correct": true}, {"label": "B", "text": "Hypermetropic shift", "correct": false}, {"label": "C", "text": "Length of the lens capsule", "correct": false}, {"label": "D", "text": "Growth of the lens capsule", "correct": false}], "correct_answer": "A. Myopic shift", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please analyze the image provided and determine the specific abnormality or injury present .", "options": [{"label": "A", "text": "Viral keratitis", "correct": true}, {"label": "B", "text": "Fungal keratitis", "correct": false}, {"label": "C", "text": "Bacterial keratitis", "correct": false}, {"label": "D", "text": "Interstitial keratitis", "correct": false}], "correct_answer": "A. Viral keratitis", "question_images": ["https://image.prepladder.com/content/w98WUHsAweYRUI89M5TG1691233680.png"], "explanation_images": ["https://image.prepladder.com/content/w98WUHsAweYRUI89M5TG1691233680.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\"&gt;Viral&lt;/span&gt; k\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely reason for a 21-year-old student to have ocular redness, feeling of a foreign object in the eye, and excessive tearing after wearing a soft contact lens, as indicated by the corneal scraping interface contrast microscopy image?", "options": [{"label": "A", "text": "Acanthamoeba", "correct": true}, {"label": "B", "text": "Naegleria fowleri", "correct": false}, {"label": "C", "text": "Entamoeba histolytica", "correct": false}, {"label": "D", "text": "Balamuthia mandrillaris", "correct": false}], "correct_answer": "A. Acanthamoeba", "question_images": ["https://image.prepladder.com/content/BFCllsbCRFBse9IfPGcz1715249250.JPG"], "explanation_images": [], "explanation": "<p>Correct Option A - Acanth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What measures can be taken to decrease the likelihood of endometrial cancer in a postmenopausal woman undergoing hormone replacement therapy (HRT)?", "options": [{"label": "A", "text": "Combined oral contraceptive pills", "correct": false}, {"label": "B", "text": "Clonidine", "correct": false}, {"label": "C", "text": "Vitamin E", "correct": false}, {"label": "D", "text": "Adding progesterone to estrogen", "correct": true}], "correct_answer": "D. Adding progesterone to estrogen", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended approach for managing a middle-aged woman with a progressive pterygium that is extending towards the pupillary area?", "options": [{"label": "A", "text": "Keratoplasty", "correct": false}, {"label": "B", "text": "Excision with conjunctival autograft", "correct": true}, {"label": "C", "text": "Observation", "correct": false}, {"label": "D", "text": "Beta-radiation", "correct": false}], "correct_answer": "B. Excision with conjunctival autograft", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Excision with conjunctival autog\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a patient who has a painless, firm nodule on the upper eyelid that is growing away from the lid margin?", "options": [{"label": "A", "text": "Stye", "correct": false}, {"label": "B", "text": "Entropion", "correct": false}, {"label": "C", "text": "Chalazion", "correct": true}, {"label": "D", "text": "Blepharitis", "correct": false}], "correct_answer": "C. Chalazion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CSgtEAe55U1HMSbjJ5HQ1715249154.JPG"], "explanation": "<p>Correct Option C - Ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 27-year-old male patient who experiences eye trauma from vegetative matter, and currently exhibits symptoms including a corneal ulcer, hypopyon, satellite lesions, mild pain, photophobia, and redness?", "options": [{"label": "A", "text": "Fungal keratitis", "correct": true}, {"label": "B", "text": "Acanthamoeba keratitis", "correct": false}, {"label": "C", "text": "Viral keratitis", "correct": false}, {"label": "D", "text": "Bacterial keratitis", "correct": false}], "correct_answer": "A. Fungal keratitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Fungal k\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective treatment for a patient who experiences considerable discomfort when reading text from paper or a screen, despite having normal visual acuity and other eye examination findings, except for a Schirmer's test result of 5mm?", "options": [{"label": "A", "text": "Steroids", "correct": false}, {"label": "B", "text": "Anti-histamine", "correct": false}, {"label": "C", "text": "Lubricating eye drops", "correct": true}, {"label": "D", "text": "Prescribed spectacles", "correct": false}], "correct_answer": "C. Lubricating eye drops", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Lubricating\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 5-year-old boy who is experiencing severe itching, and thick discharge from his eyes . Upon examination the following finding as shown in the image was observed.", "options": [{"label": "A", "text": "Trachoma", "correct": false}, {"label": "B", "text": "Vernal keratoconjunctivitis", "correct": true}, {"label": "C", "text": "Phylctenular conjunctivitis", "correct": false}, {"label": "D", "text": "Xerophthalmia", "correct": false}], "correct_answer": "B. Vernal keratoconjunctivitis", "question_images": ["https://image.prepladder.com/content/2LN8yLVW5UZ5T6Tba1uH1714041118.png"], "explanation_images": ["https://image.prepladder.com/content/3pyxJfyMl6X9tKAxGity1714041190.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"b2a2e3ba5c1692777201528ac05837\"&gt;Vernal&lt;/span&gt; keratoconjunctiv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presents with severe dysmenorrhoea, dyspareunia and infertility. A diagnosis of endometriosis was made, and she was posted for laparoscopic surgery. During the procedure, dense pelvic adhesions were seen with the bowel stuck to the fundus and cystic ovaries stuck to each other. What is the next step in managing this patient?", "options": [{"label": "A", "text": "LUNA for chronic pelvic pain", "correct": false}, {"label": "B", "text": "Gestrinone to decrease the LH surge", "correct": false}, {"label": "C", "text": "Cystectomy and adhesiolysis", "correct": true}, {"label": "D", "text": "Hysterectomy and oophorectomy", "correct": false}], "correct_answer": "C. Cystectomy and adhesiolysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Postmenopausal bleeding is most commonly caused by", "options": [{"label": "A", "text": "Cervical cancer", "correct": true}, {"label": "B", "text": "Decubitus Ulcer", "correct": false}, {"label": "C", "text": "Tubercular Endometritis", "correct": false}, {"label": "D", "text": "Hormone replacement therapy", "correct": false}], "correct_answer": "A. Cervical cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A- cerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with unilateral breast cancer is started on tamoxifen. This will increase the risk of which of the following?", "options": [{"label": "A", "text": "Ovarian cancer", "correct": false}, {"label": "B", "text": "Endometrial cancer", "correct": true}, {"label": "C", "text": "Breast cancer in the opposite breast", "correct": false}, {"label": "D", "text": "Cervical cancer", "correct": false}], "correct_answer": "B. Endometrial cancer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In this case, a 27-year-old woman comes to the emergency department after experiencing bleeding from the vagina, which was preceded by a lack of menstrual periods for 7 weeks. The woman is in a state of hemodynamic shock and has a positive result for serum beta hCG. During the examination, a mass can be felt in the lower abdomen. What is the probable diagnosis in this situation?", "options": [{"label": "A", "text": "Pyelonephritis", "correct": false}, {"label": "B", "text": "Gastrointestinal stromal tumor", "correct": false}, {"label": "C", "text": "Red generation of fibroid", "correct": false}, {"label": "D", "text": "Ruptured ectopic pregnancy", "correct": true}], "correct_answer": "D. Ruptured ectopic pregnancy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the best recommended management in a case of vault prolapse with cystocele and rectocele?", "options": [{"label": "A", "text": "Anterior colporrhaphy only", "correct": false}, {"label": "B", "text": "Posterior colpoperineorrhaphy only", "correct": false}, {"label": "C", "text": "Both A &amp;amp; B", "correct": true}, {"label": "D", "text": "Hysterectomy", "correct": false}], "correct_answer": "C. Both A &amp; B", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30 year old G2P2 delivered by normal vaginal delivery with no complications. The study of normal human placenta was done. The normal human placenta is ? Discoid Hemochorial Deciduate", "options": [{"label": "A", "text": "1 &amp;amp; 2", "correct": false}, {"label": "B", "text": "2 &amp;amp; 3", "correct": false}, {"label": "C", "text": "1 &amp;amp; 3", "correct": false}, {"label": "D", "text": "1, 2 and 3", "correct": true}], "correct_answer": "D. 1, 2 and 3", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mMmlFHNCgxDDl4P2T4yG1715836296.png"], "explanation": "<p>Correct Option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The highest incidence of ureteric injury is seen in which of the following?", "options": [{"label": "A", "text": "Vaginal hysterectomy", "correct": false}, {"label": "B", "text": "Wertheim’s hysterectomy", "correct": true}, {"label": "C", "text": "Abdominal hysterectomy", "correct": false}, {"label": "D", "text": "Emergency Caesarean section", "correct": false}], "correct_answer": "B. Wertheim’s hysterectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the menstrual cycle, which phase is characterized by the presence of vacuolation as a histological feature?", "options": [{"label": "A", "text": "Secretory phase", "correct": true}, {"label": "B", "text": "Proliferative phase", "correct": false}, {"label": "C", "text": "Menstrual phase", "correct": false}, {"label": "D", "text": "All the above", "correct": false}], "correct_answer": "A. Secretory phase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/S0P6YR2BfK7IjnYtxeCf1715836361.png"], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 55-year-old woman experiencing post-menopausal bleeding, which investigation is most appropriate?", "options": [{"label": "A", "text": "Ultrasound", "correct": false}, {"label": "B", "text": "Endometrial biopsy", "correct": true}, {"label": "C", "text": "Fractional curettage", "correct": false}, {"label": "D", "text": "CA-125 estimation", "correct": false}], "correct_answer": "B. Endometrial biopsy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A nulliparous lady with a BMI of 23, presents with hirsutism. Ultrasonography was done and an image of the same is shown below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Polycystic ovarian syndrome", "correct": true}, {"label": "B", "text": "Tubal block", "correct": false}, {"label": "C", "text": "Multiple fibroids", "correct": false}, {"label": "D", "text": "Mesenteritis", "correct": false}], "correct_answer": "A. Polycystic ovarian syndrome", "question_images": ["https://image.prepladder.com/content/djIQvkyb23zjTBax5Z911715836565.png"], "explanation_images": ["https://image.prepladder.com/content/hf4ztT1xd9nFzzaCXZZV1715836587.png", "https://image.prepladder.com/content/OtXwT2GBxUfXYkVOG3Aw1715836601.png"], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Ritodrine, a medication used to prevent premature labor, is associated with several maternal complications, except for which of the following?", "options": [{"label": "A", "text": "Tremors", "correct": false}, {"label": "B", "text": "Tachycardia", "correct": false}, {"label": "C", "text": "Hypoglycemia", "correct": true}, {"label": "D", "text": "Pulmonary oedema", "correct": false}], "correct_answer": "C. Hypoglycemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about radiotherapy for a 52-year-old woman diagnosed with stage 2B cervical carcinoma is incorrect?", "options": [{"label": "A", "text": "Point B is 3 cm lateral to point A", "correct": false}, {"label": "B", "text": "Point A is 2 cm above the external os and 5 cm lateral to the interna uterine canal", "correct": true}, {"label": "C", "text": "Point A receive a dose of 7000 cGy", "correct": false}, {"label": "D", "text": "Point B received a dose of 6000 cGy", "correct": false}], "correct_answer": "B. Point A is 2 cm above the external os and 5 cm lateral to the interna uterine canal", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fudoFfxBZOj4O0UNzUUL1715836765.png"], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p>IA1</p>\n</td>\n<td>\n<p>&lt;3 mm NO LVSI</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Conization of Extra fascial Hysterectomy</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>&lt;3 mm with LVSI</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Radical Trachelectomy</p>\n</li>\n<li>\n<p>Or Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">Hysterectomy</span> + <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> LAD</p>\n</li>\n<li>\n<p>Or SLN (External Illiac (MC)&gt; obturator)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>IA2</p>\n</td>\n<td>\n<p>3 mm &lt;5,,</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Same</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>IB1</p>\n</td>\n<td>\n<p>5mm &lt;2 cm</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Same</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>IB2</p>\n</td>\n<td>\n<p>2 cm &lt;4 cm</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">Hysterectomy</span> + <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> <span class=\"customMeta\" data-dictid=\"ad5f8a44f91692777191f70a74cc50\">LAD</span> or Chemoradiation </p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>IIA2</p>\n</td>\n<td>\n<p>4 cm+ upper vagina</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Chemoradiation </p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75 year old woman with complaints of mass per vaginum, as shown in the below image was posted for operative repair. During the pre-anaesthetic check-up, she was found to be unfit for major surgery. Which of the following procedures is recommended for her?", "options": [{"label": "A", "text": "Abdominal wall cervicopexy", "correct": false}, {"label": "B", "text": "Shirodkar’s sling procedure", "correct": false}, {"label": "C", "text": "Le Fort’s repair", "correct": true}, {"label": "D", "text": "Khanna’s sling procedure", "correct": false}], "correct_answer": "C. Le Fort’s repair", "question_images": ["https://image.prepladder.com/content/BOG4l4j7BTnWH7Wy1F2Z1715836980.png"], "explanation_images": [], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What might be the likely diagnosis for a 34-year-old woman who has previously given birth once and has experienced abdominal pain, vaginal bleeding during labor, and a lack of fetal movement? She smokes occasionally but does not use alcohol or recreational drugs. Upon examination, her pulse rate is 80 beats per minute, blood pressure is 150/90 mm Hg, and her abdomen feels tense when palpated.", "options": [{"label": "A", "text": "Abruptio placenta", "correct": true}, {"label": "B", "text": "Placenta previa", "correct": false}, {"label": "C", "text": "Hydramnios", "correct": false}, {"label": "D", "text": "Preterm labour", "correct": false}], "correct_answer": "A. Abruptio placenta", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Grade</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Vaginal Bleeding </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Uterine Tetany</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Fetal Distress</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Maternal Shock</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>USG</strong></p>\n</td>\n</tr>\n<tr>\n<td>0</td>\n<td>-</td>\n<td>-</td>\n<td>-</td>\n<td>-</td>\n<td>RPC: Small</td>\n</tr>\n<tr>\n<td>1</td>\n<td>+</td>\n<td>+/-</td>\n<td>-</td>\n<td>-</td>\n<td>+/-</td>\n</tr>\n<tr>\n<td>2 (MC)</td>\n<td>+/-</td>\n<td>+/-</td>\n<td>+</td>\n<td>-</td>\n<td>+/-</td>\n</tr>\n<tr>\n<td>3</td>\n<td>+/-</td>\n<td>+</td>\n<td>Fetal Demise </td>\n<td>+ With possible DIC</td>\n<td>+/-</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27 year old primigravida delivered by normal vaginal delivery has postpartum vaginal discharge. What is the average duration of lochial discharge in a puerperal woman?", "options": [{"label": "A", "text": "5-15 days", "correct": true}, {"label": "B", "text": "10-20 days", "correct": false}, {"label": "C", "text": "24-36 days", "correct": false}, {"label": "D", "text": "36-42 days", "correct": false}], "correct_answer": "A. 5-15 days", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most suitable treatment for a 55-year-old patient with simple endometrial hyperplasia with atypia?", "options": [{"label": "A", "text": "Simple hysterectomy", "correct": true}, {"label": "B", "text": "Medroxy progesterone acetate", "correct": false}, {"label": "C", "text": "Levonorgestrel", "correct": false}, {"label": "D", "text": "Radiotherapy", "correct": false}], "correct_answer": "A. Simple hysterectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of hyperplasia </strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Risk of conversion to malignancy </strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Treatment </strong></p>\n</td>\n</tr>\n<tr>\n<td>Simple <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">Hyperplasia</span> without atypia</td>\n<td>1%</td>\n<td>Progesterone </td>\n</tr>\n<tr>\n<td>Complex <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">Hyperplasia</span> without atypia</td>\n<td>3%</td>\n<td>Progesterone</td>\n</tr>\n<tr>\n<td>Simple Hyperplasia </td>\n<td>8%</td>\n<td>Simple hysterectomy</td>\n</tr>\n<tr>\n<td>Complex <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">Hyperplasia</span> with atypia</td>\n<td>29%</td>\n<td>Simple hysterectomy</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 21-year-old woman is brought in a drowsy state from a PHC with complaints of fever, severe lower abdominal pain, and vaginal discharge. Her friend revealed that she had an unsafe abortion a week ago. On examination, tenderness over the uterus and foul-smelling vaginal discharge were observed; her BP was 80/60 mmHg, PR was 140 bpm, and RR was 36/min. On blood culture, a gram-positive and aerobic bacterium is isolated. Which of the following is a causative agent of her present condition?", "options": [{"label": "A", "text": "Clostridium perfringens", "correct": false}, {"label": "B", "text": "Streptococcus pyogenes", "correct": true}, {"label": "C", "text": "Clostridium welchii", "correct": false}, {"label": "D", "text": "Escherichia coli", "correct": false}], "correct_answer": "B. Streptococcus pyogenes", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B – &lt;span class=\"customMeta\" data-dictid=\"9562e26acc16927771995a2028dd05\"&gt;Streptococcus&lt;/span&gt; pyog\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable cause of a 14-year-old girl's condition, who has not experienced menarche yet, and presents with cyclic abdominal pain and a hypogastric lump visible during per vaginal examination, along with a bluish swelling?", "options": [{"label": "A", "text": "Bartholin", "correct": false}, {"label": "B", "text": "Transverse vaginal septum", "correct": false}, {"label": "C", "text": "Imperforate hymen", "correct": true}, {"label": "D", "text": "Endometrioma", "correct": false}], "correct_answer": "C. Imperforate hymen", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for an 18-year-old girl who has been experiencing low-grade fever, weight loss, abdominal pain, and amenorrhea for the past six months? During examination, a pelvic mass is detected on the left side, and signs of ascites are evident.", "options": [{"label": "A", "text": "Submucous fibroid", "correct": false}, {"label": "B", "text": "Ovarian malignancy", "correct": false}, {"label": "C", "text": "Ectopic pregnancy", "correct": false}, {"label": "D", "text": "Genital tuberculosis", "correct": true}], "correct_answer": "D. Genital tuberculosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D: Genital tubercu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the next course of action in the management of a pregnant woman who is 36 weeks pregnant, has a prosthetic valve replacement for mitral stenosis, and is currently on warfarin therapy with an international normalized ratio (INR) of 3?", "options": [{"label": "A", "text": "Stop warfarin and start LMWH", "correct": true}, {"label": "B", "text": "Stop warfarin and start aspirin", "correct": false}, {"label": "C", "text": "Continue warfarin", "correct": false}, {"label": "D", "text": "Stop warfarin, start LMWH and aspirin", "correct": false}], "correct_answer": "A. Stop warfarin and start LMWH", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on the provided image, what possible diagnosis can be determined?", "options": [{"label": "A", "text": "Multiple myeloma", "correct": false}, {"label": "B", "text": "Ankylosing spondylitis", "correct": false}, {"label": "C", "text": "Pyogenic spondylitis", "correct": false}, {"label": "D", "text": "Pott’s spine", "correct": true}], "correct_answer": "D. Pott’s spine", "question_images": ["https://image.prepladder.com/content/xD5dYQT8mb7inu0JLpnk1697440029.png"], "explanation_images": ["https://image.prepladder.com/content/SoS5kpSqnieQOYbBHdOt1691385979.png"], "explanation": "<p>Correct Option D- Pott’s spine: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of a 74-year-old man, who comes to the outpatient department (OPD) with a history of substantial unintentional weight loss, lack of appetite, and iron deficiency anemia, after a chest x-ray was performed and the results are provided below?", "options": [{"label": "A", "text": "Bronchogenic carcinoma", "correct": false}, {"label": "B", "text": "Mesothelioma", "correct": false}, {"label": "C", "text": "Metastasis", "correct": true}, {"label": "D", "text": "Pneumoconiosis", "correct": false}], "correct_answer": "C. Metastasis", "question_images": ["https://image.prepladder.com/content/TRedbcCp3amcSzGZD9Wg1684992436.png"], "explanation_images": [], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the subject matter of the X-ray image below?", "options": [{"label": "A", "text": "Emphysema", "correct": false}, {"label": "B", "text": "Tension pneumothorax", "correct": false}, {"label": "C", "text": "Pleural effusion", "correct": true}, {"label": "D", "text": "Bronchiectasis", "correct": false}], "correct_answer": "C. Pleural effusion", "question_images": ["https://image.prepladder.com/content/CxPRsvYYf01Jmvf2hg2j1684992686.png"], "explanation_images": ["https://image.prepladder.com/content/CCP8eOXshvlSOFKeyj1A1684992745.png"], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "From the provided MRI, please identify the medical condition observed in the lower back of the newborn, which presents as an abnormal lump.", "options": [{"label": "A", "text": "Meningocele", "correct": true}, {"label": "B", "text": "Myelomeningocele", "correct": false}, {"label": "C", "text": "Spina bifida occulta", "correct": false}, {"label": "D", "text": "Bone cyst", "correct": false}], "correct_answer": "A. Meningocele", "question_images": ["https://image.prepladder.com/content/C5dcFrIQw0brFpIOquzK1697198455.png"], "explanation_images": ["https://image.prepladder.com/content/k7QbZY6zI5GBXUP97rza1684993032.png"], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following radioactive isotopes is not employed in brachytherapy?", "options": [{"label": "A", "text": "Iodine-125", "correct": false}, {"label": "B", "text": "Iodine-131", "correct": true}, {"label": "C", "text": "Cobalt-60", "correct": false}, {"label": "D", "text": "Iridium-192", "correct": false}], "correct_answer": "B. Iodine-131", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kJv7cZT8ti96VYe9NbB41684993170.png"], "explanation": "<p>Correct Option B\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Isotope</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Half -Life</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Decay Process</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Photon Energy (KeV)</strong></p>\n</td>\n</tr>\n<tr>\n<td><sup>226</sup>Ra</td>\n<td>1.600 y</td>\n<td>α</td>\n<td>830</td>\n</tr>\n<tr>\n<td><sup>60</sup>Co</td>\n<td>5.26</td>\n<td>β</td>\n<td>1.250</td>\n</tr>\n<tr>\n<td><sup>125</sup>I</td>\n<td>59.4 d</td>\n<td>e-capture</td>\n<td>35</td>\n</tr>\n<tr>\n<td><sup>109</sup>Pd</td>\n<td>17 d</td>\n<td>e-capture</td>\n<td>21</td>\n</tr>\n<tr>\n<td><sup>131</sup>Cs</td>\n<td>9.7 d</td>\n<td>e-capture</td>\n<td>30</td>\n</tr>\n<tr>\n<td><sup>137</sup>Cs</td>\n<td>30 t</td>\n<td>β</td>\n<td>662</td>\n</tr>\n<tr>\n<td><sup>192</sup>Ir</td>\n<td>74.3d</td>\n<td>β</td>\n<td>380</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn had hypoplasia of the mandibles and zygomatic bones, malformed external ears, and slanted palpebral fissures. Abnormality in the development of which of the following pharyngeal arches will most likely lead to the given condition?", "options": [{"label": "A", "text": "Pharyngeal arch 1", "correct": true}, {"label": "B", "text": "Pharyngeal arch 2", "correct": false}, {"label": "C", "text": "Pharyngeal arch 3", "correct": false}, {"label": "D", "text": "Pharyngeal arch 4", "correct": false}], "correct_answer": "A. Pharyngeal arch 1", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the structure indicated in the image below.", "options": [{"label": "A", "text": "Midbrain", "correct": false}, {"label": "B", "text": "Pons", "correct": true}, {"label": "C", "text": "Medulla oblongata", "correct": false}, {"label": "D", "text": "Spinal cord", "correct": false}], "correct_answer": "B. Pons", "question_images": ["https://image.prepladder.com/content/LdXyOVK2k0bbWc1fUp0I1691387404.png"], "explanation_images": [], "explanation": "<p>Correct Option B - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent a left submandibular gland excision during which the hypoglossal nerve was injured. Which of the following deficits would be seen in this case?", "options": [{"label": "A", "text": "Deviated tongue to the contralateral side", "correct": false}, {"label": "B", "text": "Deviated tongue to the same side", "correct": true}, {"label": "C", "text": "Inability to protrude tongue", "correct": false}, {"label": "D", "text": "Loss of taste in posterior 1/3rd of the tongue", "correct": false}], "correct_answer": "B. Deviated tongue to the same side", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s1lQUdD3kmRuob673Lce1715083877.png"], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the function of the muscle indicated in the provided image?", "options": [{"label": "A", "text": "Retraction of scapula", "correct": false}, {"label": "B", "text": "Protraction of scapula", "correct": false}, {"label": "C", "text": "Abduction of shoulder joint", "correct": true}, {"label": "D", "text": "Adduction of shoulder joint", "correct": false}], "correct_answer": "C. Abduction of shoulder joint", "question_images": ["https://image.prepladder.com/content/YTF19xHJqlks5OiAwmtB1691387901.png"], "explanation_images": ["https://image.prepladder.com/content/4K31BIO5HxQ29IbizRF91715340373.png"], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the vertebral level of the abdominal plane labelled 2?", "options": [{"label": "A", "text": "Lower border of L1", "correct": false}, {"label": "B", "text": "Upper border of L1", "correct": false}, {"label": "C", "text": "Upper border of L3", "correct": true}, {"label": "D", "text": "Lower border of L4", "correct": false}], "correct_answer": "C. Upper border of L3", "question_images": ["https://image.prepladder.com/content/KHqS3WmZkhloFQ22UKYb1684996551.png"], "explanation_images": ["https://image.prepladder.com/content/qAXyYcumji7JwnJIoWHF1716464395.png"], "explanation": "<p>Correct Option C: Upper border of L3\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following aids in supination and pronation of the forearm?", "options": [{"label": "A", "text": "Pivot joint", "correct": true}, {"label": "B", "text": "Saddle joint", "correct": false}, {"label": "C", "text": "Ellipsoid joint", "correct": false}, {"label": "D", "text": "Ball and socket joint", "correct": false}], "correct_answer": "A. Pivot joint", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5RdFBJJzmY9o6chapJXX1715764626.png", "https://image.prepladder.com/content/MKoZReMQLQWuZt2WAaQ31684997031.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"20e5c798981692777195a599eb19c8\"&gt;Pivot&lt;/span&gt; j\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Infer the extent of the thyroid gland from the given image.", "options": [{"label": "A", "text": "B to D", "correct": false}, {"label": "B", "text": "A to C", "correct": false}, {"label": "C", "text": "A to D", "correct": true}, {"label": "D", "text": "C to D", "correct": false}], "correct_answer": "C. A to D", "question_images": ["https://image.prepladder.com/content/TrJQTzfUYTFk0B8Djjh91712215189.png"], "explanation_images": [], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presented with sudden onset of dysphagia, dysarthria, and gait ataxia. MRI revealed an acute infarct in the right dorsolateral medulla. What is the likely diagnosis?", "options": [{"label": "A", "text": "Dejerine’s anterior bulbar syndrome", "correct": false}, {"label": "B", "text": "Wallenberg syndrome", "correct": true}, {"label": "C", "text": "Babinski-Nageotte syndrome", "correct": false}, {"label": "D", "text": "Weber syndrome", "correct": false}], "correct_answer": "B. Wallenberg syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Smv13Tg6S1a311vTdCBA1714979196.png", "https://image.prepladder.com/content/bm5IrpXh68GAdhZYlfR91714979244.png"], "explanation": "<p>Correct Option B - Wallenberg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image shows the cross-section of the abdominal cavity. Identify the structure marked ‘A.’", "options": [{"label": "A", "text": "Descending aorta", "correct": true}, {"label": "B", "text": "Superior vena cava", "correct": false}, {"label": "C", "text": "Inferior vena cava", "correct": false}, {"label": "D", "text": "Ascending aorta", "correct": false}], "correct_answer": "A. Descending aorta", "question_images": ["https://image.prepladder.com/content/QRz7jhnG86m8WW60HRg21684997416.png"], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following dural venous sinuses receives the great cerebral vein of Galen as its tributary?", "options": [{"label": "A", "text": "A", "correct": false}, {"label": "B", "text": "B", "correct": true}, {"label": "C", "text": "C", "correct": false}, {"label": "D", "text": "D", "correct": false}], "correct_answer": "B. B", "question_images": ["https://image.prepladder.com/content/2sXYYwSVnrjg56N6gcu91712215379.png"], "explanation_images": ["https://image.prepladder.com/content/HyblwTHSo2nvNKxZuKSf1715084930.png"], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the anatomical structure marked in the given image.", "options": [{"label": "A", "text": "Abductor pollicis brevis", "correct": false}, {"label": "B", "text": "Extensor pollicis brevis", "correct": false}, {"label": "C", "text": "Abductor pollicis longus", "correct": false}, {"label": "D", "text": "Extensor pollicis longus", "correct": true}], "correct_answer": "D. Extensor pollicis longus", "question_images": ["https://image.prepladder.com/content/b0JMsEV24ASmH5GDCN9s1712569334.png"], "explanation_images": ["https://image.prepladder.com/content/PWyHFC3gZaXx5qPofSmf1712569356.png", "https://image.prepladder.com/content/3UwKWr6kRyz0PSnFGf9Q1712569392.png"], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\"&gt;Extensor&lt;/span&gt; pollicis longu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following arteries is palpated in the image shown below?", "options": [{"label": "A", "text": "Anterior tibial artery", "correct": false}, {"label": "B", "text": "Posterior tibial artery", "correct": true}, {"label": "C", "text": "Dorsalis pedis artery", "correct": false}, {"label": "D", "text": "Popliteal artery", "correct": false}], "correct_answer": "B. Posterior tibial artery", "question_images": ["https://image.prepladder.com/content/lHejgKU1anBs03dlhqnO1712726962.png"], "explanation_images": ["https://image.prepladder.com/content/4cPsw87X1H3L6pvXlyny1712727423.png"], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of joint shown in the given image.", "options": [{"label": "A", "text": "Symphysis", "correct": false}, {"label": "B", "text": "Syndesmosis", "correct": true}, {"label": "C", "text": "Synchondrosis", "correct": false}, {"label": "D", "text": "Synostosis", "correct": false}], "correct_answer": "B. Syndesmosis", "question_images": ["https://image.prepladder.com/content/N1DANUC8q9kcvsIX1kEh1684998000.png"], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After a fall from a height with his hand outstretched, a man is brought to the emergency department. An X-ray reveals a fracture in the clavicle. Which specific region of the clavicle is the most likely to be fractured?", "options": [{"label": "A", "text": "Junction of medial 2/3rd and lateral 1/3rd", "correct": true}, {"label": "B", "text": "Junction of medial 1/3rd and lateral 2/3rd", "correct": false}, {"label": "C", "text": "Junction of middle 1/3rd and medial 1/3rd", "correct": false}, {"label": "D", "text": "Middle of the clavicle", "correct": false}], "correct_answer": "A. Junction of medial 2/3rd and lateral 1/3rd", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VVBAcHAUDCCE09MNPryZ1715256394.png"], "explanation": "<p>Correct Option A - \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "To what level of vertebrae does the given structure correspond?", "options": [{"label": "A", "text": "At the junction of L1 &amp;amp; L2", "correct": false}, {"label": "B", "text": "At the junction of L2 &amp;amp; L3", "correct": false}, {"label": "C", "text": "At the junction of T12 &amp;amp; L1", "correct": false}, {"label": "D", "text": "At the junction of L3 &amp;amp; L4", "correct": true}], "correct_answer": "D. At the junction of L3 &amp; L4", "question_images": ["https://image.prepladder.com/content/L7xA9Aafm01RpFzlmteO1712646742.png"], "explanation_images": [], "explanation": "<p>Correct Option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Name the dural venous arrow marked in the radiograph.", "options": [{"label": "A", "text": "Straight sinus", "correct": true}, {"label": "B", "text": "Superior sagittal sinus", "correct": false}, {"label": "C", "text": "Inferior sagittal sinus", "correct": false}, {"label": "D", "text": "Confluence of sinuses", "correct": false}], "correct_answer": "A. Straight sinus", "question_images": ["https://image.prepladder.com/content/SiCTFJstnz7j9CineeVX1712215833.png"], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 61-year-old university professor complains of vision loss in his left eye. He compares the sensation to a curtain being pulled over his affected eye. Additionally, he experienced flashing lights and floaters a week ago. The provided image shows a B-scan of his left eye. What could be the possible diagnosis for his condition?", "options": [{"label": "A", "text": "Glaucoma", "correct": false}, {"label": "B", "text": "Posterior vitreous detachment", "correct": false}, {"label": "C", "text": "Retinal detachment", "correct": true}, {"label": "D", "text": "Corneal ulcer", "correct": false}], "correct_answer": "C. Retinal detachment", "question_images": ["https://image.prepladder.com/content/d1UMtpWoNPKlDpjjqhcs1715257569.JPG"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\"&gt;Retinal&lt;/span&gt; detach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 3-year-old boy who has been displaying increased clumsiness for the past 6 months, and upon examination, a cauliflower-like growth, leukocoria, and an absent red reflex in the left eye? Enucleation was performed, and microscopic examination of the specimen reveals the presence of Flexner-Wintersteiner rosettes.", "options": [{"label": "A", "text": "Retinoblastoma", "correct": true}, {"label": "B", "text": "Neurofibroma", "correct": false}, {"label": "C", "text": "Retinopathy of prematurity", "correct": false}, {"label": "D", "text": "Toxcariasis", "correct": false}], "correct_answer": "A. Retinoblastoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sRBjnRWU9PuTO9UHd7Fk1715163701.png"], "explanation": "<p>Correct Option A - R\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following combinations of cylindrical lenses can be employed for the treatment of astigmatism in the with-the-rule orientation?", "options": [{"label": "A", "text": "+5.00 DC x 180, -3.00 DC x 90", "correct": false}, {"label": "B", "text": "+7.00 DC x 180, +5.00 DC x 90", "correct": false}, {"label": "C", "text": "-4.00 DC x 180, -5.00 DC x 90", "correct": false}, {"label": "D", "text": "-3.00 DC x 180, +1.00 DC x 90", "correct": true}], "correct_answer": "D. -3.00 DC x 180, +1.00 DC x 90", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dD74v2ZybkFgYRJD8sv11685074969.png"], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable cause of uniocular diplopia in a young boy who has experienced trauma to his right eye?", "options": [{"label": "A", "text": "Paresis of extraocular muscle", "correct": false}, {"label": "B", "text": "Displacement of one eyeball", "correct": false}, {"label": "C", "text": "Symblepharon", "correct": false}, {"label": "D", "text": "Iridodialysis", "correct": true}], "correct_answer": "D. Iridodialysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - I\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p><span><span><span><strong><span><span><span>Diplopia</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Causes</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><strong><span><span><span>Binocular diplopia</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<ul>\n<li><span><span><span><span><span><span>Paralysis or <span class=\"customMeta\" data-dictid=\"fec3fca4a316927771949da843f588\">paresis</span> of the <span class=\"customMeta\" data-dictid=\"7d57c304c01692777187da125d18d8\">extraocular</span> muscles (Commonest cause)</span></span></span></span></span></span></li>\n<li><span><span><span><span><span><span>Displacement of one <span class=\"customMeta\" data-dictid=\"53c6bebcbb169277718777b3fe0e5c\">eyeball</span> either due to the <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> in the orbit and the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> wall.</span></span></span></span></span></span></li>\n<li><span><span><span><span><span><span>Mechanical restriction of the <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> movement caused by the thick pterygium, <span class=\"customMeta\" data-dictid=\"1727fa8cc816927771994ad2a947b5\">symblepharon</span> and <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> ophthalmopathy.</span></span></span></span></span></span></li>\n<li><span><span><span><span><span><span>Deviation of rays of light in one eye as caused by Decentred spectacles.</span></span></span></span></span></span></li>\n<li><span><span><span> <span><span><span>Anisometropia</span></span></span></span></span></span></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><strong><span><span><span>Uniocular diplopia</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<ul>\n<li><span><span><span><span><span><span>Subluxated clear lens</span></span></span></span></span></span></li>\n<li><span><span><span><span><span><span>Subluxated <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> lens</span></span></span></span></span></span></li>\n<li><span><span><span><span><span><span>Double <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> due to <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> or large <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"744b697ac31692777190fa2c638b3a\">iridectomy</span> or iridodialysis.</span></span></span></span></span></span></li>\n<li><span><span><span><span><span><span>Incipient cataract</span></span></span></span></span></span></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For the purpose of preventing surgical site infection, what is the recommended technique and optimal timing for hair removal prior to surgery?", "options": [{"label": "A", "text": "On the OT table with electric hair clippers", "correct": true}, {"label": "B", "text": "With a razor 24 hours before surgery", "correct": false}, {"label": "C", "text": "With a hair removal cream on the previous day", "correct": false}, {"label": "D", "text": "On the OT table with a razor", "correct": false}], "correct_answer": "A. On the OT table with electric hair clippers", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrives at the emergency department after being involved in a car accident. The patient is experiencing difficulty breathing and their neck veins appear dilated. The x-ray reveals a significant amount of air on the left side. What is the most appropriate course of action for treatment?", "options": [{"label": "A", "text": "Wide bore needle insertion in the 5th intercostal space", "correct": true}, {"label": "B", "text": "Endotracheal intubation", "correct": false}, {"label": "C", "text": "Tracheostomy", "correct": false}, {"label": "D", "text": "Pericardiocentesis", "correct": false}], "correct_answer": "A. Wide bore needle insertion in the 5th intercostal space", "question_images": ["https://image.prepladder.com/content/DCmCbzUYHJw9yGjkxfiY1685075467.png"], "explanation_images": ["https://image.prepladder.com/content/CJ3oHw5Ti5a00zTi5zw61685075526.png"], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old male had acute appendicitis 3 days ago and presented to the surgery department with abdominal pain and tenderness . Which of the following incisions would be appropriate for this condition?", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "3", "correct": true}, {"label": "D", "text": "5", "correct": false}], "correct_answer": "C. 3", "question_images": ["https://image.prepladder.com/content/Xrhh7cw7DtCQGTsi2xGi1685075679.png"], "explanation_images": [], "explanation": "<p>Correct Option C - 3\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Due to a prolonged period of consuming maize as a main food source, a 34-year-old man developed diarrhoea and exhibited lesions on his neck, as depicted in the accompanying image. This condition is caused by a deficiency in:", "options": [{"label": "A", "text": "Niacin", "correct": true}, {"label": "B", "text": "Zinc", "correct": false}, {"label": "C", "text": "Thiamine", "correct": false}, {"label": "D", "text": "Iron", "correct": false}], "correct_answer": "A. Niacin", "question_images": ["https://image.prepladder.com/content/PlWsjkmV19Txpbj0zGqS1691234770.png"], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old man was referred to the surgery OPD from the infertility clinic . On inspection, the scrotum appeared as in the image. On palpation, a bag of worm sensation was felt . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hydrocele", "correct": false}, {"label": "B", "text": "Varicocele", "correct": true}, {"label": "C", "text": "Testicular torsion", "correct": false}, {"label": "D", "text": "Epididymo Orchitis", "correct": false}], "correct_answer": "B. Varicocele", "question_images": ["https://image.prepladder.com/content/Tb3Ro1JcAmgUhc1C5njq1713960228.png"], "explanation_images": ["https://image.prepladder.com/content/6SN3Ttp4DA3LxreqjUtU1713851249.png", "https://image.prepladder.com/content/XwWMs4VHeKwxtmXtQikB1713851228.png"], "explanation": "<p>Correct Option B - V\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Condition</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Definition</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Clinical Presentation</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Hydrocele</strong></p>\n</td>\n<td>\n<p>Collection of fluid within the <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis</p>\n</td>\n<td>\n<p>Painless swelling feels like a smooth mass on palpation, may be transilluminated</p>\n</td>\n<td>\n<p>Clinical examination, ultrasound</p>\n</td>\n<td>\n<p>Asymptomatic cases may be observed; surgery may be required for large or <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> hydroceles</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Varicocele</strong></p>\n</td>\n<td>\n<p>Enlargement of veins within the scrotum</p>\n</td>\n<td>\n<p>Painless swelling, \"bag of worms\" sensation on palpation, usually left-sided</p>\n</td>\n<td>\n<p>Clinical examination, ultrasound</p>\n</td>\n<td>\n<p>Surgical repair may be considered for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> varicoceles or for infertility</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Testicular Torsion</strong></p>\n</td>\n<td>\n<p>Twisting of the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n<td>\n<p>Acute onset of severe pain, swelling, testicular tenderness, nausea, vomiting</p>\n</td>\n<td>\n<p>Clinical examination, ultrasound</p>\n</td>\n<td>\n<p>Emergency <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention is required to prevent testicular loss</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Epididymo- orchitis</strong></p>\n</td>\n<td>\n<p>Inflammation of the <span class=\"customMeta\" data-dictid=\"755b023ad31692777187f4c9bd10fb\">epididymis</span> and/or testis</p>\n</td>\n<td>\n<p>Pain, swelling, <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> of the scrotum, fever, discharge</p>\n</td>\n<td>\n<p>Clinical examination, ultrasound, <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and blood tests</p>\n</td>\n<td>\n<p>Antibiotics, pain management, surgery in severe case</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The lab technician observes that a urine sample obtained from a 4-year-old male appeared normal initially, but underwent a change in color as depicted in the image after a few hours. Subsequently, the color intensified over the following hours. Which deficiency can potentially lead to this condition?", "options": [{"label": "A", "text": "Beta-carotene", "correct": false}, {"label": "B", "text": "Tyrosine aminotransferase", "correct": false}, {"label": "C", "text": "L-ascorbic acid", "correct": false}, {"label": "D", "text": "Homogentisic acid oxidase", "correct": true}], "correct_answer": "D. Homogentisic acid oxidase", "question_images": ["https://image.prepladder.com/content/lbeiqarOMJOZV1SQpfcm1685075936.png"], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Complex IV is inhibited by?", "options": [{"label": "A", "text": "Rotenone", "correct": false}, {"label": "B", "text": "Cyanide", "correct": true}, {"label": "C", "text": "Carboxin", "correct": false}, {"label": "D", "text": "Antimycin A", "correct": false}], "correct_answer": "B. Cyanide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><span><span><span><strong><span><span><span>Topic</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p style=\"text-align:center\"><span><span><span><strong><span><span><span>Information</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Complex IV</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Complex IV, also known as <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> c oxidase, is the final <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> in the <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transport chain located in the inner mitochondrial membrane. It catalyses the transfer of electrons from <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> c to molecular oxygen, generating water and producing a <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> across the inner mitochondrial membrane.</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Cyanide</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Cyanide is a potent <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> of Complex IV. It binds to the <span class=\"customMeta\" data-dictid=\"d4fff554a316927771885dc8700abe\">heme</span> group of <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> c <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> and prevents the transfer of electrons to molecular oxygen, thereby <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> the <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transport chain and halting <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> phosphorylation. <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">Cyanide</span> <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> can result in rapid <span class=\"customMeta\" data-dictid=\"2f3a62230316927771846649e8b780\">cell death</span> due to the cessation of <span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\">ATP</span> production. It causes <span class=\"customMeta\" data-dictid=\"9c1068c4ed16927771892ed05b11d6\">histotoxic</span> hypoxia. </span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Mechanism of inhibition</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Cyanide binds to the <span class=\"customMeta\" data-dictid=\"5a046503cb169277720259dec3f2be\">ferric</span> (Fe3+) <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of the <span class=\"customMeta\" data-dictid=\"d4fff554a316927771885dc8700abe\">heme</span> group in <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> c <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> and converts it to the <span class=\"customMeta\" data-dictid=\"ffb2e30f4b1692777202053635c365\">ferrous</span> (Fe2+) form, which has a higher <span class=\"customMeta\" data-dictid=\"227269f3ec1692777180d76a7898dd\">affinity</span> for oxygen. This prevents the transfer of electrons from <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> c to oxygen, effectively halting the <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transport chain.</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Clinical significance</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Cyanide <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> can occur through inhalation, ingestion, or <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> through the skin. Symptoms of <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> include headache, dizziness, confusion, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress, and coma. Treatment typically involves administration of antidotes such as hydroxocobalamin, which binds to <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> and forms a stable complex that is excreted in the urine.</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Use in research</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Cyanide is commonly used in research as a tool to study Complex IV function and the <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transport chain. Inhibiting Complex IV with <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> can be used to study the <span class=\"customMeta\" data-dictid=\"f5467ab59316927771863c852a23a6\">downstream</span> effects of <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> <span class=\"customMeta\" data-dictid=\"619ba5e99c16927771958308fb8687\">phosphorylation</span> inhibition, such as changes in <span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\">ATP</span> production, <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> metabolism, and gene expression.</span></span></span></span></span></span></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following CT findings is not an indication to perform angiography in a splenic trauma patient under conservative management?", "options": [{"label": "A", "text": "Subcapsular hematoma covering 40% surface area.", "correct": true}, {"label": "B", "text": "Significant hemoperitoneum", "correct": false}, {"label": "C", "text": "Presence of pseudoaneurysm", "correct": false}, {"label": "D", "text": "Contrast extravasation", "correct": false}], "correct_answer": "A. Subcapsular hematoma covering 40% surface area.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/u3CV22G5s3nqBrNDIjvH1712295418.png"], "explanation": "<p>Correct Option A - Subcapsular &lt;span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\"&gt;hematoma&lt;/span&gt; covering 40% su\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Grade</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Hematoma</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Laceration </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>I</p>\n</td>\n<td>\n<p>Subcapsular hematoma</p>\n</td>\n<td>\n<p>Capsular tear &lt;1 cm in depth</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>II</p>\n</td>\n<td>\n<p>S/C <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving 10-50% Surface area</p>\n</td>\n<td>\n<p>1-3cm depth</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>III</p>\n</td>\n<td>\n<p>S/C <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> involving &gt;50% Surface area</p>\n</td>\n<td>\n<ul>\n<li>\n<p>&gt; 3 cm or involving </p>\n</li>\n<li>\n<p>Trabecular vessels </p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>IV</p>\n</td>\n<td>\n<p>&gt;25% devascularization </p>\n</td>\n<td>\n<ul>\n<li>\n<p>Laceration involving</p>\n</li>\n<li>\n<p>Hilar vessels </p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>V</p>\n</td>\n<td>\n<p>Completely shattered spleen</p>\n</td>\n<td>\n<p>Complete devascularization </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statements below accurately describes the characteristics of the Michaelis-Menten graph?", "options": [{"label": "A", "text": "Km is directly proportional to substrate concentration", "correct": true}, {"label": "B", "text": "Km doesn't vary with the enzyme concentration", "correct": false}, {"label": "C", "text": "Km is indirectly proportional to substrate concentration", "correct": false}, {"label": "D", "text": "Km has no relation to substrate concentration", "correct": false}], "correct_answer": "A. Km is directly proportional to substrate concentration", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "By the action of the enzyme aromatase, testosterone is transformed into which of the subsequent hormones?", "options": [{"label": "A", "text": "5-hydroxy testosterone", "correct": false}, {"label": "B", "text": "Estradiol", "correct": true}, {"label": "C", "text": "Cortisol", "correct": false}, {"label": "D", "text": "Cortisone", "correct": false}], "correct_answer": "B. Estradiol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - E\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the optimal management approach for a patient presenting with fever and abdominal pain five days after experiencing a common bile duct injury resulting in a leak ?", "options": [{"label": "A", "text": "Ultrasound–guided aspiration", "correct": false}, {"label": "B", "text": "ERCP and stenting", "correct": true}, {"label": "C", "text": "Re-exploration and hepaticojejunostomy", "correct": false}, {"label": "D", "text": "Re-exploration and primary repair", "correct": false}], "correct_answer": "B. ERCP and stenting", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"b2276d3d4c16927771872281723792\"&gt;ERCP&lt;/span&gt; and stenting\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient sustained a crush injury on their right arm. He was taken to the hospital and on examination, his arm was pulseless, swollen, and dark red. What would be the best way to manage this case?", "options": [{"label": "A", "text": "Intraosseous administration of fluids", "correct": false}, {"label": "B", "text": "Acidification of urine", "correct": false}, {"label": "C", "text": "Fasciotomy", "correct": true}, {"label": "D", "text": "Hemodialysis", "correct": false}], "correct_answer": "C. Fasciotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a fasting state, glucagon promotes the production of glucose by which of the following pathways?", "options": [{"label": "A", "text": "Glycolysis and gluconeogenesis", "correct": false}, {"label": "B", "text": "Gluconeogenesis and glycogenolysis", "correct": true}, {"label": "C", "text": "Glycogenesis and gluconeogenesis", "correct": false}, {"label": "D", "text": "Only gluconeogenesis", "correct": false}], "correct_answer": "B. Gluconeogenesis and glycogenolysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"724a9faafe1692777188ca8840ec5c\"&gt;Gluconeogenesis&lt;/span&gt; and glycog\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old alcoholic with a history of binge drinking presents with an episode of vomiting bright red blood . His vitals are stable. An endoscopy was performed, an image of which is given below; what is the probable diagnosis here?", "options": [{"label": "A", "text": "Tension pneumothorax", "correct": false}, {"label": "B", "text": "Boerhaave syndrome", "correct": false}, {"label": "C", "text": "Mallory Weiss Tear", "correct": true}, {"label": "D", "text": "Gastric ulcer perforation", "correct": false}], "correct_answer": "C. Mallory Weiss Tear", "question_images": ["https://image.prepladder.com/content/RzItqIRo5lfMLpJyv0XQ1712294590.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Mallory Weiss T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable cause of massive, sudden onset hematemesis in a 50-year-old patient with a history of chronic liver disease and chronic alcoholism, who has arrived at the emergency department?", "options": [{"label": "A", "text": "Mallory Weiss tear", "correct": false}, {"label": "B", "text": "Bleeding esophageal varices", "correct": true}, {"label": "C", "text": "Boerhaave’s syndrome", "correct": false}, {"label": "D", "text": "Perforated ulcer", "correct": false}], "correct_answer": "B. Bleeding esophageal varices", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Bleeding &lt;span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\"&gt;esophageal&lt;/span&gt; v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the next course of action in the management of a 30-year-old breastfeeding mother who is experiencing pain and fever in her left breast? The left breast appears abnormal as depicted in the provided image. There is slight swelling of the lymph nodes in the armpit on the affected side, while the opposite breast appears normal. Despite multiple attempts at draining the fluid with the use of antibiotics, it was unsuccessful. An ultrasound examination revealed the presence of fluid collection.", "options": [{"label": "A", "text": "Incision an drainage", "correct": true}, {"label": "B", "text": "Broad spectrum antibiotics only", "correct": false}, {"label": "C", "text": "Breast conservation surgery", "correct": false}, {"label": "D", "text": "Punch biopsy", "correct": false}], "correct_answer": "A. Incision an drainage", "question_images": ["https://image.prepladder.com/content/G86RtcUZnYwhdaIKdp0L1691235977.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the causative agent responsible for causing acne fulminans among the following options?", "options": [{"label": "A", "text": "Actinomyces", "correct": false}, {"label": "B", "text": "Propionibacterium", "correct": true}, {"label": "C", "text": "Mobiluncus", "correct": false}, {"label": "D", "text": "Bifidobacterium", "correct": false}], "correct_answer": "B. Propionibacterium", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/t0skBj6dcYf5fwBJwViD1685077900.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of a woman who has suffered third and fourth degree burns on her back, what would be the appropriate sequence of steps in her treatment?", "options": [{"label": "A", "text": "Resuscitation – reconstruction – debridement", "correct": false}, {"label": "B", "text": "Resuscitation – debridement – allograft or autograft", "correct": true}, {"label": "C", "text": "Debridement – resuscitation – autograft", "correct": false}, {"label": "D", "text": "Debridement – reconstruction – resuscitation", "correct": false}], "correct_answer": "B. Resuscitation – debridement – allograft or autograft", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Burn Degree</strong><br/>\n<br/>\n\t\t\t </p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>First-degree</p>\n</td>\n<td>\n<p>Affect only the <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> (outermost layer of skin)<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Redness, pain, and mild swelling<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Cool compresses, pain relief medications, and <span class=\"customMeta\" data-dictid=\"7b57133ce21692777181a83cfe6855\">aloe</span> vera gel</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Second-degree</p>\n</td>\n<td>\n<p>Affect the <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> and <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> (second layer of skin)<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Redness, pain, blisters, and swelling<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Cool compresses, pain relief medications, and <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> dressings to prevent infection</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Third-degree</p>\n</td>\n<td>\n<p>Affect all layers of the skin, including nerves and blood vessels<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>White or blackened, charred skin, no pain or sensation, and swelling<br/>\n\t\t\t </p>\n</td>\n<td>\n<p>Emergency medical treatment, including wound cleaning, antibiotics, and skin grafting</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Fourth-degree</p>\n</td>\n<td>\n<p>Affect all layers of the skin and underlying tissue, including muscle, tendons, and bones</p>\n</td>\n<td>\n<p>Similar to third-degree burns but with extensive tissue damage and exposed bone</p>\n</td>\n<td>\n<p>Emergency medical treatment, including wound cleaning, antibiotics, and skin grafting</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following represents a type III choledochal cyst from the given image ?", "options": [{"label": "A", "text": "A", "correct": false}, {"label": "B", "text": "B", "correct": false}, {"label": "C", "text": "C", "correct": true}, {"label": "D", "text": "D", "correct": false}], "correct_answer": "C. C", "question_images": ["https://image.prepladder.com/content/0Xb4r6O9pUM0DZ10gu2a1685078127.png"], "explanation_images": ["https://image.prepladder.com/content/KhPk5zNJKcJCCKJpPWfZ1714383857.png"], "explanation": "<p>Correct Option C - C\n<table>\n<tbody>\n<tr>\n<td colspan=\"3\">\n<p style=\"text-align:center\"><strong>Todani <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">Modification</span> of ALONSO-LEJ Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"3\">\n<p><strong>Type I</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td>\n<p><strong>I a</strong></p>\n</td>\n<td>\n<p>Cystic <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (most common)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>II b</strong></p>\n</td>\n<td>\n<p>Focal <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>I c</strong></p>\n</td>\n<td>\n<p>Fusiform <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Type II</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"1\">\n<p>Diverticular dilataion of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Type III</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"1\">\n<p>Dilatation of <span class=\"customMeta\" data-dictid=\"977c284355169277719056fe0e0992\">intraduodenal</span> part of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (choledochocele)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"2\">\n<p><strong>Type IV</strong></p>\n</td>\n<td>\n<p><strong>IV a</strong></p>\n</td>\n<td>\n<p>Dilatation of both <span class=\"customMeta\" data-dictid=\"f4cdbeaedf16927771906a0e1ec3de\">intra</span> and <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>IV b</strong></p>\n</td>\n<td>\n<p>Multiple cysts involving <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> only</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Type V</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"1\">\n<p>Multiple cysts involving only <span class=\"customMeta\" data-dictid=\"f4cdbeaedf16927771906a0e1ec3de\">intra</span> <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (Caroli's disease)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate preoperative fasting recommendation?", "options": [{"label": "A", "text": "4 hours for solids in adults", "correct": false}, {"label": "B", "text": "2 hours for liquids in adults", "correct": true}, {"label": "C", "text": "2 hours for breast milk in infants", "correct": false}, {"label": "D", "text": "4 hours for solids in infants", "correct": false}], "correct_answer": "B. 2 hours for liquids in adults", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kcemcfUp48QHshvtBjjG1714990908.png"], "explanation": "<p>Correct Option B: 2 hours for liquids in adu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are s torage symptoms of benign prostatic hyperplasia ? 1. Urgency 2. Enuresis 3. Hesitancy 4. Frequency 5. Dribbling", "options": [{"label": "A", "text": "1, 3, 4", "correct": false}, {"label": "B", "text": "2 and 5", "correct": false}, {"label": "C", "text": "1, 2, 4, 5", "correct": false}, {"label": "D", "text": "1, 2, 4", "correct": true}], "correct_answer": "D. 1, 2, 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 1, 2, 4\n<table style=\"width:692px\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Storage Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Voiding Symptoms</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Urgency</strong>: A sudden, strong urge to <span class=\"customMeta\" data-dictid=\"c0b5bbe709169277720177f8c58ad5\">urinate</span> that may be difficult to suppress.</p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Hesitancy</strong>: Difficulty initiating urination, often characterized by a delay in the start of the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> stream</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Enuresis</strong>: <span class=\"customMeta\" data-dictid=\"42b110efe11692777190ea5720c867\">Involuntary</span> leakage of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> during sleep.</p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Dribbling</strong>: Continued leakage of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> after the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> stream has stopped.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Frequency</strong>: Need to <span class=\"customMeta\" data-dictid=\"c0b5bbe709169277720177f8c58ad5\">urinate</span> frequently, often more than 8 times a day.</p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Intermittency</strong>: <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> flow stops and starts during micturition.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Nocturia</strong>: Need to wake at night at least once to void.</p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p>Poor flow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Urgency <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">Incontinence</span> (UI)</strong>: <span class=\"customMeta\" data-dictid=\"42b110efe11692777190ea5720c867\">Involuntary</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> leakage, often large volume, immediately preceded by urgency.</p>\n</td>\n<td style=\"border-bottom:1px solid #e3e3e3; border-left:1px solid #e3e3e3; border-right:1px solid #e3e3e3; border-top:1px solid #e3e3e3; vertical-align:bottom\">\n<p><strong>Incomplete emptying</strong>: Sensation of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> fullness persisting at the end of micturition.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following carries the lowest risk of developing invasive ductal carcinoma?", "options": [{"label": "A", "text": "Florid epithelial hyperplasia", "correct": false}, {"label": "B", "text": "Papilloma with fibrovascular core", "correct": false}, {"label": "C", "text": "Atypical hyperplasia", "correct": false}, {"label": "D", "text": "Squamous metaplasia", "correct": true}], "correct_answer": "D. Squamous metaplasia", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p>No increased risk Adenosis, <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">sclerosing</span> or florid<br/>\n\t\t\t </p>\n</td>\n<td>\n<ul>\n<li>\n<p>Apocrine metaplasia</p>\n</li>\n<li>\n<p> Cysts, macro and/or micro</p>\n</li>\n<li>\n<p> Duct ectasia</p>\n</li>\n<li>\n<p> Fibroadenoma</p>\n</li>\n<li>\n<p> Fibrosis</p>\n</li>\n<li>\n<p> Hyperplasia</p>\n</li>\n<li>\n<p> Mastitis (inflammation)</p>\n</li>\n<li>\n<p> Periductal mastitis</p>\n</li>\n<li>\n<p> Squamous metaplasia </p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Slightly increased risk (1.5 – 2 times) </p>\n<p> </p>\n<p>Moderately increased risk (5 times) </p>\n</td>\n<td>\n<ul>\n<li>\n<p>Hyperplasia, moderate or florid, solid or papillary </p>\n</li>\n<li>\n<p>Papilloma with a <span class=\"customMeta\" data-dictid=\"a415391b321692777202ff36543c1c\">fibrovascular</span> core </p>\n</li>\n<li>\n<p>Atypical <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (ductal or lobular)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Insufficient data to assign a risk </p>\n</td>\n<td>\n<ul>\n<li>\n<p>Solitary <span class=\"customMeta\" data-dictid=\"1e290549131692777194843b565ceb\">papilloma</span> of <span class=\"customMeta\" data-dictid=\"8ef2f22a3f1692777191d43bb00fb2\">lactiferous</span> sinus </p>\n</li>\n<li>\n<p> Radial <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">Scar</span> lesion </p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the operating theater, you observe the utilization of a particular vaporizer. Which of the listed gases would you anticipate it to comprise?", "options": [{"label": "A", "text": "a.Desflurane", "correct": true}, {"label": "B", "text": "b.Sevoflurane", "correct": false}, {"label": "C", "text": "c.Halothane", "correct": false}, {"label": "D", "text": "Isoflurane", "correct": false}], "correct_answer": "A. a.Desflurane", "question_images": ["https://image.prepladder.com/content/EUQD4fEgYlCZiMwOtGC71691236431.png"], "explanation_images": ["https://image.prepladder.com/content/4r440KmoxWxqP2GddEYE1685079323.png"], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><span><span><span><strong><span><span><span>Feature</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p style=\"text-align:center\"><span><span><span><strong><span><span><span>Description</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Chemical structure</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Halogenated ether</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Administration</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Inhalation</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Indications</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>General <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> for <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Metabolism</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Minimal</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Onset of action</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Rapid (1-2 minutes)</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Maintenance of action</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Rapid recovery due to low <span class=\"customMeta\" data-dictid=\"a9295e67a41692777198dce0de3f34\">solubility</span> in blood and tissues</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Elimination</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Primarily exhaled unchanged, minimal metabolism</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Side effects</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Respiratory irritation, tachycardia, hypertension</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Special considerations</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Requires specialized vaporizers and scavenging systems to minimize environmental pollution.</span></span></span></span></span></span></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a pregnant woman of age 30 who visits the dermatology outpatient department (OPD) with the following condition?", "options": [{"label": "A", "text": "Systemic lupus erythematosus", "correct": false}, {"label": "B", "text": "Viral infection", "correct": false}, {"label": "C", "text": "Rosacea", "correct": false}, {"label": "D", "text": "Chloasma", "correct": true}], "correct_answer": "D. Chloasma", "question_images": ["https://image.prepladder.com/content/EAazijJ5oCMR10ULcgRH1691236378.png"], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td><strong>Chloasma</strong></td>\n<td>Also known as <span class=\"customMeta\" data-dictid=\"925677d28d1692777192ab31b9e6e4\">melasma</span> or \"mask of pregnancy.\"</td>\n</tr>\n<tr>\n<td><strong>Definition</strong></td>\n<td>Hyperpigmented patches on the skin, often on the face.</td>\n</tr>\n<tr>\n<td><strong>Etiology</strong></td>\n<td>Hormonal changes, UV exposure, genetics, and other factors.</td>\n</tr>\n<tr>\n<td><strong>Distribution</strong></td>\n<td>Primarily occurs on the face, especially cheeks and forehead.</td>\n</tr>\n<tr>\n<td><strong>Color</strong></td>\n<td>Patches are darker than surrounding skin, can be brown or gray.</td>\n</tr>\n<tr>\n<td><strong>Risk Factors</strong></td>\n<td>Pregnancy, hormonal medications, sun exposure, genetics.</td>\n</tr>\n<tr>\n<td><strong>Pattern</strong></td>\n<td>Often <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">symmetrical</span> and well-defined patches.</td>\n</tr>\n<tr>\n<td><strong>Trigger Factors</strong></td>\n<td>Sun exposure and hormonal changes can exacerbate chloasma.</td>\n</tr>\n<tr>\n<td><strong>Diagnosis</strong></td>\n<td>Clinical appearance; Wood's lamp examination may help.</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td>Sun protection (SPF), <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> creams, chemical peels.</td>\n</tr>\n<tr>\n<td> </td>\n<td>Management can be challenging, and complete resolution is not always achieved.</td>\n</tr>\n<tr>\n<td><strong>Prevention</strong></td>\n<td>Sun protection and avoiding triggers can help prevent worsening.</td>\n</tr>\n<tr>\n<td><strong>Psychological Impact</strong></td>\n<td>Chloasma may lead to <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> concerns; it doesn't cause physical harm.</td>\n</tr>\n<tr>\n<td><strong>Relation to Pregnancy</strong></td>\n<td>Often occurs during pregnancy due to hormonal changes.</td>\n</tr>\n<tr>\n<td> </td>\n<td>May fade after pregnancy but can persist.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What diagnosis would you suggest for a 10-month-old male baby who presented with an empty scrotum , wherein ultrasonography showed the right testis located in the right inguinal canal and the left testis located in the perineum?", "options": [{"label": "A", "text": "Bilateral undescended testis", "correct": false}, {"label": "B", "text": "Bilateral ectopic testis", "correct": false}, {"label": "C", "text": "Right side undescended testis and left sided ectopic testis", "correct": true}, {"label": "D", "text": "Right side ectopic testis and left side undescended testis", "correct": false}], "correct_answer": "C. Right side undescended testis and left sided ectopic testis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rwAbshGevjTmjL7fAYBV1714546657.png", "https://image.prepladder.com/content/gqpHa2gFAEaVfShTwWBQ1714546628.png"], "explanation": "<p>Correct Option C - Right side undescended &lt;span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\"&gt;testis&lt;/span&gt; and left sided &lt;span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\"&gt;ectopic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not exhibit the Koebner's phenomenon?", "options": [{"label": "A", "text": "Vitiligo", "correct": false}, {"label": "B", "text": "Psoriasis", "correct": false}, {"label": "C", "text": "Lichen planus", "correct": false}, {"label": "D", "text": "Herpes", "correct": true}], "correct_answer": "D. Herpes", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jpv4dUR80EqU5PFy1O8V1685079617.png", "https://image.prepladder.com/content/JdtcLujM6gvDFvbCc1Fb1685079649.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of psoriasis in the given picture.", "options": [{"label": "A", "text": "Guttate", "correct": true}, {"label": "B", "text": "Erythrodermic", "correct": false}, {"label": "C", "text": "Pustular", "correct": false}, {"label": "D", "text": "Inverse", "correct": false}], "correct_answer": "A. Guttate", "question_images": ["https://image.prepladder.com/content/sQjdDqWXloB3D5Mp5soe1691236533.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"96a5419449169277718878d0bf6088\"&gt;Guttate&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which method is considered the most effective for evaluating the extent of muscle relaxation?", "options": [{"label": "A", "text": "Tetanic stimulation", "correct": false}, {"label": "B", "text": "Double-burst stimulation", "correct": false}, {"label": "C", "text": "Train of four", "correct": true}, {"label": "D", "text": "Electromyography", "correct": false}], "correct_answer": "C. Train of four", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug among the options provided would assist a chronic smoker in their aim to quit smoking ?", "options": [{"label": "A", "text": "Bupropion", "correct": false}, {"label": "B", "text": "Mirtazapine", "correct": false}, {"label": "C", "text": "Varenicline", "correct": false}, {"label": "D", "text": "Both a and c", "correct": true}], "correct_answer": "D. Both a and c", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which diagnostic tool is used to identify the condition depicted in the image below?", "options": [{"label": "A", "text": "Culture", "correct": false}, {"label": "B", "text": "Wood’s lamp examination", "correct": true}, {"label": "C", "text": "Gram staining", "correct": false}, {"label": "D", "text": "Patch test", "correct": false}], "correct_answer": "B. Wood’s lamp examination", "question_images": ["https://image.prepladder.com/content/2AfzbPzYjz9M5BsLLTGm1691236603.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the inclusion of a split-thickness skin graft in wound closure on the thigh entail?", "options": [{"label": "A", "text": "Epidermis and full dermis", "correct": false}, {"label": "B", "text": "Epidermis and variable part of the dermis", "correct": true}, {"label": "C", "text": "Epidermis, dermis and fat", "correct": false}, {"label": "D", "text": "Epidermis only", "correct": false}], "correct_answer": "B. Epidermis and variable part of the dermis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Epidermis and variable part of the dermis: \n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>STSG (Thierseh)</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>FTSG (Wolfe's)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Epidermis + part of <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> used.</p>\n</li>\n<li>\n<p>Large <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> can be taken </p>\n</li>\n<li>\n<p>Graft survival: Easy</p>\n</li>\n<li>\n<p>Donor site heals spontaneously. So, reneated grafts can be taken</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Epidermis + full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of <span class=\"customMeta\" data-dictid=\"521e76df7d1692777186faf836b3f8\">dermis</span> used.</p>\n</li>\n<li>\n<p>Only small <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> can be taken</p>\n</li>\n<li>\n<p>Graft survival: Difficult</p>\n</li>\n<li>\n<p>Donor site develops permanent <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> so repeated grafts cannot be taken</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Significant <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> contractions </p>\n</li>\n</ul>\n<p> ↓</p>\n<p> Poor <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance</p>\n<ul>\n<li>\n<p>Donor sites </p>\n<ul>\n<li>\n<p>Most common: Inner aspect of thigh</p>\n</li>\n<li>\n<p>Upper arm </p>\n</li>\n<li>\n<p>Flexor aspect of forearm </p>\n</li>\n<li>\n<p>Abdominal Wall</p>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Lesser <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> contractions</p>\n</li>\n</ul>\n<p> ↓</p>\n<p> Better <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appearance </p>\n<ul>\n<li>\n<p>Donor sites</p>\n<ul>\n<li>\n<p>Upper eye lid </p>\n</li>\n<li>\n<p>Retro <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> skin</p>\n</li>\n<li>\n<p>Supraclavicular skin</p>\n</li>\n<li>\n<p>Antecubital skin</p>\n</li>\n<li>\n<p>Inframammary skin</p>\n</li>\n<li>\n<p>Inguinal skin</p>\n</li>\n<li>\n<p>Genital skin</p>\n</li>\n<li>\n<p>Gluteal skin</p>\n</li>\n</ul>\n</li>\n<li>\n<p>Axilla is not used as donor site for full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> skin grafting </p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be done after immediate defibrillation is performed on a young male patient who was brought to the emergency department unconscious after collapsing at a railway station, with no pulse felt and a monitor showing ventricular fibrillation?", "options": [{"label": "A", "text": "Check for a pulse", "correct": false}, {"label": "B", "text": "Resume chest compressions", "correct": true}, {"label": "C", "text": "Epinephrine 1 mg IV", "correct": false}, {"label": "D", "text": "Amiodarone 300 mg IV bolus", "correct": false}], "correct_answer": "B. Resume chest compressions", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gd0zzheQmOIhxCxuiehN1712034822.png"], "explanation": "<p>Correct Option B - Resume ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old male presented with a skin lesion as shown below. Biopsy shows the presence of hyperkeratosis . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Atopic dermatitis", "correct": false}, {"label": "B", "text": "Psoriasis", "correct": true}, {"label": "C", "text": "Pemphigus vulgaris", "correct": false}, {"label": "D", "text": "Pemphigus foliaceus", "correct": false}], "correct_answer": "B. Psoriasis", "question_images": ["https://image.prepladder.com/content/BqFFGJqaMYrdmRqMo1ir1714026946.PNG"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 39-year-old man who frequently washes his hands (15-20 times a day), leading to a negative impact on his work performanc e? He attributes this behavior to persistent thoughts that his hands are contaminated with dirt.", "options": [{"label": "A", "text": "Bipolar disorder", "correct": false}, {"label": "B", "text": "Obsessive compulsive disorder", "correct": true}, {"label": "C", "text": "Schizophrenia", "correct": false}, {"label": "D", "text": "Mania", "correct": false}], "correct_answer": "B. Obsessive compulsive disorder", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Obsessive &lt;span class=\"customMeta\" data-dictid=\"8e09a4a39b1692777184e5e57a8435\"&gt;compulsive&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A known case of asthmatic bronchitis was reported to the hospital with breathlessness, palpitations, and oxygen saturation of 88%. The hospital does not have a ventilator. All the following can be given to the patient, except?", "options": [{"label": "A", "text": "Hydrocortisone", "correct": false}, {"label": "B", "text": "Theophylline", "correct": false}, {"label": "C", "text": "Oxygen with oxygen mask, and reservoir", "correct": true}, {"label": "D", "text": "Leukotriene antagonist", "correct": false}], "correct_answer": "C. Oxygen with oxygen mask, and reservoir", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Oxygen with oxygen mask, and reserv\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><span><span><span><strong><span><span><span>Aspect</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p style=\"text-align:center\"><span><span><span><strong><span><span><span>Description</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Indications</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Hypoxemia due to various causes, such as <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, pneumonia, or asthma</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Oxygen source</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Oxygen tank or concentrator</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Oxygen delivery devices</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Nasal cannula, simple face mask, non-rebreather mask, venturi mask</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Oxygen flow rate</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Determined by the patient's <span class=\"customMeta\" data-dictid=\"b98c3a8ea216927771949889d9505f\">oxygen saturation</span> and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> status</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Target oxygen saturation</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Generally, 92-96%</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Monitoring and titration</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Regular assessment of <span class=\"customMeta\" data-dictid=\"b98c3a8ea216927771949889d9505f\">oxygen saturation</span> and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> status to adjust oxygen flow rate as needed</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Side effects and complications</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Oxygen toxicity, <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> atelectasis, drying of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> mucosa, CO2 <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> in chronic <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Special considerations</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Caution in patients with COPD, as high flow oxygen can cause <span class=\"customMeta\" data-dictid=\"1f0bd058f91692777189f9a7c1992e\">hypercapnia</span> and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</span></span></span></span></span></span></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What plasma protein is found in the highest concentration?", "options": [{"label": "A", "text": "Bence jones protein", "correct": false}, {"label": "B", "text": "Globulin", "correct": false}, {"label": "C", "text": "Fibrinogen", "correct": false}, {"label": "D", "text": "Albumin", "correct": true}], "correct_answer": "D. Albumin", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><span><span><span><strong><span><span><span>Plasma Protein</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p style=\"text-align:center\"><span><span><span><strong><span><span><span>Function</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Albumin</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Maintains <span class=\"customMeta\" data-dictid=\"5d369be246169277719451754ab37a\">oncotic</span> pressure, transports hormones and <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acids</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Globulins</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Transport lipids and metal ions, act as antibodies</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Fibrinogen</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Essential for blood clotting</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Prothrombin</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Precursor to thrombin, which is necessary for blood clotting</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Complement proteins</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Part of the immune system, help destroy pathogens</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Immunoglobulins</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Antibodies produced by <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells, bind to antigens</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Transferrin</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Binds to and transports iron</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Ceruloplasmin</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Binds to and transports copper</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Haptoglobin</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Binds to free hemoglobin, prevents its breakdown</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Alpha-1-antitrypsin</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Inhibits enzymes that break down <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Alpha-fetoprotein</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Produced during <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development, used as a marker for certain cancers</span></span></span></span></span></span></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a case presented in the outpatient department (OPD), a patient reported experiencing abdominal pain and diarrhea. Upon further examination, the patient exhibited symptoms of cutaneous flushing, extensive wheezing, and tricuspid insufficiency. Subsequent contrast enhanced MRI scans indicated the presence of endocardial fibrosis. As a result of this condition, which substance is likely to be excreted excessively by the patient?", "options": [{"label": "A", "text": "Vanillylmandelic acid", "correct": false}, {"label": "B", "text": "Imidazoleacetic acid", "correct": false}, {"label": "C", "text": "5-hydroxy indole acetic acid", "correct": true}, {"label": "D", "text": "Choline", "correct": false}], "correct_answer": "C. 5-hydroxy indole acetic acid", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the substance that is most likely to be secreted by the hypothalamus?", "options": [{"label": "A", "text": "Hexokinase I", "correct": false}, {"label": "B", "text": "Hexokinase II", "correct": false}, {"label": "C", "text": "Hexokinase III", "correct": false}, {"label": "D", "text": "Hexokinase IV", "correct": true}], "correct_answer": "D. Hexokinase IV", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"f6bd38b28e16927771897f2f362097\"&gt;Hexokinase&lt;/span&gt; IV: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Lithium usage in pregnancy can lead to which of the following teratogenic effects?", "options": [{"label": "A", "text": "Cardiac defects", "correct": true}, {"label": "B", "text": "Facial defects", "correct": false}, {"label": "C", "text": "CNS defects", "correct": false}, {"label": "D", "text": "Urogenital defects", "correct": false}], "correct_answer": "A. Cardiac defects", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate dietary recommendation for a middle-aged man diagnosed with a rare variant of pyruvate dehydrogenase deficiency, resulting in high anion gap metabolic acidosis?", "options": [{"label": "A", "text": "High protein and low carbohydrate intake", "correct": false}, {"label": "B", "text": "High carbohydrate and low fat intake", "correct": false}, {"label": "C", "text": "High fat and low carbohydrate intake", "correct": true}, {"label": "D", "text": "Only carbohydrate intake henceforth", "correct": false}], "correct_answer": "C. High fat and low carbohydrate intake", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><span><span><span><strong><span><span><span>Feature</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p style=\"text-align:center\"><span><span><span><strong><span><span><span>Description</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Inheritance</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>X-linked recessive</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Incidence</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Estimated to be 1 in 100,000 to 300,000 live births</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Symptoms</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Neurological symptoms such as developmental delay, intellectual disability, seizures, and ataxia; muscle weakness; <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis; poor feeding; and failure to thrive</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Diagnosis</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Blood and <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> tests, genetic testing</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Treatment</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>Supportive care, including a high-fat, low-carbohydrate diet; <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> supplementation; and medications to control seizures and other symptoms</span></span></span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span><span><span>Prognosis</span></span></span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span><span><span>The severity of symptoms varies widely, and the <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> depends on the specific <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> and the age of onset. Some patients have a milder <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of the disease and can live relatively normal lives with appropriate treatment, while others have severe <span class=\"customMeta\" data-dictid=\"6b9286cde51692777190fded98b3e5\">intellectual disability</span> and may have a <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> lifespan.</span></span></span></span></span></span></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient who is tall, obese, known to have hypertension, and has recently been diagnosed with metabolic syndrome during a routine examination, which of the following findings are characteristic findings?", "options": [{"label": "A", "text": "Increase in uric acid and insulin", "correct": false}, {"label": "B", "text": "Raised blood pressure and normal insulin", "correct": false}, {"label": "C", "text": "Increase in triglycerides and total cholesterol", "correct": true}, {"label": "D", "text": "Raised blood sugar and low insulin", "correct": false}], "correct_answer": "C. Increase in triglycerides and total cholesterol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Increase in triglycerides and total ch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old woman who complains of a painless mass in her left breast that can be felt? The mass is highly movable, measures 3 x 3 cm, and has a rubbery texture.", "options": [{"label": "A", "text": "Breast abscess", "correct": false}, {"label": "B", "text": "Phyllodes tumor", "correct": false}, {"label": "C", "text": "Fibroadenoma", "correct": true}, {"label": "D", "text": "Invasive ductal carcinoma", "correct": false}], "correct_answer": "C. Fibroadenoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oqJGUfzISGIt2OjVvTk71685081999.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old diabetic man presents with a progressive increase in pain in his calf. He now prefers to sleep in a seated position by hanging his leg to alleviate pain.Pain is more in the distal part like toes and feet. It gets aggravated with movements and pressure. The pain is increased in lying down and elevation of foot; it may be reduced on hanging the foot down. Which of the following is the most likely cause?", "options": [{"label": "A", "text": "Rest pain", "correct": true}, {"label": "B", "text": "Sciatica", "correct": false}, {"label": "C", "text": "Neurological claudication", "correct": false}, {"label": "D", "text": "Venous claudication", "correct": false}], "correct_answer": "A. Rest pain", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following provides long-lasting results in a coronary artery bypass graft (CABG) ?", "options": [{"label": "A", "text": "Long saphenous vein", "correct": false}, {"label": "B", "text": "Internal mammary artery", "correct": true}, {"label": "C", "text": "Poly tetra fluoro eythlene (PTFE)", "correct": false}, {"label": "D", "text": "Gastroepiploic artery", "correct": false}], "correct_answer": "B. Internal mammary artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-day old neonat e presents abdominal distension and bilious vomiting . Among the following, which is the most appropriate investigation to diagnose the condition?", "options": [{"label": "A", "text": "Barium swallow", "correct": false}, {"label": "B", "text": "Barium meal", "correct": false}, {"label": "C", "text": "Barium meal follow through", "correct": false}, {"label": "D", "text": "CECT abdomen", "correct": true}], "correct_answer": "D. CECT abdomen", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - CECT\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In your OPD, a young male patient with a paternal family history of bipolar disorder has presented with three episodes of mania. Considering the most effective treatment, which of the following mood stabilizers can be prescribed to him?", "options": [{"label": "A", "text": "Valproate", "correct": false}, {"label": "B", "text": "Lamotrigine", "correct": false}, {"label": "C", "text": "Olanzapine", "correct": false}, {"label": "D", "text": "Lithium", "correct": true}], "correct_answer": "D. Lithium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Lithiu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the pathology in the given radiograph of a newborn .:", "options": [{"label": "A", "text": "Meningocele", "correct": false}, {"label": "B", "text": "Imperforate anus", "correct": true}, {"label": "C", "text": "Congenital megacolon", "correct": false}, {"label": "D", "text": "Pyloric stenosis", "correct": false}], "correct_answer": "B. Imperforate anus", "question_images": ["https://image.prepladder.com/content/4f2w53ZmoDS8DBPhpBOt1713356415.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Imperforate anu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the investigation and the lesion depicted in the image given below.", "options": [{"label": "A", "text": "Retrograde cystourethrogram with membranous urethra stricture", "correct": false}, {"label": "B", "text": "Retrograde cystourethrogram with penile urethral stricture", "correct": true}, {"label": "C", "text": "Micturating cystourethrography with bulbar stricture", "correct": false}, {"label": "D", "text": "Micturating cystourethrography with psoriatic urethra stricture", "correct": false}], "correct_answer": "B. Retrograde cystourethrogram with penile urethral stricture", "question_images": ["https://image.prepladder.com/content/X1L0ITtxtiN5cyyrjMCI1713356454.png"], "explanation_images": ["https://image.prepladder.com/content/Wb3FTFl4NL0OQTABwu0M1712230689.png"], "explanation": "<p>Correct Option B - Retrograde &lt;span class=\"customMeta\" data-dictid=\"7d3833cfbf1692777185c44c246cf4\"&gt;cystourethrogram&lt;/span&gt; with penile urethral strictu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the best investigation to establish a diagnosis of GERD ?", "options": [{"label": "A", "text": "24 hours ambulatory pH monitoring", "correct": true}, {"label": "B", "text": "Upper GI endoscopy", "correct": false}, {"label": "C", "text": "CECT", "correct": false}, {"label": "D", "text": "MRI", "correct": false}], "correct_answer": "A. 24 hours ambulatory pH monitoring", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 24 hours &lt;span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\"&gt;ambulatory&lt;/span&gt; pH monitoring\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the phenomenon where a patient in the ward responds to the question \"what is your name?\" by repeating the same sentence ?", "options": [{"label": "A", "text": "Coprolalia", "correct": false}, {"label": "B", "text": "Echopraxia", "correct": false}, {"label": "C", "text": "Copropraxia", "correct": false}, {"label": "D", "text": "Echolalia", "correct": true}], "correct_answer": "D. Echolalia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Echolalia: \n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>Definition</td>\n<td>\n<ul>\n<li>Repeating words or phrases immediately after hearing them</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Characteristics</td>\n<td>\n<ul>\n<li>Often a symptom of neurological and psychiatric conditions like autism, schizophrenia, and dementia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Causes</td>\n<td>\n<ul>\n<li>Damage to the brain's language centers (e.g., stroke, <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> brain injury)</li>\n<li>Developmental disorders like <span class=\"customMeta\" data-dictid=\"59f989084e16927771822f692979f5\">autism</span> spectrum disorder</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Types</td>\n<td>\n<ul>\n<li>Immediate echolalia: Repeating immediately after hearing</li>\n<li>Delayed echolalia: Repeating after a delay, often hours or days later</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Diagnosis and Management</td>\n<td>\n<ul>\n<li>Diagnosis through observation of behavior and communication patterns</li>\n<li>Treatment may include speech and language therapy, medication, and behavioral interventions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Prognosis</td>\n<td>\n<ul>\n<li>Varies depending on underlying cause and severity</li>\n<li>With appropriate diagnosis and management, communication and quality of life can improve.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old alcoholic and a chronic smoker presented with bouts of vomiting and stabbing pain in the epigastrium . He was binge drinking shortly before the symptoms started. He is febrile and tachycardic . The given findings were seen on bedside radiological imaging. Which among the following is a likely cause of this?", "options": [{"label": "A", "text": "Tension pneumothorax", "correct": false}, {"label": "B", "text": "Peptic ulcer perforation", "correct": true}, {"label": "C", "text": "Boerhaave syndrome", "correct": false}, {"label": "D", "text": "Mallory Weiss tear", "correct": false}], "correct_answer": "B. Peptic ulcer perforation", "question_images": ["https://image.prepladder.com/content/E1ZWnUmMRaZhbduTox1e1698123186.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Peptic &lt;span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\"&gt;ulcer&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented to the hospital with a history of increased frequency of micturition . On cystoscopy, a pale ureteric orifice was seen. The patient’s KUB x-ray is given below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Bladder carcinoma", "correct": false}, {"label": "B", "text": "Schistosomiasis", "correct": false}, {"label": "C", "text": "Bladder tuberculosis", "correct": true}, {"label": "D", "text": "Papilloma of urinary bladder", "correct": false}], "correct_answer": "C. Bladder tuberculosis", "question_images": ["https://image.prepladder.com/content/mSR9oD67hzgHu3slkUER1713960330.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\"&gt;Bladder&lt;/span&gt; tubercu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The frontal sinus can be viewed by taking an X-ray at a specific angle, which is depicted in the image below. What is the name of the view depicted?", "options": [{"label": "A", "text": "Caldwell’s view", "correct": true}, {"label": "B", "text": "Towne’s view", "correct": false}, {"label": "C", "text": "Law’s view", "correct": false}, {"label": "D", "text": "Stenvers view", "correct": false}], "correct_answer": "A. Caldwell’s view", "question_images": ["https://image.prepladder.com/content/d9JBxOtlLCX61oSbJR7c1713509210.png"], "explanation_images": ["https://image.prepladder.com/content/cI71Nd3cB9UjT2n0UZcI1713509232.png", "https://image.prepladder.com/content/TSyJtD0Fb5JseCXOZ1dC1713509247.png"], "explanation": "<p>Correct Option A - Caldwell's v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diagnoses give the hematological picture as given below ?", "options": [{"label": "A", "text": "Minamata disease", "correct": false}, {"label": "B", "text": "Saturnism", "correct": true}, {"label": "C", "text": "Chronic iron toxicity", "correct": false}, {"label": "D", "text": "Arsenic poisoning", "correct": false}], "correct_answer": "B. Saturnism", "question_images": ["https://image.prepladder.com/content/8qzPPM42DvzooLRHZS0X1715323139.png"], "explanation_images": ["https://image.prepladder.com/content/rKypkP9m8uj9vKZVEn4x1715323159.png"], "explanation": "<p>Correct Option B - Satu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 77-year-old man presented with worsening hip and back pain . He also reports weight loss and loss of appetite . His PSA levels are elevated. What is the most likely diagnosis here?", "options": [{"label": "A", "text": "Ankylosing spondylitis", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": false}, {"label": "D", "text": "Prostate cancer", "correct": true}], "correct_answer": "D. Prostate cancer", "question_images": ["https://image.prepladder.com/content/z5A2j69HG5ya43ZQr8J21713960409.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common deficiency observed after gastric bypass /bariatric surgery ?", "options": [{"label": "A", "text": "Iron", "correct": true}, {"label": "B", "text": "Copper", "correct": false}, {"label": "C", "text": "Zinc", "correct": false}, {"label": "D", "text": "Calcium", "correct": false}], "correct_answer": "A. Iron", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly man underwent Roux-en-Y gastric bypass surgery for obesity . He now presents to his physician with complaints of dizziness, fatigue, and tremors 2 hours after the ingestion of a carbohydrate-rich meal . His symptoms occur mainly due to 1. Hypoglycemia 2. Small volume of food intake 3. High osmotic load of food 4. Increased release of insulin 5. Increased release of glucagon", "options": [{"label": "A", "text": "1, 2 and 5", "correct": false}, {"label": "B", "text": "1, 3 and 5", "correct": false}, {"label": "C", "text": "1 and 4", "correct": true}, {"label": "D", "text": "3 and 5", "correct": false}], "correct_answer": "C. 1 and 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 1 and 4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly diabetic female patient presented with a black, foul-smelling discharge from the nose. On examination, a blackish necrotic mass has filled the nasal cavity and eroded the septum and hard palate. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Aspergillosis", "correct": false}, {"label": "B", "text": "Mucormycosis", "correct": true}, {"label": "C", "text": "Foreign body", "correct": false}, {"label": "D", "text": "Rhinosporidiosis", "correct": false}], "correct_answer": "B. Mucormycosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bsgEx6z539LxQ8W7wwaP1714044774.png"], "explanation": "<p>Correct Option B - Mu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young adult with gastric outlet obstruction presents with vomiting . Which of the following fluids is preferred in this patient for initial resuscitation ?", "options": [{"label": "A", "text": "Normal saline", "correct": true}, {"label": "B", "text": "Ringer lactate", "correct": false}, {"label": "C", "text": "5% dextrose in water", "correct": false}, {"label": "D", "text": "20% dextrose in water", "correct": false}], "correct_answer": "A. Normal saline", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - N\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old farm worker from a remote village was brought to the hospital 8 hours later, following a snake bite at 5 in the morning. The patient complained of headache, blurred vision, tingling sensation around the mouth, dizziness and vertigo and had multiple episodes of vomiting since the bite. He has signs of respiratory depression and bradycardia (HR&amp;lt;50) . The local wound showed mild swelling and blistering. There are no apparent bleeding manifestations. He was administered 10 vials of antivenom. Which of the following is the subsequent step of management?", "options": [{"label": "A", "text": "Check the blood coagulation profile", "correct": false}, {"label": "B", "text": "Neostigmine with atropine", "correct": true}, {"label": "C", "text": "Epinephrine injection", "correct": false}, {"label": "D", "text": "I.V hydrocortisone", "correct": false}], "correct_answer": "B. Neostigmine with atropine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Neostigmine with\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 60-year-old individual with diabetes who is experiencing intense ear pain and otorrhea that is not improving with antibiotics? During examination, the presence of granulation tissue in the ear canal and facial nerve paralysis was observed?", "options": [{"label": "A", "text": "Otomycosis", "correct": false}, {"label": "B", "text": "Serous otitis media", "correct": false}, {"label": "C", "text": "Malignant otitis externa", "correct": true}, {"label": "D", "text": "Eczematous otitis externa", "correct": false}], "correct_answer": "C. Malignant otitis externa", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/l42Ch6UOdhfer32OoHDx1714130902.png"], "explanation": "<p>Correct Option C - Malignant &lt;span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\"&gt;otitis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate term to describe the behavior of a man who consistently derives sexual pleasure from causing physical harm to his partner , often resulting in cuts and burns on their arms ?", "options": [{"label": "A", "text": "Voyeurism", "correct": false}, {"label": "B", "text": "Fetishism", "correct": false}, {"label": "C", "text": "Sadism", "correct": true}, {"label": "D", "text": "Masochism", "correct": false}], "correct_answer": "C. Sadism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of the 40-year-old female patient's acute onset leg swelling and loose stools, considering her family members also have similar symptoms and mustard oil is a regular part of their diet?", "options": [{"label": "A", "text": "Clavine alkaloids", "correct": false}, {"label": "B", "text": "Sanguinarine", "correct": true}, {"label": "C", "text": "BOAA", "correct": false}, {"label": "D", "text": "Pyrrolizidine alkaloids", "correct": false}], "correct_answer": "B. Sanguinarine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the classification of the head injury of a patient involved in a road traffic accident, based on a GCS score of 10?", "options": [{"label": "A", "text": "Moderate traumatic brain injury", "correct": true}, {"label": "B", "text": "Severe traumatic brain injury", "correct": false}, {"label": "C", "text": "Minor traumatic brain injury", "correct": false}, {"label": "D", "text": "Mild traumatic brain injury", "correct": false}], "correct_answer": "A. Moderate traumatic brain injury", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" rowspan=\"1\">\n<p style=\"text-align: center;\"><strong>Eye opening </strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"1\">\n<p style=\"text-align: center;\"><strong>Verbal response </strong></p>\n<p style=\"text-align: center;\"><strong>(Mnemonics: \"ONE CONFUSED WORD SOUNDS NOWHERE\")</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td colspan=\"2\" rowspan=\"1\">\n<p style=\"text-align: center;\"><strong>Motor response (Best)</strong></p>\n<p style=\"text-align: center;\"><strong>(Mnemonics: \"OBEY LOCALITIES WITH <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">FLEXION</span> AND EXTENSION\")</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td>E4</td>\n<td>Spontaneous</td>\n<td>V5</td>\n<td>Oriented</td>\n<td>M6</td>\n<td>Patient obeys command</td>\n</tr>\n<tr>\n<td>E3</td>\n<td>To loud voice (Speech)</td>\n<td>V4</td>\n<td>Disoriented / confused</td>\n<td>M5</td>\n<td>Localizes pain</td>\n</tr>\n<tr>\n<td>E2</td>\n<td>To pain (Pressure)</td>\n<td>V3</td>\n<td>Inappropriate (words)</td>\n<td>M4</td>\n<td>Withdrawal to pain (there is normal flexion)</td>\n</tr>\n<tr>\n<td>E1</td>\n<td>No response</td>\n<td>V2</td>\n<td>Incomprehensible (sounds)</td>\n<td>M3</td>\n<td>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> posturing</td>\n</tr>\n<tr>\n<td> </td>\n<td> </td>\n<td>V1</td>\n<td>No response</td>\n<td>M2</td>\n<td>Extension posturing</td>\n</tr>\n<tr>\n<td> </td>\n<td> </td>\n<td> </td>\n<td> </td>\n<td>M1</td>\n<td>No response</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the amendment in the medical termination of pregnancy (MTP) Bill of 2020 , until what gestational age is it permissible to induce MTP in mentally ill rape victims?", "options": [{"label": "A", "text": "20 weeks", "correct": false}, {"label": "B", "text": "22 weeks", "correct": false}, {"label": "C", "text": "24 weeks", "correct": true}, {"label": "D", "text": "28 weeks", "correct": false}], "correct_answer": "C. 24 weeks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 24 week\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>The <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> Act 1971 and The <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> Act Amendments 2021</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MTP Act 1971</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>The <span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\">MTP</span> Amendment Act 2021</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Indications(Contraceptive Failure)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only applies to married women</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unmarried women are also covered</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gestational Age Limit</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20 weeks for all indications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>24 weeks for rape survivors</li>\n<li>Beyond 24 weeks for substantial <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> abnormalities</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medical practitioner opinions required before termination</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>One <span class=\"customMeta\" data-dictid=\"60461869c01692777197bef3f17f7b\">RMP</span> till 12 weeks</li>\n<li>Two RMPs till 20 weeks</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>One <span class=\"customMeta\" data-dictid=\"60461869c01692777197bef3f17f7b\">RMP</span> till 20 weeks</li>\n<li>Two RMPs 20-24 weeks</li>\n<li>Medical Board approval after 24 weeks</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breach of the woman’s confidentiality</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fine up to Rs 1000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fine and/or Imprisonment of 1 year</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the potential clinical diagnosis for a 35-year-old man who visited the clinic reporting intermittent dizziness, sensation of pressure and fullness in the ear, reduced hearing, and a low-frequency roaring sound in the ears?", "options": [{"label": "A", "text": "Meniere’s disease", "correct": true}, {"label": "B", "text": "Benign paroxysmal positional vertigo", "correct": false}, {"label": "C", "text": "Labyrinthitis", "correct": false}, {"label": "D", "text": "Syncope", "correct": false}], "correct_answer": "A. Meniere’s disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/y55urgu8A5iYdNcwlWGX1713339072.png"], "explanation": "<p>Correct Option A - Meniere’\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As an internal medicine consultant at a private clinic , you are handling the case of a patient who has chronic renal disease and needs hemodialysis . You provide dietary and fluid management recommendations and closely monitor the patient. Unfortunately, the patient decides to take ayurvedic supplements and occasionally disregards your instructions without informing you. Consequently, the patient's condition deteriorates, leading to respiratory distress . Subsequently, the patient's attendant files a legal complaint, accusing the doctor of negligence. Which of the following can serve as a defense for the doctor in court ?", "options": [{"label": "A", "text": "Vicarious liability", "correct": false}, {"label": "B", "text": "Res Ipsa loquitur", "correct": false}, {"label": "C", "text": "Therapeutic misadventure", "correct": false}, {"label": "D", "text": "Contributory negligence", "correct": true}], "correct_answer": "D. Contributory negligence", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred treatment for a primipara who is experiencing hearing impairment that has worsened during her pregnancy? The Rinne's test yields negative results in both ears, while the Weber's test shows lateralization to the right side. The otoscopy reveals normal tympanic membranes, and audiometry indicates a dip in bone conduction at 2000 Hz.", "options": [{"label": "A", "text": "a.Sodium fluoride", "correct": false}, {"label": "B", "text": "b.Tympanoplasty", "correct": false}, {"label": "C", "text": "c.Stapedectomy", "correct": false}, {"label": "D", "text": "d.Stapedotomy", "correct": true}], "correct_answer": "D. d.Stapedotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the examination of a victim of assault , you notice a wound with ragged, irregular and uneven margins with tears diverging at an angle from the end of the main wound and typical swallowtails. Bleeding from this wound is not significant and shows crushed blood vessels and hair bulbs . You would document this wound as a/an.", "options": [{"label": "A", "text": "Incised wound", "correct": false}, {"label": "B", "text": "Chopped wound", "correct": false}, {"label": "C", "text": "Stab wound", "correct": false}, {"label": "D", "text": "Lacerated wound", "correct": true}], "correct_answer": "D. Lacerated wound", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pSjBhba5tVzBjrUUfoQy1685085186.png"], "explanation": "<p>Correct Option D - Lacerated wou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the subsequent conditions is Bone Anchored Hearing Aid (BAHA) implemented?", "options": [{"label": "A", "text": "Sensorineural hearing loss", "correct": false}, {"label": "B", "text": "Acoustic neuroma", "correct": false}, {"label": "C", "text": "Congenital external auditory atresia", "correct": true}, {"label": "D", "text": "Otitis media", "correct": false}], "correct_answer": "C. Congenital external auditory atresia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yv7XoI1NpdvDuTNNFBYy1713339136.png"], "explanation": "<p>Correct Option C - Congenital external &lt;span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\"&gt;auditory&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements does not apply during cross-examination in a court of law ?", "options": [{"label": "A", "text": "Witness is examined by the defense lawyer", "correct": false}, {"label": "B", "text": "Leading questions are not allowed", "correct": true}, {"label": "C", "text": "Objective of cross-examination is to weaken case of opponent", "correct": false}, {"label": "D", "text": "There is no time limit to cross examination", "correct": false}], "correct_answer": "B. Leading questions are not allowed", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Leading qu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the signs and symptoms caused by hormones released from tumor tissue, which cannot be explained by the tumor's anatomical distribution?", "options": [{"label": "A", "text": "Pretumor syndrome", "correct": false}, {"label": "B", "text": "Paraneoplastic syndrome", "correct": true}, {"label": "C", "text": "Paratumour syndrome", "correct": false}, {"label": "D", "text": "Autocrine phenomenon", "correct": false}], "correct_answer": "B. Paraneoplastic syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the next step in the management of an old patient who has undergone complete excision of glioblastoma ?", "options": [{"label": "A", "text": "Chemotherapy with Bevacizumab", "correct": false}, {"label": "B", "text": "No further management", "correct": false}, {"label": "C", "text": "Chemoradiation", "correct": false}, {"label": "D", "text": "Radiotherapy", "correct": true}], "correct_answer": "D. Radiotherapy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Radioth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which test is employed to distinguish human blood from blood of other species among the options provided?", "options": [{"label": "A", "text": "Teichman test", "correct": false}, {"label": "B", "text": "Precipitin test", "correct": true}, {"label": "C", "text": "Barberio test", "correct": false}, {"label": "D", "text": "Takayama test", "correct": false}], "correct_answer": "B. Precipitin test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EpQZQ8qEIupZ6KhXqdKW1715323195.png"], "explanation": "<p>Correct Option B - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with painless cervical lymphadenopathy and right ear pain. On examination, the right ear reveals conductive hearing loss with a dull tympanic membrane. Moreover, decreased mobility of the soft palate was also noted. What is the probable diagnosis?", "options": [{"label": "A", "text": "Nasopharyngeal carcinoma", "correct": true}, {"label": "B", "text": "Adenoid cystic cancer", "correct": false}, {"label": "C", "text": "Juvenile nasopharyngeal angiofibroma", "correct": false}, {"label": "D", "text": "Quinsy", "correct": false}], "correct_answer": "A. Nasopharyngeal carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\"&gt;Nasopharyngeal&lt;/span&gt; C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the context of biomedical waste disposal, which type of waste is discarded in a yellow bag?", "options": [{"label": "A", "text": "Blood bag", "correct": true}, {"label": "B", "text": "Gloves", "correct": false}, {"label": "C", "text": "Sharps", "correct": false}, {"label": "D", "text": "Urine bag", "correct": false}], "correct_answer": "A. Blood bag", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: Blood bag\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Type of waste</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Examples of waste</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Treatment and disposal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Human <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Animal <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Soiled waste.</li>\n<li>Discarded or expired medicine.</li>\n<li>Microbiology, <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> and other <span class=\"customMeta\" data-dictid=\"3ec60edb4a16927771842bb9fd9aa4\">clinical laboratory</span> waste.</li>\n<li>Chemical waste.</li>\n<li>Chemical liquid waste.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Placenta.</li>\n<li>Post-operative body parts.</li>\n<li>Plaster of Paris (POP).</li>\n<li>Pathological waste.</li>\n<li>Cotton waste.</li>\n<li>Dressing materials.</li>\n<li>Beddings.</li>\n<li>Body fluid contaminated paper and cloth.</li>\n<li>Face mask, cap, shoe cover and head cover.</li>\n<li>Cytotoxic, expired and discarded medicines.</li>\n<li>Microbiology and <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> lab waste.</li>\n<li>Blood bag</li>\n<li>Vacutainers with blood</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Incineration</li>\n<li>Plasma pyrolysis</li>\n<li>Deep burial.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following characteristics is not typically associated with a true bruise?", "options": [{"label": "A", "text": "Negative chemical tests", "correct": false}, {"label": "B", "text": "Progression of the color of bruise over time", "correct": false}, {"label": "C", "text": "Irregular margins", "correct": false}, {"label": "D", "text": "Presence of Itching", "correct": true}], "correct_answer": "D. Presence of Itching", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old male is brought to the emergency room. On examination, his PR is 50 bpm, BP is 80/60 mmHg, RR is 7 breaths/min and his temperature is 95° F . He has a pinpoint pupil and is disoriented. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Benzodiazepine overdose", "correct": false}, {"label": "B", "text": "Cocaine intoxication", "correct": false}, {"label": "C", "text": "Opioid withdrawal", "correct": false}, {"label": "D", "text": "Opioid intoxication", "correct": true}], "correct_answer": "D. Opioid intoxication", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which fungal infection is frequently observed in the maxillary sinus?", "options": [{"label": "A", "text": "Blastomycosis", "correct": false}, {"label": "B", "text": "Aspergillosis", "correct": true}, {"label": "C", "text": "Candidiasis", "correct": false}, {"label": "D", "text": "Histoplasmosis", "correct": false}], "correct_answer": "B. Aspergillosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Asperg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options can be employed for the treatment of Kesari dal toxicity?", "options": [{"label": "A", "text": "Sodium bicarbonate", "correct": false}, {"label": "B", "text": "Vitamin A", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": true}, {"label": "D", "text": "IV immunoglobulin", "correct": false}], "correct_answer": "C. Vitamin C", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/J7SmGJQPrPtFcSZXerI01685087127.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following treatment options is not recommended for a 4-year-old boy presenting with low-grade fever, inspiratory stridor, and barking cough for the past 5 days? The examination shows a hoarse voice, a moderately inflamed pharynx, and a slightly increased respiratory rate. The chest x-ray reveals subglottic narrowing resembling a steeple.", "options": [{"label": "A", "text": "Nebulized racemic epinephrine", "correct": false}, {"label": "B", "text": "Parenteral cefotaxime", "correct": true}, {"label": "C", "text": "Helium oxygen mixture", "correct": false}, {"label": "D", "text": "Intramuscular dexamethasone", "correct": false}], "correct_answer": "B. Parenteral cefotaxime", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the next step in managing the symptoms of a 7-year-old child who underwent a tonsillectomy and now presents with snoring, palpitations, mouth breathing, a slight hearing loss, a high arched palate, and a decline in school performance, causing concern to the mother?", "options": [{"label": "A", "text": "a.Adenoidectomy", "correct": false}, {"label": "B", "text": "b.Myringoplasty", "correct": false}, {"label": "C", "text": "c.Adenoidectomy with grommet insertion", "correct": true}, {"label": "D", "text": "d.Conservative management", "correct": false}], "correct_answer": "C. c.Adenoidectomy with grommet insertion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/r6HFLal2XjL47UpdyQSb1713332438.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Metastatic calcification occurs in all except ?", "options": [{"label": "A", "text": "Kidney", "correct": false}, {"label": "B", "text": "Fundus of the stomach", "correct": false}, {"label": "C", "text": "Pulmonary veins", "correct": false}, {"label": "D", "text": "Atheroma", "correct": true}], "correct_answer": "D. Atheroma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Ath\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Metastatic calcification</strong></td>\n<td style=\"text-align:center\"><strong>Dystrophic calcification</strong></td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Metastatic <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> is caused by increased <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> in the blood and may result from hypercalcemia, hyperphosphatemia, or both</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>The deposition of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> salt in degenerated tissues in the absence of a <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"2cc844bc9c1692777189739abf1dc5\">imbalance</span> is called dystrophic calcification</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>It is commonly associated with hyperparathyroidism, sarcoidosis, metastatic disease, and myeloma</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>It is mostly associated with trauma, inflammation, or infection</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes the fifth stage of the demographic cycle?", "options": [{"label": "A", "text": "Birth rate remains unchanged", "correct": false}, {"label": "B", "text": "Death rate increases", "correct": false}, {"label": "C", "text": "Demographic gap is positive", "correct": false}, {"label": "D", "text": "Birth rate falls below death rate", "correct": true}], "correct_answer": "D. Birth rate falls below death rate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Birth Rate Falls below Death R\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/U0ZxIBONlyHJdewmWBhC1746475920.mp3", "video": ""}, {"text": "You see a child with delayed speech development as part of a health visit at a local school. The otoscopic appearance of the ear is shown below. Hearing loss of 20 dB is detected in audiometric tests. What is your diagnosis?", "options": [{"label": "A", "text": "Acute suppurative otitis media", "correct": false}, {"label": "B", "text": "Serous otitis media", "correct": true}, {"label": "C", "text": "Chronic suppurative otitis media", "correct": false}, {"label": "D", "text": "Glomus tumor", "correct": false}], "correct_answer": "B. Serous otitis media", "question_images": ["https://image.prepladder.com/content/RkYmPR59uDiUxF839wJe1713339243.png"], "explanation_images": ["https://image.prepladder.com/content/k3XuYNDpsqZsLpovDDjI1713339279.png", "https://image.prepladder.com/content/gDn8NL95BLnqslpWucQX1713339293.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\"&gt;Serous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\"&gt;otitis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the method used to assess the relative risk (RR)?", "options": [{"label": "A", "text": "Case control study", "correct": false}, {"label": "B", "text": "Cohort study", "correct": true}, {"label": "C", "text": "Randomized controlled trial", "correct": false}, {"label": "D", "text": "Cross-sectional study", "correct": false}], "correct_answer": "B. Cohort study", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"dbb5ff6b6c1692777184160220ac92\"&gt;Cohort&lt;/span&gt; Stu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yrjMKHwymoLYMkn4LgsD1746251809.mp3", "video": ""}, {"text": "Which of the following statements is false regarding the staff of an urban primary health center?", "options": [{"label": "A", "text": "2 doctors", "correct": false}, {"label": "B", "text": "5 Multiskilled staff nurse", "correct": true}, {"label": "C", "text": "1 lab technician", "correct": false}, {"label": "D", "text": "1 pharmacist", "correct": false}], "correct_answer": "B. 5 Multiskilled staff nurse", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 5 Multiskilled staff nu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Human Resource at UPHC</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sr. no.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staff category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Number</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medical officer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2* (1 regular and 1 part time)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Staff Nurse</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pharmacist</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lab Technician</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Public Health Manager/ Community Mobilisor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>LHV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AMNs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-5** Depending upon population</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8. </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secretarial Staff including for account keeping and MIS</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Support staff</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the NACO guidelines, what level of prevention is achieved when an HIV patient undergoes counselling and screening for TB at an ICTC clinic?", "options": [{"label": "A", "text": "Primordial", "correct": false}, {"label": "B", "text": "Primary", "correct": false}, {"label": "C", "text": "Secondary", "correct": false}, {"label": "D", "text": "Primary &amp;amp; secondary", "correct": true}], "correct_answer": "D. Primary &amp; secondary", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Primary and S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate measure of central tendency when there is a diverse range of values within a community?", "options": [{"label": "A", "text": "Mean", "correct": false}, {"label": "B", "text": "Mode", "correct": false}, {"label": "C", "text": "Median", "correct": true}, {"label": "D", "text": "Standard deviation", "correct": false}], "correct_answer": "C. Median", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the provided population pyramid indicate, with the exception of?", "options": [{"label": "A", "text": "Developing countries", "correct": false}, {"label": "B", "text": "Developed countries", "correct": true}, {"label": "C", "text": "Increasing population", "correct": false}, {"label": "D", "text": "More young population", "correct": false}], "correct_answer": "B. Developed countries", "question_images": ["https://image.prepladder.com/content/LIsuHFNk7xTc84ajbzEV1685089332.png"], "explanation_images": ["https://image.prepladder.com/content/7O56YWfCtlouO6Wf3kly1713779866.png", "https://image.prepladder.com/content/f6qec1DpRrH9KvZmZMcV1685089490.png", "https://image.prepladder.com/content/kIhAqQxpGG5JoxPkGybP1685089496.png", "https://image.prepladder.com/content/Ypvxw1fbUdXhCCtbpvzP1685089516.png"], "explanation": "<p>Correct Option B - Developed Cou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yVr78Ahyhpdp3gveqAJf1746476063.mp3", "video": ""}, {"text": "Which of the following cells is responsible for graft rejection?", "options": [{"label": "A", "text": "Macrophages", "correct": false}, {"label": "B", "text": "T cells", "correct": true}, {"label": "C", "text": "B cells", "correct": false}, {"label": "D", "text": "Plasma cells", "correct": false}], "correct_answer": "B. T cells", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term commonly used to describe a mode of communication wherein 4-8 speakers engage in a discussion on a specific topic in front of a large audience, without following a specific agenda, predetermined speeches, or a set order of speaking, and eventually interact with the audience?", "options": [{"label": "A", "text": "Panel discussion", "correct": true}, {"label": "B", "text": "Symposium", "correct": false}, {"label": "C", "text": "Workshop", "correct": false}, {"label": "D", "text": "Seminar", "correct": false}], "correct_answer": "A. Panel discussion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/r8bY0MbCddEuJmW83mKc1685091575.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the increase in resistance of an artery if its radius is reduced to one-third?", "options": [{"label": "A", "text": "9 times", "correct": false}, {"label": "B", "text": "81 times", "correct": true}, {"label": "C", "text": "27 times", "correct": false}, {"label": "D", "text": "18 times", "correct": false}], "correct_answer": "B. 81 times", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A boy was diagnosed with a medical condition that is believed to have been passed down from his grandmother to his father, and now to him. What is the pattern of inheritance in this case ?", "options": [{"label": "A", "text": "X-linked dominant", "correct": false}, {"label": "B", "text": "X-linked recessive", "correct": false}, {"label": "C", "text": "Autosomal dominant", "correct": true}, {"label": "D", "text": "Autosomal recessive", "correct": false}], "correct_answer": "C. Autosomal dominant", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LvR2VwfshHJqQUHzjU2w1712123892.png"], "explanation": "<p>Correct Option C - Autosomal D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AYvVsfB0XOo5s7HVUXBv1748370303.mp3", "video": ""}, {"text": "Insulin acts on glucose metabolism by", "options": [{"label": "A", "text": "↑ Facilitated diffusion of glucose", "correct": true}, {"label": "B", "text": "↓ Permeability of glucose across cell membrane", "correct": false}, {"label": "C", "text": "↑ Reabsorption of glucose from renal tubules", "correct": false}, {"label": "D", "text": "↑ Glucose reabsorption from intestine", "correct": false}], "correct_answer": "A. ↑ Facilitated diffusion of glucose", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/eseiH5zuRTgAmLh2yC961685092145.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of pancreatic neuroendocrine tumor is responsible for recurrent episodes of secretory diarrhea?", "options": [{"label": "A", "text": "VIPoma", "correct": true}, {"label": "B", "text": "Glucagonoma", "correct": false}, {"label": "C", "text": "Insulinoma", "correct": false}, {"label": "D", "text": "Zollinger Ellison disease", "correct": false}], "correct_answer": "A. VIPoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vmezwyL6cG9q8nJQtilk1685092334.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following conditions is macrocytic anemia seen?", "options": [{"label": "A", "text": "Thalassemia", "correct": false}, {"label": "B", "text": "Anemia of chronic disease", "correct": false}, {"label": "C", "text": "Sideroblastic anemia", "correct": false}, {"label": "D", "text": "Liver disease", "correct": true}], "correct_answer": "D. Liver disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Liv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "On ocular examination, a teenage girl with low body weight is observed to have the following finding. Which WHO grade corresponds to this finding?", "options": [{"label": "A", "text": "1A", "correct": false}, {"label": "B", "text": "1B", "correct": true}, {"label": "C", "text": "2A", "correct": false}, {"label": "D", "text": "2B", "correct": false}], "correct_answer": "B. 1B", "question_images": ["https://image.prepladder.com/content/UEksvjHPXhSLjmQkKkEK1685091687.png"], "explanation_images": ["https://image.prepladder.com/content/8U0KocaTLZUvCf7C39261685092181.png"], "explanation": "\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\"><strong>Xerophthalmia</strong></td>\n</tr>\n<tr>\n<td><strong>Primary X</strong></td>\n<td><strong>Secondary X</strong></td>\n</tr>\n<tr>\n<td>\n<p><strong>Reversible</strong></p>\n<ul>\n<li>XIA (conjectival Xerosis)</li>\n<li>XIB\n\t\t\t\t<ul>\n<li>Bitot spots</li>\n</ul>\n</li>\n</ul>\n<p><img src=\"https://image.prepladder.com/content/8U0KocaTLZUvCf7C39261685092181.png\"/></p>\n<ul>\n<li>X2\n\t\t\t\t<ul>\n<li>Corneal Xerosis</li>\n</ul>\n</li>\n<li>X3A\n\t\t\t\t<ul>\n<li>Corneal ulcer</li>\n</ul>\n</li>\n</ul>\n<p><strong>Irr</strong><strong>eversible</strong></p>\n<ul>\n<li>X3B\n\t\t\t\t<ul>\n<li>Keratomalacia (irreversible) which may lead to absolute blindness</li>\n</ul>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>XN\n\t\t\t\t<ul>\n<li>Night blindness</li>\n</ul>\n</li>\n<li>XF\n\t\t\t\t<ul>\n<li>Xerophthalmic <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> changes</li>\n</ul>\n</li>\n<li>XS\n\t\t\t\t<ul>\n<li>Xerophthalmic scarring</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the peripheral tissue, which enzyme is accountable for converting T4 to T3?", "options": [{"label": "A", "text": "Iodothyronine deiodinase I", "correct": true}, {"label": "B", "text": "Iodothyronine deiodinase III", "correct": false}, {"label": "C", "text": "Iodothyronine deiodinase II", "correct": false}, {"label": "D", "text": "Iodotyrosine deiodinase", "correct": false}], "correct_answer": "A. Iodothyronine deiodinase I", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following stains is used for the detection of hemosiderin deposits?", "options": [{"label": "A", "text": "Mason-Fontana stain", "correct": false}, {"label": "B", "text": "Oil Red O", "correct": false}, {"label": "C", "text": "Sudan black", "correct": false}, {"label": "D", "text": "Perls Prussian blue", "correct": true}], "correct_answer": "D. Perls Prussian blue", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Perls Prussian Blu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following effects of puberty are not influenced by estrogen?", "options": [{"label": "A", "text": "facial hair growth", "correct": true}, {"label": "B", "text": "Cervical mucus secretion", "correct": false}, {"label": "C", "text": "Vaginal cornification", "correct": false}, {"label": "D", "text": "Menstruation", "correct": false}], "correct_answer": "A. facial hair growth", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TkisrxVrSmGZNVbOyBG01685092683.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your diagnosis for a patient who has a prior history of trauma and is currently experiencing symptoms such as double vision, nosebleeds, and limited eye movements, based on the provided CT image?", "options": [{"label": "A", "text": "Le-fort fracture", "correct": false}, {"label": "B", "text": "Fracture maxilla", "correct": false}, {"label": "C", "text": "Fracture zygomatic", "correct": false}, {"label": "D", "text": "Blow out fracture", "correct": true}], "correct_answer": "D. Blow out fracture", "question_images": ["https://image.prepladder.com/content/ERnK3ccveseBtFqpMK3N1685092649.png"], "explanation_images": ["https://image.prepladder.com/content/HjDBx4AvDamBvxkCvzIw1685092727.png"], "explanation": "<p>Correct Option D - Blow-out fracture: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the affinity of carbon monoxide to hemoglobin in comparison to oxygen ?", "options": [{"label": "A", "text": "100", "correct": false}, {"label": "B", "text": "4", "correct": false}, {"label": "C", "text": "250", "correct": true}, {"label": "D", "text": "150", "correct": false}], "correct_answer": "C. 250", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - 250: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable cause of surgical emphysema in a patient following an emergency tracheostomy?", "options": [{"label": "A", "text": "High tracheostomy", "correct": false}, {"label": "B", "text": "Tear in posterior tracheal wall", "correct": false}, {"label": "C", "text": "Block in tracheostomy", "correct": false}, {"label": "D", "text": "Tight suture around tracheostomy site", "correct": true}], "correct_answer": "D. Tight suture around tracheostomy site", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wohKFOB1i0KxA4VW4jCa1713502243.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options below can be used to elucidate the mechanism by which ANP (atrial natriuretic peptide) exerts its effects?", "options": [{"label": "A", "text": "cAMP", "correct": false}, {"label": "B", "text": "cGMP", "correct": true}, {"label": "C", "text": "IP3-DAG", "correct": false}, {"label": "D", "text": "JAK/STAT", "correct": false}], "correct_answer": "B. cGMP", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - cGMP\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following acts as a secondary messenger in the mechanism of gastric acid secretion ?", "options": [{"label": "A", "text": "cGMP", "correct": false}, {"label": "B", "text": "cAMP", "correct": true}, {"label": "C", "text": "CCK-B receptor", "correct": false}, {"label": "D", "text": "Ach", "correct": false}], "correct_answer": "B. cAMP", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - cAMP\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is true about oxytocin among the options provided?", "options": [{"label": "A", "text": "It is responsible for galactokinesis", "correct": true}, {"label": "B", "text": "It can be given by oral route", "correct": false}, {"label": "C", "text": "It is secreted by anterior pituitary", "correct": false}, {"label": "D", "text": "In higher doses, it exerts diuretic like action", "correct": false}], "correct_answer": "A. It is responsible for galactokinesis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jpz0kzIvLkSTfTED5OxQ1685093316.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the initial point of contact for individuals seeking medical assistance within a community?", "options": [{"label": "A", "text": "Primary health center (PHC)", "correct": false}, {"label": "B", "text": "Community health center (CHC)", "correct": false}, {"label": "C", "text": "Sub-centre", "correct": true}, {"label": "D", "text": "District hospital", "correct": false}], "correct_answer": "C. Sub-centre", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C-Su\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What hormone is responsible for the breast cramps experienced by a mother while breastfeeding her child?", "options": [{"label": "A", "text": "Progesterone", "correct": false}, {"label": "B", "text": "Estrogen", "correct": false}, {"label": "C", "text": "Prolactin", "correct": false}, {"label": "D", "text": "Oxytocin", "correct": true}], "correct_answer": "D. Oxytocin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5SfjhTA5inKlgLl337dK1685093534.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following mechanisms is similar to cervical dilation and delivery occurring during uterine contraction?", "options": [{"label": "A", "text": "Milk ejection by oxytocin", "correct": true}, {"label": "B", "text": "Water retention by ADH", "correct": false}, {"label": "C", "text": "FSH secretion by anterior pituitary", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Milk ejection by oxytocin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QMCjr3IeNM1YrUk7LYby1685093728.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent effects of puberty are not influenced by estrogen?", "options": [{"label": "A", "text": "Hair growth", "correct": true}, {"label": "B", "text": "Cervical mucus secretion", "correct": false}, {"label": "C", "text": "Vaginal cornification", "correct": false}, {"label": "D", "text": "Menstruation", "correct": false}], "correct_answer": "A. Hair growth", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding a primary healthcare center (PHC)?", "options": [{"label": "A", "text": "There is 1 PHC per 30,000 population in plain areas", "correct": false}, {"label": "B", "text": "Type A PHC conducts &amp;lt;20 deliveries per month", "correct": false}, {"label": "C", "text": "Provides maternal and child health care, family planning and MTP", "correct": false}, {"label": "D", "text": "Is the first referral unit", "correct": true}], "correct_answer": "D. Is the first referral unit", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type B</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Deliveries/ month: &lt;20</li>\n</ul>\n<p><strong>Staffing pattern</strong></p>\n<ul>\n<li>MBBS MO: 1</li>\n<li>Ayush MO: 1</li>\n<li><strong>Total Staff: </strong>13-18</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Deliveries/ month: ≥20</li>\n</ul>\n<p><strong>Staffing pattern</strong></p>\n<ul>\n<li>MBBS MO: 2</li>\n<li>Ayush MO: 1</li>\n<li><strong>Total Staff:</strong> 14-21</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following pubertal changes in a 12-year-old girl, specifically breast development and pubic hair scale at stage 4, is not exclusively caused by estrogen?", "options": [{"label": "A", "text": "Vaginal cornification", "correct": false}, {"label": "B", "text": "Pubic and axillary hair growth", "correct": true}, {"label": "C", "text": "Cervical mucus production", "correct": false}, {"label": "D", "text": "Menstruation", "correct": false}], "correct_answer": "B. Pubic and axillary hair growth", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with swelling in his big toe , and his serum uric acid levels were found to be elevated. After acute treatment, the patient was put on a maintenance regimen with a drug which is considered first-line management for chronic gout; What is the mechanism of action of this drug?", "options": [{"label": "A", "text": "Pyrimidine antimetabolite", "correct": false}, {"label": "B", "text": "Inhibitor of neutrophil recruitment", "correct": false}, {"label": "C", "text": "Uricosuric drug", "correct": false}, {"label": "D", "text": "Xanthine oxidase inhibitor", "correct": true}], "correct_answer": "D. Xanthine oxidase inhibitor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Xanthine &lt;span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\"&gt;oxidase&lt;/span&gt; inh\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Drug Class</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Xanthine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">Oxidase</span> Inhibitors</p>\n</td>\n<td>\n<p>Allopurinol, Febuxostat</p>\n</td>\n<td>\n<p>Inhibit <span class=\"customMeta\" data-dictid=\"c9a23eabc41692777202d1d98467d5\">xanthine</span> oxidase, the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> involved in <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid production</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Uricosuric Agents</p>\n</td>\n<td>\n<p>Probenecid, Lesinurad</p>\n</td>\n<td>\n<p>Increase <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> from the kidneys</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Colchicine</p>\n</td>\n<td>\n<p>Colchicine</p>\n</td>\n<td>\n<p>Inhibit <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and reduce <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> attacks</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nonsteroidal Anti-inflammatory Drugs (NSAIDs)</p>\n</td>\n<td>\n<p>Ibuprofen, Naproxen</p>\n</td>\n<td>\n<p>Reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and relieve pain</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Glucocorticoids</p>\n</td>\n<td>\n<p>Prednisone, Methylprednisolone</p>\n</td>\n<td>\n<p>Reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and relieve pain</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most prevalent cause of macrocytic anemia among the options provided?", "options": [{"label": "A", "text": "Vitamin B12 deficiency", "correct": false}, {"label": "B", "text": "Bone marrow disorders", "correct": false}, {"label": "C", "text": "Alcohol", "correct": true}, {"label": "D", "text": "Drug-induced", "correct": false}], "correct_answer": "C. Alcohol", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is not preferred as an analgesic in rheumatoid arthritis ?", "options": [{"label": "A", "text": "Tramadol", "correct": false}, {"label": "B", "text": "Ketorolac", "correct": true}, {"label": "C", "text": "Naproxen", "correct": false}, {"label": "D", "text": "Oxycodone", "correct": false}], "correct_answer": "B. Ketorolac", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - K\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Drug Class</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nonsteroidal Anti-inflammatory Drugs (NSAIDs)</p>\n</td>\n<td>\n<p>Ibuprofen, Naproxen, Celecoxib</p>\n</td>\n<td>\n<p>Reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and relieve pain</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Disease-modifying <span class=\"customMeta\" data-dictid=\"fc3fc706581692777181d901117e4a\">Antirheumatic</span> Drugs (DMARDs)</p>\n</td>\n<td>\n<p>Methotrexate, Sulfasalazine, Hydroxychloroquine</p>\n</td>\n<td>\n<p>Slow or stop&gt;</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Biologic DMARDs</p>\n</td>\n<td>\n<p>Adalimumab, Etanercept, Infliximab</p>\n</td>\n<td>\n<p>Target specific immune system components involved in inflammation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Janus <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">Kinase</span> Inhibitors (JAK inhibitors)</p>\n</td>\n<td>\n<p>Tofacitinib, Baricitinib</p>\n</td>\n<td>\n<p>Inhibit Janus kinase, an <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> involved in immune system signaling</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Corticosteroids</p>\n</td>\n<td>\n<p>Prednisone, Methylprednisolone</p>\n</td>\n<td>\n<p>Reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and suppress the immune system</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a community, an awareness session on handwashing was organized. The appropriate order of events in this session is:", "options": [{"label": "A", "text": "Awareness &amp;gt; interest &amp;gt; adoption &amp;gt; evaluation", "correct": false}, {"label": "B", "text": "Awareness &amp;gt; interest &amp;gt; evaluation &amp;gt; adoption", "correct": true}, {"label": "C", "text": "Evaluation &amp;gt; adoption &amp;gt; awareness &amp;gt; interest", "correct": false}, {"label": "D", "text": "Adoption &amp;gt; awareness &amp;gt; interest &amp;gt; evaluation", "correct": false}], "correct_answer": "B. Awareness &gt; interest &gt; evaluation &gt; adoption", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A tourist with a travel history to India presents with complaints of abdominal pain and multiple episodes of watery diarrhea. He reports having food at a local restaurant the previous night. Which of the following antidiarrheal agents is used in this condition?", "options": [{"label": "A", "text": "Octreotide", "correct": false}, {"label": "B", "text": "Loperamide", "correct": true}, {"label": "C", "text": "Rifaximin", "correct": false}, {"label": "D", "text": "Bismuth subsalicylate", "correct": false}], "correct_answer": "B. Loperamide", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man is unemployed because he is unable to walk after an accident . His unemployment is classified as a:", "options": [{"label": "A", "text": "Disability", "correct": false}, {"label": "B", "text": "Handicap", "correct": true}, {"label": "C", "text": "Disease/disorder", "correct": false}, {"label": "D", "text": "Impairment", "correct": false}], "correct_answer": "B. Handicap", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - H\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is not treated with high-ceiling diuretics?", "options": [{"label": "A", "text": "Generalized edema", "correct": false}, {"label": "B", "text": "Cerebral edema", "correct": false}, {"label": "C", "text": "Acute pulmonary edema", "correct": false}, {"label": "D", "text": "Pulmonary hypertension", "correct": true}], "correct_answer": "D. Pulmonary hypertension", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Pulmonary h\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Drug Name</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Brand Name</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Onset of Action</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Duration of Action</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Dose</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Furosemide</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Lasix</p>\n</td>\n<td>\n<p style=\"text-align: center;\">30-60 min</p>\n</td>\n<td>\n<p style=\"text-align: center;\">6-8 hours</p>\n</td>\n<td>\n<p style=\"text-align: center;\">20-160 mg orally, 20-40 mg IV</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Bumetanide</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Bumex</p>\n</td>\n<td>\n<p style=\"text-align: center;\">30-60 min</p>\n</td>\n<td>\n<p style=\"text-align: center;\">4-6 hours</p>\n</td>\n<td>\n<p style=\"text-align: center;\">0.5-2 mg orally, 0.5-1 mg IV</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Torsemide</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Demadex</p>\n</td>\n<td>\n<p style=\"text-align: center;\">60 min</p>\n</td>\n<td>\n<p style=\"text-align: center;\">6-8 hours</p>\n</td>\n<td>\n<p style=\"text-align: center;\">10-40 mg orally, 10-20 mg IV</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about the treatment of a farmer presenting with symptoms of diarrhea, sweating, excessive tearing, and salivation in the emergency department is not accurate?", "options": [{"label": "A", "text": "Carbamates bind to acetylcholinesterase irreversibly.", "correct": false}, {"label": "B", "text": "Atropine is used as an antidote for OP poisoning", "correct": false}, {"label": "C", "text": "Pralidoxime has a role in reversing the enzyme in carbamate poisoning", "correct": true}, {"label": "D", "text": "Succinylcholine use is avoided in rapid sequence intubation", "correct": false}], "correct_answer": "C. Pralidoxime has a role in reversing the enzyme in carbamate poisoning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Pralidoxime has a role in reversing the &lt;span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\"&gt;enzyme&lt;/span&gt; in &lt;span class=\"customMeta\" data-dictid=\"1c84f47ead169277718314715645dd\"&gt;carbamate&lt;/span&gt; poisoning\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Drug</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Mechanism of Action</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Indication</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Adverse Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Atropine</strong></p>\n</td>\n<td>\n<p>The competitive <span class=\"customMeta\" data-dictid=\"2e432a4f3c1692777181e8e244ca0e\">antagonist</span> of <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> at <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors</p>\n</td>\n<td>\n<p>Symptomatic relief of <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> symptoms (e.g., bradycardia, bronchoconstriction, sweating, salivation)</p>\n</td>\n<td>\n<p>Tachycardia, dry mouth, mydriasis, <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Pralidoxime</strong></p>\n</td>\n<td>\n<p>Reactivates <span class=\"customMeta\" data-dictid=\"63b92227451692777180db3901b72f\">acetylcholinesterase</span> by removing the OP molecule from the enzyme</p>\n</td>\n<td>\n<p>Reversal of <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> <span class=\"customMeta\" data-dictid=\"70d039f1401692777183bb2f23a21a\">blockade</span> and improvement of muscle strength; may improve <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> function and reduce the need for mechanical ventilation.</p>\n</td>\n<td>\n<p>Hypertension, tachycardia, blurred vision, headache</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Diazepam</strong></p>\n</td>\n<td>\n<p>Enhances the activity of GABA, an <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> <span class=\"customMeta\" data-dictid=\"e28fd027b416927771932bc23ba0a5\">neurotransmitter</span> in the brain</p>\n</td>\n<td>\n<p>Sedation, <span class=\"customMeta\" data-dictid=\"f350ca9b3516927771814951e4c70c\">anticonvulsant</span> activity, and relief of anxiety and agitation</p>\n</td>\n<td>\n<p>Drowsiness, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> depression, hypotension</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Midazolam</strong></p>\n</td>\n<td>\n<p>Enhances the activity of GABA, an <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> <span class=\"customMeta\" data-dictid=\"e28fd027b416927771932bc23ba0a5\">neurotransmitter</span> in the brain</p>\n</td>\n<td>\n<p>Sedation, <span class=\"customMeta\" data-dictid=\"f350ca9b3516927771814951e4c70c\">anticonvulsant</span> activity, and relief of anxiety and agitation</p>\n</td>\n<td>\n<p>Drowsiness, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> depression, hypotension</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common side effect of Lamotrigine ?", "options": [{"label": "A", "text": "Diplopia", "correct": false}, {"label": "B", "text": "Tremors", "correct": false}, {"label": "C", "text": "Neutropenia", "correct": false}, {"label": "D", "text": "Rash", "correct": true}], "correct_answer": "D. Rash", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Rash\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Drug class</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Antiepileptic</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td>\n<p>Voltage-gated <span class=\"customMeta\" data-dictid=\"276be2047116927771989f7bf5ed02\">sodium channel</span> blocker</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Indications</strong></p>\n</td>\n<td>\n<ul>\n<li>\n<p>Partial seizures, generalized seizures, <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> disorder</p>\n</li>\n<li>\n<p>DOC for <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> seizures elderly</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Dosage forms</strong></p>\n</td>\n<td>\n<p>Tablets, chewable tablets, orally disintegrating tablets</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Dosage</strong></p>\n</td>\n<td>\n<p>Varies depending on the condition being treated and other factors; usually started at a low dose and gradually increased over several weeks</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Common side effects</strong></p>\n</td>\n<td>\n<p>Rash, headache, nausea, dizziness, blurred vision</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Serious side effects</strong></p>\n</td>\n<td>\n<ul>\n<li>\n<p>Steven Johnson Syndrome (skin surface &lt;30%)</p>\n</li>\n<li>\n<p>Toxic <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">Epidermal</span> <span class=\"customMeta\" data-dictid=\"254d4c2ea21692777193838ccf204d\">Necrolysis</span> (skin surface &gt;30%)</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In how many days should the post exposure Measles vaccine be given?", "options": [{"label": "A", "text": "With in 7 days", "correct": false}, {"label": "B", "text": "With in 3 days", "correct": true}, {"label": "C", "text": "With in 1 days", "correct": false}, {"label": "D", "text": "With in 10 days", "correct": false}], "correct_answer": "B. With in 3 days", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs does not reduce mortality in patients with heart failure with reduced ejection fraction (HFrEF)?", "options": [{"label": "A", "text": "Digoxin", "correct": true}, {"label": "B", "text": "Beta-blockers", "correct": false}, {"label": "C", "text": "ACE inhibitors", "correct": false}, {"label": "D", "text": "Hydralazine + isosorbide dinitrate", "correct": false}], "correct_answer": "A. Digoxin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Dig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is a short-acting beta blocker ?", "options": [{"label": "A", "text": "Nadolol", "correct": false}, {"label": "B", "text": "Propranolol", "correct": false}, {"label": "C", "text": "Esmolol", "correct": true}, {"label": "D", "text": "Atenolol", "correct": false}], "correct_answer": "C. Esmolol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - E\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Class of <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">Beta</span> Blockers</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Examples</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Selectivity</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Lipid Solubility</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Duration</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">First Generation</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Propranolol, Timolol</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Non-Selective</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Lipid Soluble</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Short to Intermediate</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Second Generation</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Metoprolol, Atenolol, Bisoprolol</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Beta-1 Selective</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Hydrophilic</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Intermediate</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Third Generation</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Carvedilol, Nebivolol</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Alpha-1/Beta Blocker, Beta-1 Selective</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Lipid soluble, hydrophilic</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Intermediate to long</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old man presented with bleeding gums for 20 days. He has gingival hyperplasia and hepatosplenomegaly. On investigation, Hb-11 g/dL, platelet count-95,000 platelets/mm3, and WBC count-45000 cells/mm3. A bone marrow biopsy shows 100% cellularity, with many blast cells that are peroxidase-negative and non-specific esterase-positive . The most likely diagnosis is:", "options": [{"label": "A", "text": "Acute myeloid leukemia M2 (AML M2)", "correct": false}, {"label": "B", "text": "Acute myeloid leukemia M0 (AML M0)", "correct": false}, {"label": "C", "text": "Acute myeloid leukemia M5 (AML M5)", "correct": true}, {"label": "D", "text": "Acute myeloid leukemia M7 (AML M7)", "correct": false}], "correct_answer": "C. Acute myeloid leukemia M5 (AML M5)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\"&gt;myeloid&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"4521dbf4b91692777191a73002bf98\"&gt;leukemia&lt;/span&gt; M5 (AML M5)\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td>AML M0 - <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> undifferentiated</td>\n<td>Myeloperoxidase negative</td>\n</tr>\n<tr>\n<td>AML M2 - <span class=\"customMeta\" data-dictid=\"9ab5f0308116927771814e1fcc72d6\">AML</span> with maturation</td>\n<td>t(8;21) = RUNX1-RUNX1T1 fusion</td>\n</tr>\n<tr>\n<td>AML M3 - <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> promyelocytic leukemia</td>\n<td>t(15;17) = PML-RARA fusion</td>\n</tr>\n<tr>\n<td>AML M4 - <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"215dafdbad1692777193dcb48ddd63\">myelomonocytic</span> leukemia</td>\n<td>inv(16) = CBF-MYH fusion</td>\n</tr>\n<tr>\n<td>AML M5 - Acute monocytic leukemia</td>\n<td>Non-specific <span class=\"customMeta\" data-dictid=\"ca1d8cf43716927771875762739d8d\">esterase</span> positive</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what age is the first dose of hepatitis B vaccine given?", "options": [{"label": "A", "text": "Birth", "correct": true}, {"label": "B", "text": "6 weeks", "correct": false}, {"label": "C", "text": "10 weeks", "correct": false}, {"label": "D", "text": "6 months", "correct": false}], "correct_answer": "A. Birth", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - At Birth\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:123px\">\n<p style=\"text-align:center\"><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:123px\">\n<p style=\"text-align:center\"><strong>When to give</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:123px\">\n<p style=\"text-align:center\"><strong>Dose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:123px\">\n<p style=\"text-align:center\"><strong>Route</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:123px\">\n<p style=\"text-align:center\"><strong>Site</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:616px\">\n<p><strong>For pregnant women</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>TT-1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Early in pregnancy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>TT-2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>4 weeks after T-1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>TT-booster</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>If received 2 TT doses in a pregnancy within last 3 years*</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Upper arm</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:616px\">\n<p><strong>For infants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>BCG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>At birth or as early as possible till one year of age</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.1 ml (0.05ml till 1 <span class=\"customMeta\" data-dictid=\"d9b41e05751692777192bdc7627944\">moth</span> age)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Intra dermal </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Left upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Hepatitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>At birth or as early possible within 24 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Intra muscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Antero <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side of mid-thigh</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>OPV-0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>At birth or as early as possible within 15 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>2 drops</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>OPV-1, 2 &amp; 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>At 6 weeks, 10 weeks &amp; 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>2 drops</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>DPT 1, 2 &amp; 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>At 6 weeks, 10 weeks &amp; 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Antero <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side mid-thigh</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Hep B 1, 2 &amp; 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>At 6 weeks, 10 weeks &amp; 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Antero <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side mid-thigh</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Meals</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>9 completed month – 12 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Right upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Vitamin – A (1<sup>st</sup> dose)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>At 9 months with measles</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>1 ml (1 lakh IU)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Oral</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:616px\">\n<p><strong>For Children </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>DPT booster</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>16-24 month</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Intra muscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Antero-lateral side of <span class=\"customMeta\" data-dictid=\"75b57d54f21692777192dc01883ad1\">mid</span> thigh</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Measles 2<sup>nd</sup> dose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>16-24 month</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Right upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>OPV booster</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>16-24 month</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>2 drops</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Japanese encephalitis </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>16-24 month</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Left upper arm</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:616px\">\n<p><strong>Vitamin – A</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>(2<sup>nd</sup> to 9<sup>th</sup> dose)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>16 months then one dose every 6 month upto age of 5 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>2 ml (2 lakh IU)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>DPT booster</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>5-6 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Intra muscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>TT</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>10 years &amp; 16 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Intra muscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:123px\">\n<p>Upper arm</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the inheritance pattern observed in neural tube defects?", "options": [{"label": "A", "text": "a.Autosomal dominant", "correct": false}, {"label": "B", "text": "X-linked dominant", "correct": false}, {"label": "C", "text": "c.Autosomal recessive", "correct": false}, {"label": "D", "text": "d.Multifactorial inheritance", "correct": true}], "correct_answer": "D. d.Multifactorial inheritance", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the number of maternal deaths per 100,000 live births ?", "options": [{"label": "A", "text": "Maternal mortality rate", "correct": false}, {"label": "B", "text": "Maternal mortality ratio", "correct": true}, {"label": "C", "text": "Infant mortality rate", "correct": false}, {"label": "D", "text": "Perinatal mortality rate", "correct": false}], "correct_answer": "B. Maternal mortality ratio", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wDnIScgas9yE5D21Rm0N1746251941.mp3", "video": ""}, {"text": "The X-ray of a middle-aged man showed multiple lytic lesions , following which a urine examination was done . The sample revealed Bence Jones proteins. Which is the most common immunoglobulin associated with this condition ?", "options": [{"label": "A", "text": "IgA", "correct": false}, {"label": "B", "text": "IgD", "correct": false}, {"label": "C", "text": "IgG", "correct": true}, {"label": "D", "text": "IgM", "correct": false}], "correct_answer": "C. IgG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - IgG\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 7-year-old girl who presents with cramping abdominal pain, rashes on the back of her legs, buttocks, and extensor surface of her forearms, along with proteinuria and microscopic hematuria upon laboratory analysis?", "options": [{"label": "A", "text": "Systemic lupus erythematosus", "correct": false}, {"label": "B", "text": "Henoch-Schonlein purpura", "correct": true}, {"label": "C", "text": "Post-streptococcal glomerulonephritis", "correct": false}, {"label": "D", "text": "Hemolytic uremic syndrome", "correct": false}], "correct_answer": "B. Henoch-Schonlein purpura", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jLzodgTeSR6RuYC32daI1685096460.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A labourer’s younger child is brought to the OPD with a swollen belly and dull face. He has mostly fed rice water in his diet. On investigations, the child was found to have low serum protein, low serum protein, and low albumin. What is the probable diagnosis?", "options": [{"label": "A", "text": "Kwashiorkor", "correct": true}, {"label": "B", "text": "Marasmus", "correct": false}, {"label": "C", "text": "Indian childhood cirrhosis", "correct": false}, {"label": "D", "text": "Kawasaki disease", "correct": false}], "correct_answer": "A. Kwashiorkor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AT3ZNGrWalFkvticl5Ed1713434623.png"], "explanation": "<p>Correct option A: Kwashiork\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>Kwashiorkor</strong></td>\n<td><strong>Marasmus</strong></td>\n</tr>\n<tr>\n<td><strong>Edema</strong></td>\n<td>Present</td>\n<td>Absent</td>\n</tr>\n<tr>\n<td><strong>Appetite</strong></td>\n<td>Poor</td>\n<td>Voracious</td>\n</tr>\n<tr>\n<td><strong>CNS involvement</strong></td>\n<td>Apathy and lethargy</td>\n<td>Active and alert</td>\n</tr>\n<tr>\n<td><strong>Hepatomegaly</strong></td>\n<td>Usually present</td>\n<td>Usually absent</td>\n</tr>\n<tr>\n<td><strong>Skin and hair changes</strong></td>\n<td>More common</td>\n<td>Less common</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the best way to use a graphical representation to illustrate patterns and changes in the occurrence of diarrheal disease within a specific region?", "options": [{"label": "A", "text": "Line graph", "correct": true}, {"label": "B", "text": "Histogram", "correct": false}, {"label": "C", "text": "Ogive", "correct": false}, {"label": "D", "text": "Tree diagram", "correct": false}], "correct_answer": "A. Line graph", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Z2ibdVFz7m6KCp60DlrM1714557699.png"], "explanation": "<p>Correct Option A: Line graph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came to the causality with acute bronchial asthma after treatment for glaucoma . Which of the following is a most probable causative agent?", "options": [{"label": "A", "text": "Timolol", "correct": true}, {"label": "B", "text": "Betaxolol", "correct": false}, {"label": "C", "text": "Latanoprost", "correct": false}, {"label": "D", "text": "Bimatoprost", "correct": false}], "correct_answer": "A. Timolol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - T\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Class of Drug</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Adverse Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Prostaglandin analogs</p>\n</td>\n<td>\n<p>Latanoprost, Bimatoprost, Travoprost, Tafluprost</p>\n</td>\n<td>\n<p>Conjunctival hyperemia, <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> surface disease, <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">iris</span> pigmentation, <span class=\"customMeta\" data-dictid=\"5b4dd03e7d16927771877ac3787035\">eyelash</span> growth, uveitis, <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> edema</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Beta-blockers</p>\n</td>\n<td>\n<p>Timolol, Betaxolol, Levobunolol, Carteolol, Metipranolol</p>\n</td>\n<td>\n<p>Bronchospasm, bradycardia, hypotension, fatigue, depression, impotence</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Alpha-2 agonists</p>\n</td>\n<td>\n<p>Brimonidine</p>\n</td>\n<td>\n<p>Ocular allergy, dry mouth, fatigue, headache, hypotension, bradycardia, dizziness</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> inhibitors</p>\n</td>\n<td>\n<p>Dorzolamide, Brinzolamide</p>\n</td>\n<td>\n<p>Bitter taste, <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> stinging, blurred vision, dry mouth, fatigue, depression, <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> disturbances</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rho <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors</p>\n</td>\n<td>\n<p>Netarsudil</p>\n</td>\n<td>\n<p>Ocular hyperemia, conjunctival hemorrhage, <span class=\"customMeta\" data-dictid=\"5b4dd03e7d16927771877ac3787035\">eyelash</span> growth</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child is brought to the OPD for a regular check-up. His growth chart shows a BMI between the 85th and 95th percentile . Which of the following categories would you place him in?", "options": [{"label": "A", "text": "Moderate wasting", "correct": false}, {"label": "B", "text": "Severe acute malnutrition", "correct": false}, {"label": "C", "text": "Overweight", "correct": true}, {"label": "D", "text": "Obese", "correct": false}], "correct_answer": "C. Overweight", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Overweigh\n<table align=\"left\" border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td><strong>Underweight</strong></td>\n<td>Below 5<sup>th</sup> percentile</td>\n</tr>\n<tr>\n<td><strong>Healthy/normal</strong></td>\n<td>Between 5<sup>th</sup> and 85<sup>th</sup> percentile</td>\n</tr>\n<tr>\n<td><strong>Overweight</strong></td>\n<td>Between 85<sup>th</sup> and 95<sup>th</sup> percentile</td>\n</tr>\n<tr>\n<td><strong>Obese</strong></td>\n<td>Above 95<sup>th</sup> percentile</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child visited the hospital with her mother with complaints of severe fatigue, lethargy, pallor, and irritation. She has a known case of iron deficiency anemia and is on oral iron supplements. On reviewing the child, the physician in charge plans to start IV iron supplementation. What is the next best test to be done in assessing this child?", "options": [{"label": "A", "text": "Blood hemoglobin", "correct": false}, {"label": "B", "text": "Total iron binding capacity", "correct": false}, {"label": "C", "text": "Serum ferritin", "correct": true}, {"label": "D", "text": "Hematocrit", "correct": false}], "correct_answer": "C. Serum ferritin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\"&gt;Serum&lt;/span&g\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td> </td>\n<td style=\"text-align:center\"><strong>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anemia</strong></td>\n<td style=\"text-align:center\"><strong>Anemia of chronic disease</strong></td>\n<td style=\"text-align:center\"><strong>Sideroblastic anemia</strong></td>\n</tr>\n<tr>\n<td><strong>Serum iron</strong></td>\n<td style=\"text-align:center\">↓</td>\n<td style=\"text-align:center\">↓</td>\n<td style=\"text-align:center\">↑</td>\n</tr>\n<tr>\n<td><strong>Transferrin saturation</strong></td>\n<td style=\"text-align:center\">↓</td>\n<td style=\"text-align:center\">↓</td>\n<td style=\"text-align:center\">↑</td>\n</tr>\n<tr>\n<td><strong>Ferritin</strong></td>\n<td style=\"text-align:center\">↓</td>\n<td style=\"text-align:center\">↑</td>\n<td style=\"text-align:center\">↑</td>\n</tr>\n<tr>\n<td><strong>Total iron binding capacity</strong></td>\n<td style=\"text-align:center\">↑</td>\n<td style=\"text-align:center\">↓</td>\n<td style=\"text-align:center\">↓</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary factor responsible for the demographic burden?", "options": [{"label": "A", "text": "Decreased old age dependency ratio", "correct": false}, {"label": "B", "text": "Increased young age dependency ratio", "correct": false}, {"label": "C", "text": "Decreased young age dependency ratio", "correct": false}, {"label": "D", "text": "Increased old age dependency ratio", "correct": true}], "correct_answer": "D. Increased old age dependency ratio", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UHJ3wNBg1bqvX9dKfLTV1746252073.mp3", "video": ""}, {"text": "Which of the following is not routinely screened before conducting a blood transfusion?", "options": [{"label": "A", "text": "Hepatitis A", "correct": true}, {"label": "B", "text": "Hepatitis B", "correct": false}, {"label": "C", "text": "Hepatitis C", "correct": false}, {"label": "D", "text": "HIV 1 / HIV 2", "correct": false}], "correct_answer": "A. Hepatitis A", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\"&gt;Hepatitis&lt;/span&gt; A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother expresses concern about her child's unwillingness to eat properly . Her 15-month-old son's length falls 2 standard deviations below the median for his age . What is the most probable medical condition ?", "options": [{"label": "A", "text": "Acute malnutrition", "correct": false}, {"label": "B", "text": "Severe wasting", "correct": false}, {"label": "C", "text": "Moderately underweight", "correct": false}, {"label": "D", "text": "Moderate stunting", "correct": true}], "correct_answer": "D. Moderate stunting", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LzevpWCxxK6WQIiCZHLH1701755986.png"], "explanation": "<p>Correct Option D - Moderate stunting\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Nutritional status</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Criteria (from birth to 5 years)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Moderately stunted (or) moderate chronic malnutrition</p>\n</td>\n<td>\n<ul>\n<li>Height/Length-for-age ≤-2 SD and ≥-3 SD</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Severely stunted (or) severe chronic malnutrition</p>\n</td>\n<td>\n<ul>\n<li>Height/Length-for-age &lt;-3 SD</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following demographic indicators is used to compare the life expectancy of two different countries?", "options": [{"label": "A", "text": "QALY", "correct": false}, {"label": "B", "text": "DALY", "correct": false}, {"label": "C", "text": "HDI", "correct": true}, {"label": "D", "text": "HPI", "correct": false}], "correct_answer": "C. HDI", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - HDI:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Minimum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Maximum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MYS (mean years of schooling)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0 y</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13.1 y</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Expected years of schooling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0 y</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18 y</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Education index</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.978</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Income (PPP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100$</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>107,721$</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Live <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> at birth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20 y</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>83.4 y</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Combination of indicators</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>PQLI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HDI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0 &lt; PQLI &lt; 100</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>0 &lt; HDI &lt; +1</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>India 65</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>India 0.640</li>\n<li>.5 to .8 is medium country development</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vitamins is deficient in breast milk?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin C", "correct": false}, {"label": "C", "text": "Vitamin E", "correct": false}, {"label": "D", "text": "Vitamin K", "correct": true}], "correct_answer": "D. Vitamin K", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D: Vitamin K\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man is found to have hepatomegaly on physical examination. He also complains of having dark tan skin despite avoiding sun exposure . His liver microscopy is given on the slide below. What is this patient most likely suffering from?", "options": [{"label": "A", "text": "Wilson’s disease", "correct": false}, {"label": "B", "text": "Autoimmune hepatitis", "correct": false}, {"label": "C", "text": "α-1 antitrypsin deficiency", "correct": false}, {"label": "D", "text": "Hemochromatosis", "correct": true}], "correct_answer": "D. Hemochromatosis", "question_images": ["https://image.prepladder.com/content/p60wqqurd6xYDpigAtjP1691237816.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Hemoch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 18-months-old child is brought to the hospital with a history of breathlessness, fever, cough, and cold. The respiratory rate was 46/min on examination, and there were no danger signs. Which is the most appropriate management?", "options": [{"label": "A", "text": "Administer IV antibiotics and observe", "correct": false}, {"label": "B", "text": "Administer IV antibiotics and refer to higher centre", "correct": false}, {"label": "C", "text": "Administer oral antibiotics, warn of danger signs, and send home", "correct": true}, {"label": "D", "text": "Administer only home remedies", "correct": false}], "correct_answer": "C. Administer oral antibiotics, warn of danger signs, and send home", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classify as</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of any general</p>\n<p>danger sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Give 1 dose of <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> <span class=\"customMeta\" data-dictid=\"e1a1f4fa35169277718150f74fa895\">ampicillin</span> and <span class=\"customMeta\" data-dictid=\"ca244a562f16927771884ac81c7d2e\">gentamicin</span> and refer urgently to hospital</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of either chest</p>\n<p>indrawing and/or fast</p>\n<p>breathing but no general</p>\n<p>danger sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Start oral <span class=\"customMeta\" data-dictid=\"d1e73ea72b1692777181fe0162bd92\">amoxicillin</span> x 5 days</li>\n<li>The child is sent home and assessed after 48 hours</li>\n<li>If the child has improved continue the same treatment</li>\n<li>If the child has worsened, refer to a higher center</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No fast breathing, no chest</p>\n<p>indrawing, no general</p>\n<p>danger signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No pneumonia: <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">Cough</span> or cold only</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Home-based supportive care</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fast breathing:</p>\n<ul>\n<li>&lt; 2 months: &gt; 60/ min</li>\n<li>2-12 months: &gt; 50/ min</li>\n<li>1-5 years: &gt; 40/ min</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General danger signs:</p>\n<ul>\n<li>Convulsions</li>\n<li>Lethargy</li>\n<li>Inability to drink or breastfeed</li>\n<li>Persistent vomiting</li>\n<li>Unconsciousness</li>\n<li>Stridor in a calm child</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classify as</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of any general</p>\n<p>danger sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Give 1 dose of <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> <span class=\"customMeta\" data-dictid=\"e1a1f4fa35169277718150f74fa895\">ampicillin</span> and <span class=\"customMeta\" data-dictid=\"ca244a562f16927771884ac81c7d2e\">gentamicin</span> and refer urgently to hospital</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of either chest</p>\n<p>indrawing and/or fast</p>\n<p>breathing but no general</p>\n<p>danger sign</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pneumonia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Start oral <span class=\"customMeta\" data-dictid=\"d1e73ea72b1692777181fe0162bd92\">amoxicillin</span> x 5 days</li>\n<li>The child is sent home and assessed after 48 hours</li>\n<li>If the child has improved continue the same treatment</li>\n<li>If the child has worsened, refer to a higher center</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No fast breathing, no chest</p>\n<p>indrawing, no general</p>\n<p>danger signs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No pneumonia: <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">Cough</span> or cold only</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Home-based supportive care</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fast breathing:</p>\n<ul>\n<li>&lt; 2 months: &gt; 60/ min</li>\n<li>2-12 months: &gt; 50/ min</li>\n<li>1-5 years: &gt; 40/ min</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General danger signs:</p>\n<ul>\n<li>Convulsions</li>\n<li>Lethargy</li>\n<li>Inability to drink or breastfeed</li>\n<li>Persistent vomiting</li>\n<li>Unconsciousness</li>\n<li>Stridor in a calm child</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CZGvvr6aUyEhLBXyPWzg1745045254.mp3", "video": ""}, {"text": "In the WHO grading of astrocytoma, which grade does glioblastoma fall under?", "options": [{"label": "A", "text": "I", "correct": false}, {"label": "B", "text": "II", "correct": false}, {"label": "C", "text": "III", "correct": false}, {"label": "D", "text": "IV", "correct": true}], "correct_answer": "D. IV", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - IV\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td>Grade I</td>\n<td>\n<ul>\n<li>Pilocytic astrocytoma</li>\n<li>Pleomorphic xantoastrocytoma</li>\n<li>Subependymal giant cell astrocytoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Grade II</td>\n<td>\n<ul>\n<li>Diffuse astrocytoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Grade III</td>\n<td>\n<ul>\n<li>Anaplastic astrocytoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Grade IV</td>\n<td>\n<ul>\n<li>Glioblastoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is used to clean up blood spills in the operation theater?", "options": [{"label": "A", "text": "Chlorine compound", "correct": true}, {"label": "B", "text": "Phenolic compound", "correct": false}, {"label": "C", "text": "Quaternary ammonium compounds", "correct": false}, {"label": "D", "text": "Alcoholic compounds", "correct": false}], "correct_answer": "A. Chlorine compound", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common cause of seizures in a 2-year-old child ?", "options": [{"label": "A", "text": "Trauma to the head", "correct": false}, {"label": "B", "text": "Malnutrition", "correct": false}, {"label": "C", "text": "Febrile seizures", "correct": true}, {"label": "D", "text": "Neurological deficit", "correct": false}], "correct_answer": "C. Febrile seizures", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\"&gt;Febrile&lt;/span&gt; seizu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A health care worker has been found to be seropositive for HBsAg, HBeAg, and anti-HBc IgM, indicating an acute HBV infection with high infectivity. A liver biopsy in such cases is likely to show all the following except:", "options": [{"label": "A", "text": "Ballooning change of hepatocytes", "correct": false}, {"label": "B", "text": "Ground glass hepatocytes", "correct": true}, {"label": "C", "text": "Focal or spotty necrosis", "correct": false}, {"label": "D", "text": "Confluent necrosis of hepatocytes", "correct": false}], "correct_answer": "B. Ground glass hepatocytes", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vbAgzMapKSDMzQn8F8ac1713765368.png"], "explanation": "<p>Correct Option B - Ground glass h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is NOT a favorable prognostic marker for a middle-aged woman diagnosed with breast carcinoma presenting with a lump in her right breast?", "options": [{"label": "A", "text": "Luminal subtype", "correct": false}, {"label": "B", "text": "Low Ki7 index", "correct": false}, {"label": "C", "text": "Her2 overexpression", "correct": true}, {"label": "D", "text": "Mucinous carcinoma", "correct": false}], "correct_answer": "C. Her2 overexpression", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p><span><span><span><strong> </strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Good prognosis</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Bad prognosis</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><strong><span><span><span>Extent</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>In Situ carcinoma</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Invasive carcinoma</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><strong> </strong></span></span></span></p>\n<p><span><span><span><strong><span><span><span>Spread</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong> </strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Locally advanced disease,</span></span></span></strong></span></span></span></p>\n<p><span><span><span><strong><span><span><span>Lymphovascular invasion</span></span></span></strong></span></span></span></p>\n<p><span><span><span><strong><span><span><span>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> </span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><strong><span><span><span>Size</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Size &lt;1 cm</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Size &gt;2 cm</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><strong><span><span><span>Histological subtype</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>·</span></span></span></strong><strong> </strong><strong><span><span><span>Tubular carcinoma</span></span></span></strong></span></span></span></p>\n<p><span><span><span><strong><span><span><span>·</span></span></span></strong><strong> </strong><strong><span><span><span>Mucinous carcinoma</span></span></span></strong></span></span></span></p>\n<p><span><span><span><strong><span><span><span>·</span></span></span></strong><strong> </strong><strong><span><span><span>Lobular carcinoma</span></span></span></strong></span></span></span></p>\n<p><span><span><span><strong><span><span><span>·</span></span></span></strong><strong> </strong><strong><span><span><span>Papillary carcinoma</span></span></span></strong></span></span></span></p>\n<p><span><span><span><strong><span><span><span>·</span></span></span></strong><strong> </strong><strong><span><span><span>Adenoid <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> carcinoma</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>·</span></span></span></strong><strong> </strong><strong><span><span><span>Metaplastic carcinoma</span></span></span></strong></span></span></span></p>\n<p><span><span><span><strong><span><span><span>·</span></span></span></strong><strong> </strong><strong><span><span><span>Micropapillary carcinoma</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><strong><span><span><span>Histologic grade</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Low grade</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>High grade</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><strong><span><span><span>Molecular subtype</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Luminal A subtype</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Her2-enriched and <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> subtype</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><strong><span><span><span>Proliferation rate (Ki67 index)</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>Low <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> rate</span></span></span></strong></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><strong><span><span><span>High <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> rate</span></span></span></strong></span></span></span></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the most appropriate course of action for managing a patient presenting with fatigue, a haemoglobin level below 9 g/dl, and sickle-shaped red blood cells on peripheral smear examination?", "options": [{"label": "A", "text": "Administer IV antibiotics", "correct": false}, {"label": "B", "text": "Blood transfusion", "correct": true}, {"label": "C", "text": "Administer desferoxamine", "correct": false}, {"label": "D", "text": "Wait and watch", "correct": false}], "correct_answer": "B. Blood transfusion", "question_images": ["https://image.prepladder.com/content/t41gZVrZN8lS7uf0Hnou1747953636.png"], "explanation_images": ["https://image.prepladder.com/content/wIK1QtQYhO9bt0VA9EiH1747953932.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is associated with untoward side effects of renal tubular damage ?", "options": [{"label": "A", "text": "Cisplatin", "correct": true}, {"label": "B", "text": "Streptozocin", "correct": false}, {"label": "C", "text": "Methysergide", "correct": false}, {"label": "D", "text": "Cyclophosphamide", "correct": false}], "correct_answer": "A. Cisplatin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Class of Drug</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Adverse Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Alkylating Agents</p>\n</td>\n<td>\n<p>Cyclophosphamide, Ifosfamide, Carmustine, Lomustine</p>\n</td>\n<td>\n<p>Nausea, vomiting, diarrhea, myelosuppression, infertility, hemorrhagic cystitis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Antimetabolites</p>\n</td>\n<td>\n<p>Methotrexate, Fluorouracil, Capecitabine, Gemcitabine</p>\n</td>\n<td>\n<p>Nausea, vomiting, diarrhea, myelosuppression, mucositis, alopecia, hand-foot syndrome</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Antitumor Antibiotics</p>\n</td>\n<td>\n<p>Doxorubicin, Daunorubicin, Epirubicin</p>\n</td>\n<td>\n<p>Cardiotoxicity, myelosuppression, mucositis, alopecia, hand-foot syndrome</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Microtubule Inhibitors</p>\n</td>\n<td>\n<p>Vinblastine, Vincristine, Paclitaxel, Docetaxel</p>\n</td>\n<td>\n<p>Peripheral neuropathy, myelosuppression, alopecia, mucositis, <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reactions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Platinum Compounds</p>\n</td>\n<td>\n<p>Cisplatin, Carboplatin, Oxaliplatin</p>\n</td>\n<td>\n<p>Nephrotoxicity, ototoxicity, neuropathy, myelosuppression, <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reactions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Topoisomerase Inhibitors</p>\n</td>\n<td>\n<p>Irinotecan, Topotecan, Etoposide, Teniposide</p>\n</td>\n<td>\n<p>Diarrhea, myelosuppression, mucositis, alopecia, <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reaction</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What vitamin deficiency is responsible for the following symptoms in a patient: tingling sensation in the hands and feet, generalized weakness, easy fatigability, pallor, and ataxia?", "options": [{"label": "A", "text": "Vitamin B1", "correct": false}, {"label": "B", "text": "Vitamin B12", "correct": true}, {"label": "C", "text": "Vitamin B2", "correct": false}, {"label": "D", "text": "Vitamin B3", "correct": false}], "correct_answer": "B. Vitamin B12", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">Vitamin</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Deficiency Disease</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Symptoms</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B1 (Thiamine)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Beriberi</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Peripheral neuropathy, muscle wasting, heart failure</span></span></span></span></p>\n<p><span><span><span><span style=\"color:black\">Wernicke-Korsakoff’s syndrome</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B2 (Riboflavin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Ariboflavinosis</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Glossitis, cheilosis, skin rash, <span class=\"customMeta\" data-dictid=\"9038419f6f169277719188195b72b5\">magenta</span> color tongue, <span class=\"customMeta\" data-dictid=\"5d5241c3cf1692777198a1ba71f8d4\">seborrheic</span> dermatitis</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B3 (Niacin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Pellagra</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Dermatitis, diarrhea, dementia</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B5 (Pantothenic acid)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Paresthesia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Numbness, tingling, burning sensation in hands and feet(burning foot syndrome)</span></span></span></span></p>\n<p><span><span><span><span style=\"color:black\">Dermatitis, enteritis, <span class=\"customMeta\" data-dictid=\"5cac5dbe851692777181a2373219b0\">alopecia</span> , ataxia</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B6 (Pyridoxine)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Anemia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Microcytic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> ,convulsions, depression</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B7 (Biotin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Dermatitis, enteritis</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Dermatitis, , atrophic glossitis, alopecia, <span class=\"customMeta\" data-dictid=\"14d1b66f821692777194e77a2edc9f\">paresthesia</span> , muscle pain, anorexia, hallucinations</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B9 (Folate)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Megaloblastic anemia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Megaloblastic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> ,neuropathy, <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects, atrophic glossitis</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B12 (Cobalamin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Pernicious anemia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Peripheral neuropathy, weakness, fatigue, pallor- dementia, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord degeneration, homocysteinemia</span></span></span></span></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most significant side-effect of tamoxifen ?", "options": [{"label": "A", "text": "Cancer in the opposite breast", "correct": false}, {"label": "B", "text": "Osteoporosis", "correct": false}, {"label": "C", "text": "Endometrial hyperplasia", "correct": true}, {"label": "D", "text": "Infertility", "correct": false}], "correct_answer": "C. Endometrial hyperplasia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Endometrial h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following describes LD 50?", "options": [{"label": "A", "text": "50% animal mortality is an experiment after exposure to the drug", "correct": true}, {"label": "B", "text": "50% reduction of infection in the given population of experimental animals", "correct": false}, {"label": "C", "text": "Dose of the drug that causes adverse effects in 50% of the population", "correct": false}, {"label": "D", "text": "Range of concentration at which the likelihood of efficacy is high and the probability of adverse effects is low", "correct": false}], "correct_answer": "A. 50% animal mortality is an experiment after exposure to the drug", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SaBBReXSGQn0fXgUFkoH1715143598.png"], "explanation": "<p>Correct Option A - 50% animal mortality is an experiment after exposure to the drug\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which medication could potentially cause constipation, blurred vision, and dry mouth in a 70-year-old patient with a history of schizophrenia receiving treatment for drug-induced Parkinson's disease?", "options": [{"label": "A", "text": "Lithium", "correct": false}, {"label": "B", "text": "Pramipexole", "correct": false}, {"label": "C", "text": "Benzhexol", "correct": true}, {"label": "D", "text": "Selegiline", "correct": false}], "correct_answer": "C. Benzhexol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Benzh\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Drug Class</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anticholinergic</p>\n</td>\n<td>\n<p>Benzhexol, Trihexyphenidyl, Biperiden</p>\n</td>\n<td>\n<p>Blockade of <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors in the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dopamine agonist</p>\n</td>\n<td>\n<p>Pramipexole, Ropinirole</p>\n</td>\n<td>\n<p>Direct <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> receptors</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Beta-blocker</p>\n</td>\n<td>\n<p>Propranolol</p>\n</td>\n<td>\n<p>Blockade of beta-receptors in the brain</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>GABA agonist</p>\n</td>\n<td>\n<p>Baclofen</p>\n</td>\n<td>\n<p>Enhancement of GABA-mediated <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> in the CNS</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Amantadine</p>\n</td>\n<td>\n<p>Amantadine</p>\n</td>\n<td>\n<p>Enhancement of <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> release and <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of reuptake</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamins</p>\n</td>\n<td>\n<p>Vitamin E</p>\n</td>\n<td>\n<p>An <span class=\"customMeta\" data-dictid=\"1f3c08447d16927771819ccd566468\">antioxidant</span> effect that may reduce <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> damage in the CNS</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic patient presents with a fungal sinus and peri-orbital region infection with significant visual impairment , as shown below. The most appropriate drug for the treatment of this patient is:", "options": [{"label": "A", "text": "Itraconazole", "correct": false}, {"label": "B", "text": "Liposomal amphotericin B", "correct": true}, {"label": "C", "text": "Ketoconazole", "correct": false}, {"label": "D", "text": "Broad spectrum antibiotics", "correct": false}], "correct_answer": "B. Liposomal amphotericin B", "question_images": ["https://image.prepladder.com/content/Lyx9NHPNuEF1kibITimd1715143907.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Liposomal amphotericin B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A known case of lung cancer presents with breathing difficulty. On auscultation at the left infrascapular area bronchial breathing is heard with a dull percussion note. What is the diagnosis?", "options": [{"label": "A", "text": "Cardiac tamponade", "correct": true}, {"label": "B", "text": "Chronic constrictive pericarditis", "correct": false}, {"label": "C", "text": "Pulmonary embolism", "correct": false}, {"label": "D", "text": "Left-sided pleural effusion", "correct": false}], "correct_answer": "A. Cardiac tamponade", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is characterized by the absence of P waves?", "options": [{"label": "A", "text": "Ventricular tachycardia", "correct": false}, {"label": "B", "text": "Focal atrial tachycardia", "correct": false}, {"label": "C", "text": "Ventricular fibrillation", "correct": false}, {"label": "D", "text": "Atrial fibrillation", "correct": true}], "correct_answer": "D. Atrial fibrillation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Atrial F\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>P wave abnormality</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Possible causes</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Absent P wave</p>\n</td>\n<td>\n<p>Atrial fibrillation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sawtooth P wave</p>\n</td>\n<td>\n<p>Atrial flutter</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inverted P wave</p>\n</td>\n<td>\n<p>Dextrocardia</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Notched P wave</p>\n</td>\n<td>\n<p>Left atrial enlargement, <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> stenosis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Peaked P wave</p>\n</td>\n<td>\n<p>Right atrial enlargement, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Broad P wave</p>\n</td>\n<td>\n<p>Chronic obstructive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease (COPD), emphysema, MS, MR, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> hypertension</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Low <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> P wave</p>\n</td>\n<td>\n<p>Chronic obstructive <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease (COPD), <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Variable P wave morphology</p>\n</td>\n<td>\n<p>Wandering atrial pacemaker, <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> atrial tachycardia.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient with a history of chronic smoking presents with the complaint of dysphagia . Out of the following, which type of lung cancer is most likely to be found in this patient?", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": true}, {"label": "B", "text": "Adenocarcinoma", "correct": false}, {"label": "C", "text": "Large cell carcinoma", "correct": false}, {"label": "D", "text": "Bronchogenic carcinoma", "correct": false}], "correct_answer": "A. Squamous cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Squamou\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Squamous cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Adenocarcinoma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Small cell / <span class=\"customMeta\" data-dictid=\"3d2453376b16927771947134f6a67d\">oat</span> cell </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Large cell </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key to remember </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smoking</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>SSS - Smoking Sq, Small</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gender</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common in male and female</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Location</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Central - squamous, small</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Genetics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Loss of</p>\n<ul>\n<li>chr3</li>\n<li>chr17p</li>\n<li>p53</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gain of function of</p>\n<ul>\n<li>EGFR 1</li>\n<li>ALK</li>\n<li>KRAS</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"17cb05d8871692777184bff4fa9ea6\">chr</span> 3p</p>\n<p>Almost all</p>\n<p> </p>\n<p>L myc amplification</p>\n<p> </p>\n<p>P53 inact</p>\n<p>RB inact</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>KRAS</strong>- KPL tumors:</p>\n<ul>\n<li>Colon</li>\n<li>Pancreatic</li>\n<li>Lung cancer</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Precancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CIS <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (common with every <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell ca)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>AAH</strong></p>\n<p><strong>AIS </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neuroendocrine</p>\n<p>DIPNEH</p>\n<p>Diffuse <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> hyperplasia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Markers </strong></p>\n<p>IHC</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>P40 is the best marker</p>\n<p>p63</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mnemonic: all A and I</p>\n<p>NAPSIN A</p>\n<p>MUC I</p>\n<p>TTF I</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Synaptophysin</p>\n<p>Chromogranin</p>\n<p>Bombesin</p>\n<p>NSE</p>\n<p>CD56</p>\n<p>CD57</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PNS (Para <span class=\"customMeta\" data-dictid=\"c82360aadd16927771936d67fa30a4\">neoplastic</span> syndrome)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypercalcemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Migratory thrombophlebitis</p>\n<ul>\n<li>Itis - inflammation</li>\n<li>Thrombus - clot</li>\n<li>Phlebo - vein</li>\n<li>Awara - <span class=\"customMeta\" data-dictid=\"5ee3e4a7a81692777192f6d4d042a9\">migratory</span> (mnemonic)</li>\n</ul>\n<p>Trousseau phenomenon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>SIADH- syndrome of inappropriate <span class=\"customMeta\" data-dictid=\"401dd7c3941692777180e4d78eee80\">ADH</span> secretion</li>\n<li>Cushing’s syndrome</li>\n<li>Lambert eaton syndrome</li>\n</ul>\n<p>Most aggressive Lung cancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gynaecomastia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trousseau phenomenon</p>\n<ul>\n<li>Lung adeno</li>\n<li>PANCREATIC adenocarcinoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be done next in the management of a patient who is diabetic and presents with symptoms of vomiting and abdominal pain? Upon examination, the patient displays hyperventilation, sweet breath, and low blood pressure. The blood glucose level is 320 mg/dL, and urine ketones are detected.", "options": [{"label": "A", "text": "IV insulin drip", "correct": false}, {"label": "B", "text": "IV soda-bicarbonate", "correct": false}, {"label": "C", "text": "Check blood ketone levels", "correct": false}, {"label": "D", "text": "IVF and check K+", "correct": true}], "correct_answer": "D. IVF and check K+", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ff6yb0BiEnirklCTCDRZ1714131407.png"], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"cf23a56e0916927771903ba7e75f72\"&gt;IVF&lt;/span&gt; and check K+\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Interpret the ECG given below.", "options": [{"label": "A", "text": "Ventricular fibrillation", "correct": false}, {"label": "B", "text": "Atrial fibrillation", "correct": false}, {"label": "C", "text": "Supra ventricular tachycardia", "correct": true}, {"label": "D", "text": "Ventricular tachycardia", "correct": false}], "correct_answer": "C. Supra ventricular tachycardia", "question_images": ["https://image.prepladder.com/content/DE5zD7clDdrihVHIgVhT1714548839.png"], "explanation_images": ["https://image.prepladder.com/content/1vqhyzY1w9SumUL8B1jI1714549008.png", "https://image.prepladder.com/content/xEblgKKPz1WRxk3Uf0mA1714548985.png", "https://image.prepladder.com/content/cAOJdOrUBDS9th99dAXk1714548961.png"], "explanation": "<p>Correct Option C - Supra &lt;span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\"&gt;ventricular&lt;/span&gt; tach\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of Tachycardia</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>ECG Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sinus Tachycardia</p>\n</td>\n<td>\n<p>Regular rhythm, narrow QRS complex, normal P waves</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Atrial Tachycardia</p>\n</td>\n<td>\n<p>Regular or <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> rhythm, narrow QRS complex, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> P waves</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Atrial Flutter</p>\n</td>\n<td>\n<p>Regular or <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> rhythm, sawtooth-shaped P waves, narrow QRS complex</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Atrial Fibrillation</p>\n</td>\n<td>\n<p>Irregular rhythm, absent P waves, narrow QRS complex or variable</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>AV Nodal Reentrant Tachycardia</p>\n</td>\n<td>\n<p>No P wave, pseudo R wave</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Junctional Tachycardia</p>\n</td>\n<td>\n<p>Regular or <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> rhythm, narrow QRS complex, inverted, or absent P waves</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ventricular Tachycardia</p>\n</td>\n<td>\n<p>Regular or <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> rhythm, wide QRS complex, no discernible P waves</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Torsades <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> Pointes</p>\n</td>\n<td>\n<p>Regular or <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> rhythm, twisting QRS complexes, QT prolongation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following healthcare providers is not working at the village level ?", "options": [{"label": "A", "text": "ANM", "correct": true}, {"label": "B", "text": "AWW", "correct": false}, {"label": "C", "text": "TBA", "correct": false}, {"label": "D", "text": "ASHA", "correct": false}], "correct_answer": "A. ANM", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - ANM\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient is identified as having a tumor in the ileum leading to urinary 5 HIAA being elevated. What is the diagnosis?", "options": [{"label": "A", "text": "Carcinoid tumor", "correct": true}, {"label": "B", "text": "Neuroblastoma", "correct": false}, {"label": "C", "text": "Leiomyoma", "correct": false}, {"label": "D", "text": "Chromaffinoma", "correct": false}], "correct_answer": "A. Carcinoid tumor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A - &lt;span class=\"customMeta\" data-dictid=\"2eaab075f416927771834adb276f1d\"&gt;Carcinoid&lt;/span&gt; tu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 50-year-old woman with a skin lesion visible in the provided image, which initially appeared small but has now spread to her entire limb and abdomen? Despite being on anticoagulation therapy, she has a longstanding history of diabetes and recurring deep vein thrombosis episodes.", "options": [{"label": "A", "text": "Insulinoma", "correct": false}, {"label": "B", "text": "Gastrinoma", "correct": false}, {"label": "C", "text": "Glucagonoma", "correct": true}, {"label": "D", "text": "VIPoma", "correct": false}], "correct_answer": "C. Glucagonoma", "question_images": ["https://image.prepladder.com/content/SrWg8OIxUXJ2cl4L5Ti21685100530.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Glucag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby presents for a routine examination in the outpatient department. A growth chart is utilized to record the baby's weight, which falls within the 85th - 95th percentile range. What is the present condition of the child?", "options": [{"label": "A", "text": "Obesity", "correct": false}, {"label": "B", "text": "SAM", "correct": false}, {"label": "C", "text": "Overweight", "correct": true}, {"label": "D", "text": "Interpretation cannot be made without BMI", "correct": false}], "correct_answer": "C. Overweight", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aOeU7IcZZn7rI1wkKIWm1685100766.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man presents with fatigue, pallor, weight loss, and heaviness in the left hypochondrium, for the past 2 months. Abdominal palpation reveals splenomegaly. His hemogram and peripheral smear results are given below. What is the most likely diagnosis? Hemogram: Hb-10 gm/dl WBC count – 1,65,000/cu.mm (leukocytosis) Platelet count – 3 lakhs/mm 3 Peripheral smear: Metamyelocytes – 15% Promyeloblasts – 30% Myeloblasts – 45%", "options": [{"label": "A", "text": "Chronic lymphocytic leukemia", "correct": false}, {"label": "B", "text": "Chronic myeloid leukemia", "correct": true}, {"label": "C", "text": "Acute lymphoblastic leukemia", "correct": false}, {"label": "D", "text": "Acute myeloid leukemia", "correct": false}], "correct_answer": "B. Chronic myeloid leukemia", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male patient presents with palpitations, episodic headaches , and sweating episodes . Workup shows a small left-sided suprarenal mass . Which of the following would be done for confirmation?", "options": [{"label": "A", "text": "Urinary vanillyl mandelic acid levels", "correct": true}, {"label": "B", "text": "Blood 5-HIAA levels", "correct": false}, {"label": "C", "text": "Urine myoglobin", "correct": false}, {"label": "D", "text": "Stool trypsin levels", "correct": false}], "correct_answer": "A. Urinary vanillyl mandelic acid levels", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Urinary vanillyl mandelic acid lev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with chronic complaints of a productive cough in the morning . The expectoration is yellow, foul smelling and increases on turning from left to right side. Which of the following lung diseases is likely to be present ?", "options": [{"label": "A", "text": "Lung cancer", "correct": false}, {"label": "B", "text": "Bronchiectasis", "correct": true}, {"label": "C", "text": "Bronchial asthma", "correct": false}, {"label": "D", "text": "Pulmonary embolism", "correct": false}], "correct_answer": "B. Bronchiectasis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Bronch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly woman presented with symptoms of confusion, thirst, and abdominal pain. On examination, she had pallor and thoracic spine tenderness. Her lab investigations showed the following findings. An x-ray of her skull is shown below. What is the most likely diagnosis? Hb-6.9g/dl WBC 4000/cm3 with normal differential count Serum calcium 13mg/dl Creatinine 2.3mg/dl Albumin 2.4g/dl Urinalysis: positive for Bence-Jones proteins", "options": [{"label": "A", "text": "Metastatic breast cancer", "correct": false}, {"label": "B", "text": "Multiple myeloma", "correct": true}, {"label": "C", "text": "Primary hyperparathyroidism", "correct": false}, {"label": "D", "text": "Milk alkali syndrome", "correct": false}], "correct_answer": "B. Multiple myeloma", "question_images": ["https://image.prepladder.com/content/dFjwadUHFCV7ZEsQGSNy1711975150.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vaccines are given at birth?", "options": [{"label": "A", "text": "Pentavalent, MR, HiB", "correct": false}, {"label": "B", "text": "BCG, OPV, MR", "correct": false}, {"label": "C", "text": "BCG, OPV, Hepatitis B", "correct": true}, {"label": "D", "text": "BCG, IP, Hepatitis B", "correct": false}], "correct_answer": "C. BCG, OPV, Hepatitis B", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - BCG, OPV, &lt;span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\"&gt;Hepatitis&lt;/span&gt; B\n<table>\n<tbody>\n<tr>\n<td><strong>6 Weeks</strong></td>\n<td><strong>10 Weeks</strong></td>\n<td><strong>14 weeks</strong></td>\n</tr>\n<tr>\n<td>DPT<sub>1</sub></td>\n<td>DPT<sub>2</sub></td>\n<td>DPT<sub>3</sub></td>\n</tr>\n<tr>\n<td>OPV<sub>1</sub></td>\n<td>OPV<sub>2</sub></td>\n<td>OPV<sub>3</sub></td>\n</tr>\n<tr>\n<td>Hep B<sub>1</sub></td>\n<td>Hep B<sub>2</sub></td>\n<td>Hep B<sub>3</sub></td>\n</tr>\n<tr>\n<td>HiB<sub>1</sub></td>\n<td>HiB<sub>2</sub></td>\n<td>HiB<sub>3</sub></td>\n</tr>\n<tr>\n<td>Rotavirus<sub>1</sub></td>\n<td>Rotavirus<sub>2</sub></td>\n<td>Rotavirus<sub>3</sub></td>\n</tr>\n<tr>\n<td>FIPV<sub>1</sub></td>\n<td> </td>\n<td>FIPV<sub>2</sub></td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td><strong>5 Years</strong></td>\n<td><strong>10 years</strong></td>\n<td><strong>16 years</strong></td>\n</tr>\n<tr>\n<td>DPT<sub>8</sub></td>\n<td>TT</td>\n<td>TT</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 264 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "What significant error did the intern make while creating a banner on measures to prevent the spread of non-communicable diseases, as assigned by a group of doctors?", "options": [{"label": "A", "text": "Ban smoking in public areas", "correct": false}, {"label": "B", "text": "Restrictions on alcohol selling/consumption", "correct": false}, {"label": "C", "text": "Shift from PUFA to transfat", "correct": true}, {"label": "D", "text": "Decrease additive salts", "correct": false}], "correct_answer": "C. Shift from PUFA to transfat", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "If the RNA sequence is CAAGGU, what is the sequence of the template strand of DNA?", "options": [{"label": "A", "text": "CAAGGT", "correct": false}, {"label": "B", "text": "GTTCCA", "correct": false}, {"label": "C", "text": "ACCTTG", "correct": true}, {"label": "D", "text": "TGGAAC", "correct": false}], "correct_answer": "C. ACCTTG", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old female who is a known case of sickle cell anaemia was rushed to the emergency department with a complaint of extreme pain in the legs and fingers for the past 4 hours. Further examination revealed pain and tenderness in the right upper quadrant, and investigations showed sickle cells on peripheral blood smear and high bilirubin(indirect). What is the diagnosis?", "options": [{"label": "A", "text": "IDA", "correct": false}, {"label": "B", "text": "Thalassemia", "correct": false}, {"label": "C", "text": "Anaemia of chronic disease", "correct": false}, {"label": "D", "text": "Sickle cell crisis", "correct": true}], "correct_answer": "D. Sickle cell crisis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/OhgQgFAXJHCCNTNEQZbh1747649370.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is absolutely contraindicated in pregnancy?", "options": [{"label": "A", "text": "Captopril", "correct": true}, {"label": "B", "text": "Paracetamol", "correct": false}, {"label": "C", "text": "Ranitidine", "correct": false}, {"label": "D", "text": "Cefixime", "correct": false}], "correct_answer": "A. Captopril", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Teratogenic drugs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Teratogenic Disorder</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Acitretin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Craniofacial anomalies, heart defects, CNS malformations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Alcohol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Fetal Alcohol Syndrome</strong> (growth retardation, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> anomalies, CNS dysfunction, ASD, VSD).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>ACE inhibitors &amp; Angiotensin-receptor blockers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Renal dysgenesis, oligohydramnios, lung hypoplasia, skull hypoplasia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Carbamazepine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Neural tube defects (spina bifida), <span class=\"customMeta\" data-dictid=\"576134019e16927771859f4eac1021\">craniofacial</span> defects.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Isotretinoin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Craniofacial anomalies, heart defects, CNS malformations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Lithium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Ebstein's <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> (tricuspid <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> malformation)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Thalidomide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Severe limb defects (phocomelia), ear, cardiac, and <span class=\"customMeta\" data-dictid=\"2fd33fb2ac16927771889901daadeb\">genitourinary</span> malformations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Carbimazole &amp; methimazole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Choanal atresia, <span class=\"customMeta\" data-dictid=\"5dff4943631692777181b8974b302b\">aplasia</span> cutis, and <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> goitre.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Penicillamine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Cutis laxa syndrome.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Statins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Vertebral, anal, cardiac, tracheo-oesophageal fistula, renal, arterial, and limb defects (<strong>VACTERAL</strong> defects).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>SSRIs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Persistent <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> of the newborn.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Valproic acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p>Neural tube defects (spina bifida), <span class=\"customMeta\" data-dictid=\"576134019e16927771859f4eac1021\">craniofacial</span> defects, <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> malformations, and developmental delay.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Warfarin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:middle\">\n<p><strong>Fetal <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">warfarin</span> syndrome:</strong> Nasal hypoplasia, <span class=\"customMeta\" data-dictid=\"3d7836b47f1692777199a5bbfc749f\">stippled</span> epiphyses, limb hypoplasia, and central nervous system abnormalities.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the option with the least risk of TOLAC (trial of labor after cesarean)?", "options": [{"label": "A", "text": "Classical C section", "correct": false}, {"label": "B", "text": "Pre-eclampsia", "correct": false}, {"label": "C", "text": "Low-segment transverse incision", "correct": true}, {"label": "D", "text": "Breech presentation", "correct": false}], "correct_answer": "C. Low-segment transverse incision", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:671px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lower Segment <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">Cesarean</span> Section (CSCS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Classical <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">Cesarean</span> Section</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically slight difficult</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically easy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood loss is less</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood loss is more</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The wall is thin, and as such, the <span class=\"customMeta\" data-dictid=\"7339502e9916927771815edcf9dc99\">apposition</span> is perfect</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The wall is thick, and the <span class=\"customMeta\" data-dictid=\"7339502e9916927771815edcf9dc99\">apposition</span> of the margins is imperfect</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perfect <span class=\"customMeta\" data-dictid=\"63a6e9164616927771959f1d330e1d\">peritonization</span> is possible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not possible</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Post- operative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hemorrhage and shock is less</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peritonitis is less even in the infected <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> because of perfect <span class=\"customMeta\" data-dictid=\"63a6e9164616927771959f1d330e1d\">peritonization</span> and, if occurs, <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> to the pelvis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chance of <span class=\"customMeta\" data-dictid=\"8e8712947516927771951838cd4100\">peritonitis</span> is more in the presence of <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> sepsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peritoneal adhesions and intestinal obstructions are less</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More because of <span class=\"customMeta\" data-dictid=\"48e662e9b5169277718987f79531ef\">imperfect</span> peritonization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Convalescence is better</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Relatively delayed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Morbidity and mortality are much lower</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Morbidity and mortality are high</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wound healing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> is better healed because of:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> is weak because of:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>a. Perfect muscle <span class=\"customMeta\" data-dictid=\"7339502e9916927771815edcf9dc99\">apposition</span> due to thin margins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>a. <span class=\"customMeta\" data-dictid=\"48e662e9b5169277718987f79531ef\">Imperfect</span> muscle <span class=\"customMeta\" data-dictid=\"7339502e9916927771815edcf9dc99\">apposition</span> because of thick margins</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>b. Minimal wound hematoma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>b. More wound <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> formation</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>c. The wound remains quiescent during the <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> process</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>c. The wound is in a state of tension due to <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> and <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> of the upper segment. As a result, the knots may slip, or the sutures may become loose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>d. Chance of <span class=\"customMeta\" data-dictid=\"9c851eff8a1692777188d638767d86\">gutter</span> formation is unlikely</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>d. Chance of <span class=\"customMeta\" data-dictid=\"9c851eff8a1692777188d638767d86\">gutter</span> formation on the inner aspect is more</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>During future pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scar <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> is less (0.5-1.5%)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More risk of <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> (4-9%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trial of labor after <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">cesarean</span> (TOLAC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Possible in next pregnancy (for 1 previous LSCS only)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contraindicated due to risk of <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> rupture</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old patient presents with blurred vision, photophobia, and mild ocular pain. Examination reveals aqueous flares and keratic precipitates in the anterior chamber. What is the likely diagnosis?", "options": [{"label": "A", "text": "Intermediate uveitis", "correct": false}, {"label": "B", "text": "Posterior uveitis", "correct": false}, {"label": "C", "text": "Toxoplasma uveitis", "correct": false}, {"label": "D", "text": "Iridocyclitis", "correct": true}], "correct_answer": "D. Iridocyclitis", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Uveitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Granulomatous iridocyclitis</strong>, <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">iris</span> nodules, large mutton fat KPs, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chamber cells and flare, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> synechiae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intermediate <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitreous cells, snowball opacities, snowbanking</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Choroidal and <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> granulomas, <span class=\"customMeta\" data-dictid=\"99516d71df1692777185eb2585a44f\">cystoid</span> <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> edema, <span class=\"customMeta\" data-dictid=\"bd07bff8e716927771956e7a57bd70\">periphlebitis</span> retinae with candle <span class=\"customMeta\" data-dictid=\"9eae373ada1692777202074bbc0222\">wax</span> droppings appearance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral Multifocal Chorioretinitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small, <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> atrophic spots, highly suggestive of sarcoidosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uveoparotid Fever (Heerfordt’s Syndrome)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> panuveitis, painful <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> enlargement, <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsies, skin rashes, fever, malaise</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient has an infection of the cavernous sinus, involving the nerve located on its medial side. To confirm the involvement of the abducens nerve, you will ask the patient to look in which direction?", "options": [{"label": "A", "text": "Superior", "correct": false}, {"label": "B", "text": "Inferior", "correct": false}, {"label": "C", "text": "Medial", "correct": false}, {"label": "D", "text": "Lateral", "correct": true}], "correct_answer": "D. Lateral", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YgMbkFYqh6fOVstj6Vlz1747305132.png", "https://image.prepladder.com/notes/zXOxF2Ih2xyxw2hK83As1747655499.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Abducens Nerve (cranial nerve VI)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pons (lower border, opposite the <span class=\"customMeta\" data-dictid=\"70469583201692777196a8f1c66bfc\">pyramid</span> of the medulla).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Course </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"954\" src=\"https://image.prepladder.com/content/YgMbkFYqh6fOVstj6Vlz1747305132.png\" width=\"600\"/></p>\n<p style=\"text-align:center\"><img alt=\"Abducens nerve\" data-author=\"\" data-hash=\"12982\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"400\" src=\"https://image.prepladder.com/notes/zXOxF2Ih2xyxw2hK83As1747655499.png\" width=\"400\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Functional component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>General <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> <span class=\"customMeta\" data-dictid=\"8833ce72c71692777187014d5585e7\">efferent</span> fibres</strong>: Arise from the <strong>abducent nucleu</strong>s in the <span class=\"customMeta\" data-dictid=\"5e4684038e16927771967a14f73f37\">pons</span> and supply the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle of the eyeball.</li>\n<li><strong>General <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> </strong>fibres carry <span class=\"customMeta\" data-dictid=\"cd38f5515716927771969b9fb17e95\">proprioceptive</span> sensations from the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> and terminate in the <span class=\"customMeta\" data-dictid=\"722dfab4551692777192ec9f24aedf\">mesencephalic</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> of the <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> nerve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Supply </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle of the eyeball</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical aspect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lesion or injury (elevated <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure) of the <span class=\"customMeta\" data-dictid=\"493415137f1692777180adce8b5447\">abducens</span> nerve results in <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> of the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle, leading to:</p>\n<ul>\n<li>Inability to <span class=\"customMeta\" data-dictid=\"cc4da2fb151692777180dc699ae203\">abduct</span> the eye <strong>(Option B)</strong></li>\n<li>Diplopia (double vision)</li>\n<li>Convergent <span class=\"customMeta\" data-dictid=\"4d366430b5169277719914874d78a5\">squint</span> (due to the unopposed action of <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> rectus)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a part of the global hunger index?", "options": [{"label": "A", "text": "U5MR", "correct": false}, {"label": "B", "text": "Malnutrition", "correct": false}, {"label": "C", "text": "Inadequate food supply", "correct": false}, {"label": "D", "text": "Infant mortality rate", "correct": true}], "correct_answer": "D. Infant mortality rate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Fs3lR4c8Bnq1YKKZZjIG1747306635.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male presents with right-sided serous otitis media and a history of cervical lymphadenopathy. The probable diagnosis is?", "options": [{"label": "A", "text": "Angiofibroma", "correct": false}, {"label": "B", "text": "Nasopharyngeal cancer", "correct": true}, {"label": "C", "text": "Adenoid hypertrophy", "correct": false}, {"label": "D", "text": "Tonsillar abscess", "correct": false}], "correct_answer": "B. Nasopharyngeal cancer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Nasal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Obstruction</li>\n<li>Discharge</li>\n<li>Denasal speech (rhinolalia clausa)</li>\n<li>Epistaxis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Otologic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conductive hearing loss</li>\n<li><strong>Serous or <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media (Unilateral <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media in adults is an important indicator)</strong></li>\n<li>Tinnitus</li>\n<li>Dizziness due to Eustachian tube obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ophthalmoneurologic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Squint</li>\n<li>Diplopia (CN VI involvement)</li>\n<li>Ophthalmoplegia (CN III, IV, VI)</li>\n<li>Facial pain</li>\n<li>Reduced corneal <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> (CN V involvement)</li>\n<li>Exophthalmos</li>\n<li>Blindness (CN II)</li>\n<li>Jugular <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> syndrome with CN IX, X, and XI involvement</li>\n<li>Horner syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cervical Nodal Metastases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lump of nodes between the angle of the jaw and mastoid, or along the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> triangle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant Metastases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common sites-bone, lung, and liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cervical lymphadenopathy</strong></li>\n<li>Hearing loss</li>\n<li>Nasal obstruction</li>\n<li>Epistaxis</li>\n<li>Cranial nerve palsies (CN VI most common)</li>\n<li>Headache</li>\n<li>Earache</li>\n<li>Neck pain</li>\n<li>Weight loss</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male patient presents with a left groin swelling for a few years, which increases in size on standing and decreases when lying down. On examination, the swelling shows a positive cough impulse. What is the appropriate management?", "options": [{"label": "A", "text": "Incision and drainage", "correct": false}, {"label": "B", "text": "Herniotomy", "correct": false}, {"label": "C", "text": "Herniorrhaphy", "correct": false}, {"label": "D", "text": "Reduction of contents, repair defects and reinforcement with mesh", "correct": true}], "correct_answer": "D. Reduction of contents, repair defects and reinforcement with mesh", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qgvD4NcaPSRiHWHANiB51747294287.png", "https://image.prepladder.com/content/uXi7wWMOXcAoMyOKzkfl1747294293.png", "https://image.prepladder.com/content/KcQvLLOhldeJpAv9EI4a1747294305.png", "https://image.prepladder.com/content/kHOHpxes6xL6KD16c7HS1747294314.png", "https://image.prepladder.com/content/GnRCYgXrVcigyk88Iqca1747294327.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bassini's Repair:</strong></p>\n<ul>\n<li>Involves suturing the internal oblique, <span class=\"customMeta\" data-dictid=\"b4b7ff709c1692777200a120b1b991\">transversus</span> abdominis, and <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> to the inguinal ligament. Known as a triple-layer repair.</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"608\" src=\"https://image.prepladder.com/content/qgvD4NcaPSRiHWHANiB51747294287.png\" width=\"408\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shouldice Repair </strong>involves a four-layer repair (double breasting of <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> transversalis), resulting in lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to Bassini's.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"Kumar hari rajah M. Somanathan \"' data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/The-shouldice-repair_fig2_376511441\" data-tags=\"\" height=\"290\" src=\"https://image.prepladder.com/content/uXi7wWMOXcAoMyOKzkfl1747294293.png\" width=\"408\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Modified Shouldice</strong>: A six-layer repair, including additional layers for reinforcement.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>TEP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>TAPP</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery done <strong>above the</strong> peritoneum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery done<strong> beneath the</strong> peritoneum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> injury and peritoneal complications.</li>\n<li>Reduced risk of adhesions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Larger working space</li>\n<li>Better visualisation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smaller working spaces can make the procedure more technically challenging.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A higher risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> injury and <span class=\"customMeta\" data-dictid=\"2b1931a185169277718065e3fa42dd\">adhesion</span> formation due to entry into the peritoneal cavity.</li>\n<li>Potential for increased <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain compared to TEP.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old woman was hospitalized for three days for left leg cellulitis. She was treated with clindamycin. Two days after her discharge, abdominal pain, and watery diarrhea. Lab results showed leukocytes 17,500/mm3, elevated ESR and CRP. What is the causative agent?", "options": [{"label": "A", "text": "Escherichia coli", "correct": false}, {"label": "B", "text": "Norovirus", "correct": false}, {"label": "C", "text": "Clostridioides difficile", "correct": true}, {"label": "D", "text": "Rotavirus", "correct": false}], "correct_answer": "C. Clostridioides difficile", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jJldrRF8vXvwdiCECp0y1747292049.png", "https://image.prepladder.com/content/Vyl326AW8KkeZzXNb27f1747292049.png", "https://image.prepladder.com/content/hqZvjzoSocb7BDhfGswB1747292049.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:572px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>1. Colonoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Examination of the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> whitish-yellow plaques on the <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> known as microabscesses.</li>\n<li>Although it is highly specific, it is not as sensitive as ELISA, hence it is not considered the Gold standard for diagnosis.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NAKlinikum Dritter Orden, München. Abteilung Innere Medizin\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pseudomembranoese_Colitis_Endo3.jpg\" data-tags=\"\" height=\"405\" src=\"https://image.prepladder.com/content/hqZvjzoSocb7BDhfGswB1747292049.png\" width=\"511\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>2. Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Stool samples cultured on selective media to identify C. difficile;<strong> less sensitive than <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> detection.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>3. <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">Toxin</span> Detection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>ELISA: Detects toxins A and/or B in <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> samples, the gold standard.</strong></li>\n<li>Cell Culture: Toxins produce characteristic effects on Hep-2 or human <span class=\"customMeta\" data-dictid=\"52d06e3e001692777186400050f388\">diploid</span> cell cultures, neutralized by C. sordellii antitoxin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>4. Molecular Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>PCR: Detects genes coding for toxins A and B in <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> samples.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>5. Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>This can be performed with <span class=\"customMeta\" data-dictid=\"1cbb322f2c1692777188d48b3e3ef7\">hematoxylin</span> and <span class=\"customMeta\" data-dictid=\"2379e628e2169277718790981be825\">eosin</span> stains</li>\n<li>Highly specific but low sensitivity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Antibiotic Discontinuation</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Stop the <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> suspected of contributing to the infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Antibiotic Therapy</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral vancomycin or metronidazole.</li>\n<li>Severe cases: Combination of oral vancomycin, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> metronidazole, and rectal vancomycin enemas.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Antibiotic Stewardship</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Limit the use of <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics like clindamycin, ampicillin, and fluoroquinolones; prevent <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of normal gut flora.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Infection Control Measures</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Meticulous hand <span class=\"customMeta\" data-dictid=\"15fa752a4f1692777189fe275abf3f\">hygiene</span> and <span class=\"customMeta\" data-dictid=\"3cad0eb1921692777185d0a7b642fc\">contact precautions</span> in healthcare settings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Recent Treatment Option</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Fecal Transplants</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Replenishing gut <span class=\"customMeta\" data-dictid=\"0af84af4761692777202fbf6914573\">flora</span> with donated faeces from screened healthy donor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a swelling in the thyroid region that moves with deglutination and protrusion of the tongue. The swelling has ruptured, resulting in pus discharge. What is the preferred treatment?", "options": [{"label": "A", "text": "Sistrunk procedure", "correct": true}, {"label": "B", "text": "Antibiotics", "correct": false}, {"label": "C", "text": "Incision and drainage", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Sistrunk procedure", "question_images": ["https://image.prepladder.com/content/QoOVBLOlPHru07eRqGdE1747293410.png"], "explanation_images": ["https://image.prepladder.com/content/F4fu0kqF14aNn2emdcBY1747293450.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent surgery for pilonidal sinus, which type of flap is used in this surgery?", "options": [{"label": "A", "text": "Rhomboid flap", "correct": true}, {"label": "B", "text": "Advanced flap", "correct": false}, {"label": "C", "text": "Rotational flap", "correct": false}, {"label": "D", "text": "Free flap", "correct": false}], "correct_answer": "A. Rhomboid flap", "question_images": ["https://image.prepladder.com/content/pQPEHeZXdELjqSkIl7Pd1747291826.png"], "explanation_images": ["https://image.prepladder.com/content/opbEdlP5pGQeyKLVjqYP1747291908.png", "https://image.prepladder.com/content/qH8XKBw2Dg5m8mgVOqJC1747291963.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conservative Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>For mild cases: cleaning, hair removal, and <span class=\"customMeta\" data-dictid=\"15fa752a4f1692777189fe275abf3f\">hygiene</span> maintenance.</li>\n<li>Cauterization with silver <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> or laser in less complex cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drainage through a small <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> over the abscess.</li>\n<li>Thorough cleaning of the <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> to remove <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue and hair.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedures include:</strong></p>\n<ul>\n<li>Laying open <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tracks (with/without marsupialisation)</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> (with/without primary closure)</li>\n<li>Off-midline <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> techniques (Limberg, Z-plasty, Karydakis procedures).</li>\n<li>Bascom Procedure: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> to clean the <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> cavity, <span class=\"customMeta\" data-dictid=\"e0b35b76f816927771875efaec6acd\">excise</span> midline pits, and leave <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wounds open to heal secondarily.</li>\n<li>Flap Procedures: Used if initial treatments fail or if the <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> recurs.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following eye signs can be appreciated in the image?", "options": [{"label": "A", "text": "Tache noire", "correct": true}, {"label": "B", "text": "Kevorkian sign", "correct": false}, {"label": "C", "text": "Corneal changes", "correct": false}, {"label": "D", "text": "Vitreous humour changes", "correct": false}], "correct_answer": "A. Tache noire", "question_images": ["https://image.prepladder.com/content/t2sY4khVje8Oj27LO0bi1747296025.png"], "explanation_images": ["https://image.prepladder.com/content/8Ahp8idamlAd1p2mGY5k1747296064.png", "https://image.prepladder.com/content/WLKqhMbmtEQVCNzBcFY91747296064.png", "https://image.prepladder.com/content/e6pBgLEBv8HmvvYSBbW81747296064.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Part of Eye</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Time Since Death (TSD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Retina (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Kevorkian Sign:</strong> Fragmentation or <span class=\"customMeta\" data-dictid=\"aa998dc528169277719850af075181\">segmentation</span> of blood column in <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> vessels (cattle trucking or shunting)</li>\n<li>Occurs within minutes and lasts about an hour.</li>\n<li>Seen using an opthalmoscope.</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"283\" src=\"https://image.prepladder.com/content/8Ahp8idamlAd1p2mGY5k1747296064.png\" width=\"281\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Few minutes</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"293\" src=\"https://image.prepladder.com/content/WLKqhMbmtEQVCNzBcFY91747296064.png\" width=\"291\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vitreous Humor (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vitreous humor’s accessibility and resistance to <span class=\"customMeta\" data-dictid=\"cb6efad46e16927771961e21da0ce6\">putrefaction</span> make it ideal for <span class=\"customMeta\" data-dictid=\"d505e5aff31692777203af0565576c\">forensic</span> analysis.</li>\n<li>Potassium along with <span class=\"customMeta\" data-dictid=\"304c30e55316927771895062b17e8b\">hypoxanthine</span> increases due to <span class=\"customMeta\" data-dictid=\"877f6aa72116927771821fd0400f03\">autolysis</span> of <span class=\"customMeta\" data-dictid=\"87b317afbd16927771844e0e534940\">choroid</span> and <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> cells.</li>\n<li><strong>Potassium levels provide accurate TSD estimates</strong>, unaffected by external factors.</li>\n<li>The Sturner and Gantner formula is used to estimate TSD from <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sclera (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Tache Noire: </strong>Appears as two yellow triangles on the sclera<strong> </strong>(base on limbus, <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> at <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> or <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> canthus), which darken to brown and then black.</li>\n<li>Caused by <span class=\"customMeta\" data-dictid=\"673e89ae80169277718683d94657d7\">desiccation</span> and deposition of <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> debris, mucus, and dust on exposed <span class=\"customMeta\" data-dictid=\"d168af6e7f1692777185683fea5e7f\">conjunctiva</span> and the <span class=\"customMeta\" data-dictid=\"3e4400809d16927771983252fc08b1\">sclera</span> underneath.</li>\n<li>Forms if eyelids remain open for 3-4 hours postmortem.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 - 4 hours</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Oscar.garcia.miranda\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Tache_noir_de_la_sclerotique#/media/File:Mancha_negra_escler%C3%B3tica_(macha_de_Sommer-Larcher_o_tache_noire_de_la_sclerotique).png\" data-tags=\"\" height=\"208\" src=\"https://image.prepladder.com/content/e6pBgLEBv8HmvvYSBbW81747296064.png\" width=\"292\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cornea (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cornea becomes hazy within 2 hours of death<strong> </strong>due to drying and dust deposition.</li>\n<li>Delayed for about 2 hours if lids are closed after death.</li>\n<li>Transient haziness can be removed by applying water, but permanent <span class=\"customMeta\" data-dictid=\"a8eadab50316927771948be0cc91ca\">opacity</span> occurs after 10-12 hours due to decomposition.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within 2 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eyeball </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eyes appear sunken and become softer within minutes due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> tension.</li>\n<li>Intraocular pressure drops from 10-22 mmHg during life to <span class=\"customMeta\" data-dictid=\"116e588c7b1692777202c7f3040428\">zero</span> within 2 hours.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within 2 hours (IOP becomes zero)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 66-year-old man with a history of chronic kidney disease presents with poorly controlled diabetes mellitus. You are considering adjusting his diabetes medication regimen to improve glycemic control. Which of the following needs no dose modification in this patient?", "options": [{"label": "A", "text": "Repaglinide", "correct": false}, {"label": "B", "text": "Linagliptin", "correct": true}, {"label": "C", "text": "Glyburide", "correct": false}, {"label": "D", "text": "Saxagliptin", "correct": false}], "correct_answer": "B. Linagliptin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dipeptidyl peptidase-4 (DPP-4) inhibitors:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Increase <span class=\"customMeta\" data-dictid=\"148de0e6a61692777190372a1432f0\">Incretin</span> Levels</strong>: Prevents <span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\">degradation</span> of <span class=\"customMeta\" data-dictid=\"148de0e6a61692777190372a1432f0\">incretin</span> hormones (GLP-1 and GIP)</li>\n<li><strong>Enhance Insulin Secretion</strong> from the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> in response to meals. (no risk of hypoglycemia)</li>\n<li><strong>Reduce <span class=\"customMeta\" data-dictid=\"c4d90ebfde1692777188e3689c1753\">glucagon</span> secretion</strong></li>\n<li>Maintain neutral weight</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"6bffb538c616927771895e03011a28\">hypoglycemic</span> drug (type-2 diabetes)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Linagliptin: Safe in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Teneligliptin: Safe in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Vildagliptin: Hepatotoxic</li>\n<li>Alogliptin</li>\n<li>Sitagliptin</li>\n<li>Saxagliptin: <strong>(Option D)</strong>\n<ul>\n<li>Metabolised by <strong>CYP3A4</strong>, it has more drug interactions.</li>\n<li>Requires dose adjustment in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> due to partial <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> excretion.</li>\n<li>Risk of congestive heart failure.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nausea and <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> (most common)</li>\n<li><strong>Pancreatitis</strong> (lesser than GLP-1)</li>\n<li>Risk of pancreatic and <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer (lesser than GLP-1)</li>\n<li>Arthritis, Nasopharyngitis:\n\t\t\t\t<ul>\n<li>Increase interleukins and cytokines levels (similar structure to CD26)</li>\n</ul>\n</li>\n<li>Hypersensitivity reactions: Steven-Johnson syndrome, angioedema</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old patient with a history of thromboembolic stroke, currently taking warfarin and aspirin, presents with a headache and confusion after a fall in the toilet. A non-contrast CT of the head is given in the image. What is the next best step in management?", "options": [{"label": "A", "text": "Aspirin + Clopidogrel", "correct": false}, {"label": "B", "text": "Vitamin K + FFP + Neurosurgery consultation", "correct": true}, {"label": "C", "text": "IV Mannitol", "correct": false}, {"label": "D", "text": "Observation", "correct": false}], "correct_answer": "B. Vitamin K + FFP + Neurosurgery consultation", "question_images": ["https://image.prepladder.com/content/qayUPuCv4contbGePUk21747292152.png"], "explanation_images": ["https://image.prepladder.com/content/FpGWyUYTOJzadQraKl7e1747292269.png", "https://image.prepladder.com/content/YkiTd4jNKOZFDlqjEHnX1747292238.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subdural Hematoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extradural <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Arachnoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Skull</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Crescent-shaped</strong></li>\n<li><strong>Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Biconvex or lens-shaped </strong></li>\n<li>Well-defined &amp; Localized,</li>\n<li><strong>Won’t cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tearing of <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> veins</strong>, often due to <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma / acceleration-deceleration injuries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rupture of the middle meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or vein</strong> due to skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Develop over days to weeks; Acute SDH can occur rapidly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually develop rapidly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Craniotomy / Craniectomy</strong>, if significant.</li>\n<li>Conservative management for smaller, stable cases.</li>\n<li><strong>Burr hole <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> </strong>is preferred for significant chronic cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> for significant or deteriorating cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subdural_hematoma#/media/File:Subduralandherniation.PNG\" data-tags=\"\" height=\"349\" src=\"https://image.prepladder.com/content/FpGWyUYTOJzadQraKl7e1747292269.png\" width=\"280\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sharma, Dr Anand &amp; Dewan, Yashbir.\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/A-NCCT-head-right-fronto-parietal-acute-extradural-hematoma-with-midline-shift-towards_fig1_283980160\" data-tags=\"\" height=\"283\" src=\"https://image.prepladder.com/content/YkiTd4jNKOZFDlqjEHnX1747292238.png\" width=\"240\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 17-year-old boy presents to the clinic complaining of a painless lump on the lateral aspect of his left knee. The radiograph of the patient is shown below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Enchondroma", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Osteomyelitis", "correct": false}, {"label": "D", "text": "Osteochondroma", "correct": true}], "correct_answer": "D. Osteochondroma", "question_images": ["https://image.prepladder.com/content/pssDudiEUNLPywK8yKDo1747287759.png"], "explanation_images": ["https://image.prepladder.com/content/oarvikmxUDKq25pEaiCG1747287814.png", "https://image.prepladder.com/content/R69rAUAjoKktJHMA041k1747287860.png", "https://image.prepladder.com/content/ZaUPQ75nkyx1FIw2KyiA1747287866.png", "https://image.prepladder.com/content/3Xd6DB2H0Z9yNPQoQyx41747287884.png", "https://image.prepladder.com/content/SJMTReYzVPNJ3GgueXKv1747287903.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The first line of treatment for glaucoma in adults is?", "options": [{"label": "A", "text": "PG analogues", "correct": true}, {"label": "B", "text": "Atropine", "correct": false}, {"label": "C", "text": "Acetazolamide", "correct": false}, {"label": "D", "text": "Pilocarpine", "correct": false}], "correct_answer": "A. PG analogues", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the finding that is seen in antemortem drowning?", "options": [{"label": "A", "text": "Cadaveric spasm", "correct": true}, {"label": "B", "text": "Pugilistic attitude", "correct": false}, {"label": "C", "text": "Washerwoman hand", "correct": false}, {"label": "D", "text": "Emphysema aquosum", "correct": false}], "correct_answer": "A. Cadaveric spasm", "question_images": ["https://image.prepladder.com/content/IRRvYsOH0ujrniXK1cY71747302492.png"], "explanation_images": ["https://image.prepladder.com/content/vRPu30qyAiknUmFEAkQZ1747302526.png", "https://image.prepladder.com/content/NNfzVeMzTMQ29VBqlXSp1747302526.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Cadaveric spasm, also known as <span class=\"customMeta\" data-dictid=\"719164f4ef1692777183c61abc7913\">cataleptic</span> <span class=\"customMeta\" data-dictid=\"9ab07bba3016927771976de44bf865\">rigidity</span> or instantaneous rigor, is an ante-mortem phenomenon occurring immediately at the time of death.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ATP <span class=\"customMeta\" data-dictid=\"7061e0e0051692777186ba9c5f27df\">depletion</span> in a specific group of muscles that were contracted just before death.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscles that were in use at the time of death remain stiff and rigid immediately after death.</li>\n<li>No primary <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> phase, but secondary <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> occurs during decomposition.</li>\n<li>Cannot be artificially induced, making it an exclusively ante-mortem finding.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medico-Legal Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cadaveric <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> helps in determining whether <span class=\"customMeta\" data-dictid=\"5031a7245c1692777186f7e7aabc06\">drowning</span> was ante-mortem or post-mortem.</p>\n<p>In cases of <span class=\"customMeta\" data-dictid=\"e95b8b18db1692777181eb63100f9b\">antemortem</span> drowning, the <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> can cause the victim to tightly grip objects like weeds or mud, indicating they were alive and struggling before death. This provides evidence of active efforts during the <span class=\"customMeta\" data-dictid=\"5031a7245c1692777186f7e7aabc06\">drowning</span> process.</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ajith Rathnaweera\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Clenched-both-hands-with-cadaveric-spasm_fig1_342568293\" data-tags=\"\" height=\"353\" src=\"https://image.prepladder.com/content/vRPu30qyAiknUmFEAkQZ1747302526.png\" width=\"279\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<p>Conversely, if no <span class=\"customMeta\" data-dictid=\"1c0e0073bd16927771849519bc7cdf\">cadaveric spasm</span> is present, it may suggest post-mortem immersion, indicating that the body was placed in water after death.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What skin condition is characterized by the presence of coral red fluorescence under a woods lamp?", "options": [{"label": "A", "text": "Erythrasma", "correct": true}, {"label": "B", "text": "Acanthosis nigricans", "correct": false}, {"label": "C", "text": "Allergic contact dermatitis", "correct": false}, {"label": "D", "text": "Cutaneous candidiasis", "correct": false}], "correct_answer": "A. Erythrasma", "question_images": ["https://image.prepladder.com/notes/wCeH7JPs6vbcOmgy9baV1747663130.png"], "explanation_images": ["https://image.prepladder.com/notes/mDGym4MvyWGut8lUt1LU1747663230.png", "https://image.prepladder.com/notes/wCeH7JPs6vbcOmgy9baV1747663130.png", "https://image.prepladder.com/content/8BJl9nogIxy8nOSHiOak1747376885.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Colour on Wood’s light</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitiligo</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Milky white</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erythrasma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coral pink</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pityriasis versicolor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yellow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tinea capitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Green</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pseudomonas</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Green</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scabies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluorescein solution fills the burrows and is viewed with Wood’s light</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Porphyria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluorescence observed in urine, <span class=\"customMeta\" data-dictid=\"17dfb015d2169277720023db8fe9e5\">teeth</span> and blood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tuberous sclerosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ash-leaf macules</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are correct about NETs except?", "options": [{"label": "A", "text": "May result in SLE", "correct": false}, {"label": "B", "text": "Phagocytosis", "correct": true}, {"label": "C", "text": "Sepsis", "correct": false}, {"label": "D", "text": "Arginine needed", "correct": false}], "correct_answer": "B. Phagocytosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AKZhdLDMUahpRJY6RVWX1747305366.png", "https://image.prepladder.com/content/kpiVZqjsKIdoj8HrNLRJ1747305369.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Type of voice associated with the hypertrophied adenoids?", "options": [{"label": "A", "text": "Rhinolalia clausa", "correct": true}, {"label": "B", "text": "Rhinolalia aperta", "correct": false}, {"label": "C", "text": "Hot potato voice", "correct": false}, {"label": "D", "text": "Hypernasality", "correct": false}], "correct_answer": "A. Rhinolalia clausa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A) Rhinolalia clau\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A first-trimester pregnant female has DVT and needs anticoagulation. Which of the following anticoagulants is preferred?", "options": [{"label": "A", "text": "Enoxaparin", "correct": false}, {"label": "B", "text": "Clopidogrel", "correct": true}, {"label": "C", "text": "Betrixaban", "correct": false}, {"label": "D", "text": "Warfarin", "correct": false}], "correct_answer": "B. Clopidogrel", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anticoagulants in pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gestational period </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anticoagulants preferred </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>0-12 weeks </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>LMW/ULMW heparin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>12-36 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>LMW/ULMW heparin</li>\n<li>As <span class=\"customMeta\" data-dictid=\"9bd7909f881692777194ca6ea37a0c\">organogenesis</span> is completed, <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">Warfarin</span> may be used only in cases of patients with mechanical <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> valves</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>36 weeks till delivery </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>LMW/ULMW heparin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>During delivery </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">anticoagulant</span> is used due to the risk of <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>During <span class=\"customMeta\" data-dictid=\"4abd8094e51692777191b1eb073735\">lactation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Warfarin is preferred over heparin</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anticoagulants safe in pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anticoagulants contraindicated in pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Heparin (unfractionated and low <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">molecular weight</span> heparin)</li>\n<li>Fondaparinux</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Warfarin</li>\n<li>Direct Oral Anticoagulants dabigatran, rivaroxaban, apixaban, and edoxaban</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old boy is brought to the ED after being stung by a bee while playing outside. Within minutes of the sting, he developed shock, respiratory failure, and vascular collapse. What type of hypersensitivity reaction is most likely responsible?", "options": [{"label": "A", "text": "IgG-mediated reaction", "correct": false}, {"label": "B", "text": "IgA-mediated hypersensitivity", "correct": false}, {"label": "C", "text": "IgE-mediated reaction", "correct": true}, {"label": "D", "text": "T cell-mediated response", "correct": false}], "correct_answer": "C. IgE-mediated reaction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Rx51VcJOTu4CLYvnXJjk1747292684.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:734px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Early Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seconds to minutes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mast cell/basophil degranulation</strong>: <span class=\"customMeta\" data-dictid=\"a54166a5961692777189c5557f61f3\">IgE</span> <span class=\"customMeta\" data-dictid=\"2cf4952c63169277718543a0883583\">cross-linking</span> leads to the release of <span class=\"customMeta\" data-dictid=\"b5d4ddbfe71692777189a12acd5502\">histamine</span> and other mediators.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin</strong>: <span class=\"customMeta\" data-dictid=\"7e814d15c31692777201fe0d9c1a61\">Urticaria</span> (hives), <span class=\"customMeta\" data-dictid=\"8f179d376f16927771905338bc9387\">itching</span> (pruritus), <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> (redness), <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"5f26e5a9e916927771816a407f7545\">angioedema</span> (swelling around lips, eyes)</p>\n<p><strong>Respiratory</strong>: <span class=\"customMeta\" data-dictid=\"c9116ef24d16927771838d51f2946f\">Bronchoconstriction</span> leading to wheezing, shortness of breath, chest tightness, sneezing, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> (allergic rhinitis)</p>\n<p><strong>Cardiovascular</strong>: Vasodilation and <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> (drop in blood pressure), dizziness, <span class=\"customMeta\" data-dictid=\"9f04fb3f2f1692777199272e3daf84\">syncope</span> (fainting)</p>\n<p><strong>Gastrointestinal</strong>: Nausea, vomiting, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> due to smooth muscle contraction</p>\n<p><strong>Systemic Reaction</strong>: <span class=\"customMeta\" data-dictid=\"d6d717efa216927771819fee139235\">Anaphylaxis</span> in severe cases, with generalized urticaria, angioedema, severe hypotension, and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> (life-threatening)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Late Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4–12 hours, peaks at 24–48 hours, lasting up to days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inflammatory cell recruitment</strong>: Cytokines/chemokines attract eosinophils, neutrophils, and macrophages, causing sustained inflammation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin</strong>: Persistent redness, swelling, intense itching, and development of an eczema-like <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> (seen in <span class=\"customMeta\" data-dictid=\"afad60190f1692777182663499dc42\">atopic</span> dermatitis)</p>\n<p><strong>Respiratory</strong>: <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> bronchoconstriction, prolonged wheezing, coughing, chest tightness, <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> production, and <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"47610e211516927771892548eb5626\">hyperresponsiveness</span> (chronic <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> exacerbation)</p>\n<p><strong>Eyes</strong>: Persistent redness and <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> in <span class=\"customMeta\" data-dictid=\"d168af6e7f1692777185683fea5e7f\">conjunctiva</span> (allergic conjunctivitis)</p>\n<p><strong>Chronic Changes</strong>: In prolonged or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> reactions, there may be tissue remodeling, fibrosis, and thickening of affected areas (e.g., airways in asthma, skin in chronic dermatitis)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I Early</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgE-mediated <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cell degranulation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hives, swelling, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate (minutes)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I Delayed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgE-mediated <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cell degranulation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wheezing, chest tightness, <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> itching</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hours to days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibody-mediated cell destruction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hemolytic anemia, thrombocytopenia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delayed (hours to days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immune complex deposition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Joint pain, fever, vasculitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delayed (hours to days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T-cell mediated response</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin rash, contact dermatitis</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delayed (48-72 hours)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female patient is admitted to the emergency department following an accidental burn incident. On examination, it is noted that she has sustained burn injuries to her right upper limb, the entire right lower limb, and the entire front and back of her abdomen. Based on the rule of nine, what is the estimated percentage of her total body surface area (TBSA) that is burned?", "options": [{"label": "A", "text": "45%", "correct": true}, {"label": "B", "text": "60%", "correct": false}, {"label": "C", "text": "28%", "correct": false}, {"label": "D", "text": "70%", "correct": false}], "correct_answer": "A. 45%", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/86u48NDuW0SeF5pcoREJ1747295790.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:744px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Body Part</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Estimated TBSA Adults</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Labeled Image</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Entire left arm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>9%</p>\n</td>\n<td rowspan=\"10\" style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"561\" src=\"https://image.prepladder.com/content/86u48NDuW0SeF5pcoREJ1747295790.png\" width=\"488\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Entire right arm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>9%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Head &amp; neck</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>9%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Chest</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>9%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Back of chest</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>9%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Abdomen</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>9%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Back of Abdomen</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>9%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Perineum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>1%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Entire left leg</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Entire right leg</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Who conducts inquest in Police custodial death?", "options": [{"label": "A", "text": "Higher police official", "correct": false}, {"label": "B", "text": "Judicial magistrate", "correct": true}, {"label": "C", "text": "Medical examiner", "correct": false}, {"label": "D", "text": "Coroner", "correct": false}], "correct_answer": "B. Judicial magistrate", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Police Inquest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Magistrate Inquest</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conducted by</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Police officer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Magistrate (DM, SDM, Judicial, or Executive Magistrate)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Involvement of witnesses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires signatures of panchas</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Does not require witness signatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Witness statements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Admissible in court</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not admissible in court</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Can order arrest</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No, but can arrest in cognizable offenses</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can issue arrest warrants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Exhumation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cannot order exhumation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can order <span class=\"customMeta\" data-dictid=\"9ede3648ef1692777187540bde750b\">exhumation</span> of a body</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Autopsy orders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sends bodies for <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> indiscriminately</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Orders <span class=\"customMeta\" data-dictid=\"f0b5c46ede1692777182013e65115b\">autopsy</span> only when necessary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Forensic analysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cannot order chemical analysis of viscera</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can order chemical analysis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male presented with vertigo, tinnitus and hearing loss. The audiogram is given below. What is the most likely diagnosis based on the given image?", "options": [{"label": "A", "text": "BPPV", "correct": false}, {"label": "B", "text": "Meniers disease", "correct": true}, {"label": "C", "text": "Vestibular neuronitis", "correct": false}, {"label": "D", "text": "Presbycusis", "correct": false}], "correct_answer": "B. Meniers disease", "question_images": ["https://image.prepladder.com/content/3IoaHKR64JVwEi0BuYS11747295086.png"], "explanation_images": ["https://image.prepladder.com/content/eSoSSUcNZoo9688kJKPC1747295141.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with recurrent vomiting undergoes an x-ray, as shown below. What is the most likely electrolyte imbalance in this patient?", "options": [{"label": "A", "text": "Hypokalemia", "correct": true}, {"label": "B", "text": "Hyperkalemia", "correct": false}, {"label": "C", "text": "Hyponatremia", "correct": false}, {"label": "D", "text": "Hypernatremia", "correct": false}], "correct_answer": "A. Hypokalemia", "question_images": ["https://image.prepladder.com/content/O36rOcwSGSGP6KM92Mtl1747288606.png"], "explanation_images": ["https://image.prepladder.com/content/YUK36wfWiBJOLpqs6wCI1747289079.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the required dose adjustment in a person who started anti-tubercular therapy and is already on ART therapy with Tenofovir 200 mg, Dolutegravir 100 mg at night, and Lamivudine 200 mg?", "options": [{"label": "A", "text": "Add tenofovir 200 mg in the morning", "correct": false}, {"label": "B", "text": "Add dolutegravir 100 mg in the morning", "correct": true}, {"label": "C", "text": "No dose adjustment", "correct": false}, {"label": "D", "text": "Add lamivudine 200 mg in the morning", "correct": false}], "correct_answer": "B. Add dolutegravir 100 mg in the morning", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following hormones acts on post ovulatory endometrium?", "options": [{"label": "A", "text": "Luteinizing hormone", "correct": false}, {"label": "B", "text": "Follicular stimulating hormone", "correct": false}, {"label": "C", "text": "Progesterone", "correct": true}, {"label": "D", "text": "Oestrogen", "correct": false}], "correct_answer": "C. Progesterone", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What content is present in the contraceptive shown below?", "options": [{"label": "A", "text": "Nonoxynol-9", "correct": true}, {"label": "B", "text": "Menfegol", "correct": false}, {"label": "C", "text": "Octoxynol-8", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Nonoxynol-9", "question_images": ["https://image.prepladder.com/notes/nfUOuO8uoqwx7hSflCtw1747664975.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which HLA is associated with Reiter syndrome?", "options": [{"label": "A", "text": "HLA-DR3", "correct": false}, {"label": "B", "text": "HLA-B27", "correct": true}, {"label": "C", "text": "HLA-DQ8", "correct": false}, {"label": "D", "text": "HLA- DR4", "correct": false}], "correct_answer": "B. HLA-B27", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is characteristic of hypovolemic shock?", "options": [{"label": "A", "text": "Increase in cardiac output", "correct": false}, {"label": "B", "text": "High vascular resistance", "correct": true}, {"label": "C", "text": "Increase in venous pressure", "correct": false}, {"label": "D", "text": "Increased mixed venous saturation", "correct": false}], "correct_answer": "B. High vascular resistance", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Shock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiac Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mean Arterial Pressure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypovolemic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>↑</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cardiogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Distributive(Septic, anaphylactic, neurogenic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑ or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓ or N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Obstructive (pulmonary embolism, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tamponade, tension pneumothorax)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">↓</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child is got to the OPD with complaints of poor appetite and failure to thrive. Upon further clinical examination, loss of skin turgor, and dry mucous membranes are noted. What is the glucose content of the rehydration solution used to treat this condition?", "options": [{"label": "A", "text": "100 mmol/L", "correct": false}, {"label": "B", "text": "125 mmol/L", "correct": true}, {"label": "C", "text": "150 mmol/L", "correct": false}, {"label": "D", "text": "200 mmol/L", "correct": false}], "correct_answer": "B. 125 mmol/L", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Composition of <span class=\"customMeta\" data-dictid=\"ffe9347bcc169277719793b2de1c6d\">Rehydration</span> Solutions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resomal (300 mOsm/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Standard <span class=\"customMeta\" data-dictid=\"dba8ab2e8416927771945fed398293\">ORS</span> (311 mOsm/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reduced Osmolarity <span class=\"customMeta\" data-dictid=\"dba8ab2e8416927771945fed398293\">ORS</span> (245 mOsm/L)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sodium</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>45 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>90 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>75 mmol/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>40 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20 mmol/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chloride</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>70 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>80 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>65 mmol/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Citrate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 mmol/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>125 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>111 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>75 mmol/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Zinc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>40 μmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Copper</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>70 μmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Magnesium</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 mmol/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Total Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>300 mOsm/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>311 mOsm/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>245 mOsm/L</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following cataracts is seen in blunt trauma?", "options": [{"label": "A", "text": "Rosette cataract", "correct": true}, {"label": "B", "text": "Toxic cataract", "correct": false}, {"label": "C", "text": "Metabolic cataract", "correct": false}, {"label": "D", "text": "Nuclear cataract", "correct": false}], "correct_answer": "A. Rosette cataract", "question_images": ["https://image.prepladder.com/content/65vOMJmTZ6DlljuZS8u61747305522.png"], "explanation_images": ["https://image.prepladder.com/content/HK9WeG4LrANScrK7iGai1747305701.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer presents with a lesion on his arm after working with cattle on his farm. Gram staining of a sample from the lesion reveals gram-positive rods with square ends and central spores. What is the most likely organism causing this lesion?", "options": [{"label": "A", "text": "Brucella abortus", "correct": false}, {"label": "B", "text": "Pseudomonas aeruginosa", "correct": false}, {"label": "C", "text": "Bacillus anthracis", "correct": true}, {"label": "D", "text": "Bacillus cereus", "correct": false}], "correct_answer": "C. Bacillus anthracis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/e2M18nGwRMqiNJuy4BMg1747292276.png", "https://image.prepladder.com/content/uqfU1q5ddpAZ5hZEHnTt1747292276.png", "https://image.prepladder.com/content/IfnSzGpDyjJrDRf81rnQ1747292276.png", "https://image.prepladder.com/content/uljtBiiLcEsCbugGMGdV1747292276.png", "https://image.prepladder.com/content/nFOD9RPonVvzUWNEYpjj1747292276.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bacillus Anthracis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"BruceBlaus\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bacillus_Anthracis.png\" data-tags=\"\" height=\"325\" src=\"https://image.prepladder.com/content/uqfU1q5ddpAZ5hZEHnTt1747292276.png\" width=\"325\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bacillus anthracis appears as <strong>large (3-10 µm x 1-1.6 µm), rectangular, rod-shaped </strong>bacteria (<strong>“box-car appearance”</strong>), often arranged in chains. It is Gram-positive.</p>\n<p>It is</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Blood Agar</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Sidwa, Tom &amp; Salzer, Johanna &amp; Traxler, Rita &amp; Swaney, Erin &amp; Sims, Marcus &amp; Bradshaw, Pam &amp; O’Sullivan, Briana &amp; Parker, Kathy &amp; Waldrup, Kenneth &amp; Bower, William &amp; Hendricks, Kate.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Bacillus-anthracis-24-hour-growth-on-sheep-blood-agar-from-a-swab-of-a-cutaneous-anthrax_fig3_346840702\" data-tags=\"\" height=\"215\" src=\"https://image.prepladder.com/content/IfnSzGpDyjJrDRf81rnQ1747292276.png\" width=\"220\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Large (2 to 5 mm), grey, flat,<strong> non-hemolytic</strong> colonies with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> margins- giving a <strong>frosted glass appearance</strong>.</li>\n<li>Tenacious <span class=\"customMeta\" data-dictid=\"bb67ce71481692777185f0e078535f\">consistency</span> firmly adheres to agar.</li>\n<li><strong>\"Medusa head\" appearance</strong> under microscope.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Agar with Penicillin</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Megan Mathias and J. Todd Parker, USCDCP\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bacillus_anthracis_plate.jpg\" data-tags=\"\" height=\"197\" src=\"https://image.prepladder.com/content/uljtBiiLcEsCbugGMGdV1747292276.png\" width=\"219\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Susceptible to penicillin.</li>\n<li>Grows large, spherical cells in 3-6 hours on media with 0.05-0.50 units of penicillin/ml.</li>\n<li>Forms <strong>\"string of pearls\"</strong> chains.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Gelatin Liquefaction</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.brainkart.com/article/Properties-of-the-Bacteria-Bacillus-anthracis_18066/#google_vignette\" data-tags=\"\" height=\"182\" src=\"https://image.prepladder.com/content/nFOD9RPonVvzUWNEYpjj1747292276.png\" width=\"219\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Obligate aerobe.</li>\n<li>More growth and energy production at the surface.</li>\n<li>Liquefaction starts from the top, resembling an <strong>\"inverted fir tree\". </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>PLET Medium</p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Contains polymyxin, lysozyme, EDTA, and <span class=\"customMeta\" data-dictid=\"7a2238c8b81692777200f92806ac4f\">thallous</span> <span class=\"customMeta\" data-dictid=\"47765053a81692777180738f50cd4e\">acetate</span> in heart <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> (PLET)</li>\n<li>Selective for isolating B. anthracis from samples with other spore-forming bacilli.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Serology</p>\n<p> </p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Ascoli's Thermoprecipitin Test: Detects <span class=\"customMeta\" data-dictid=\"00f05eda23169277718196fcb2f71f\">anthrax</span> antigens in tissue extracts.</li>\n<li>DFA: Detects antibodies against B. anthracis; confirms presence via <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> <span class=\"customMeta\" data-dictid=\"aea912322316927771960b320d4f65\">polysaccharide</span> and <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> antigens.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Laboratory Safety Note</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>High risk of infection from spores.</li>\n<li>Caution is advised when handling B.anthracis isolates.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old male with a history of multiple episodes of vomiting, binge drinking, and heavy meals presents to the emergency department with sudden onset of severe left-sided chest pain radiating to the left shoulder. Pneumoperitoneum is noted on X-ray. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Mediastinal air leak", "correct": false}, {"label": "B", "text": "Esophageal perforation", "correct": true}, {"label": "C", "text": "Pneumoperitoneum", "correct": false}, {"label": "D", "text": "Peptic ulcer", "correct": false}], "correct_answer": "B. Esophageal perforation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0gI7BBSgf6oKJ27Petjn1747644174.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Esophageal perforation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A breach in the <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> wall leads to leakage and increased <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iatrogenic injury, <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> (Boerhaave's syndrome), foreign bodies, <span class=\"customMeta\" data-dictid=\"16a98a214c16927771852d7f6c344e\">corrosive</span> substances, <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> esophagitis, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Varies by cause and location:</li>\n<li>Iatrogenic (recent instrumentation)</li>\n<li>Boerhaave's (vomiting, chest pain, emphysema)</li>\n<li>Cervical (neck pain, etc.)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imaging: Chest X-ray, contrast swallow studies, CT scan</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Boerhaave syndrome\" data-author=\"Fatt Yang Chew and Su-Tso Yang\" data-hash=\"12935\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.cmaj.ca/content/193/38/e1499\" data-tags=\"May2025\" height=\"404\" src=\"https://image.prepladder.com/notes/0gI7BBSgf6oKJ27Petjn1747644174.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seal perforation, ensure drainage, supportive measures (nutrition, <span class=\"customMeta\" data-dictid=\"1b798ee2c21692777183440eb9102c\">cardiorespiratory</span> support, <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> control)</li>\n<li>Conservative Management: Suitable for stable patients: antibiotics, nil by mouth, observation</li>\n<li>Endoscopic Interventions: Visualization, retrieval, sealing with clips/stents, <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube placement</li>\n<li>Surgical Intervention: Required for significant sepsis, large perforations, pleural involvement, delayed presentation</li>\n<li>Surgical Options: Primary repair, controlled <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> creation, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> diversion, <span class=\"customMeta\" data-dictid=\"5871c6089b1692777187961e72bc82\">esophagectomy</span> (rare)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer has a lesion on the shoulder. What is the most likely diagnosis based on the histopathological image of the lesion given below?", "options": [{"label": "A", "text": "SCC", "correct": true}, {"label": "B", "text": "BCC", "correct": false}, {"label": "C", "text": "Molluscum contagiosum", "correct": false}, {"label": "D", "text": "Verrucous carcinoma", "correct": false}], "correct_answer": "A. SCC", "question_images": ["https://image.prepladder.com/content/Jq3D4388cjNMfpwqbShp1747306445.png"], "explanation_images": ["https://image.prepladder.com/content/idQTUZuPby4Qks4tN5pq1747306472.png", "https://image.prepladder.com/content/Kx9VMl8r6eW3j2Jd3B5v1747306486.png", "https://image.prepladder.com/content/0g8cKYfLD2WfwPwVXJDU1747306486.png", "https://image.prepladder.com/content/4hud84PweK4l35PUioTP1747306486.png", "https://image.prepladder.com/notes/lDc4XlehiY5WnSvHcGes1747649760.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the histopathological image.", "options": [{"label": "A", "text": "Basal cell carcinoma", "correct": true}, {"label": "B", "text": "Squamous cell carcinoma", "correct": false}, {"label": "C", "text": "Adenocarcinoma", "correct": false}, {"label": "D", "text": "Malignant melanoma", "correct": false}], "correct_answer": "A. Basal cell carcinoma", "question_images": ["https://image.prepladder.com/content/Bj3fM8BqWNhokkG1AakI1747306559.png"], "explanation_images": ["https://image.prepladder.com/content/6b4WxcLKvC6Q5hv5EeKY1747306600.png", "https://image.prepladder.com/notes/HhYRWZ44O7luHH14x19N1747649979.png", "https://image.prepladder.com/content/jg4eWusGgmN986sXelQd1747306600.png", "https://image.prepladder.com/content/1GmIiOY1Kmty8xEAf8Bh1747306600.png", "https://image.prepladder.com/notes/z6rdo0SbR8eQtrb3eFGs1747650219.png", "https://image.prepladder.com/notes/QWhTQENOyvMx5Jvlb7xC1747650179.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Acute liver failure is a clinical feature of which of the following?", "options": [{"label": "A", "text": "OP poisoning", "correct": false}, {"label": "B", "text": "Amanita Phalloides poisoning", "correct": true}, {"label": "C", "text": "Belladonna poisoning", "correct": false}, {"label": "D", "text": "Morphine poisoning", "correct": false}], "correct_answer": "B. Amanita Phalloides poisoning", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:652px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Early mushroom poisoning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Late mushroom poisoning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hallucinogenic mushroom poisoning</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Species</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inocybe</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Amanita phalloides</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Amanita muscaria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Toxin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Muscarine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Amatoxin <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Muscimol</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cholinergic symptoms (DUMBBELLS)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hepatotoxicity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hallucinations, seizures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atropine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thioctic acid</p>\n<p>Silibinin</p>\n<p>(hepatoprotective)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supportive treatment</p>\n<p>ATROPINE CONTRAINDICATED</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with a bulky scrotal swelling. On evaluation, malignancy is suspected, and an orchidectomy is performed. The gross section of the testicular mass is shown in the image. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Seminoma", "correct": true}, {"label": "B", "text": "Teratoma", "correct": false}, {"label": "C", "text": "Yolk sac tumour", "correct": false}, {"label": "D", "text": "Endodermal sinus tumor", "correct": false}], "correct_answer": "A. Seminoma", "question_images": ["https://image.prepladder.com/notes/MNMZZlW7sZT2JM3bgzHt1747643957.png"], "explanation_images": ["https://image.prepladder.com/content/OpZHQV4Cy0CyIqqh1eq01747293245.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seminoma, the most common pure testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumour in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> aged 25-45</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Germinal <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> of the <span class=\"customMeta\" data-dictid=\"1406286c02169277719897928fb9f1\">seminiferous</span> tubules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless, firm <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or mass in the testicle, typically unilateral. Accounts for 50% of all testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumors. 10% have secondary hydrocele, 5% have gynecomastia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>AFP: Normal</p>\n<p>hCG: Normal or mildly elevated</p>\n<p>LDH: Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ultrasound: Homogeneous, <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> mass</p>\n<p>Histology: Sheets of <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> cells with clear cytoplasm, large <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> with prominent <span class=\"customMeta\" data-dictid=\"829d67cd9816927771800b7303f9cc\">acidophilic</span> nucleoli</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Seminoma_high_mag.jpg#mw-jump-to-license\" data-tags=\"\" height=\"675\" src=\"https://image.prepladder.com/content/OpZHQV4Cy0CyIqqh1eq01747293245.png\" width=\"675\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>FNAC: Contraindicated due to risk of tumor cell seeding and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary: High Inguinal Radical Orchidectomy</p>\n<p>Adjuvant: Radiation therapy or <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> for positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tumor marker</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of Tumor</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>AFP (Alpha-fetoprotein)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> tumor</li>\n<li>Embryonal carcinoma</li>\n<li>Teratoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HCG (Human Chorionic Gonadotropin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Choriocarcinoma</li>\n<li>Embryonal carcinoma</li>\n<li>Mixed Germ Cell Tumor</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LDH (Lactate Dehydrogenase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seminoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PLAP (Placenta Like Alkaline Phosphatase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seminoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GGT (Gamma Glutamyl Transpeptidase)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seminoma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where does the majority of water absorption occur within the renal tubules?", "options": [{"label": "A", "text": "Proximal Convoluted Tubule (PCT)", "correct": true}, {"label": "B", "text": "Distal Convoluted Tubule (DCT)", "correct": false}, {"label": "C", "text": "Loop of Henle (LOH)", "correct": false}, {"label": "D", "text": "Collecting Duct", "correct": false}], "correct_answer": "A. Proximal Convoluted Tubule (PCT)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nephron Segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tonicity relative to Plasma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Filtration (Glomerulus)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Isotonic (Same as <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolality)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Proximal Convoluted <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">Tubule</span> (PCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Isotonic</p>\n<ul>\n<li>Absorption of <span class=\"customMeta\" data-dictid=\"6fe354b91616927771982cc53f71fc\">solute</span> is proportional to the <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of water.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thin Descending Limb </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertonic (Water reabsorption, no <span class=\"customMeta\" data-dictid=\"6fe354b91616927771982cc53f71fc\">solute</span> reabsorption)</p>\n<ul>\n<li>Isotonic - - - - -&gt; Hypertonic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thick Ascending Limb </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Isotonic (Solute reabsorption, no water reabsorption)</p>\n<ul>\n<li>Hypertonic - - - - - &gt; Isotonic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distal Convoluted <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">Tubule</span> (DCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypotonic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Collecting <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> (CD) </strong></p>\n<p>It depends upon the presence of ADH in the blood</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>With ADH, </strong>more <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of water and Hypertonic.</li>\n<li><strong>Without ADH, </strong>water <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> is nil, which i<strong>s more</strong> hypotonic.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The hysterosalpingogram of a patient shows fluid-filled S-shaped structures on both sides. Choose the best answer correlating to this finding.", "options": [{"label": "A", "text": "Normal HSG", "correct": false}, {"label": "B", "text": "Bilateral cornual block", "correct": false}, {"label": "C", "text": "Extravasation into venous system", "correct": false}, {"label": "D", "text": "Bilateral hydrosalpinx", "correct": true}], "correct_answer": "D. Bilateral hydrosalpinx", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/sJ1pZQVEJ3pxsL38GZdX1747666881.png", "https://image.prepladder.com/notes/Qmf7fGFg762bGmafnGzR1747667018.png", "https://image.prepladder.com/notes/epnkm8RV5U7GsKyMo8Kb1747667058.png", "https://image.prepladder.com/notes/vudlM4lJjSql6vj3OoKm1747667132.png", "https://image.prepladder.com/notes/9jovPWWKuE1z7NMv5qLh1747667187.png", "https://image.prepladder.com/notes/ionXatMbPxImFFKm5qor1747667615.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a foul smell from the nose, anosmia, and nasal obstruction. The following is noted during examination. What is the diagnosis?", "options": [{"label": "A", "text": "Atrophic rhinitis", "correct": true}, {"label": "B", "text": "Rhinitis sicca", "correct": false}, {"label": "C", "text": "Rhinitis medicamentosa", "correct": false}, {"label": "D", "text": "Allergic rhinitis", "correct": false}], "correct_answer": "A. Atrophic rhinitis", "question_images": ["https://image.prepladder.com/content/tTAP6NJyjhdatSHH2W7g1747295267.png"], "explanation_images": ["https://image.prepladder.com/content/EJSsIL19e02uHYQoYt4o1747295293.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old pregnant female in her first trimester presents to the OPD for a regular antenatal checkup. During blood type screening, potential ABO incompatibility is discussed. The healthcare provider explains that certain antibody types are less concerning than others during pregnancy. ABO incompatibility does not occur due to which antibody in her case?", "options": [{"label": "A", "text": "IgA", "correct": false}, {"label": "B", "text": "IgG", "correct": false}, {"label": "C", "text": "IgD", "correct": false}, {"label": "D", "text": "IgM", "correct": true}], "correct_answer": "D. IgM", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following antidiabetic drugs can cause glucosuria?", "options": [{"label": "A", "text": "Glimepiride", "correct": false}, {"label": "B", "text": "Exenatide", "correct": false}, {"label": "C", "text": "Acarbose", "correct": false}, {"label": "D", "text": "Empagliflozin", "correct": true}], "correct_answer": "D. Empagliflozin", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Sodium-glucose co-transporter 2 (SGLT2) Inhibitors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Canagliflozin</li>\n<li>Dapagliflozin</li>\n<li>Empagliflozin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mechanism of Action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Blocks <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule, promoting the <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of sodium and <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> in urine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Reduce <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease (CKD)</li>\n<li>Diuretic effect, leading to sodium loss</li>\n<li>Reduces <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> (SBP) by 3-6 mmHg</li>\n<li>Cardiorenal advantage</li>\n<li>CHF to decrease mortality with or without DM</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Increased risk of <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections (UTIs)</li>\n<li>Glucosuria (leading to UTIs and <span class=\"customMeta\" data-dictid=\"b0b814e5441692777202c969196f0e\">vulvovaginal</span> candidiasis)</li>\n<li>Dehydration (orthostatic hypotension)</li>\n<li>Weight loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Not recommended if estimated <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> rate (eGFR) &lt; 45 ml/min</li>\n<li>Use with caution in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> (decreased <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> with decreased GFR)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Iron absorption is decreased in which of the following?", "options": [{"label": "A", "text": "Amla", "correct": false}, {"label": "B", "text": "Sprouting", "correct": false}, {"label": "C", "text": "Tea", "correct": true}, {"label": "D", "text": "Lemon", "correct": false}], "correct_answer": "C. Tea", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A group of people are travelling to the mountains, and a girl starts complaining of mountain sickness. What is the drug of choice?", "options": [{"label": "A", "text": "Promethazine", "correct": false}, {"label": "B", "text": "Acetazolamide", "correct": true}, {"label": "C", "text": "Dimenhydrinate", "correct": false}, {"label": "D", "text": "Thiazide", "correct": false}], "correct_answer": "B. Acetazolamide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A family died in a closed room that was full of smoke from a wood fire. Which of the following findings is likely to be seen on the body?", "options": [{"label": "A", "text": "Cherry red hypostasis", "correct": true}, {"label": "B", "text": "Cyanosis", "correct": false}, {"label": "C", "text": "Blackish discoloration", "correct": false}, {"label": "D", "text": "Brown colored pigmentation", "correct": false}], "correct_answer": "A. Cherry red hypostasis", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:466px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Poison</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Postmortem <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">Staining</span> Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Opium (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Purple or blackish staining</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carbon <span class=\"customMeta\" data-dictid=\"03077f6c8716927771923763487a9e\">monoxide</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cherry red discoloration (COHb &gt; 30%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hydrogen <span class=\"customMeta\" data-dictid=\"0e84bc8bb5169277719934af06eb80\">sulfide</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Greenish discoloration in tissues</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Datura</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asphyxial signs (no specific color)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Organochlorine/Kerosene </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asphyxial signs (no specific color)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phosphates, aniline, and nitrites (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Brown-colored pigmentation</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Carbon Monoxide</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Odourless, colorless, non-irritating gas, lighter than air</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sources of Poisoning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Incomplete <span class=\"customMeta\" data-dictid=\"260cad33301692777184652a5acd7d\">combustion</span> </strong>of almost of fuel (wood, charcoal, gas, kerosene)</li>\n<li>Automobile exhaust</li>\n<li>Fires: A common cause of <span class=\"customMeta\" data-dictid=\"fb7ff97e071692777180252299cf10\">accidental</span> <span class=\"customMeta\" data-dictid=\"44758fcec31692777184e24fa84582\">CO</span> <span class=\"customMeta\" data-dictid=\"072b8af16e1692777196f21b086f92\">poisoning</span> resulting in mass deaths - large building (hotel, theatre, block of flats, etc.) in flames</li>\n<li>Paint remover (especially <span class=\"customMeta\" data-dictid=\"f1f83adcbd1692777192944952fb13\">methylene</span> chloride)</li>\n<li>Tobacco smoke</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"44758fcec31692777184e24fa84582\">CO</span> level in plasma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>1 to 5 %</li>\n<li>7 to 8 % in smokers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mode of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>230 to 270 times greater affinity</strong> for <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> than oxygen</li>\n<li>Leftward shift of the <span class=\"customMeta\" data-dictid=\"fe0bb103fc1692777194ee9f85bd86\">oxyhemoglobin</span> <span class=\"customMeta\" data-dictid=\"18fb34ab321692777186e9bc95a726\">dissociation</span> curve</li>\n<li>Reduced arterial oxygen content</li>\n<li>Inactivating mitochondrial <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> - <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"aea081ceb416927771976e2c17be74\">respiration</span> is interfered</li>\n<li>CO-induced brain injuries are common in <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia, cerebral white matter, hippocampus, and cerebellum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Depends on the concentration of <span class=\"customMeta\" data-dictid=\"44758fcec31692777184e24fa84582\">CO</span> in the blood</li>\n<li>CO exposure during pregnancy is teratogenic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carboxyhemoglobin level (COHb) in blood</li>\n<li>Arterial blood gases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Oxygen (100%)</strong> through a tight-fitting mask or <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> tube, until COHb falls to 15 to 20%</li>\n<li><strong>Hyperbaric oxygen:</strong> Inhalation of oxygen at a pressure greater than 1 atmosphere absolute</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Autopsy Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cherry red (pink) color</strong> of skin, inner aspects of lips, nail beds, tongue, palms and soles</li>\n<li><strong>Cutaneous bullae</strong> (skin blisters) in the calves, buttocks, wrists, and knees</li>\n<li>Cherry pink color of blood and tissues</li>\n<li>Firmer <span class=\"customMeta\" data-dictid=\"faffdfe705169277720242bf7ee9b5\">white matter</span> of the brain</li>\n<li>Necrosis and <span class=\"customMeta\" data-dictid=\"6e3d0adac31692777183113e8b2e05\">cavitation</span> of <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which Leopold's maneuver is done to assess the lie of the fetus?", "options": [{"label": "A", "text": "Leopold's 1", "correct": true}, {"label": "B", "text": "Leopold's 2", "correct": false}, {"label": "C", "text": "Leopold's 3", "correct": false}, {"label": "D", "text": "Leopold's 4", "correct": false}], "correct_answer": "A. Leopold's 1", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hjozys3GueQ0MQzlE3Ml1747287052.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Maneuver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hand Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First (Fundal Grip)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both hands on <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> <span class=\"customMeta\" data-dictid=\"c4e40f33721692777202dd7486f4f4\">facing</span> patient</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Determines <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> presentation and position</p>\n<p>Identifies <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> parts (head or buttocks)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Head: Hard, round</p>\n<p>Breech: Soft, irregular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Second (Lateral Grip)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hands placed on sides of abdomen</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Locate <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> back and limbs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Back: Smooth surface</p>\n<p>Limbs: Small knob-like parts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Third (Deep Pelvic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thumb and fingers grasp above <span class=\"customMeta\" data-dictid=\"48b6a0a5fb1692777199da12372b14\">symphysis</span> pubis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Identify presenting part</p>\n<p>Determines if head is engaged</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Head: Hard, round</p>\n<p>Breech: Soft, irregular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fourth (Pelvic Grip)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Facing patient's feet, fingers pressed downward</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assess engagement</p>\n<p>Confirms <span class=\"customMeta\" data-dictid=\"3b78d9438716927771841c88afb16c\">cephalic</span> prominence</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Engaged: Fixed part</p>\n<p>Not engaged: Mobile part</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Anencephaly occurs due to the inability of the neural tube to close at which week of intrauterine life?", "options": [{"label": "A", "text": "3rd week", "correct": false}, {"label": "B", "text": "4th week", "correct": true}, {"label": "C", "text": "5th week", "correct": false}, {"label": "D", "text": "2nd week", "correct": false}], "correct_answer": "B. 4th week", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/w8C3pfzaqJDc78PzuYen1747668095.png", "https://image.prepladder.com/notes/P1fLVV0g9Pb8twbgVSFU1747668112.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vitamin acts as a coenzyme required for Glucose-6-Phosphate Dehydrogenase (G6PD)?", "options": [{"label": "A", "text": "Riboflavin", "correct": false}, {"label": "B", "text": "Thiamine", "correct": false}, {"label": "C", "text": "Niacin", "correct": true}, {"label": "D", "text": "Biotin", "correct": false}], "correct_answer": "C. Niacin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Niacin (Vitamin B3)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chemical Structure</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Niacin</strong>: Pyridine-3-carboxylic acid.</li>\n<li><strong>Niacinamide</strong>: Acid <span class=\"customMeta\" data-dictid=\"893810d3d51692777181098ec45a2b\">amide</span> derivative.</li>\n<li>Active tissue form: Niacinamide</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coenzyme Forms and Functions</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>NAD+</strong>: Generates 2.5 ATPs in <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> phosphorylation.</li>\n<li><strong>NADPH</strong>: Used in reductive <span class=\"customMeta\" data-dictid=\"859a34e1061692777183872a5e4441\">biosynthesis</span> (e.g., <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid synthesis).</li>\n<li>Provides ADP-ribose for protein <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> (ADP-ribosylation).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Synthesis and Metabolism</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>60 mg of <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> = 1 mg niacin</strong> (requires <span class=\"customMeta\" data-dictid=\"ad5806d5ad1692777196f1158adc4e\">pyridoxal</span> phosphate-dependent kynureninase).</li>\n<li>Niacin attaches to <span class=\"customMeta\" data-dictid=\"387285772b16927771979217d6cd30\">ribose</span> phosphate, forming a mononucleotide, then combines with AMP to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> dinucleotides.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deficiency Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dietary Deficiency: </strong>Staple diets like <strong>maize </strong>(bound niacin) or <strong>sorghum </strong>(leucine inhibits <span class=\"customMeta\" data-dictid=\"acad87464816927771937783e41318\">niacin</span> conversion).</li>\n<li><strong>Enzyme Defects: <span class=\"customMeta\" data-dictid=\"ad5806d5ad1692777196f1158adc4e\">Pyridoxal</span> deficiency</strong> inhibits <span class=\"customMeta\" data-dictid=\"97a025c2cc16927771915cf0fb9618\">kynureninase</span> activity.</li>\n<li><strong>Drugs: Isoniazid </strong>inhibits <span class=\"customMeta\" data-dictid=\"ad5806d5ad1692777196f1158adc4e\">pyridoxal</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> formation.</li>\n<li><strong>Congenital Disorders: Hartnup disease</strong> (impaired <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> and increased <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> excretion).</li>\n<li><strong>Carcinoid Syndrome</strong>: Excess <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> used for <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> synthesis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Condition</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pellagra</strong>: <span class=\"customMeta\" data-dictid=\"acad87464816927771937783e41318\">Niacin</span> or <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> causing<strong> \"rough skin\".</strong></li>\n<li><strong>Symptoms (3 Ds): Dermatitis (Casal’s necklace), Diarrhea (may involve blood/mucus), Dementia (irritability, poor memory, delirium).</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sources</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Richest: Dried yeast, rice </strong></li>\n<li><strong>, liver, peanuts, cereals, legumes, meat, fish.</strong></li>\n<li>50% requirement <span class=\"customMeta\" data-dictid=\"fffe8d8cdd169277719212053c343d\">met</span> by <span class=\"customMeta\" data-dictid=\"059bdf5c031692777200fedbf3ef66\">tryptophan</span> conversion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RDA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adults<strong>: 20 mg/day</strong>; Additional 5 mg during lactation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Therapeutic Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lowers <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> cholesterol and Lp(a) by reducing free <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid <span class=\"customMeta\" data-dictid=\"d44646a1d3169277720326043cef85\">flux</span> from <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Excess (&gt;50 mg/day): Vasodilation, itching, liver damage.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which part of renal tubules reabsorbs maximum water in the presence of ADH?", "options": [{"label": "A", "text": "PCT", "correct": false}, {"label": "B", "text": "DCT", "correct": false}, {"label": "C", "text": "Loop of Henle", "correct": false}, {"label": "D", "text": "Collecting duct", "correct": true}], "correct_answer": "D. Collecting duct", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nephron Segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tonicity relative to Plasma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Filtration (Glomerulus)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Isotonic (Same as <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolality)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Proximal Convoluted Tubule (PCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Isotonic</p>\n<ul>\n<li>Absorption of <span class=\"customMeta\" data-dictid=\"6fe354b91616927771982cc53f71fc\">solute</span> is proportional to the <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of water.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thin <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">Descending</span> Limb </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertonic (Water reabsorption, no <span class=\"customMeta\" data-dictid=\"6fe354b91616927771982cc53f71fc\">solute</span> reabsorption)</p>\n<ul>\n<li>Isotonic - - - - -&gt; Hypertonic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thick <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">Ascending</span> Limb </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Isotonic (Solute reabsorption, no water reabsorption)</p>\n<ul>\n<li>Hypertonic - - - - - &gt; Isotonic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distal Convoluted Tubule (DCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypotonic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Collecting <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> (CD) </strong></p>\n<p>It depends upon the presence of ADH in the blood</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>With ADH, </strong>more <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of water and Hypertonic.</li>\n<li><strong>Without ADH, </strong>water <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> is nil, which i<strong>s more</strong> hypotonic.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the type of hernia in which the internal organ forms a portion of the wall of the hernia sac?", "options": [{"label": "A", "text": "Lumbar hernia", "correct": false}, {"label": "B", "text": "Sliding hernia", "correct": true}, {"label": "C", "text": "Spigelian hernia", "correct": false}, {"label": "D", "text": "Richter hernia", "correct": false}], "correct_answer": "B. Sliding hernia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/rI6t31SgspxXpFkuSnOt1747644898.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: 1. IL-5 A. Regulates acute phase reactants 2. IL-6 B. T cell maturation 3. IL-7 C. Neutrophil recruitment 4. IL-8 D. Eosinophils activation", "options": [{"label": "A", "text": "1-B, 2-C, 3-D, 4-A", "correct": false}, {"label": "B", "text": "1-D, 2-A, 3-B, 4-C", "correct": true}, {"label": "C", "text": "1-C, 2-D, 3-B, 4-A", "correct": false}, {"label": "D", "text": "1-D, 2-C, 3-B, 4-A", "correct": false}], "correct_answer": "B. 1-D, 2-A, 3-B, 4-C", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:513px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>IL-5 (Interleukin-5)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Eosinophils activation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IL-6 (Interleukin-6)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regulates <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> phase reactants</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IL-7 (Interleukin-7)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T cell maturation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IL-8 (Interleukin-8)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neutrophil recruitment</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the ANMOL program for auxiliary nurse midwives?", "options": [{"label": "A", "text": "Tablet-based software", "correct": true}, {"label": "B", "text": "TV based", "correct": false}, {"label": "C", "text": "Newspaper", "correct": false}, {"label": "D", "text": "Telephone-based", "correct": false}], "correct_answer": "A. Tablet-based software", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Shield ulcer is seen in which of the following?", "options": [{"label": "A", "text": "Spring catarrh", "correct": false}, {"label": "B", "text": "Phlyctenular conjunctivitis", "correct": false}, {"label": "C", "text": "Atopic keratoconjunctivitis", "correct": true}, {"label": "D", "text": "Autoimmune Conditions", "correct": false}], "correct_answer": "C. Atopic keratoconjunctivitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/BPAoDMZ3t23m8Aqhos2C1747655806.png", "https://image.prepladder.com/content/jFmZNwlBDa0EJAQZC4vl1747305846.png", "https://image.prepladder.com/content/5V8KoedgsbwriQ3utaPW1747305846.png", "https://image.prepladder.com/content/HVEcGc2MS7CcySdxr4aQ1747305846.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:686px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Vernal <span class=\"customMeta\" data-dictid=\"8b4e6e36bb169277719032f22681c2\">keratoconjunctivitis</span> or Spring catarrh</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>It is a <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"6ce77d5f5e1692777185cf7f8a67cd\">conjunctivitis</span> that tends to occur with the onset of warm weather. It primarily affects young children and adolescents, particularly boys.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Course </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>The condition typically starts in childhood and may resolve on its own over 5–10 years.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Burning, Itching, Photophobia (sensitivity to light), and <span class=\"customMeta\" data-dictid=\"7b8d2e6b3a1692777191cfff333306\">lacrimation</span> (excessive tearing).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Palpebral Form</strong>: Hypertrophied palpebral <span class=\"customMeta\" data-dictid=\"d168af6e7f1692777185683fea5e7f\">conjunctiva</span> with a cobblestone appearance; bluish-white color; dense <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue with thickened epithelium.</li>\n<li><strong>Limbal </strong>or <strong>Bulbar Form</strong>: Opacification at the limbus, <span class=\"customMeta\" data-dictid=\"be6fe9c6c316927771889dbaaf2b89\">gelatinous</span> thickening, and Horner–Trantas dots</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Mucoid nodules and tranta dots\" data-author=\"DeGaulle I. Chigbu, Bisant A. Labib\" data-hash=\"12983\" data-license=\"CC BY 4.0\" data-source=\"https://www.mdpi.com/1424-8247/14/7/658\" data-tags=\"May2025\" height=\"222\" src=\"https://image.prepladder.com/notes/BPAoDMZ3t23m8Aqhos2C1747655806.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Pseudogerontoxon/cupid’s bow (which resembles <span class=\"customMeta\" data-dictid=\"e11c93da8d1692777182758f2163d6\">arcus</span> senilis) is a grayish-white ring at the <span class=\"customMeta\" data-dictid=\"799979f3bc169277719134cd535c7c\">limbus</span> seen in severe <span class=\"customMeta\" data-dictid=\"71928251b41692777191a31e57c47f\">limbal</span> <span class=\"customMeta\" data-dictid=\"b2a2e3ba5c1692777201528ac05837\">vernal</span> <span class=\"customMeta\" data-dictid=\"8b4e6e36bb169277719032f22681c2\">keratoconjunctivitis</span> (VKC).</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Seyfettin Erdem\" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Limbal-type-VKC-pseudogerontoxone-image-palpebral-papilla-64-patients-447-limbal_fig3_336972956\" data-tags=\"\" height=\"279\" src=\"https://image.prepladder.com/content/jFmZNwlBDa0EJAQZC4vl1747305846.png\" width=\"470\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li><strong>Shield ulcers</strong> are a significant <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of VKC, particularly in severe cases. These microerosions typically <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> on the upper third of the cornea.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Yusuke Matsuzaki, Hiroshi Toshida, Toshihiko Ohta, Akira Murakami\" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/Slitlamp-microscopic-image-of-a-25-year-old-man-showing-corneal-shield-ulcer-at-40-days_fig1_236941145\" data-tags=\"\" height=\"311\" src=\"https://image.prepladder.com/content/5V8KoedgsbwriQ3utaPW1747305846.png\" width=\"409\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li><strong>Mixed form: </strong>Exhibits characteristics of both the <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> (palpebral) and <span class=\"customMeta\" data-dictid=\"71928251b41692777191a31e57c47f\">limbal</span> subtypes, typically presenting in only one eye.</li>\n</ul>\n<p><strong>Maxwell Lyon's sign</strong> is a <span class=\"customMeta\" data-dictid=\"a952f661da169277719691c48c8cbe\">pseudomembrane</span> formed due to excessive <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> deposition on the <span class=\"customMeta\" data-dictid=\"0a6b15e83616927771941190f46a83\">papilla</span> resulting in cobblestone papillae.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Alexandre Xavier Costa, José Álvaro Pereira Gomes, Leonardo Guedes Candido Marculino, Vera Lucia Liendo, Telma Pereira Barreiro, Myrna Serapião dos Santos\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Efficacy-of-supratarsal-triamcinolone-injection-after-1-week-on-the-upper-tarsal_fig1_318869687\" data-tags=\"\" height=\"312\" src=\"https://image.prepladder.com/content/HVEcGc2MS7CcySdxr4aQ1747305846.png\" width=\"390\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>In the palpebral form, <strong>hypertrophied </strong>papillae are observed, rich in eosinophils and other <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Topical therapy:</strong>\n<ul>\n<li>Antihistamines - Levocabastine &amp; emedastine</li>\n<li>Mast cell stabilizers - Sodium cromoglicate</li>\n<li>Mild steroids - Fluorometholone and <span class=\"customMeta\" data-dictid=\"1ef009aee816927771912e72480697\">loteprednol</span> etabonate,</li>\n<li>Acetylcysteine can control <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> mucus.</li>\n</ul>\n</li>\n<li><strong>Local therapy</strong>: Subtarsal <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> injections and <span class=\"customMeta\" data-dictid=\"7a2baeba7416927771858fcddc798f\">cryotherapy</span> for severe cases.</li>\n<li><strong>Surgical treatment: </strong>Excision of giant <span class=\"customMeta\" data-dictid=\"c948d4dca7169277719474a468ff5e\">papillae</span> and treatment of <span class=\"customMeta\" data-dictid=\"018fabee35169277719835cd1bf49c\">shield</span> ulcers with debridement and <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> or <span class=\"customMeta\" data-dictid=\"4f62176420169277718214bfcafae5\">bandage</span> contact lens.</li>\n<li>Cold compresses and tinted <span class=\"customMeta\" data-dictid=\"9e8e9086691692777188b5a212bcc7\">glasses</span> for comfort.</li>\n<li>Avoid eye rubbing</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Optic nerve glioma is seen in?", "options": [{"label": "A", "text": "NF-1", "correct": true}, {"label": "B", "text": "Tuberous sclerosis", "correct": false}, {"label": "C", "text": "NF-2", "correct": false}, {"label": "D", "text": "Schwannoma", "correct": false}], "correct_answer": "A. NF-1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Leukocoria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Congenital cataract</li>\n<li>Inflammatory deposits in <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> following a plastic <span class=\"customMeta\" data-dictid=\"fd270d89c016927771857f2dcac3fd\">cyclitis</span> or choroiditis,</li>\n<li>Coloboma of the choroid,</li>\n<li>Retinopathy of prematurity<strong> </strong></li>\n<li>Persistent hyperplastic primary vitreous</li>\n<li>Toxocara endophthalmitis</li>\n<li>Exudative <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">retinopathy</span> of Coats</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endophytic retinoblastoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tuberous sclerosis</li>\n<li><strong>Neurofibromatosis-1 (Option A)</strong></li>\n<li>Astrocytoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Exophytic Retinoblastoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Exudative <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">retinopathy</span> of Coats</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition in a neonate with the swelling of the head shown in the image below at a few weeks of life?", "options": [{"label": "A", "text": "Caput succedaneum", "correct": false}, {"label": "B", "text": "Cephalhematoma", "correct": true}, {"label": "C", "text": "Subgaleal bleed", "correct": false}, {"label": "D", "text": "Encephalocele", "correct": false}], "correct_answer": "B. Cephalhematoma", "question_images": ["https://image.prepladder.com/notes/BFRzz4hE7v5IBT4jSrDk1747668220.png"], "explanation_images": ["https://image.prepladder.com/notes/SrEyx0PtC5WsOaQQ7wi81747668356.png", "https://image.prepladder.com/notes/HIftJ2SqiFeQi3adE3kD1747668483.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Caput <span class=\"customMeta\" data-dictid=\"9a4c3925fe1692777199df9ad74c8a\">succedaneum</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cephalhematoma</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subgaleal <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At point of contact; can extend across sutures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually over <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> bones; does not cross sutures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Beneath epicranial aponeurosis; may extend to orbits, <span class=\"customMeta\" data-dictid=\"dddc9e4fbd16927771932a4f315ee5\">nape</span> of neck</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vaguely demarcated; <span class=\"customMeta\" data-dictid=\"a8c53e6875169277719588cd709854\">pitting</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> that shifts with gravity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distinct margins; initially firm, more <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> after 48 h</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Firm to fluctuant; ill-defined borders; may have <span class=\"customMeta\" data-dictid=\"2483707fe9169277718541a169f5b4\">crepitus</span> or fluid waves</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maximal size and firmness at birth; resolves in 48-72 h</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases after birth for 12-24 h; resolution over 2-3 wk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Progressive after birth; resolution over 2-3 wk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Volume of blood</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely severe</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May be massive, especially if there is an associated coagulopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Linear skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (5-25%); hyperbilirubinemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Ideal thickness of lead aprons to be worn by workers working in radiology department?", "options": [{"label": "A", "text": "0.5mm", "correct": true}, {"label": "B", "text": "1mm", "correct": false}, {"label": "C", "text": "0.75mm", "correct": false}, {"label": "D", "text": "2mm", "correct": false}], "correct_answer": "A. 0.5mm", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/DzEryrKxzl44pOEfupPe1747656526.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 8-year-old child with a history of GTCS came with an episode of convulsions for more than 45 minutes. What will be the appropriate management for this patient?", "options": [{"label": "A", "text": "Lorazepam followed by levetiracetam", "correct": true}, {"label": "B", "text": "Valproate followed by gabapentin", "correct": false}, {"label": "C", "text": "Carbamazepine followed by lorazepam", "correct": false}, {"label": "D", "text": "Levetiracetam followed by valproate", "correct": false}], "correct_answer": "A. Lorazepam followed by levetiracetam", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zLthToiJueyjVjgJFVAs1747295716.png", "https://image.prepladder.com/notes/JYUAe9j4BLAKRJ35iSc91747663677.png", "https://image.prepladder.com/notes/VJTut5lrv4lOfpNdEarU1747663700.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of seizure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anti-epileptic drug</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Partial or <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> seizure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lamotrigine</li>\n<li>Oxcarbazepine</li>\n<li>Eslicarbazepine</li>\n<li>Carbamazepine</li>\n<li>Phenytoin</li>\n<li>Levetiracetam</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generalized <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">tonic</span> clonic seizure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Valproate</li>\n<li>Lamotrigine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absence seizure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ethosuximide</li>\n<li>Valproate</li>\n<li>Lamotrigine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Febrile seizure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diazepam (rectal) (drug of choice)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Status epilepticus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lorazepam (drug of choice)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Juvenile myoclonic <span class=\"customMeta\" data-dictid=\"7546d26cea1692777187c257d4e14c\">epilepsy</span> (Janz syndrome)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug of choice: Valproate &gt; Lamotrigine &gt; Topiramate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lennox Gestaut syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Valproate (first line drug)</strong></p>\n<p style=\"text-align: center;\"><img alt=\"Lennox Gestaut \" data-author=\"\" data-hash=\"13024\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"598\" src=\"https://image.prepladder.com/notes/JYUAe9j4BLAKRJ35iSc91747663677.png\" width=\"300\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dravet's syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Valproate (drug of choice)</strong></p>\n<p style=\"text-align:center\"><img alt=\"Dravet syndrome management\" data-author=\"\" data-hash=\"13025\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"104\" src=\"https://image.prepladder.com/notes/VJTut5lrv4lOfpNdEarU1747663700.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infantile <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> ( also known as West syndrome or Hypsarrhythmia)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Occasional episodes: </strong></p>\n<ul>\n<li><strong>Drug of choice: ACTH hormone +/- glucocorticoids</strong></li>\n</ul>\n<p> </p>\n<p><strong>Associated with <span class=\"customMeta\" data-dictid=\"93b7b2cfd31692777201efc538e5a2\">tuberous</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> (lifelong seizures):</strong></p>\n<ul>\n<li><strong>Drug of choice: Vigabatrin</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pregnancy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Levetiracetam (safest in pregnancy)</strong></li>\n<li>Lamotrigine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve is most commonly injured during indirect inguinal hernia surgery?", "options": [{"label": "A", "text": "Femoral nerve", "correct": false}, {"label": "B", "text": "Genitofemoral nerve", "correct": false}, {"label": "C", "text": "Obturator nerve", "correct": false}, {"label": "D", "text": "Ilioinguinal nerve", "correct": true}], "correct_answer": "D. Ilioinguinal nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic patient came to the outpatient department with complaints of fatigue and frequent urination. On examination vitals are stable and an HbA1c is done. What is the cut-off percentage used for determining controlled diabetes?", "options": [{"label": "A", "text": "6.0", "correct": false}, {"label": "B", "text": "6.5", "correct": false}, {"label": "C", "text": "7.0", "correct": true}, {"label": "D", "text": "7.5", "correct": false}], "correct_answer": "C. 7.0", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 1-month-old infant presents with immediate crying after breastfeeding, accompanied by diarrhea and vomiting. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Lactose Intolerance", "correct": false}, {"label": "B", "text": "Duodenal Atresia", "correct": false}, {"label": "C", "text": "Galactosemia", "correct": true}, {"label": "D", "text": "Pyloric Stenosis", "correct": false}], "correct_answer": "C. Galactosemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Galactosemia </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Galactose-1-phosphate uridylyltransferase (GALT) - <strong>Classical type</strong></li>\n<li>Galactokinase- <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> disease with only oil drop cataract.</li>\n<li>Epimerase- SNHL + symptoms of classical type</li>\n</ul>\n<p>(Low galactose-based diet can be given which is contraindicated in the classical type)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Accumulation of galactose-1-phosphate <strong>(toxic causing jaundice, and liver damage)</strong></li>\n<li>Inability to metabolize <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> from milk</li>\n<li>Damage to liver, kidney, and brain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatic: Jaundice, hepatomegaly</li>\n<li>GI: Vomiting, diarrhea, failure to thrive</li>\n<li>CNS: Seizures, intellectual disability</li>\n<li>Eyes: Oil drop cataracts</li>\n<li>Increased risk of E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> sepsis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reducing substance in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (positive)( Positive Benedict test but negative <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> test)</li>\n<li>Direct <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> (GALT) assay</li>\n<li>Genetic testing <strong>(Perinatal diagnosis is possible)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lactose-free diet</li>\n<li>Breast Milk contraindicated</li>\n<li>Soy-based or elemental formulas</li>\n<li>Calcium supplementation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following anti-tubercular drugs is associated with visual disturbances?", "options": [{"label": "A", "text": "Rifampicin", "correct": false}, {"label": "B", "text": "Streptomycin", "correct": false}, {"label": "C", "text": "Pyrazinamide", "correct": false}, {"label": "D", "text": "Ethambutol", "correct": true}], "correct_answer": "D. Ethambutol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ethambutol</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits <strong>arabinosyl transferases</strong> involved in arabinogalactan synthesis, thereby <span class=\"customMeta\" data-dictid=\"653140d1dc16927771903445309f4e\">interfering</span> with mycolic acid <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> in cell wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutation of <strong>embAB genes, </strong>which encodes the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> <strong>arabinosyl transferase,</strong> reducing its <span class=\"customMeta\" data-dictid=\"227269f3ec1692777180d76a7898dd\">affinity</span> for ethambutol</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In the treatment of</p>\n<ul>\n<li>Mycobacterium tuberculosis</li>\n<li>Mycobacterium avium complex (MAC)</li>\n<li>Mycobacterium kansasii</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless loss of vision\n\t\t\t\t<ul>\n<li>Field defects due to <strong>retrobulbar neuritis</strong></li>\n<li>Loss of visual acuity</li>\n<li><strong>Red-green colour blindness</strong></li>\n</ul>\n</li>\n<li>Nausea, rashes, fever</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following oxygen-sensitive channels is present in peripheral chemoreceptors?", "options": [{"label": "A", "text": "K+", "correct": true}, {"label": "B", "text": "Na+", "correct": false}, {"label": "C", "text": "Ca++", "correct": false}, {"label": "D", "text": "Cl-", "correct": false}], "correct_answer": "A. K+", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An infant presents to the Pediatrics OPD with a distended abdomen and jaundice. The mother reports that the baby has shown an increased appetite in recent months. During the clinical examination, the physician notes hepatomegaly. Which of the following enzyme deficiencies is most likely responsible for this condition?", "options": [{"label": "A", "text": "Glycogen Synthase", "correct": false}, {"label": "B", "text": "Glycogen phosphorylase", "correct": false}, {"label": "C", "text": "Glucose-6-Phosphatase", "correct": false}, {"label": "D", "text": "Galactose-1-Phosphate Uridyl Transferase", "correct": true}], "correct_answer": "D. Galactose-1-Phosphate Uridyl Transferase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Galactosemia </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Galactose-1-phosphate uridylyltransferase (GALT) - <strong>Classical type</strong></li>\n<li><strong>Galactokinase- <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> disease with only oil drop cataract.</strong></li>\n<li>Epimerase- SNHL + symptoms of classical type</li>\n</ul>\n<p>(Low galactose-based diet can be given which is contraindicated in the classical type)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Accumulation of galactose-1-phosphate <strong>(toxic causing jaundice, and liver damage)</strong></li>\n<li>Inability to metabolize <span class=\"customMeta\" data-dictid=\"99e53092e01692777188465c49d9b8\">galactose</span> from milk</li>\n<li>Damage to liver, kidney, and brain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hepatic: Jaundice, hepatomegaly</li>\n<li>GI: Vomiting, diarrhea, failure to thrive</li>\n<li>CNS: Seizures, intellectual disability</li>\n<li>Eyes: Oil drop cataracts</li>\n<li>Increased risk of E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> sepsis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reducing substance in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (positive)( Positive Benedict test but negative <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> test)</li>\n<li>Direct <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> (GALT) assay</li>\n<li>Genetic testing <strong>(Perinatal diagnosis is possible)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lactose-free diet</li>\n<li>Breast Milk contraindicated</li>\n<li>Soy-based or elemental formulas</li>\n<li>Calcium supplementation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An audiogram of a 30-year-old female is given. What is the diagnosis?", "options": [{"label": "A", "text": "Otosclerosis", "correct": true}, {"label": "B", "text": "Meniers disease", "correct": false}, {"label": "C", "text": "Noise-induced hearing loss", "correct": false}, {"label": "D", "text": "Presbycusis", "correct": false}], "correct_answer": "A. Otosclerosis", "question_images": ["https://image.prepladder.com/content/eYwG7ygBeyQrQiDfECpy1747294993.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An adult male presents to the outpatient department with a painful scrotal swelling accompanied by fever. The swelling is associated with the tunica vaginalis and is characterized by fluid accumulation. What is the likely diagnosis?", "options": [{"label": "A", "text": "Varicocele", "correct": false}, {"label": "B", "text": "Hydrocele", "correct": true}, {"label": "C", "text": "Cystocele", "correct": false}, {"label": "D", "text": "Torsion testis", "correct": false}], "correct_answer": "B. Hydrocele", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Aetiology</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Defective <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of fluid by <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis due to endothelial wall damage by <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> infection</li>\n<li>Excessive production of fluid (secondary hydrocele)</li>\n<li>Interference with <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of fluid by <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> vessels of the cord</li>\n<li>Communication with the peritoneal cavity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common in middle-aged men, prevalent in tropical countries</li>\n<li>Testis is usually large and non-palpable</li>\n<li>Fluctuant</li>\n<li>Can get above the swelling</li>\n<li>Initially transilluminant, but becomes non-transilluminant if long-standing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infantile Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tunica and <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">processus</span> vaginalis distended up to the internal ring</li>\n<li>No connection with the peritoneal cavity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Congenital Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Processus vaginalis communicates with the peritoneal cavity</li>\n<li>Fluid disappears when lying down and recollects when standing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Encysted <span class=\"customMeta\" data-dictid=\"6522d668b016927771897ccc1cb2bf\">Hydrocele</span> of the Cord</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fluid collection in a portion of the patent <span class=\"customMeta\" data-dictid=\"5f2b559f9d1692777203a2e3ac1ba6\">funicular process</span> of <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis</li>\n<li>Fluctuant and transilluminant</li>\n<li>Located in the inguinal/inguinoscrotal/scrotal part</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Secondary <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> Hydrocele</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Causes: Infection (filariasis, tuberculosis), injury (trauma, post herniorrhaphy), tumor (malignancy)</li>\n<li>Usually small, lax, and <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">testis</span> is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> except in cases of <span class=\"customMeta\" data-dictid=\"bcab368ebc169277720239f1f3dfb9\">filariasis</span> where it can be very large</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgical Procedure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lord's <span class=\"customMeta\" data-dictid=\"8d378280de169277719566b2898510\">plication</span> - small, thin <span class=\"customMeta\" data-dictid=\"6522d668b016927771897ccc1cb2bf\">hydrocele</span> with clear fluid</li>\n<li>Jaboulay's operation - partial <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> removal and eversion</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with acute rheumatic fever was presented in the OPD. Examination shows- gram-positive cocci in chains. The etiological agent is?", "options": [{"label": "A", "text": "Streptococcus viridans", "correct": false}, {"label": "B", "text": "Streptococcus pyogenes", "correct": true}, {"label": "C", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "D", "text": "Enterococcus", "correct": false}], "correct_answer": "B. Streptococcus pyogenes", "question_images": ["https://image.prepladder.com/notes/MuOtEe5HIpxJJBlaug2z1747651339.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:632px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pharyngitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sore throat, fever, swollen <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Throat culture, rapid <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> test</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Penicillin, amoxicillin, cephalosporins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rheumatic fever, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> glomerulonephritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scarlet Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rash, fever, strawberry tongue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical presentation, throat culture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Penicillin, erythromycin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rheumatic fever, septicemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Impetigo- Non-bullous</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Honey-crusted lesions on the face and limbs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical presentation, culture of lesions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Topical mupirocin, oral antibiotics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Post-streptococcal glomerulonephritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erysipelas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Raised, well-demarcated erythematous lesions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical presentation, blood cultures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Penicillin, erythromycin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bacteremia, septicemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cellulitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diffuse, <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> infection of the skin and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical presentation, blood cultures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Penicillin, clindamycin, cephalosporins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Necrotizing fasciitis, sepsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Necrotizing Fasciitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe pain, swelling, fever, rapid spread of infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical presentation, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgical debridement, <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Septic shock, multi-organ failure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Streptococcal Toxic Shock Syndrome (STSS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fever, hypotension, multi-organ involvement</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical presentation, blood cultures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IV fluids, vasopressors, <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (ARDS)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute Rheumatic Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Migratory arthritis, carditis, chorea, <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> marginatum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical criteria (Jones criteria), throat culture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Penicillin, anti-inflammatory drugs (aspirin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic rheumatic heart disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute glomerulonephritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hematuria, proteinuria, edema, hypertension</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical presentation, <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> analysis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supportive care, antihypertensives</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Streptococcus pyogenes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Gram Stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Gram-positive <span class=\"customMeta\" data-dictid=\"57640139fe169277718418f95ae49f\">cocci</span> in chains</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Appearance on Blood Agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Pinpoint colonies with a wide zone of hemolysis</li>\n<li>Indicates beta-hemolysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Transport Medium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pike's media</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Selective Media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>PNF (Phenylethyl alcohol agar), Crystal Violet Blood <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">Agar</span> (CVBA)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Liquid Media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Granular turbidity</li>\n<li>Suggests the presence of streptococci, as these organisms can cause cloudiness in liquid media.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Biochemical Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Result</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Catalase Test</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Oxidase Test</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>PYR Test</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Bacitracin Sensitivity</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sensitive</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:568px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Antibiotic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Dosage (Children)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Dosage (Adolescents/Adults)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Special Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Penicillin V (Oral)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>250 mg 2–3 times daily for 10 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>250 mg 4 times daily or 500 mg twice daily for 10 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>First-line oral </strong>treatment; is effective and inexpensive.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Amoxicillin (Oral)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>50 mg/kg once daily (max 1000 mg) or 25 mg/kg twice daily (max 500 mg) for 10 days</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>N/A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Preferred for younger children </strong>due to better palatability; similar <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> to penicillin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Benzathine <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">Penicillin</span> G (IM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>600,000 U (for children &lt;27 kg) 1 dose</li>\n<li>1,200,000 U (for children ≥27 kg) 1 dose</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>N/A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>For patients who <strong>cannot tolerate oral therapy </strong>or have <strong>poor adherence</strong> to a 10-day regimen.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Radioisotope used in PET-CT scan?", "options": [{"label": "A", "text": "18F-FDG", "correct": true}, {"label": "B", "text": "lodine", "correct": false}, {"label": "C", "text": "Radium", "correct": false}, {"label": "D", "text": "Cesium-131", "correct": false}], "correct_answer": "A. 18F-FDG", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/w81knXENAoUUijn4J4mu1747313278.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aerobic Glycolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cancer cells rely heavily on glycolysis, increasing <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and 18F-FDG uptake, even with oxygen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transport &amp; Trapping</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GLUT-1 transporters mediate <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> entry. 18F-FDG is phosphorylated and trapped inside cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor Heterogeneity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differences in tumor subtype, size, and <span class=\"customMeta\" data-dictid=\"3728deb0881692777192af3b093774\">microvasculature</span> affect 18F-FDG uptake.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Implication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognostic Indicator</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher 18F-FDG <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> correlates with <strong>worse prognosis</strong> (e.g., shorter DFS in <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> ductal carcinoma).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reverse Warburg Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cancer-associated fibroblasts (CAFs) increase <span class=\"customMeta\" data-dictid=\"185a500ee91692777188b3044db06d\">glycolysis</span> in tumor cells via <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> coupling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Monitoring</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PET <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> tracks changes in 18F-FDG uptake, reflecting <strong>therapy responses</strong> <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> <span class=\"customMeta\" data-dictid=\"185a500ee91692777188b3044db06d\">glycolysis</span> or mitochondria.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the characteristic laboratory findings in primary hypothyroidism?", "options": [{"label": "A", "text": "Elevated TSH, low T4 levels", "correct": true}, {"label": "B", "text": "Elevated TSH, low T3 levels", "correct": false}, {"label": "C", "text": "Elevated TSH, elevated T4 levels", "correct": false}, {"label": "D", "text": "Low TSH, low T4 levels", "correct": false}], "correct_answer": "A. Elevated TSH, low T4 levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary Hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Secondary Hypothyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thyroid <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> leads to inadequate <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone production</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pituitary <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> leads to insufficient TSH secretion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoimmune (Hashimoto's thyroiditis)</li>\n<li>Iatrogenic (e.g., post-thyroidectomy, radiation)</li>\n<li>Iodine deficiency</li>\n<li>Medications (e.g., amiodarone, lithium)</li>\n<li>Infiltrative diseases (e.g., sarcoidosis)</li>\n<li>Food <span class=\"customMeta\" data-dictid=\"30e693d8521692777188a5ea13201b\">goitrogen</span> → Cabbage, cassava.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pituitary tumors</li>\n<li>Pituitary surgery or radiation</li>\n<li>Sheehan’s syndrome</li>\n<li>Trauma</li>\n<li>Genetic <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormone deficiencies</li>\n<li>Non-obstetric cause of <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> damage called Simmonds's disease (AVM, tumor, HTN)</li>\n<li>Sarcoidosis</li>\n<li>Hemochromatosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TSH - ↑;</p>\n<p>Free T3/T4 - ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TSH - Normal or ↓;</p>\n<p>Free T3/T4 - ↓<strong> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fatigue, weight gain, cold intolerance</li>\n<li>Dry skin, hair loss</li>\n<li>Bradycardia, constipation</li>\n<li>Myxedema (puffy face, non-pitting edema)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Similar to primary hypothyroidism</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormone deficiencies (e.g., low cortisol, low LH/FSH)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Levothyroxine (T4) replacement with <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">dosage</span> based on TSH levels</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Levothyroxine (T4) replacement, but monitored by free T4 levels (since TSH is unreliable)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient experienced a fall onto an outstretched hand, and an X-ray revealed a fracture of the first metacarpophalangeal (MCP) joint with accompanying subluxation. Define this type of fracture.", "options": [{"label": "A", "text": "Bennett’s fracture", "correct": true}, {"label": "B", "text": "Scaphoid fracture", "correct": false}, {"label": "C", "text": "Reverse Colle’s fracture", "correct": false}, {"label": "D", "text": "Colle’s fracture", "correct": false}], "correct_answer": "A. Bennett’s fracture", "question_images": ["https://image.prepladder.com/notes/v7fDVeow3jWVxvFQbY8u1747657746.png"], "explanation_images": ["https://image.prepladder.com/content/fDv3dqWeFnUuAKCq1u5X1747288045.png", "https://image.prepladder.com/content/j4BJzSD6wdhgGGGN4eDp1747288045.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cervarix vaccine is effective against which of the following Human papillomavirus serotypes?", "options": [{"label": "A", "text": "HPV 16 and 18", "correct": true}, {"label": "B", "text": "HPV 6 and 11", "correct": false}, {"label": "C", "text": "HPV 6 and 16", "correct": false}, {"label": "D", "text": "HPV 11 and 18", "correct": false}], "correct_answer": "A. HPV 16 and 18", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Girls aged 9–14 years:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Two doses (0 and 6 months).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Girls aged 15 years and older:</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Three doses:\n\t\t\t\t<ul>\n<li>Cervarix: 0, 1, and 6 months.</li>\n<li>Gardasil: 0, 2, and 6 months.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunocompromised individuals (any age):</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Three doses:\n\t\t\t\t<ul>\n<li>Cervarix: 0, 1, and 6 months.</li>\n<li>Gardasil: 0, 2, and 6 months</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Girls aged 9–14 years:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>One or two doses.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Girls and women aged 15–20 years:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>One or two doses.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Women older than 21 years:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two doses, 6 months apart.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vaccine Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Targeted HPV Types</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cervarix</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bivalent (types 16, 18)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Quadrivalent Gardasil </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 11, 16, 18</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nonavalent Gardasil 9</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Made from the major <strong>capsid (L1) protein </strong>of HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:455px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risk types of Human Papilloma Virus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 11, 42, 43, and 44.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High Risk</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70</p>\n<p><strong>16 and 18 </strong>are responsible for most cancers.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle movements are related to the Abducens nerve?", "options": [{"label": "A", "text": "Lateral rectus", "correct": true}, {"label": "B", "text": "Medial rectus", "correct": false}, {"label": "C", "text": "Superior oblique", "correct": false}, {"label": "D", "text": "Inferior oblique", "correct": false}], "correct_answer": "A. Lateral rectus", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Z3R0wsRVDkg317P3VPCB1747651871.png", "https://image.prepladder.com/notes/e7lRJ5slvScH10O5dyv11747652019.png", "https://image.prepladder.com/content/5sZlT7lXtyt1fQalYCD11747378854.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:610px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Voluntary muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Involuntary muscles</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Four recti muscles</strong>\n<ul>\n<li>Superior rectus</li>\n<li>Inferior rectus</li>\n<li>Medial rectus</li>\n<li>Lateral rectus</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n<ul>\n<li><strong>Two <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> muscles </strong>\n<ul>\n<li>Superior oblique</li>\n<li>Inferior oblique</li>\n</ul>\n</li>\n<li>Levator <span class=\"customMeta\" data-dictid=\"4f6407581c1692777194e86eb9904c\">palpebrae</span> superioris (1)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Superior <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> or Muller's muscle</li>\n<li>Inferior tarsal</li>\n<li>Orbitalis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:718px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Insertion </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nerve supply</strong></p>\n<p><strong>(SO4, LR6)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Recti </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> or <span class=\"customMeta\" data-dictid=\"33613b8eda1692777200cd66184ed6\">tendinous</span> ring of Zinn.</p>\n<p>(all recti have the same origin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sclera little <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to the <span class=\"customMeta\" data-dictid=\"799979f3bc169277719134cd535c7c\">limbus</span> (corneoscleral junction)</p>\n<p> </p>\n<p>The average distance from <span class=\"customMeta\" data-dictid=\"799979f3bc169277719134cd535c7c\">Limbus</span> is:</p>\n<ul>\n<li>Superior: 7.7 mm</li>\n<li>Inferior: 6.5 mm</li>\n<li>Medial: 5.5 mm</li>\n<li>Lateral: 6.9 mm</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lateral rectus: <strong>Abducens nerve</strong></li>\n<li>Rest all other recti: <strong>Oculomotor nerve</strong></li>\n</ul>\n<p><strong>(Option B)</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Superior oblique</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The undersurface of the lesser wing of the sphenoid</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Into the <span class=\"customMeta\" data-dictid=\"3e4400809d16927771983252fc08b1\">sclera</span> behind the <span class=\"customMeta\" data-dictid=\"2056156e8d169277718799b9e86725\">equator</span> in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> superior <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> of the eyeball.</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Trochlear nerve</strong></li>\n</ul>\n<p><strong>(Option C)</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inferior oblique</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> surface of the maxilla</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Into the <span class=\"customMeta\" data-dictid=\"3e4400809d16927771983252fc08b1\">sclera</span> behind the <span class=\"customMeta\" data-dictid=\"2056156e8d169277718799b9e86725\">equator</span> in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> superior <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> of the eyeball, a little below the superior oblique.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oculomotor nerve</li>\n</ul>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Levator <span class=\"customMeta\" data-dictid=\"4f6407581c1692777194e86eb9904c\">palpebrae</span> superioris</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Orbital surface of the lesser wing of the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> bone.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Superior lamella:</strong> Anterior surface of the superior <span class=\"customMeta\" data-dictid=\"f7352fd2a916927772008dd529358e\">tarsus</span> and skin of the upper eyelid.</p>\n<p><strong>Inferior lamella:</strong> Upper margin of the superior <span class=\"customMeta\" data-dictid=\"f7352fd2a916927772008dd529358e\">tarsus</span> and the superior conjunctival fornix.</p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> (SR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Medial <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> (MR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Inferior <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> (IR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> (LR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> (SO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Inferior <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> (IO)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevation</p>\n<p>Adduction</p>\n<p>Intorsion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adduction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Depression</p>\n<p>Adduction</p>\n<p>Extorsion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abduction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Depression</p>\n<p>Abduction</p>\n<p>Intorsion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevation</p>\n<p>Abduction</p>\n<p>Extorsion</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arrange the order of the Disaster management cycle", "options": [{"label": "A", "text": "Impact-response-rehabilitation-mitigation", "correct": true}, {"label": "B", "text": "Rehabilitation-response-impact-mitigation", "correct": false}, {"label": "C", "text": "Response-disaster-rehabilitation-mitigation", "correct": false}, {"label": "D", "text": "Impact-mitigation-response-rehabilitation", "correct": false}], "correct_answer": "A. Impact-response-rehabilitation-mitigation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/04a4IzTa0YKTCquUFfpE1747307300.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the hemorrhage shown in the following image?", "options": [{"label": "A", "text": "Extradural hemorrhage", "correct": false}, {"label": "B", "text": "Intraparenchymal hemorrhage", "correct": false}, {"label": "C", "text": "Subarachnoid hemorrhage", "correct": false}, {"label": "D", "text": "Subdural hemorrhage", "correct": true}], "correct_answer": "D. Subdural hemorrhage", "question_images": ["https://image.prepladder.com/content/IT287kXc88atk5UR7DuJ1747373649.png"], "explanation_images": ["https://image.prepladder.com/content/xgvKuc2fFuB7l6lf8Kro1747373685.png", "https://image.prepladder.com/content/9EKXZYiRoScuOJ1snjO01747373685.png", "https://image.prepladder.com/content/sX1YGmbby6V7S9ySqu1R1747373685.png", "https://image.prepladder.com/notes/lJeoLNI3XjpHiVc3pE5C1747656925.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Extradural <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">Hemorrhage</span> (EDH) (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subdural <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">Hemorrhage</span> (SDH) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of Hemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arterial Hemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Venous Hemorrhage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Biconvex or lentiform</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Gaillard F, Abu Kamesh M, Worsley C\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/extradural-haemorrhage\" data-tags=\"\" height=\"440\" src=\"https://image.prepladder.com/content/xgvKuc2fFuB7l6lf8Kro1747373685.png\" width=\"392\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crescent or sickle-shaped</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subdural_hematoma\" data-tags=\"\" height=\"439\" src=\"https://image.prepladder.com/content/9EKXZYiRoScuOJ1snjO01747373685.png\" width=\"353\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limited by sutures; can cross the midline</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follows the brain surface; crosses sutures, does not cross midline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rupture of the middle meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (MMA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rupture of <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> veins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset of Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often presents with a <span class=\"customMeta\" data-dictid=\"10b50278251692777191a626ee1604\">lucid</span> interval</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms may develop gradually, often without a <span class=\"customMeta\" data-dictid=\"10b50278251692777191a626ee1604\">lucid</span> interval</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Force Required</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires more force; associated with adjacent bony rupture</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can occur with trivial trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Midline Crossing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can cross the midline</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Does not cross the midline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lucid Interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes; patient appears normal before deterioration</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No; deterioration may be more gradual</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms may include headache, loss of consciousness, and <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> neurological deficits</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms may include headache, confusion, and potential <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> deficits</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is most likely to show the following finding on USG?", "options": [{"label": "A", "text": "Fibroadenoma", "correct": true}, {"label": "B", "text": "Breast cyst", "correct": false}, {"label": "C", "text": "Breast carcinoma", "correct": false}, {"label": "D", "text": "Metastasis to the breast from another primary site", "correct": false}], "correct_answer": "A. Fibroadenoma", "question_images": ["https://image.prepladder.com/notes/NVA6D6mPcD3UgeD876Fl1747656627.png"], "explanation_images": ["https://image.prepladder.com/content/HlWYdn8DdYYp9B0LAlua1747373120.png", "https://image.prepladder.com/content/dGuVkbJSJtFyIPAm6X1o1747373120.png", "https://image.prepladder.com/content/hyvxJ8MvNgiLJYWtcCFa1747373120.png", "https://image.prepladder.com/content/kjlX48hhCVspyzMlHgzw1747373120.png", "https://image.prepladder.com/content/QfOophWIcrEUJoC9QCvr1747373120.png", "https://image.prepladder.com/content/XIS7d86s8chirGPDz0UR1747373120.png", "https://image.prepladder.com/content/KLGMiP4mHYxbTnpC6Irq1747373121.png", "https://image.prepladder.com/content/U5QXjqjqtNWLlsj4B5zo1747373121.png", "https://image.prepladder.com/content/y9nvTzpBR9JORCV5L2xU1747373121.png", "https://image.prepladder.com/content/jebEPdogNSHC03f1DaDn1747373121.png", "https://image.prepladder.com/notes/canAy7LQnNDKRXc6J8fQ1747656768.png", "https://image.prepladder.com/content/7g61Bhn6uUB8gYmYRtNK1747373121.png", "https://image.prepladder.com/content/ZBCKxmJjYp0BHTC78R4v1747373121.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:1000px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Breast pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>USG-findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>USG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Simple cyst</strong></p>\n<p><strong>(Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anechoic with <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">acoustic</span> enhancement</li>\n<li>Round or <span class=\"customMeta\" data-dictid=\"879f3da46a169277719497d18b5251\">ovoid</span> with a smooth <span class=\"customMeta\" data-dictid=\"165957ab9c16927771899a331e37b0\">hyperechoic</span> wall</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author='\"Nirupama Anne Elisabeth Sulger Ratnakishore Pallapothu\"' data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/Right-breast-ultrasound-demonstrates-an-irregular-shaped-hypoechoic-solid-mass-located_fig1_333903796\" data-tags=\"\" height=\"232\" src=\"https://image.prepladder.com/content/HlWYdn8DdYYp9B0LAlua1747373120.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complicated cyst</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Internal echoes</li>\n<li>Fat-fluid level</li>\n<li>Oil cyst,<strong> galactocoel</strong></li>\n<li>Internal contents move with change in the position of the breast</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Daniel J Bell\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/galactocele-1\" data-tags=\"\" height=\"218\" src=\"https://image.prepladder.com/content/dGuVkbJSJtFyIPAm6X1o1747373120.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complex cyst</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyperechoic thin septations</li>\n<li>BI-RADS 3:Probably benign, needs follow-up</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Serdar ÖzbaşM. ErkuşC. KaramanA. Menderes\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/COMPLEX-BREAST-CYSTS%3A-SONOGRAPHIC-FINDINGS-AND-%C3%96zba%C5%9F-Erku%C5%9F/1cd7adec50abe4d4fbed67532568aa6fefa744a8\" data-tags=\"\" height=\"203\" src=\"https://image.prepladder.com/content/hyvxJ8MvNgiLJYWtcCFa1747373120.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ill-defined or</strong> well-defined outline</li>\n<li>Maybe <span class=\"customMeta\" data-dictid=\"acb59b05f31692777181d2df5f618b\">anechoic</span> or low-level internal echoes and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> enhancement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author='\"Alphonce B Chandika Antony Gakwaya Elsie Kiguli-Malwadde Phillipo Chalya\"' data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/A-sonogram-of-a-22-yrs-old-female-showing-a-right-breast-abscess-Note-the-oval-shape-of_fig1_221730043\" data-tags=\"\" height=\"184\" src=\"https://image.prepladder.com/content/kjlX48hhCVspyzMlHgzw1747373120.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fibrocystic disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prominent fibro <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> tissue in the area of a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> nodule; however, no discernible mass</li>\n<li>small cysts in the mammary zone</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Park, Chang &amp; Lee, Jae &amp; Yim, Hyeon &amp; Kang, Bong &amp; Kim, hyeon sook &amp; Jung, Jung Im &amp; Jung, Na Young &amp; Kim, Sung. \" data-hash=\"\" data-license=\"CC BY-NC 3.0\" data-source=\"https://www.researchgate.net/figure/US-in-a-47-year-old-woman-with-fibrocystic-disease-The-mass-shows-six-or-seven_fig3_5920832\" data-tags=\"\" height=\"208\" src=\"https://image.prepladder.com/content/QfOophWIcrEUJoC9QCvr1747373120.png\" width=\"270\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fibroadenoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Round/ovoid <span class=\"customMeta\" data-dictid=\"5543384a9b169277718985e08cf7f8\">hypoechoic</span> mass</li>\n<li>May have a <span class=\"customMeta\" data-dictid=\"165957ab9c16927771899a331e37b0\">hyperechoic</span> rim (pseudo capsule)</li>\n<li>Parallel orientation(wider than tall)</li>\n<li>May have calcifications</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Sandeep Singh Awal\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/fibroadenoma-of-the-breast-2\" data-tags=\"\" height=\"178\" src=\"https://image.prepladder.com/content/XIS7d86s8chirGPDz0UR1747373120.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cystosarcoma phyllodes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inhomogeneous, solid-appearing mass is the (most common)</li>\n<li>A solid mass containing single or multiple, round or cleft-like <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> spaces and demonstrating <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">acoustic</span> enhancement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Lee, Eun &amp; Chang, Yun-Woo &amp; Oh, Jung &amp; Hwang, Jiyoung &amp; Hong, Seong &amp; Kim, Hyun-joo. (2018). Breast Lesions in Children and Adolescents: Diagnosis and Management. Korean Journal of Radiology. 19. 978. 10.3348/kjr.2018.19.5.978. \" data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/Phyllodes-tumor-in-17-year-old-girl-with-palpable-mass-in-left-breast-Ultrasonographic_fig5_326894580\" data-tags=\"\" height=\"184\" src=\"https://image.prepladder.com/content/KLGMiP4mHYxbTnpC6Irq1747373121.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fat necrosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute\n\t\t\t\t<ul>\n<li>New lesion</li>\n<li>Hyperechoic due to edema</li>\n<li>BI-RADS 3</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Late\n\t\t\t\t<ul>\n<li>1.5 years or more</li>\n<li>Calcified walls causing a <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">acoustic</span> shadow</li>\n<li>BI-RADS 3</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Natacha AbreuM. GoncalvesM. SerradoA. F. Capelinha\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Fat-necrosis-of-the-breast%3A-is-it-%28at%29-all-Abreu-Goncalves/6ec31c7b8fe4f683971eb5b868c13fb4df9d73ae/figure/1\" data-tags=\"\" height=\"210\" src=\"https://image.prepladder.com/content/U5QXjqjqtNWLlsj4B5zo1747373121.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BI-RADS 4/5/6</strong></p>\n<p><strong>(Option C,D)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypoechoic mass with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> wall (spiculated)</li>\n<li>Taller than wide orientation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Madani, Mohammad &amp; Behzadi, Mohammad &amp; Nabavi, Sheida. (2022). The Role of Deep Learning in Advancing Breast Cancer Detection Using Different Imaging Modalities: A Systematic Review. Cancers. 14. 5334. 10.3390/cancers14215334. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Ultrasound-images-from-breast-tissue-for-normal-benign-and-malignant-80_fig2_364975652\" data-tags=\"\" height=\"217\" src=\"https://image.prepladder.com/content/y9nvTzpBR9JORCV5L2xU1747373121.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intraductal papilloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dilated duct</li>\n<li>Well defined nodule</li>\n<li>BI-RADS 4A/4B/4C: suspicious for malignancy, <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> advised</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\" Alexandra Stanislavsky◉\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/intraductal-papilloma-4\" data-tags=\"\" height=\"195\" src=\"https://image.prepladder.com/content/jebEPdogNSHC03f1DaDn1747373121.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duct ectasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dilated ducts with branching <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"acb59b05f31692777181d2df5f618b\">anechoic</span> structures</li>\n<li>Diametre &gt;2 mm</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Duct ectasia\" data-author=\"Anand, Gaurav &amp; Calisi, Nabil &amp; Arif, Dauod &amp; Hamidpour, Soheila &amp; Lewis, Tiffany. \" data-hash=\"12990\" data-license=\"CC BY-NC ND\" data-source=\"https://www.researchgate.net/figure/A-Ultrasound-image-showing-moderate-to-marked-duct-ectasia-in-the-retroareolar-region_fig2_324129091\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/canAy7LQnNDKRXc6J8fQ1747656768.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Implant rupture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Step ladder sign: <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> <span class=\"customMeta\" data-dictid=\"165957ab9c16927771899a331e37b0\">hyperechoic</span> bands representing folds in collapsed shell</li>\n<li>Suggests <span class=\"customMeta\" data-dictid=\"9c6f97404e1692777190f9ed62079f\">intracapsular</span> rupture</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author='\"Jocelyn Rapelyea Christina G. Marks\"' data-hash=\"\" data-license=\"CC BY 3.0\" data-source='https://www.researchgate.net/figure/Stepladder-sign-Transverse-ultrasound-demonstrates-an-intracapsular-silicone-implant_fig4_322562378\t\"Jocelyn Rapelyea Christina G. Marks\"' data-tags=\"\" height=\"215\" src=\"https://image.prepladder.com/content/7g61Bhn6uUB8gYmYRtNK1747373121.png\" width=\"248\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Silicone granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Snowstorm sign: <span class=\"customMeta\" data-dictid=\"165957ab9c16927771899a331e37b0\">Hyperechoic</span> and well-circumscribed <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> border with dirty <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">acoustic</span> shadow</li>\n<li>Suggests <span class=\"customMeta\" data-dictid=\"ab0f3917ce1692777187309ec78709\">extracapsular</span> rupture</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"© Nevit Dilmen\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Silicone_granuloma#/media/File:Ultrasound_of_silicone_granuloma_lymphadenopathy_13112514493060900.jpg\" data-tags=\"\" height=\"288\" src=\"https://image.prepladder.com/content/ZBCKxmJjYp0BHTC78R4v1747373121.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic alcoholic came with complaints of agitation, global confusion, disorientation, hallucination, fever, hypertension, diaphoresis, and autonomic hyperactivity after cessation of alcohol for 48 hours. Which of the following is the diagnosis?", "options": [{"label": "A", "text": "Delirium tremens", "correct": true}, {"label": "B", "text": "Wernicke Encephalopathy", "correct": false}, {"label": "C", "text": "Korsakoff Psychosis", "correct": false}, {"label": "D", "text": "Magnan Phenomena", "correct": false}], "correct_answer": "A. Delirium tremens", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Delirium Tremens (DT)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Wernicke's Encephalopathy (WE) <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Korsakoff's Syndrome (KS) <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cause</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute alcohol withdrawal.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thiamine (vitamin B1) deficiency, often due to chronic alcoholism.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often a result of chronic <span class=\"customMeta\" data-dictid=\"f8b7fb6b0916927771811841fcd9fa\">alcoholism</span> and <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> deficiency.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Onset</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>48-72 hours</strong> after the last drink.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute onset, typically develops over 1-2 days</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic, long-term condition</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe agitation</li>\n<li>Tremors</li>\n<li>Hallucinations</li>\n<li>Confusion</li>\n<li>Seizures</li>\n<li>Autonomic instability.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>G - Global confusion</li>\n<li>O - Ophthalmoplegia</li>\n<li>A - Ataxia</li>\n<li>P - Polyneuropathy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterograde and <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> <span class=\"customMeta\" data-dictid=\"8078d5919c1692777181166124343a\">amnesia</span> (Intact long term memory)</li>\n<li>Confabulation</li>\n<li>Memory impairment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cognitive Function</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired consciousness, confusion, disorientation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disorientation, confusion, and memory problems.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe memory impairment, with intact long-term memory.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motor Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tremors</p>\n<p>Hyperreflexia</p>\n<p>Muscle rigidity.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ataxia (lack of coordination), <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> gait.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motor function may remain mostly intact.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thiamine</li>\n<li>Benzodiazepines</li>\n<li>Fluids</li>\n<li>Electrolytes</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thiamine supplementation (IM/IV)</li>\n<li>Fluids</li>\n<li>Electrolyte correction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thiamine supplementation</li>\n<li>Psychological support</li>\n<li>Rehabilitation therapy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old child of short stature presents with skin patches and learning difficulties. Diagnostic workup indicates a defect in DNA repair specifically related to double-strand breaks. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bloom Syndrome", "correct": true}, {"label": "B", "text": "Xeroderma Pigmentosum", "correct": false}, {"label": "C", "text": "Cockayne Syndrome", "correct": false}, {"label": "D", "text": "Lynch Syndrome", "correct": false}], "correct_answer": "A. Bloom Syndrome", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Repair Mechanism Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Associated Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Nucleotide Excision Repair Defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Xeroderma Pigmentosum (XP)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Base Excision Repair Defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>MUTYH-Associated Polyposis (MAP)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Mismatch Repair Defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Lynch Syndrome (HNPCC)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Homologous Recombination Repair Defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>BRCA1/BRCA2 Mutations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Proteasomal Degradation Defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Amyotrophic Lateral Sclerosis (ALS)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Chaperone-Mediated Protein Repair Defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Cystic Fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Cell Cycle Checkpoint Defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Ataxia-Telangiectasia (AT)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Mitochondrial DNA Repair Defect</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Mitochondrial Myopathy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old primipara presents to her obstetrician with complaints of breast pain during breastfeeding. She reports that the pain is associated with difficulty in milk flow. Physical examination reveals engorged breasts with minimal milk expression during attempted feeding. The physician suspects an issue with the milk ejection reflex. Which hormone is responsible for breast pain during breastfeeding?", "options": [{"label": "A", "text": "Oxytocin", "correct": true}, {"label": "B", "text": "Prolactin", "correct": false}, {"label": "C", "text": "Estrogen", "correct": false}, {"label": "D", "text": "Progesterone", "correct": false}], "correct_answer": "A. Oxytocin", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old male patient presents with a complaint of dysphagia, particularly for solids, which has been progressively worsening over the past few months. Additionally, he has experienced significant weight loss and cachexia over the same period. Which of the following diagnostic choices is best for this patient?", "options": [{"label": "A", "text": "UGIE", "correct": true}, {"label": "B", "text": "Manometry", "correct": false}, {"label": "C", "text": "Barium swallow", "correct": false}, {"label": "D", "text": "Barium meal follow through", "correct": false}], "correct_answer": "A. UGIE", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with repeated infections from the lesion shown in the image. The correct statement in relation to the image?", "options": [{"label": "A", "text": "Derived from ectoderm of 1st and 2nd arch", "correct": true}, {"label": "B", "text": "Derived from the pouch of 1st and 2nd arch", "correct": false}, {"label": "C", "text": "Derived from mesoderm of 1st and 2nd arch", "correct": false}, {"label": "D", "text": "Derived from ectoderm of 3rd and 4th arch", "correct": false}], "correct_answer": "A. Derived from ectoderm of 1st and 2nd arch", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions will have an FEV₁/FVC ratio &amp;lt; 0.7 and FEV₁ &amp;lt; 80% of the predicted value along with wheezing in the morning hours and shortness of breath?", "options": [{"label": "A", "text": "Asthma", "correct": true}, {"label": "B", "text": "ILD", "correct": false}, {"label": "C", "text": "IPF", "correct": false}, {"label": "D", "text": "Silicosis", "correct": false}], "correct_answer": "A. Asthma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Diagnostic Tests for Bronchial Asthama</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Spirometry/PFTs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Best initial test</li>\n<li>IOC</li>\n<li>Obstructive pattern\n\t\t\t\t<ul>\n<li>Reversible with short-acting β2-agonists (SABAs)</li>\n</ul>\n</li>\n<li>Findings:\n\t\t\t\t<ul>\n<li><strong>FEV1/FVC &lt; 70%</strong></li>\n<li><strong>↓ FEV1</strong></li>\n<li>Normal or ↓ FVC</li>\n<li>↑ Residual Volume (RV)</li>\n<li>↑ <span class=\"customMeta\" data-dictid=\"b0e95f9af21692777200e8a9faabe7\">Total Lung Capacity</span> (TLC)</li>\n<li>Normal or ↑ Diffusing Capacity of Lung for Carbon Monoxide (DLCO)</li>\n</ul>\n</li>\n<li>Reversibility:\n\t\t\t\t<ul>\n<li>Increase in FEV1 ≥ 12% and &gt;200 mL with SABA (albuterol)</li>\n</ul>\n</li>\n<li>PFTs between exacerbations: Often normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Methacholine Challenge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Tests for bronchial hyperresponsiveness</li>\n<li>Positive if ≥20% decrease in FEV1</li>\n<li>Sensitive but not specific</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Arterial blood gas </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Early\n\t\t\t\t<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> (↓ PaCO2, ↑ pH) due to hyperventilation</li>\n</ul>\n</li>\n<li>Late\n\t\t\t\t<ul>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> due to muscle fatigue (normalizing PaCO2, normalizing pH, ↓ PaO2)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chest X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Normal appearance to <span class=\"customMeta\" data-dictid=\"301f9a675d16927771892fb39029d3\">hyperinflation</span> with <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">flattening</span> of the diaphragm</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following deficiencies causes follicular hyperkeratosis?", "options": [{"label": "A", "text": "Vitamin A", "correct": true}, {"label": "B", "text": "Vitamin C", "correct": false}, {"label": "C", "text": "Vitamin E", "correct": false}, {"label": "D", "text": "Vitamin B6", "correct": false}], "correct_answer": "A. Vitamin A", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>XN</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Night blindness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>X1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X1A: Conjunctival xerosis.</li>\n<li>X1B: Bitot spots.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>X2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal xerosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>X3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X3A: Corneal ulceration, less than one-third.</li>\n<li>X3B: Corneal ulceration, more than one-third.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>XS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal scar.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>XF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Xerophthalmic fundus.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old pre-menopausal woman is diagnosed with early invasive breast cancer. Immunohistochemistry (IHC) shows that the tumor is estrogen receptor-positive (ER+) and progesterone receptor positive (PR+). Lymph node biopsy reveals metastatic involvement. The oncology team is discussing adjuvant therapy options. The drug used in a 55-year-old pre-menopausal patient with ER+, PR+ on IHC along with lymph node positive and diagnosed with early invasive breast cancer?", "options": [{"label": "A", "text": "Tamoxifen", "correct": true}, {"label": "B", "text": "Anastrozole", "correct": false}, {"label": "C", "text": "Trastuzumab", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "A. Tamoxifen", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient with infertility presents a disorder comprising the triad of situs inversus, chronic sinusitis, and bronchiectasis. Which of the following is the correct diagnosis?", "options": [{"label": "A", "text": "Kartagener's syndrome", "correct": true}, {"label": "B", "text": "Cystic fibrosis", "correct": false}, {"label": "C", "text": "Mucovicidosis", "correct": false}, {"label": "D", "text": "Klinefelter syndrome", "correct": false}], "correct_answer": "A. Kartagener's syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man presents to the hospital with complaints of drooping eyelids (ptosis) and increasing eye irritation. He notes that his symptoms worsen as the day goes on, particularly during outdoor activities. What is the most likely cause of his symptoms?", "options": [{"label": "A", "text": "Lambert-Eaton syndrome", "correct": false}, {"label": "B", "text": "Myasthenia gravis", "correct": true}, {"label": "C", "text": "Botulism toxicity", "correct": false}, {"label": "D", "text": "Tetanus toxicity", "correct": false}], "correct_answer": "B. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Myasthenia Gravis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lambert-Eaton Myasthenic Syndrome (LEMS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"06e07ce7821692777182e8ffd9676f\">autoantibody</span> target</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acetylcholine receptors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Voltage-gated <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduced <strong>postsynaptic </strong>acetylcholine receptors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased <strong>presynaptic </strong>acetylcholine release</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fatigue pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Worsens with activity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Improves with brief exercise.</p>\n<p><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reflexes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or mildly reduced</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduced or absent may improve after exercise.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Repetitive nerve stimulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decremental response.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incremental response.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Response to edrophonium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Improves symptoms.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Little to no improvement.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition that is least likely to cause postmenopausal bleeding?", "options": [{"label": "A", "text": "Endometrial CA", "correct": false}, {"label": "B", "text": "Granulosa cell tumor", "correct": false}, {"label": "C", "text": "Genital tract trauma", "correct": false}, {"label": "D", "text": "Ovarian follicular cyst", "correct": true}], "correct_answer": "D. Ovarian follicular cyst", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Percentage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endometrial Atrophy (Causes <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">senile</span> endometritis)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>60-80</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HRT (may bleed in the first year)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>15-25</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endometrial Polyp</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2-12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endometrial Hyperplasia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5-10</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endometrial Cancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old female patient was diagnosed with cervical carcinoma and radiotherapy has been planned. The radiation oncologist is reviewing the treatment plan focusing on Point A, which is a key reference point for radiation delivery. What is the dose of radiation in point A radiotherapy?", "options": [{"label": "A", "text": "2500 centigray", "correct": false}, {"label": "B", "text": "7000 centigray", "correct": true}, {"label": "C", "text": "5000 centigray", "correct": false}, {"label": "D", "text": "10,000 centigray", "correct": false}], "correct_answer": "B. 7000 centigray", "question_images": ["https://image.prepladder.com/notes/yxwSJ0IvoJMTVtAv4RYv1747664877.png"], "explanation_images": [], "explanation": "<p>Correct Answer B. 7000 centig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient reports to the outpatient department with complaints of fatigue. Investigation results indicate a Hb of 5.9, increased RDW and TIBC, and low ferritin. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Sideroblastic anemia", "correct": false}, {"label": "B", "text": "IDA", "correct": true}, {"label": "C", "text": "Anaemia of chronic disease", "correct": false}, {"label": "D", "text": "Hemolytic anemia", "correct": false}], "correct_answer": "B. IDA", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BE83xQv7fE21Pgop6PZ11747303848.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:633px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Iron Study</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Interpretation in Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Ferritin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt; 30 ng/mL) (depleted iron stores).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Iron (Fe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Total Iron Binding Capacity (TIBC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased TIBC (increased capacity of <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> to bind iron in response to low iron stores).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red Cell Distribution <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">Width</span> (RDW)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased RDW (Red Cell Distribution Width)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">Aspiration</span> and Iron Staining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confirmatory test</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:599px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Serum Iron</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Transferrin saturation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Serum Ferritin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>TIBC</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sideroblastic Anemia</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anaemia of Chronic Disease</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemolytic Anemia</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male with recurrent bleeding, presents with bowing of posterior maxillary wall on CECT. All are false except?", "options": [{"label": "A", "text": "Outgrown the blood supply", "correct": false}, {"label": "B", "text": "Tumor vessels lack contractility", "correct": true}, {"label": "C", "text": "Bleeding is from the adjacent invading blood vessels", "correct": false}, {"label": "D", "text": "It lacks capsule", "correct": false}], "correct_answer": "B. Tumor vessels lack contractility", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examination of Juvenile <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior Rhinoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reveals a reddish-purple mass obstructing the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> passages, often with blood-stained discharge.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior Rhinoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Visualizes a smooth or <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> mass in the <span class=\"customMeta\" data-dictid=\"c3f198d2a31692777193e32f2c868c\">nasopharynx</span> using a small mirror.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oral Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses for tumor extension into the oral cavity, possibly pushing the soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> downwards.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neck Palpation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detects any enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, especially in the upper <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> region.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurological Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve involvement, <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> on eye movements, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> sensation, and hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Digital palpation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Caution, avoid </strong>digital <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">palpation</span> of the <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> mass to prevent severe bleeding.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigations of Juvenile <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contrast-Enhanced CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Investigation of choice</strong>; shows tumor size, location, and bony involvement.</li>\n<li>Pathognomonic sign: Holman-Miller sign (bowing of maxillary wall).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Magnetic Resonance Imaging (MRI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Evaluates soft tissue and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension, differentiates between <span class=\"customMeta\" data-dictid=\"a479c9f4081692777187a3308ccd27\">extradural</span> and <span class=\"customMeta\" data-dictid=\"ebcba023d81692777190e9eef5bcc2\">intradural</span> spread. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Digital Subtraction Angiography (DSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Visualizes tumor vascularity, identifies <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> vessels and aids in <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">preoperative</span> <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> to reduce <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> blood loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nasopharyngoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides a direct view of the tumor, but <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is generally avoided due to high <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> caused by Eustachian tube obstruction; establishes <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> and monitors post-treatment hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Biopsy is<strong> contraindicated</strong> due to risk of profuse bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of fracture in a patient who sustained a road traffic accident resulting in fractures of both the tibia and fibula.", "options": [{"label": "A", "text": "Bumper Fracture", "correct": true}, {"label": "B", "text": "Patella sleeve fracture", "correct": false}, {"label": "C", "text": "Depressed skull fracture", "correct": false}, {"label": "D", "text": "Cervical fracture", "correct": false}], "correct_answer": "A. Bumper Fracture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UhlKhA57jzbeHoaEMr9U1747288145.png", "https://image.prepladder.com/content/V21bDEC8xtSBzrrS0Rsg1747288145.png", "https://image.prepladder.com/notes/a70WvqFKWh8QeGw4cdop1747657975.png", "https://image.prepladder.com/notes/v6tLDX6CQDAPSxq0z5WN1747657993.png", "https://image.prepladder.com/notes/v4neOs3es4CRdwz6tjYF1747658010.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> refers to the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> surface, which comprises the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surfaces of the respective <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> condyles.</p>\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> fractures are the most common.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The main mechanism of injury is a <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> force, with or without <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> load.</li>\n<li>Young Adults: Road traffic accidents, leading to <strong>split fractures</strong> (high <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injury risk).</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"239\" src=\"https://image.prepladder.com/content/UhlKhA57jzbeHoaEMr9U1747288145.png\" width=\"239\"/></p>\n<ul>\n<li>Elderly: Trivial falls, causing depression or <strong>split depression fractures</strong> (associated with osteoporosis) (low <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injury risk).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification (Schatzker)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> split <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (young adults).</p>\n<p><strong>Type II:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> split depression (young adults).</p>\n<p><strong>Type III:</strong> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> pure depression (elderly).</p>\n<p><strong>Type IV: </strong>Medial <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> fracture.</p>\n<p><strong>Type V: </strong>Bicondylar fracture.</p>\n<p><strong>Type VI: </strong>Dissociation of <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> and diaphysis.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"385\" src=\"https://image.prepladder.com/content/V21bDEC8xtSBzrrS0Rsg1747288145.png\" width=\"384\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Knee <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> due to hemarthrosis.</li>\n<li>Inability to bear weight</li>\n<li>Reduce range of knee movements</li>\n<li>Compartment syndrome (earliest sign: <strong>stretch pain</strong>).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>X-ray:</strong> Initial <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> detection.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Tibial plateau fracture A\" data-author=\"James Heilman, MD\" data-hash=\"13004\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlatFracPlainMark.png https://en.wikipedia.org/wiki/Crus_fracture#/media/File:TibPlateauF.PNG https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlateauBadMark.png\" data-tags=\"May2025\" height=\"177\" src=\"https://image.prepladder.com/notes/a70WvqFKWh8QeGw4cdop1747657975.png\" width=\"168\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"Tibial plateau fracture B\" data-author=\"James Heilman, MD\" data-hash=\"13005\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlatFracPlainMark.png https://en.wikipedia.org/wiki/Crus_fracture#/media/File:TibPlateauF.PNG https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlateauBadMark.png\" data-tags=\"May2025\" height=\"172\" src=\"https://image.prepladder.com/notes/v6tLDX6CQDAPSxq0z5WN1747657993.png\" width=\"139\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"Tibial plateau fracture C\" data-author=\"James Heilman, MD\" data-hash=\"13006\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlatFracPlainMark.png https://en.wikipedia.org/wiki/Crus_fracture#/media/File:TibPlateauF.PNG https://en.wikipedia.org/wiki/Tibial_plateau_fracture#/media/File:TibPlateauBadMark.png\" data-tags=\"May2025\" height=\"174\" src=\"https://image.prepladder.com/notes/v4neOs3es4CRdwz6tjYF1747658010.png\" width=\"147\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n<ul>\n<li><strong>CT with 3D Reconstruction:</strong> Gold standard.</li>\n<li><strong>MRI:</strong> To assess <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> injuries.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Non-surgical: Stable fractures with minimal displacement.</li>\n<li>Surgical (ORIF): For displaced fractures or significant depression.</li>\n<li>Ligament <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> if needed.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In epidural anesthesia, which of the following layers is least likely to be punctured during the procedure?", "options": [{"label": "A", "text": "Arachnoid mater", "correct": true}, {"label": "B", "text": "Ligamentum flavum", "correct": false}, {"label": "C", "text": "Supraspinous", "correct": false}, {"label": "D", "text": "Infraspinous", "correct": false}], "correct_answer": "A. Arachnoid mater", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Rukmini is attending the village health nutrition and sanitation program day. How frequently is this conducted?", "options": [{"label": "A", "text": "Every month", "correct": true}, {"label": "B", "text": "Every week", "correct": false}, {"label": "C", "text": "Every 14 days", "correct": false}, {"label": "D", "text": "Every 3 months", "correct": false}], "correct_answer": "A. Every month", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person who was mentally unsound at the time of committing a crime is exempt from liability if they were unaware of the nature of their actions or its consequences. What is this principle called?", "options": [{"label": "A", "text": "McNaughton rule", "correct": true}, {"label": "B", "text": "Durham's rule", "correct": false}, {"label": "C", "text": "Currens rule", "correct": false}, {"label": "D", "text": "Irresistible impulse test", "correct": false}], "correct_answer": "A. McNaughton rule", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Criterion that differentiates exudative from transudative pleural effusion?", "options": [{"label": "A", "text": "Low protein in pleural fluid", "correct": false}, {"label": "B", "text": "High protein in pleural fluid", "correct": true}, {"label": "C", "text": "Low sugar in pleural fluid", "correct": false}, {"label": "D", "text": "High sugar in pleural fluid", "correct": false}], "correct_answer": "B. High protein in pleural fluid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pleural fluid Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Light's Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiates transudative from <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> pleural effusions based on LDH and protein levels in pleural fluid.</p>\n<ul>\n<li>An <strong>exudative pleural effusion</strong> meets at least<strong> one</strong> of the following:\n\n\t\t\t\t<ol>\n<li>Pleural fluid protein/serum protein &gt; 0.5</li>\n<li>Pleural fluid LDH/serum LDH &gt; 0.6</li>\n<li>Pleural fluid LDH exceeds two-thirds of the normal upper limit for serum.</li>\n</ol>\n</li>\n<li>~25% of transudates may be misidentified as exudates.</li>\n<li>If <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> criteria are <span class=\"customMeta\" data-dictid=\"fffe8d8cdd169277719212053c343d\">met</span> but a transudative condition is suspected, measure protein difference; if &gt;31 g/L (3.1 g/dL), likely transudative.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which hormone is produced from the layer marked in the given image?", "options": [{"label": "A", "text": "Androgen", "correct": true}, {"label": "B", "text": "Cortisol", "correct": false}, {"label": "C", "text": "Corticosterone", "correct": false}, {"label": "D", "text": "Epinephrine", "correct": false}], "correct_answer": "A. Androgen", "question_images": ["https://image.prepladder.com/notes/ePkWYGCsq4SlMUdJUfQ31747652325.png"], "explanation_images": ["https://image.prepladder.com/content/ErjAK6JyZA9fMldZKdaL1747379566.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Layers of <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">Adrenal</span> Gland</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adrenal Cortex</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zones of the cortex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormones produced</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Main function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphology of Zone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zona Glomerulosa </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mineralocorticoid</p>\n<ul>\n<li>Aldosterone(main)</li>\n<li>Deoxycorticosterone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance of sodium balance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small clumps of cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zona fasciculata </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucocorticoids</p>\n<ul>\n<li>Cortisol</li>\n<li>Corticosterone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance of sugars</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Columnar cells that <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> long cords</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zona reticularis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sex steroids</p>\n<ul>\n<li>Dehydroepiandrosterone</li>\n<li>Androstenedione</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance of sexual functioning</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Network of <span class=\"customMeta\" data-dictid=\"cfd35769b016927771901681bcc115\">intercalated</span> cells</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adrenal medulla:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medulla</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Catecholamines:</p>\n<ul>\n<li>Norepinephrine</li>\n<li>Epinephrine</li>\n<li>Small amounts of dopamine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carbohydrate and fat metabolisms</li>\n<li>Fight or flight responses</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specialized <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> ganglion</p>\n<p>Clumps and strands of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following anti-cancer medications is used for the treatment of Gastrointestinal Stromal Tumors (GIST) and Chronic Myeloid Leukemia (CML)?", "options": [{"label": "A", "text": "Imatinib", "correct": true}, {"label": "B", "text": "Methotrexate", "correct": false}, {"label": "C", "text": "Doxorubicin", "correct": false}, {"label": "D", "text": "Cisplatin", "correct": false}], "correct_answer": "A. Imatinib", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CML</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GIST</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Imatinib</li>\n<li>Ponatinib</li>\n<li>Nilotinib</li>\n<li>Dasatinib</li>\n<li>Bosutinib</li>\n<li>Omacetaxine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sunitinib</li>\n<li>Imatinib</li>\n<li>Regorafenib</li>\n<li>Repretinib</li>\n<li>Avapritinib</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Ammonia is transported from the brain to the liver in the form of which amino acid?", "options": [{"label": "A", "text": "Glutamate", "correct": false}, {"label": "B", "text": "Alanine", "correct": false}, {"label": "C", "text": "Glycine", "correct": false}, {"label": "D", "text": "Glutamine", "correct": true}], "correct_answer": "D. Glutamine", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Transporter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Formation Process</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Source</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Destination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism/Role</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glutamine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formed from <span class=\"customMeta\" data-dictid=\"ada5fcf7e416927771886ff24152ff\">glutamate</span> and <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> by <strong>glutamine synthetase</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skeletal muscle, liver, CNS</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver, kidneys</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transports <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> from the brain and <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> to the liver. In the liver, <span class=\"customMeta\" data-dictid=\"2ce271388f1692777188515f75666c\">glutamine</span> is <span class=\"customMeta\" data-dictid=\"cf14b794fb16927771847567191a08\">cleaved</span> by <strong>glutaminase</strong> to release <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> and glutamate.</li>\n<li>Glutamate is then deaminated by <strong>glutamate <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> (GDH)</strong>, releasing additional ammonia, which enters the <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> cycle for detoxification.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alanine</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formed from <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> and <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> in muscles during the <strong>glucose-alanine cycle</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscles</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transports <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> from muscle to the liver. In the liver, <span class=\"customMeta\" data-dictid=\"7f4e6edbc91692777181c6fa295ae7\">alanine</span> is transaminated by <strong>alanine <span class=\"customMeta\" data-dictid=\"e480f2b88f1692777200e20c981927\">transaminase</span> (ALT)</strong> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> and glutamate.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> is used to <span class=\"customMeta\" data-dictid=\"37ab4f3d3a16927771991ff7316442\">synthesize</span> glucose, and the <span class=\"customMeta\" data-dictid=\"ada5fcf7e416927771886ff24152ff\">glutamate</span> can be deaminated by GDH to release <span class=\"customMeta\" data-dictid=\"edbc0adbb31692777181ed0ee792d4\">ammonia</span> for the <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> cycle.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the order of insertion of muscles on Annulus of Zinn? A. Medial rectus B. Inferior rectus C. Lateral rectus D. Superior rectus", "options": [{"label": "A", "text": "A, B, C, D", "correct": true}, {"label": "B", "text": "B, C, A, D", "correct": false}, {"label": "C", "text": "D, C, A, B", "correct": false}, {"label": "D", "text": "C, A, B, D", "correct": false}], "correct_answer": "A. A, B, C, D", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/dLWVDxW2XhLlV8IUE4111747655869.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:718px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Insertion </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nerve supply</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Recti </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> or <span class=\"customMeta\" data-dictid=\"33613b8eda1692777200cd66184ed6\">tendinous</span> ring of Zinn.</p>\n<p>(all recti have the same origin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sclera little <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to the <span class=\"customMeta\" data-dictid=\"799979f3bc169277719134cd535c7c\">limbus</span> (corneoscleral junction)</p>\n<p> </p>\n<p>The average distance from <span class=\"customMeta\" data-dictid=\"799979f3bc169277719134cd535c7c\">Limbus</span> is:</p>\n<ul>\n<li>Superior: 7.7 mm</li>\n<li>Inferior: 6.5 mm</li>\n<li>Medial: 5.5 mm</li>\n<li>Lateral: 6.9 mm</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Superior oblique: <strong>Trochlear nerve</strong></li>\n<li>Lateral rectus: <strong>Abducens nerve</strong></li>\n<li>Rest all other recti: <strong>Oculomotor nerve</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is most radiosensitive?", "options": [{"label": "A", "text": "Testis", "correct": true}, {"label": "B", "text": "Bone", "correct": false}, {"label": "C", "text": "Nerve", "correct": false}, {"label": "D", "text": "Muscle", "correct": false}], "correct_answer": "A. Testis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/itqLZPe9jjsIlqFzF6sA1747656354.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An infant presents with a distended abdomen, jaundice, increased appetite, and hepatomegaly. Which enzyme deficiency is most likely responsible for this condition?", "options": [{"label": "A", "text": "Glucose-6-phosphatase", "correct": true}, {"label": "B", "text": "Glycogen phosphorylase", "correct": false}, {"label": "C", "text": "Galactose-1-phosphate uridyl transferase", "correct": false}, {"label": "D", "text": "Glycogen synthase", "correct": false}], "correct_answer": "A. Glucose-6-phosphatase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deficiency of <span class=\"customMeta\" data-dictid=\"bcab733e981692777188fe634201b6\">glucose-6-phosphatase</span> enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inability to convert glucose-6-phosphate to glucose; leads to accumulation of glycogen, lactate, and triglycerides</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Severe hypoglycemia</strong></li>\n<li><strong>Hepatomegaly and Renomegaly</strong></li>\n<li>Growth retardation</li>\n<li>Lactic acidosis</li>\n<li>Hyperuricemia and Hyperlipidemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Biochemical tests (hypoglycemia, <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis, hyperuricemia, hyperlipidemia)</li>\n<li>Genetic testing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Frequent feedings with slow-release carbohydrates</li>\n<li>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> monitoring</li>\n<li>Medications for associated conditions</li>\n<li>Liver <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> (in severe cases)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glycogen Storage Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type 0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glycogen <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">synthase</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I (von Gierke's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucose-6-phosphatase</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type II (Pompe's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acid α-glucosidase (acid maltase)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type III (Cori's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Debranching <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> (amylo-1,6-glucosidase)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type IV (Andersen's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Branching enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type V (McArdle's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle <span class=\"customMeta\" data-dictid=\"1fa65725491692777195ead6a7c81b\">phosphorylase</span> (myophosphorylase) <strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type VI (Hers' Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver phosphorylase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type VII (Tarui's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phosphofructokinase (muscle type)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother of a breastfeeding child only eats vegetables. Which deficiency is common in this case?", "options": [{"label": "A", "text": "Vitamin B12", "correct": true}, {"label": "B", "text": "Vitamin A", "correct": false}, {"label": "C", "text": "Vitamin D", "correct": false}, {"label": "D", "text": "Vitamin K", "correct": false}], "correct_answer": "A. Vitamin B12", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cobalamin - vitamin B12</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sources </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver; Meat; Milk; Eggs; Cheese; Synthesised by gut bacteria (not found in food of vegetable origin)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Absorption </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absorbed in <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> ileum, <span class=\"customMeta\" data-dictid=\"d82fcb9d1f16927771836a9f6ccf14\">bound</span> to <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> factor.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It helps in the <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> of <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid(myelin) and DNA.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Deficiency </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Megaloblastic anemia</li>\n<li>Demyelinating <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> in the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord</li>\n<li>Infertility</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Requirements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Adults: 2-2 mcg/day.</li>\n<li>Pregnancy: extra 0.25 mcg.</li>\n<li>Lactation: extra 1 mcg.</li>\n<li>Infants and children: 1.2 mcg.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Marriage and mortality belong under?", "options": [{"label": "A", "text": "Demographic process", "correct": true}, {"label": "B", "text": "Demographic dividend", "correct": false}, {"label": "C", "text": "Demographic bonus", "correct": false}, {"label": "D", "text": "Demographic window", "correct": false}], "correct_answer": "A. Demographic process", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a medical student's obstetrics rotation, they are studying placental anatomy and the maternal-fetal interface. The attending physician explains the different layers and components of the placenta, focusing particularly on its attachment to the maternal body. Which part of the placenta is attached to the maternal body?", "options": [{"label": "A", "text": "Decidua parietalis", "correct": false}, {"label": "B", "text": "Decidua basalis", "correct": true}, {"label": "C", "text": "Chorionic plate", "correct": false}, {"label": "D", "text": "Spiral arteries", "correct": false}], "correct_answer": "B. Decidua basalis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Ydki2rq8jssoCtWFyMN61747664735.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man presents with gynecomastia. Ultrasound reveals a 1 cm solid mass within the body of the testis. Serum testosterone is 600 ng/dL, and estradiol is 35 pg/mL. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Spermatocytic tumor", "correct": false}, {"label": "B", "text": "Sertoli cell tumor", "correct": false}, {"label": "C", "text": "Granulosa cell tumor", "correct": false}, {"label": "D", "text": "Leydig cell tumor", "correct": true}], "correct_answer": "D. Leydig cell tumor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zzWcJJheyF7b1OdxwyKm1747294844.png", "https://image.prepladder.com/content/W2s6WmuMefzS4VpzIi5K1747294852.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Leydig cell tumour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sertoli cell tumour</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormonal involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It often involves androgens, oestrogens, and corticosteroids.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hormonally silent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conditions associated with</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Klinefelter syndrome.</li>\n<li>Cryptorchidism.</li>\n<li>Renal cell carcinoma.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carney complex.</li>\n<li>Peutz-Jeghers syndrome.</li>\n<li>Familial <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> polyposis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10% (in adults)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gross</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Circumscribed nodules, usually &lt; 5 cm in diameter.</li>\n<li>They have a distinctive golden brown, <span class=\"customMeta\" data-dictid=\"d9ec45007b1692777189e3b26e44ca\">homogeneous</span> appearance on cut surfaces.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Firm, small nodules with a homogeneous</p>\n<p>grey-white to yellow cut surface.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The tumour cells resemble their normal counterparts.</li>\n<li>They are large in size and have <strong>round or polygonal cell outlines</strong>, <strong>abundant</strong> <strong>granular <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm</strong>, and a <strong>round central nucleus.</strong></li>\n<li>The <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> frequently contains <strong>lipid droplets</strong>, <strong>vacuoles</strong>, or <strong>lipofuscin</strong> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> and, most characteristically, rod-shaped <strong>Reinke crystalloids</strong> (25% of the tumours).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The tumour cells are arranged in <strong>distinctive trabeculae</strong> that tend to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> <strong>cord-like structures</strong> and <strong>tubules.</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='\"1. Dr. Dharam Ramnani 2. Mikael Haggstrom &amp; Nephron 3. Dr. Roshan Nasimudeen\"' data-hash=\"\" data-license='\"1. Unknown 2. CC BY SA 3.0 3. CC BY SA 4.0\"' data-source='\"1. https://www.webpathology.com/image.asp?case=38&amp;n=4 2. https://commons.wikimedia.org/wiki/File:Call-Exner_bodies.png 3. https://commons.wikimedia.org/wiki/File:Granulosa_cell_tumor_ovary.jpg\"' data-tags=\"\" height=\"398\" src=\"https://image.prepladder.com/content/zzWcJJheyF7b1OdxwyKm1747294844.png\" width=\"330\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://librepathology.org/wiki/File:Sertoli_cell_tumour_high_mag.jpg\" data-tags=\"\" height=\"281\" src=\"https://image.prepladder.com/content/W2s6WmuMefzS4VpzIi5K1747294852.png\" width=\"417\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures does not form the boundary of Hesselbach's triangle?", "options": [{"label": "A", "text": "Inferior epigastric artery", "correct": false}, {"label": "B", "text": "Vas deferens", "correct": true}, {"label": "C", "text": "Rectus abdominis", "correct": false}, {"label": "D", "text": "Inguinal ligament", "correct": false}], "correct_answer": "B. Vas deferens", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/8ktafeIaZyil9IKU6pjo1747644781.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrived at the hospital, claiming to be experiencing a cardiac arrest. After a comprehensive medical examination, it was determined that the patient was in normal health. However, he refuses to leave the hospital and return home. He mentioned that he had been a victim of a robbery where he was held at gunpoint. What is the likely diagnosis in this case?", "options": [{"label": "A", "text": "Acute stress disorder", "correct": true}, {"label": "B", "text": "Schizophrenia", "correct": false}, {"label": "C", "text": "Avoidant personality disorder", "correct": false}, {"label": "D", "text": "Delirium", "correct": false}], "correct_answer": "A. Acute stress disorder", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Post-Traumatic Stress Disorder (PTSD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mood <strong> </strong>\n<ul>\n<li>Negative feelings like fear, guilt, anger</li>\n</ul>\n</li>\n<li>Avoidance<strong> </strong>\n<ul>\n<li>Avoiding people, places, or objects that relate to the <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> event</li>\n<li>Social withdrawal</li>\n</ul>\n</li>\n<li>Hyperarousal<strong> </strong>\n<ul>\n<li>Hypervigilant</li>\n<li>Poor sleep</li>\n<li>Exaggerated <span class=\"customMeta\" data-dictid=\"49a672054e169277719974b3f062e9\">startle</span> response</li>\n<li>Poor concentration</li>\n</ul>\n</li>\n<li><strong>Intrusive symptoms </strong>\n<ul>\n<li>Flashbacks</li>\n<li>Dreams and memories</li>\n<li>Distressing re-experiencing of the <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> event.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To diagnose <strong>Post-Traumatic Stress Disorder (PTSD)</strong> according to the <strong>DSM-5</strong> criteria, the duration of symptoms plays a critical role.</p>\n<ul>\n<li>Symptoms must persist for more than 1 month after exposure to a <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> event.</li>\n<li>Symptoms typically begin within 3 months of the trauma but can have delayed onset, appearing months or even years later.</li>\n<li>The symptoms must cause significant <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> or <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> in social, occupational, or other important areas of functioning.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pharmacotherapy</strong></p>\n<ul>\n<li>SSRI (most efficacious) drug</li>\n<li>SNRI (some initial evidence)</li>\n</ul>\n<p> </p>\n<p><strong>Psychotherapy </strong></p>\n<ul>\n<li>Trauma-focused cognitive-behavioural therapy, inclusive of prolonged exposure (PE) therapy- requires reexperiencing a <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> event.</li>\n<li>Eye movement <span class=\"customMeta\" data-dictid=\"205afd2b271692777186a3d23ad364\">desensitization</span> and reprocessing therapy (EMDR)</li>\n<li>Cognitive processing therapy (CPT) corrects overgeneralization of seeing the world as dangerous</li>\n<li>Group therapy</li>\n<li>Family therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of ulcer shown in the image below:", "options": [{"label": "A", "text": "Venous ulcer", "correct": false}, {"label": "B", "text": "Malignant ulcer", "correct": false}, {"label": "C", "text": "Arterial ulcer", "correct": false}, {"label": "D", "text": "Trophic ulcer", "correct": true}], "correct_answer": "D. Trophic ulcer", "question_images": ["https://image.prepladder.com/notes/h2bJCv7N5KPlxwWmqqwK1747643811.png"], "explanation_images": ["https://image.prepladder.com/content/NJoeV6HxnfN2QmgVSS141747293039.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lesion Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pain</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ischemic/Arterial</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smoking, <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> claudication</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Irregular edges, poor <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, dry necrotic base; round or <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> with sharp demarcation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe, particularly at night; relieved by dependency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Venous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varicose veins, DVT, trauma, surgery, multiple pregnancies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shallow, irregular/shaggy shape, granulating base, fibrinous material with moderate to heavy exudate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild; relieved by elevation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurotrophic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Numbness, paresthesias, burning, loss of sensation in the foot, DM</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Punched-out, deep sinus, variable depth partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> to severe, involving the tendon, fascia, joint capsule, or bone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malignant Ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>History of skin cancer (e.g., <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> or <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Irregular, raised borders, ulcerating tumor with hard, <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often painful, can be associated with <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> or foul odor</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not an indication for splenectomy?", "options": [{"label": "A", "text": "Iatrogenic splenic trauma", "correct": false}, {"label": "B", "text": "Thrombocytopenia", "correct": false}, {"label": "C", "text": "Hairy cell leukemia", "correct": false}, {"label": "D", "text": "Bone marrow failure", "correct": true}], "correct_answer": "D. Bone marrow failure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old woman from an endemic area presents with chronic pelvic pain, irregular menstrual cycles, and primary infertility. She has a history of pulmonary tuberculosis treated 5 years ago. Her gynecologist suspects genital tuberculosis and is discussing the pattern of organ involvement with medical students. Most common organ infected with genital tuberculosis?", "options": [{"label": "A", "text": "Ovary", "correct": false}, {"label": "B", "text": "Fallopian tube", "correct": true}, {"label": "C", "text": "Cervix", "correct": false}, {"label": "D", "text": "Uterus", "correct": false}], "correct_answer": "B. Fallopian tube", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B. Fallopian tu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy presents with a history of recurrent bacterial and fungal infections, particularly involving the skin and respiratory tract. The patient's parents report that he has had multiple abscesses and lymphadenitis. Dihydrorhodamine test results show an abnormal pattern. What is the primary suspicion based on these findings?", "options": [{"label": "A", "text": "CGD", "correct": true}, {"label": "B", "text": "SCID", "correct": false}, {"label": "C", "text": "Sialyl Lewis X", "correct": false}, {"label": "D", "text": "LAD", "correct": false}], "correct_answer": "A. CGD", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Atypical antipsychotic with the least metabolic side effects?", "options": [{"label": "A", "text": "Haloperidol", "correct": false}, {"label": "B", "text": "Risperidone", "correct": false}, {"label": "C", "text": "Ziprasidone", "correct": true}, {"label": "D", "text": "Quetiapine", "correct": false}], "correct_answer": "C. Ziprasidone", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/cq9AEzn85aA1XYDHzP1P1747668767.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ziprasidone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atypical <span class=\"customMeta\" data-dictid=\"4123308aeb1692777181e8820312dd\">antipsychotic</span> / 2nd generation antipsychotics</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>D2 and 5HT2A <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Schizophrenia</li>\n<li>Bipolar I disorder\n\t\t\t\t<ul>\n<li><strong>Acute treatment: </strong>Monotherapy of <span class=\"customMeta\" data-dictid=\"ff42ad0e5716927771914cad2ccde9\">manic</span> or mixed episodes</li>\n<li><strong>Maintenance treatment: </strong>Adjunct to <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> or valproate.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Most common side effects are somnolence</strong>, headache, dizziness, nausea, and lightheadedness.</li>\n<li><strong>Prolongation of the QTc complex</strong></li>\n<li>Less <span class=\"customMeta\" data-dictid=\"e2952dfc311692777187fa773bcc9f\">extrapyramidal</span> side effects, <span class=\"customMeta\" data-dictid=\"9c0ca3c8231692777189437f1ade91\">hyperprolactinemia</span> and more <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> side effects.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statement is true regarding laryngomalacia?", "options": [{"label": "A", "text": "Expiratory stridor", "correct": false}, {"label": "B", "text": "Breathing Improves in supine position", "correct": false}, {"label": "C", "text": "Most common congenital abnormality in newborn", "correct": true}, {"label": "D", "text": "Surgical management is required in most children", "correct": false}], "correct_answer": "C. Most common congenital abnormality in newborn", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Laryngomalacia or <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> laryngeal stridor</p>\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> of the larynx.</li>\n<li>During inspiration, an excessively <span class=\"customMeta\" data-dictid=\"d28003a82c1692777202475273e346\">flaccid</span> <span class=\"customMeta\" data-dictid=\"7813a61d5816927771991abd685f88\">supraglottic</span> <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> gets sucked in and causes the symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Presents at birth or immediately after</li>\n<li>Stridor:\n\t\t\t\t<ul>\n<li><strong>Increases on crying</strong> (increased negative <span class=\"customMeta\" data-dictid=\"09d1aa62351692777190c98d0dbb12\">intrathoracic</span> pressure pulls the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> inward, covering the laryngeal inlet)</li>\n<li><strong>Stridor present in <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> position</strong> (as the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> covers the laryngeal inlet)</li>\n<li><strong>Subsides in <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> position</strong> (as the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> falls away from the larynx)</li>\n</ul>\n</li>\n<li>Cyanosis seen sometimes</li>\n<li>Normal cry</li>\n<li>Usually disappears by 2 years of age</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations: </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Direct laryngoscopy:\n\t\t\t\t<ul>\n<li>Elongated epiglottis, curled upon itself giving an <strong>“omega-shaped” appearance</strong>.</li>\n<li>Floppy <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> folds</li>\n<li>Prominent aretynoids</li>\n</ul>\n</li>\n<li>Flexible <span class=\"customMeta\" data-dictid=\"4c11fea2841692777191286556aceb\">laryngoscopy</span> is the most preferred</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management: </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conservative treatment in most cases</li>\n<li>Tracheostomy: If severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> obstruction</li>\n<li>Supraglottoplasty: If severe laryngomalacia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which artery passes in close proximity to the area of the skull shown in the image?", "options": [{"label": "A", "text": "Anterior cerebral artery", "correct": false}, {"label": "B", "text": "Internal carotid artery", "correct": false}, {"label": "C", "text": "Middle meningeal artery", "correct": true}, {"label": "D", "text": "Deep temporal artery", "correct": false}], "correct_answer": "C. Middle meningeal artery", "question_images": ["https://image.prepladder.com/notes/BuEsieuXmYV8jMCbciKS1747652461.png"], "explanation_images": ["https://image.prepladder.com/content/rvIwI16rHH33wygn1wtq1747379645.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Conjunctival xerosis is caused by which vitamin deficiency?", "options": [{"label": "A", "text": "Vitamin A", "correct": true}, {"label": "B", "text": "Vitamin K", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": false}, {"label": "D", "text": "Vitamin D", "correct": false}], "correct_answer": "A. Vitamin A", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:561px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>WHO Grading of eye signs of vitamin A <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (VAD) in children</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Eye Sign</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>XN</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Night blindness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>X1A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Conjunctival xerosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>X1B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Bitot's spots</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>X2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Corneal xerosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>X3A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Corneal <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> covering less than 1/3 of the cornea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>X3B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Corneal <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> covering at least 1/3 of the cornea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>XS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Corneal scarring</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management of Vit A deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Standard Oral Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Children &lt;6 months: 50,000 IU</li>\n<li>Children 6-12 months: 100,000 IU</li>\n<li>Children &gt;1 year: 200,000 IU</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Administration Schedule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial dose</li>\n<li>Repeat same dose next day</li>\n<li>Final dose 4 weeks later</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parenteral Administration(For severe <span class=\"customMeta\" data-dictid=\"819ebcc6691692777191f968d41a03\">malabsorption</span> or persistent vomiting)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Children &lt;6 months: 75% of oral dose</li>\n<li>Children ≥6 months: 50% of oral dose</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ocular Emergencies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal clouding: Immediate <span class=\"customMeta\" data-dictid=\"f4eacdbe7b1692777194d7caa2017d\">parenteral</span> administration of 50,000-100,000 IU (15-30 mg retinol)</li>\n<li>Keratomalacia: Antibiotic drops/ointment and eye padding</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vitamin A Prophylaxis in Children</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Administration Timing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100,000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>With <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> vaccine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>15-18 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>200,000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>With DPT booster</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18 months - 5 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>200,000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Every 6 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Special Cases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Children with <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> or severe <span class=\"customMeta\" data-dictid=\"cbd2d1fd521692777191d00c1a4ede\">malnutrition</span> &lt;1 year</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100,000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>During illness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Children with <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> or severe <span class=\"customMeta\" data-dictid=\"cbd2d1fd521692777191d00c1a4ede\">malnutrition</span> &gt;1 year</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>200,000 IU</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>During illness</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with diarrhea was eager to drink, and the skin pinch went back slowly. Which of the following categories is the child classified into as per IMNCI?", "options": [{"label": "A", "text": "Pink", "correct": false}, {"label": "B", "text": "Yellow", "correct": true}, {"label": "C", "text": "Green", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "B. Yellow", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/eTDd7I4omLmy9hXEM2dN1747667976.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>No <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">Dehydration</span> (Green) (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Some <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">Dehydration</span> (Yellow) (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Severe <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">Dehydration</span> (Pink) (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sensorium</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Well alert</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Restless, irritable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lethargic, floppy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eyes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sunken</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very sunken</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tears</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mucosa</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moist</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dry</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very dry</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thirst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Drinks normally</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thirsty, drinks eagerly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Drinks poorly/unable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin pinch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Goes back quickly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Goes back slowly (&lt;2 sec)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Goes back very slowly (&gt;2 sec)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient had features of resting tremors, bradykinesia, and postural instability. He became bedridden and died due to respiratory failure. A brain biopsy is likely to show which of the following?", "options": [{"label": "A", "text": "Lewy bodies", "correct": true}, {"label": "B", "text": "Hirano bodies", "correct": false}, {"label": "C", "text": "Guarneri bodies", "correct": false}, {"label": "D", "text": "Negri bodies", "correct": false}], "correct_answer": "A. Lewy bodies", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Pathophysiology of Parkinson’s Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Initial Damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Damage to <span class=\"customMeta\" data-dictid=\"0650f5ca7c169277719911f2ee3df8\">substantia</span> nigra</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Consequence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"6aec63ba2e1692777186e5809a7376\">dopaminergic</span> neurons in <span class=\"customMeta\" data-dictid=\"0650f5ca7c169277719911f2ee3df8\">substantia</span> <span class=\"customMeta\" data-dictid=\"f2fc45b6181692777193ed78c4835a\">nigra</span> <strong>(pars compacta)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Decrease in <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> production</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Autopsy findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Depigmentation of <span class=\"customMeta\" data-dictid=\"0650f5ca7c169277719911f2ee3df8\">substantia</span> nigra</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Microscopic findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Inclusion bodies called <strong>Lewy bodies</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Composition of Lewy Bodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Composed of α-synuclein (intracellular <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> inclusions)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented to the outpatient department with a dilated, tortuous vein in the leg. The patient reported a history of trauma to the same area 10 years prior. Upon examination, a pulsatile vein was also noted. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Varicose vein", "correct": false}, {"label": "B", "text": "Angiofibroma", "correct": false}, {"label": "C", "text": "Hemangioma", "correct": false}, {"label": "D", "text": "A-V Fistula", "correct": true}], "correct_answer": "D. A-V Fistula", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9e0n1gjkltJwpaLRP9Uf1747292781.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Purpose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used for hemodialysis</li>\n<li>Provides high <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> for effective dialysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Site Selection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prefer <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> placement</li>\n<li>Non-dominant arm is typically used</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arterial Quality</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires a strong arterial pulse for success</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vein Preservation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Avoid placing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> lines in the arm intended for fistula</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Apoptotic bodies comprise of?", "options": [{"label": "A", "text": "Include cytoplasm + intranuclear material + organelle", "correct": true}, {"label": "B", "text": "Cytoplasm + organelle", "correct": false}, {"label": "C", "text": "Organelle + intranuclear material", "correct": false}, {"label": "D", "text": "Only organelle", "correct": false}], "correct_answer": "A. Include cytoplasm + intranuclear material + organelle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oPPoXl5qCCIolpWzuKh11747305452.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Physiological <span class=\"customMeta\" data-dictid=\"4bfa3e6f2c1692777181c53b124cf7\">Apoptosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathological Apoptosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The removal of <span class=\"customMeta\" data-dictid=\"665d8d3c3b1692777199b748b1cd0e\">supernumerary</span> cells (in <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> of the required number) during development.</li>\n</ul>\n<ul>\n<li>Involution of hormone-dependent tissues on hormone withdrawal, such as endometrial cell <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> during the <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle.</li>\n</ul>\n<ul>\n<li>Elimination of potentially harmful self-reactive lymphocytes to prevent immune reactions against one’s own tissues.</li>\n</ul>\n<ul>\n<li>Death of host cells that have served their useful purpose, such as neutrophils in an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response and lymphocytes at the end of an immune response.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>DNA damage.</li>\n<li>Accumulation of misfolded proteins</li>\n<li>Apoptosis can be <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> during certain infections- as in <span class=\"customMeta\" data-dictid=\"a122cc5a281692777180084ac1edd5\">adenovirus</span> and HIV infections and <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> hepatitis.</li>\n<li>It may also contribute to <span class=\"customMeta\" data-dictid=\"e32252a2c41692777194fe542b3e35\">pathologic</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> in parenchymal organs after <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> obstruction, such as occurs in the pancreas, <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> gland, and kidney.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following comes under ASA grade 1?", "options": [{"label": "A", "text": "Healthy patient", "correct": true}, {"label": "B", "text": "Mild disease", "correct": false}, {"label": "C", "text": "Moderate disease", "correct": false}, {"label": "D", "text": "Morbid patient", "correct": false}], "correct_answer": "A. Healthy patient", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p>Class</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p>Definition</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Normal healthy patient <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Patient with mild <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> disease (no functional limitations), normal pregnancy <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Patient with severe <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> disease (some functional limitations)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Patient with severe <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> disease that is a constant threat to life (functionality incapacitated)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Moribund patient who is not expected to survive without the operation <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Brain-dead patient whose organs are being removed for donor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>E</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>If the procedure is an emergency, the physical status is followed by “E” (e.g., “2E”)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents with itchy, flat-topped, polygonal, violaceous papules on the inner wrists and flexors surfaces of the forearms. The lesions have a characteristic shiny surface and are arranged in a linear pattern. The patient denies any recent medication changes. What is the treatment?", "options": [{"label": "A", "text": "Topical steroids", "correct": true}, {"label": "B", "text": "Antibiotics", "correct": false}, {"label": "C", "text": "Immunosuppressants", "correct": false}, {"label": "D", "text": "Anti-fungal", "correct": false}], "correct_answer": "A. Topical steroids", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient having hypertension is on thiazides and is complaining of fatigue and hypokalemia. Which of the following drugs can prevent potassium loss?", "options": [{"label": "A", "text": "Furosemide", "correct": false}, {"label": "B", "text": "Amiloride", "correct": true}, {"label": "C", "text": "Acetazolamide", "correct": false}, {"label": "D", "text": "Indapamide", "correct": false}], "correct_answer": "B. Amiloride", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> inhibitors </strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tubule, decreasing <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> reabsorption</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acetazolamide, Methazolamide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glaucoma, Altitude sickness</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metabolic acidosis, Hypokalemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Loop diuretics </strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit the Na-K-2Cl <span class=\"customMeta\" data-dictid=\"1bede64bc91692777199b477cf43f1\">symporter</span> in the thick <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> loop of Henle</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Furosemide, Bumetanide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema, Chronic heart failure, Hypercalcemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypokalemia, <strong>Ototoxicity, </strong>Metabolic alkalosis,</p>\n<p>Hyperglycemia,</p>\n<p>Hyperuricemia</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Thiazide diuretics </strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit sodium <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hydrochlorothiazide, Chlorthalidone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension, Edema</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypokalemia, Hyponatremia,</p>\n<p>Hyperglycemia</p>\n<p>Hyperuricemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Potassium-sparing</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit sodium channels in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"32562f5afa1692777193c891837db9\">nephron</span> or block <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> receptors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spironolactone, Amiloride</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heart failure, Hyperaldosteronism</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperkalemia, Gynecomastia (for Spironolactone)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Osmotic diuretics </strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increase <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> of the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> filtrate, inhibiting water reabsorption.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mannitol, Glycerin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cerebral oedema, Acute glaucoma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dehydration, <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">Electrolyte</span> imbalance</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is the least radiosensitive cell?", "options": [{"label": "A", "text": "Monocytes", "correct": false}, {"label": "B", "text": "Platelets", "correct": true}, {"label": "C", "text": "Lymphocytes", "correct": false}, {"label": "D", "text": "Neutrophils", "correct": false}], "correct_answer": "B. Platelets", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What nutritional deficiency is commonly associated with a chronic alcoholic presenting with a pruritic, eczematous rash on the neck and dorsum of the hands?", "options": [{"label": "A", "text": "Vit B3", "correct": true}, {"label": "B", "text": "Vit B1", "correct": false}, {"label": "C", "text": "Vit D", "correct": false}, {"label": "D", "text": "Vit C", "correct": false}], "correct_answer": "A. Vit B3", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lN71MlmhbXoGZmEjHLng1747377688.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following inhalation agents has a blood-gas partition coefficient similar to nitrous oxide?", "options": [{"label": "A", "text": "Isoflurane", "correct": false}, {"label": "B", "text": "Desflurane", "correct": true}, {"label": "C", "text": "Sevoflurane", "correct": false}, {"label": "D", "text": "Halothane", "correct": false}], "correct_answer": "B. Desflurane", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AR47qVDjfye3JfcX6Lzn1747291141.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Desflurane</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Properties</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desflurane is a fluorinated <span class=\"customMeta\" data-dictid=\"191f7b5f441692777187971c7d6ee2\">ether</span> with high <span class=\"customMeta\" data-dictid=\"19a5a39c6b169277720158b14e5cf1\">vapor</span> pressure (681 mm Hg at 20°C) and very low blood <span class=\"customMeta\" data-dictid=\"a9295e67a41692777198dce0de3f34\">solubility</span> (λb/g 0.42), allowing rapid <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">induction</span> and emergence.</p>\n<p>It requires a special <span class=\"customMeta\" data-dictid=\"4fa5d60f481692777201f36552b1bc\">vaporizer</span> (tec 6) for precise <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> control.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author='\"Sucharita Chakravarti Srabani Basu\"' data-hash=\"\" data-license=\"CC BY-NC SA 3.0\" data-source=\"https://www.researchgate.net/figure/Desfurane-Tec-6R-GE-b-Desflurane-D-VaporR-Drager-c-Desflurane-Sigma-AlphaR_fig4_258703085\" data-tags=\"\" height=\"473\" src=\"https://image.prepladder.com/content/AR47qVDjfye3JfcX6Lzn1747291141.png\" width=\"302\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Tec 6</strong></p>\n<ul>\n<li>Blood gas <span class=\"customMeta\" data-dictid=\"b530604f9d1692777184cf1541ae41\">coefficient</span> indicates speed of onset and recovery, <span class=\"customMeta\" data-dictid=\"a9295e67a41692777198dce0de3f34\">solubility</span> of inhalational agent in the blood.</li>\n<li>It is inversely proportional to speed of onset\n\t\t\t\t<ul>\n<li>High B/G has a slow onset</li>\n<li>Low B/G has a fast onset</li>\n</ul>\n</li>\n<li>Desflurane has similar blood-gas <span class=\"customMeta\" data-dictid=\"25c5ca7c4516927771942bb8637e83\">partition</span> co-efficient similar to <span class=\"customMeta\" data-dictid=\"b83d31a7d61692777193c128d13c7d\">Nitrous</span> oxide.</li>\n</ul>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desflurane is ideal for rapid <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">induction</span> and <span class=\"customMeta\" data-dictid=\"717a791bdf1692777187f5f058180c\">emergence</span> due to its low blood solubility, but it is not suitable for <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">induction</span> due to its pungency and <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> irritation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C/I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It should be avoided in patients with severe hypovolemia, <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> hyperthermia, and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hypertension.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiovascular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desflurane decreases <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> resistance and <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> pressure.</p>\n<p>It causes moderate increases in heart rate, central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure, and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> pressure, particularly during rapid concentration increases, which can be managed with fentanyl, esmolol, or clonidine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes decreased <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume and increased <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate. It is <span class=\"customMeta\" data-dictid=\"824995c39416927771966210e0a5db\">pungent</span> and can cause <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> irritation, making it unsuitable for <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> induction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hepatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimal <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> and risk of anesthetic-induced hepatitis, with maintained <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> oxygen delivery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimal nephrotoxicity, but decreases in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output and <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> occur with <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuromuscular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desflurane causes a dose-dependent decrease in <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> response, enhancing the effects of nondepolarizing <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> blockers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cerebral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases cerebral <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> (CBF), <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure, and cerebral <span class=\"customMeta\" data-dictid=\"b9b690b70c16927771833aae799b33\">blood volume</span> but decreases cerebral oxygen consumption. CBF can be lowered through hyperventilation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young boy from a poor socioeconomic background presents with hyperemia and yellowish nodules at the limbus. What could be the likely diagnosis?", "options": [{"label": "A", "text": "Bitot’s spots", "correct": false}, {"label": "B", "text": "Pterygium", "correct": false}, {"label": "C", "text": "Pinguecula", "correct": false}, {"label": "D", "text": "Phlyctenular conjunctivitis", "correct": true}], "correct_answer": "D. Phlyctenular conjunctivitis", "question_images": ["https://image.prepladder.com/content/0A9jd8sss3bmCnDpAUeX1747305260.png"], "explanation_images": ["https://image.prepladder.com/content/m5SmoNDj6vjTtszwEYnA1747305306.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Phlyctenular keratoconjunctivitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Allergic reactions to <span class=\"customMeta\" data-dictid=\"2a7f0b780c1692777187fe83ec76b1\">endogenous</span> antigens are often <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to bacterial infections such as <strong>Staphylococcus aureus </strong>(M/C/C in Western countries)<strong> </strong> or <strong>tuberculosis</strong>(M/C/C in India).</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Arpitha Muthialu, MD, Lauren E. Jensen, and Michael Wagoner, MD, PhD\" data-hash=\"\" data-license=\"CC BY NC ND 3.0\" data-source=\"https://webeye.ophth.uiowa.edu/eyeforum/cases/89_phlyctenular-keratoconjunctivitis-staphylococcal-blepharitis.htm#gsc.tab=0\" data-tags=\"\" height=\"311\" src=\"https://image.prepladder.com/content/m5SmoNDj6vjTtszwEYnA1747305306.png\" width=\"512\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms &amp; signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Watering, itching</li>\n<li>Reflex <span class=\"customMeta\" data-dictid=\"540b75eeb516927771831794d7ce0f\">blepharospasm</span> (involuntary blinking)</li>\n<li>Conjunctival congestion</li>\n<li><strong>Phlycten - Small, round, grayish, or yellowish nodules on the <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> <span class=\"customMeta\" data-dictid=\"d168af6e7f1692777185683fea5e7f\">conjunctiva</span> near the limbus</strong>.</li>\n<li>Corneal involvement can lead to <span class=\"customMeta\" data-dictid=\"ee875e7c3416927772026804e2e155\">fascicular</span> ulcers or ring ulcers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Type IV <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reaction.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Common Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Corneal involvement:</strong> Ulcers <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> on the cornea, leading to potential scarring.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Long-standing mild infections like <strong>tonsillitis</strong> or <strong>adenoiditis</strong>, and in populations with a high <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of <strong>tuberculosis</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Local therapy:</strong></p>\n<ul>\n<li>Corticosteroids: Drops/ointment to reduce inflammation. Address underlying cause (e.g., tuberculosis).</li>\n<li>Antibiotics</li>\n<li>Cycloplegics: Paralyze <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> muscle, relieve pain, and prevent complications.</li>\n<li>Dark Glasses/Eye Shade: For <span class=\"customMeta\" data-dictid=\"46e2a1c298169277719583f46ff587\">photophobia</span> relief.</li>\n</ul>\n<p><strong>General therapy:</strong></p>\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"8784b5a7ad16927772005323b514b8\">tetracycline</span> or <span class=\"customMeta\" data-dictid=\"d0f202322516927771863db87b76e7\">doxycycline</span> is used in <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> cases <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to Staphylococcal blepharitis.</li>\n</ul>\n<p><strong>Supportive:</strong> Dark <span class=\"customMeta\" data-dictid=\"9e8e9086691692777188b5a212bcc7\">glasses</span> or eye shade.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sudden painful loss of vision in one eye is due to the lesion at?", "options": [{"label": "A", "text": "Optic nerve", "correct": true}, {"label": "B", "text": "Optic chiasma", "correct": false}, {"label": "C", "text": "Optic tract", "correct": false}, {"label": "D", "text": "Visual cortex", "correct": false}], "correct_answer": "A. Optic nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Y2C9gAaIM9kVdG1oodAi1747306594.png", "https://image.prepladder.com/content/D0xm0B3TIXxCyxSYME711747306594.png", "https://image.prepladder.com/content/NFm06pHP2wpVinaFPyBL1747306594.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Papillitis </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Retrobulbar <span class=\"customMeta\" data-dictid=\"6e951a16031692777193af1c351309\">Neuritis</span> </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Neuroretinitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Optic disc</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Optic nerve behind the eyeball.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Optic disc and surrounding <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> in the <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> area.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fundoscopy reveals a blurred disc margin due to leakage and increased <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> permeability, an edematous and hyperaemic disc, and an obliterated <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> cup.</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://www.cdc.gov/dpdx/freelivingamebic/index.html\" data-tags=\"\" height=\"225\" src=\"https://image.prepladder.com/content/Y2C9gAaIM9kVdG1oodAi1747306594.png\" width=\"296\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pain on eye elevation</li>\n<li>RAPD (relative <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> pupillary defect) is observed.</li>\n</ul>\n<ul>\n<li>Fundoscopic examination typically reveals <strong>normal <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc</strong>, at least initially, which is why the classic phrase, “<em>the patient sees nothing, and the doctor sees nothing</em>” is often used to describe <span class=\"customMeta\" data-dictid=\"99ac6e31f71692777197220f87effc\">retrobulbar</span> neuritis.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> star is seen in fundoscopy (accumulation of lipids).</p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Rasta, Seyed &amp; Nikfarjam, Shima &amp; Javadzadeh, Alireza.\" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/FFA-image-in-presence-of-neovascularization-and-vascular-permeability_fig4_298082808\" data-tags=\"\" height=\"224\" src=\"https://image.prepladder.com/content/D0xm0B3TIXxCyxSYME711747306594.png\" width=\"279\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The needle with the syringe is disposed of in which container?", "options": [{"label": "A", "text": "Yellow", "correct": false}, {"label": "B", "text": "Red", "correct": false}, {"label": "C", "text": "Blue", "correct": false}, {"label": "D", "text": "White", "correct": true}], "correct_answer": "D. White", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Example of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment and disposal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Human <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Animal <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Soiled waste.</li>\n<li>Discarded or expired medicine.</li>\n<li>Microbiology, <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> and other <span class=\"customMeta\" data-dictid=\"3ec60edb4a16927771842bb9fd9aa4\">clinical laboratory</span> waste.</li>\n<li>Chemical waste.</li>\n<li>Chemical liquid waste.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Placenta.</li>\n<li>Post-operative body parts.</li>\n<li>Plaster of Paris (POP).</li>\n<li>Pathological waste.</li>\n<li>Cotton waste.</li>\n<li>Dressing materials.</li>\n<li>Beddings.</li>\n<li>Body fluid contaminated paper and cloth.</li>\n<li>Face mask, cap, shoe cover and head cover.</li>\n<li>Cytotoxic, expired and discarded medicines.</li>\n<li>Microbiology and <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> lab waste.</li>\n<li>Blood bag</li>\n<li>Vacutainers with blood</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incineration.</li>\n<li>Plasma pyrolysis.</li>\n<li>Deep burial.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contaminated waste that is recyclable.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Syringe without needles.</li>\n<li>Fixed needle syringes with their needle cut.</li>\n<li>IVset.</li>\n<li>Catheters.</li>\n<li>Gloves (soiled or unsoiled).</li>\n<li>Urine bag.</li>\n<li>Dialysis kit.</li>\n<li>IVbottles.</li>\n<li>Tubing's.</li>\n<li>Bottles.</li>\n<li>Vacutainers with needle cut.</li>\n<li>Vacutainers without blood.</li>\n<li>ELISA plate and vials not containing blood samples.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoclaving or microwaving/ hydroclaving followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> and waste set to registered recyclers or for energy recovery/road making.</li>\n<li>Plastic waste should not be sent to landfill sites.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>White (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waste Sharps</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Needles</li>\n<li>Syringes with fixed needles</li>\n<li>Blades</li>\n<li>Scalpers</li>\n<li>Trocar cannula</li>\n<li>Insulin pen needle</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Puncture proof , Leak proof, Tamper proof containers</li>\n<li>Autoclaving or <span class=\"customMeta\" data-dictid=\"2d95ddf7b8169277718654aee27077\">dry heat</span> <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> or <span class=\"customMeta\" data-dictid=\"5a7f7caa7716927771870658b1c5cf\">encapsulation</span> in metal container or <span class=\"customMeta\" data-dictid=\"d8691a48a91692777184708a8f2f0c\">cement</span> concrete</li>\n<li>Or sent for final disposal to iron foundries or <span class=\"customMeta\" data-dictid=\"601fb1538a16927771987048f6e712\">sanitary</span> landfill or designated concrete waste sharp pit</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blue (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glassware or <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> body implants.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Includes broken or discarded glass and <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> objects that are contaminated.</li>\n<li>Glass:\n\t\t\t\t<ul>\n<li>Broken glass.</li>\n<li>Ampoules.</li>\n<li>Lab slide</li>\n</ul>\n</li>\n<li>Metals:\n\t\t\t\t<ul>\n<li>Nails.</li>\n<li>Metallic body implants.</li>\n<li>Scissors.</li>\n<li>Artificial pacemakers.</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardboard boxes with blue coloured marking or blue coloured puncture- proof and tamper-proof containers.</li>\n<li>Disinfection (cleaning with <span class=\"customMeta\" data-dictid=\"24ff542ee616927771865a28edbc12\">detergent</span> and soaking in sodium hypochlorite) or autoclaving or microwaving or hydroclaving and then sent for recycling.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked structure:", "options": [{"label": "A", "text": "Internal capsule", "correct": true}, {"label": "B", "text": "Body of fornix", "correct": false}, {"label": "C", "text": "Globus pallidus", "correct": false}, {"label": "D", "text": "Lateral ventricle", "correct": false}], "correct_answer": "A. Internal capsule", "question_images": ["https://image.prepladder.com/notes/UxI42UU7dSkK20lHCm341747652173.png"], "explanation_images": ["https://image.prepladder.com/notes/zNP3n6tv04vjHhtr2LqD1747652251.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Primigravida at 39 weeks AOG, with good uterine contractions, normal vitals, and FHR at 150 bpm, shows a 6 cm dilated cervix (6 hours after the initiation of the contractions) and fetal head at -2 station with absent membranes. What is the appropriate management?", "options": [{"label": "A", "text": "Emergency C-section", "correct": false}, {"label": "B", "text": "Observe", "correct": true}, {"label": "C", "text": "Start oxytocin", "correct": false}, {"label": "D", "text": "Rupture of membranes and confirm cord prolapse", "correct": false}], "correct_answer": "B. Observe", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient, after consuming alcohol, started experiencing vomiting, abdominal pain, and chest pain on examination. The patient was hypotensive. What is the drug causing these symptoms?", "options": [{"label": "A", "text": "Cefoperazone", "correct": true}, {"label": "B", "text": "Propranolol", "correct": false}, {"label": "C", "text": "Calcium channel blockers", "correct": false}, {"label": "D", "text": "Pantoprazole", "correct": false}], "correct_answer": "A. Cefoperazone", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate the maternal mortality ratio in a population of 2 lakhs, with 4000 live births, and 5 stillbirths where 2 died due to ectopic, 2 by abortion, 2 by electrocution, 2 deaths by sepsis and 4 by PPH?", "options": [{"label": "A", "text": "25 per one lakh", "correct": false}, {"label": "B", "text": "250 per lakh", "correct": true}, {"label": "C", "text": "500 per lakh", "correct": false}, {"label": "D", "text": "100 per lakh", "correct": false}], "correct_answer": "B. 250 per lakh", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Xeropthalmia is considered a public health problem if the prevalence of bitot spot is more than?", "options": [{"label": "A", "text": "0.01%", "correct": false}, {"label": "B", "text": "0.05%", "correct": false}, {"label": "C", "text": "0.5%", "correct": true}, {"label": "D", "text": "1%", "correct": false}], "correct_answer": "C. 0.5%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which substance is involved in the conjugation process in the liver?", "options": [{"label": "A", "text": "Hyaluronic Acid", "correct": false}, {"label": "B", "text": "Glucuronic Acid", "correct": true}, {"label": "C", "text": "Gluconic Acid", "correct": false}, {"label": "D", "text": "Glycolic Acid", "correct": false}], "correct_answer": "B. Glucuronic Acid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Synthetic Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucuronidation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conjugation with <span class=\"customMeta\" data-dictid=\"18167012bd16927771884c32cedf99\">glucuronic acid</span> via UDP-glucuronosyl transferases (UGTs).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chloramphenicol, aspirin, paracetamol, morphine, bilirubin, <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> hormones, thyroxine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acetylation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conjugation with <span class=\"customMeta\" data-dictid=\"6ade0969281692777180216b0c3d76\">acetyl</span> CoA, mediated by N-acetyl transferases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isoniazid, sulfonamides, hydralazine, dapsone, clonazepam.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methylation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Methylation of amines and phenols by <span class=\"customMeta\" data-dictid=\"bc09155adc169277719248f9543785\">methyl</span> transferases using <span class=\"customMeta\" data-dictid=\"373f4a37af16927771920ee58f2edf\">methionine</span> or <span class=\"customMeta\" data-dictid=\"dabfa103741692777185dac756c49b\">cysteine</span> as donors.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adrenaline, histamine, methyldopa, captopril, mercaptopurine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sulfation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conjugation of phenols and steroids with <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">sulfate</span> by sulfotransferases (SULTs).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chloramphenicol, methyldopa, <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> steroids.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glycine Conjugation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conjugation with <span class=\"customMeta\" data-dictid=\"6df8c5de5016927771881dc6865f2e\">glycine</span> for drugs with <span class=\"customMeta\" data-dictid=\"077c7b455c1692777183ed9de98e47\">carboxylic acid</span> groups.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Salicylates, <span class=\"customMeta\" data-dictid=\"c10496dcc416927771937d7280d782\">nicotinic</span> acid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glutathione Conjugation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conjugation of <span class=\"customMeta\" data-dictid=\"092583d1b41692777197a506409267\">reactive</span> intermediates with <span class=\"customMeta\" data-dictid=\"f945849e691692777188ad7ce5b5e2\">glutathione</span> via glutathione-S-transferases.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paracetamol (reactive intermediates), quinones, epoxides.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ribonucleoside Synthesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conjugation for <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of <span class=\"customMeta\" data-dictid=\"c03d9c910716927771961a9a2609b5\">purine</span> and <span class=\"customMeta\" data-dictid=\"cb474d9869169277719611d301e616\">pyrimidine</span> antimetabolites.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cancer chemotherapeutic agents.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is ECG change associated with the use of anti-tubercular drug bedaquiline?", "options": [{"label": "A", "text": "QT interval prolongation", "correct": true}, {"label": "B", "text": "PR interval prolongation", "correct": false}, {"label": "C", "text": "QRS widening", "correct": false}, {"label": "D", "text": "ST-segment elevation", "correct": false}], "correct_answer": "A. QT interval prolongation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bedaquiline</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It inhibits <strong>mycobacterial ATP synthase</strong>, a crucial <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> involved in the energy production of Mycobacterium tuberculosis. By disrupting this process, <span class=\"customMeta\" data-dictid=\"d0a85225e8169277718252304cfc4b\">bedaquiline</span> effectively kills the bacteria.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cross-resistance is seen with <strong>clofazimine.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is metabolised by <strong>CYP3A4. </strong>Hence, rifampicin, a CYP3A4 inducer, reduces its efficacy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nausea and diarrhoea (common side effects)</li>\n<li>QT prolongation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was given an antipsychotic drug, haloperidol and the patient developed acute dystonia. Which is the next best step?", "options": [{"label": "A", "text": "Give Benztropine", "correct": true}, {"label": "B", "text": "Change to clozapine", "correct": false}, {"label": "C", "text": "Give Fluphenazine", "correct": false}, {"label": "D", "text": "Increase dose of haloperidol", "correct": false}], "correct_answer": "A. Give Benztropine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Extrapyramidal Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute muscle <span class=\"customMeta\" data-dictid=\"61747121f116927771862fad303b93\">Dystonia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 1-5 days of starting antipsychotic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Administering <span class=\"customMeta\" data-dictid=\"551a84e8ff16927771811f8a7cb79b\">antiparkinsonian</span> agents such as <strong>diphenhydramine or benztropine</strong> intramuscularly.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parkinsonism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 1 month</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benzhexol and benztropine<strong> </strong><strong>(NOT Levodopa)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Akathisia</strong></p>\n<p><strong>(Most common EPS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5–60 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anti-anxiety medications</p>\n<ol>\n<li><strong>DOC: </strong><strong>Propranolol</strong> (C/I: Asthma)</li>\n<li>Diazepam</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rabbit Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Months or years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Antiparkinsonian agents.</li>\n<li><strong>Amantadine </strong>is preferred due to less adverse cognitive effects.</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tardive Dyskinesia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Late-onset adverse effects (after months or years)</p>\n<p>Occurs due to D2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> <span class=\"customMeta\" data-dictid=\"1d640454be16927771999e756dca73\">supersensitivity</span> and can be permanent, even after discontinuing <span class=\"customMeta\" data-dictid=\"4123308aeb1692777181e8820312dd\">antipsychotic</span> medication.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stop <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> drugs &amp; start <strong>Clozapine</strong><strong>.</strong></p>\n<p>If symptoms persist, add Dopamine depleters (VMAT2 inhibitors)</p>\n<ol>\n<li>Valbenazine</li>\n<li>Tetrabenazine: DOC for Huntington's disease.</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which incision is most commonly used for an appendectomy?", "options": [{"label": "A", "text": "McBurney incision", "correct": true}, {"label": "B", "text": "Kocher's incision", "correct": false}, {"label": "C", "text": "Midline incision", "correct": false}, {"label": "D", "text": "Battle incision", "correct": false}], "correct_answer": "A. McBurney incision", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CgtcNXgd1pkVpyx4GYMe1747643207.png", "https://image.prepladder.com/notes/fOfqrF97XFHyXGtDldnX1747643237.png", "https://image.prepladder.com/notes/9HWOfprnxAHiWMkOiMx41747643257.png", "https://image.prepladder.com/notes/JMnX7miHzgCRbsc4iKNn1747643275.png", "https://image.prepladder.com/notes/dGvpXlVgBni5yLvMagY31747643292.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Incision Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Common Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Abdominal Incisions</strong></p>\n<p style=\"text-align: center;\"><img alt=\"Abdominal incisions 2\" data-author=\"\" data-hash=\"12929\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"394\" src=\"https://image.prepladder.com/notes/fOfqrF97XFHyXGtDldnX1747643237.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Midline</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Longitudinal cut through the <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> alba, <span class=\"customMeta\" data-dictid=\"1ad3dee7d11692777183c0670e32a1\">bloodless</span> access</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Exploratory laparotomy, trauma surgery, emergency surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Periumbilical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Incisions around the umbilicus, avoiding the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> stalk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Laparoscopy, <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repairs, <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">tubal</span> ligation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Pararectus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Along the <span class=\"customMeta\" data-dictid=\"7a23f5d3cd16927771982eb39c68c1\">semilunar</span> line, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> abdominis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Abdominal wall <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repairs, <span class=\"customMeta\" data-dictid=\"e6ea2096571692777199430b45ac4c\">stoma</span> creation, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Paramedian</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\">linea</span> alba, access to <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> viscera</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> structures,</p>\n<p>Reduced <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> risk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Kocher/Subcostal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Inferior and <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the <span class=\"customMeta\" data-dictid=\"ece2c20c001692777185d9ca0c08db\">costal</span> margin, access to upper <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Gallbladder, <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree, pancreas, liver transplants, epigastric surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Grindiron/</strong></p>\n<p><strong>McBurney/</strong></p>\n<p><strong>Lanz</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> incisions, typically for appendectomy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Appendectomy (right side), <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> <span class=\"customMeta\" data-dictid=\"c8de4db86c16927771862eeef04df3\">diverticulitis</span> (left side), <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> appendectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Thoracoabdominal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>From 7th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space to the umbilicus, exposes <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> organs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Retroperitoneal masses, pleural space, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> esophagus, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> organs</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Thoracic Incisions</strong></p>\n<p style=\"text-align:center\"><img alt=\"Thoracic incisions\" data-author=\"\" data-hash=\"12930\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"277\" src=\"https://image.prepladder.com/notes/9HWOfprnxAHiWMkOiMx41747643257.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Thoracotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Access to <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> structures, various approaches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Lung transplants, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> surgeries, trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Median Sternotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vertical <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> dividing the sternum, wide access to the mediastinum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Open-heart surgery, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> tumor resection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Trapdoor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Complex incision, supraclavicular, sternal, and <span class=\"customMeta\" data-dictid=\"38764530ef16927772005496ff59a5\">thoracotomy</span> components</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Penetrating trauma, aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> aneurysms, complex <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> access</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Infraclavicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>A <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> just below the <span class=\"customMeta\" data-dictid=\"2cb340bacd169277718404028c7d00\">clavicle</span> for <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> vessel access</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Thoracic outlet syndrome, <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> vessel surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Supraclavicular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Superior to the clavicle, providing access to the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> vessels</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Trauma, <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> outlet syndrome</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Neck Incisions</strong></p>\n<p style=\"text-align:center\"><img alt=\"Neck incisions\" data-author=\"\" data-hash=\"12931\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"514\" src=\"https://image.prepladder.com/notes/JMnX7miHzgCRbsc4iKNn1747643275.png\" width=\"600\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Collar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Incision above the sternal <span class=\"customMeta\" data-dictid=\"80dc1890d11692777193322fc863b1\">notch</span> for <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> surgeries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Thyroid surgery, mid-neck structures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Traumatic Neck</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Along the <span class=\"customMeta\" data-dictid=\"ebf38dd1b416927771994e550b0d1e\">sternocleidomastoid</span> muscle for trauma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vascular or <span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\">traumatic</span> neck injuries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Tracheostomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vertical/horizontal <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> superior to the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> for tracheostomy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Airway management in patients needing long-term ventilation</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Pelvic Incisions</strong></p>\n<p style=\"text-align:center\"><img alt=\"Pelvic incisions\" data-author=\"\" data-hash=\"12932\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"327\" src=\"https://image.prepladder.com/notes/dGvpXlVgBni5yLvMagY31747643292.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Pfannenstiel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Transverse <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> above the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Cesarean section, pelvic, urologic, and <span class=\"customMeta\" data-dictid=\"2a73ca8f1b16927771949cec7c59cc\">orthopaedic</span> surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Maylard/Cherney</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Above <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> tubercle, provides access to <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> structures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Hysterectomy, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> dissection, lower <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> surgeries</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Inguinal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the inguinal ligament</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Inguinal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repair, urologic surgeries (cryptorchidism, varicocele)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>McEvedy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Vertical <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> for <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repair</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Femoral <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> repair (obsolete now due to high <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Gibson</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Above inguinal ligament, <span class=\"customMeta\" data-dictid=\"2207398c591692777182d7ac096dbc\">arc</span> to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Kidney transplantation, <span class=\"customMeta\" data-dictid=\"5d0f37715816927771973ecda21336\">retroperitoneal</span> access (iliac vessels, ureter)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How much mg of iron and mcg of folic acid should a pregnant woman be given?", "options": [{"label": "A", "text": "60mg/500mcg biweekly", "correct": false}, {"label": "B", "text": "60mg/500mcg weekly", "correct": false}, {"label": "C", "text": "60mg/500mcg daily", "correct": true}, {"label": "D", "text": "60mg/500mcg once a month", "correct": false}], "correct_answer": "C. 60mg/500mcg daily", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Iron Dose &amp; Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Folic Acid Dose &amp; Frequency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Infants (6-59 months)</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>1 ml IFA <span class=\"customMeta\" data-dictid=\"7cab9109cd16927771994c3125bd23\">syrup</span> (20 mg elemental iron, 100 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> folic acid) biweekly</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Included in <span class=\"customMeta\" data-dictid=\"7cab9109cd16927771994c3125bd23\">syrup</span> (100 mcg) biweekly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Preschool Children (5-9 years)</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>45 mg elemental iron + 400 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> weekly</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Included in <span class=\"customMeta\" data-dictid=\"508e14a7ca16927772002140ece8fb\">tablet</span> (400 mcg) weekly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Adolescents (10-19 years)</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>60 mg elemental iron + 500 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> weekly</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Included in <span class=\"customMeta\" data-dictid=\"508e14a7ca16927772002140ece8fb\">tablet</span> (500 mcg) weekly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Pregnant &amp; Lactating Women</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>60 mg elemental iron + 500 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> daily</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Included in <span class=\"customMeta\" data-dictid=\"508e14a7ca16927772002140ece8fb\">tablet</span> (500 mcg) daily</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Women of Reproductive Age (15-49 years)</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>60 mg elemental iron + 500 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> weekly</p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Included in <span class=\"customMeta\" data-dictid=\"508e14a7ca16927772002140ece8fb\">tablet</span> (500 mcg) weekly</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the correct sequence regarding the family cycle?", "options": [{"label": "A", "text": "Formation, extension, complete extension, contraction, complete contraction, dissolution, extinction", "correct": true}, {"label": "B", "text": "Formation, extension, complete extension, complete contraction, contraction, dissolution, extinction", "correct": false}, {"label": "C", "text": "Extension, Formation, complete extension, contraction, complete contraction, dissolution, extinction", "correct": false}, {"label": "D", "text": "Formation, extension, complete extension, contraction, complete contraction, extinction, dissolution", "correct": false}], "correct_answer": "A. Formation, extension, complete extension, contraction, complete contraction, dissolution, extinction", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Marriage to the birth of the 1<sup>st</sup> child.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Extension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Birth of the 1<sup>st</sup> child to birth of the last child.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complete extension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Birth of the last child to 1<sup>st</sup> child leaving home.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contraction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The child leaving home to the last child leaving home.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complete contraction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The last child leaving home to the 1<sup>st</sup> spouse dying.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dissolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Death of the 1<sup>st</sup> spouse to the death of the survivor.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Seizures are seen in what percentage of RTA patients with brain contusion/loss of consciousness?", "options": [{"label": "A", "text": "Development of seizures in 17%", "correct": true}, {"label": "B", "text": "Development of seizures in 45%", "correct": false}, {"label": "C", "text": "Development of seizures in 75%", "correct": false}, {"label": "D", "text": "No relation between trauma and seizures", "correct": false}], "correct_answer": "A. Development of seizures in 17%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child presents with a lesion in the right eye. Histopathology reveals the presence of Flexner-Wintersteiner rosettes. What is the likely diagnosis?", "options": [{"label": "A", "text": "Retinoblastoma", "correct": true}, {"label": "B", "text": "Optic nerve glioma", "correct": false}, {"label": "C", "text": "Rhabdomyosarcoma", "correct": false}, {"label": "D", "text": "Ocular melanoma", "correct": false}], "correct_answer": "A. Retinoblastoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Nkt2svfgejGvyEUlWyGT1747305592.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Retinoblastoma</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is caused by the <span class=\"customMeta\" data-dictid=\"2f7bf58a321692777190e32a914615\">inactivation</span> of both alleles of the RB1 tumour <span class=\"customMeta\" data-dictid=\"92427347f51692777199a762a91d21\">suppressor</span> gene.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Heritable (germline):</strong>\n<ul>\n<li>It frequently leads to <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"fc941081ef16927771970c709f1103\">retinoblastoma</span> and is caused by a <span class=\"customMeta\" data-dictid=\"7fdc76e59a169277718826b9b9806d\">germline</span> <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> in the RB1 gene in all cells, followed by a <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> in the <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> cells.</li>\n<li>Affected individuals are also at increased risk for developing non-ocular tumours, such as osteosarcoma.</li>\n</ul>\n</li>\n<li><strong>Non-heritable (sporadic):</strong>\n<ul>\n<li>This <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> typically presents as a <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> tumour and results from two <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> mutations in the <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> cells occurring after embryonic development, without a <span class=\"customMeta\" data-dictid=\"7fdc76e59a169277718826b9b9806d\">germline</span> mutation.</li>\n<li>It is not inherited and does not carry an increased risk of developing non-ocular tumours.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Occurs in young children, usually before 5 years of age (<strong>most common <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> <span class=\"customMeta\" data-dictid=\"1622f69a94169277719372b76236ca\">neoplasm</span> in children</strong>).</li>\n<li>Leukocoria: White pupillary <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> (most common presenting sign of retinoblastoma).</li>\n<li>Strabismus</li>\n<li>Painful red eye</li>\n<li>Poor vision</li>\n<li>Asymptomatic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fundus examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A white, elevated mass in the <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> is characteristic of retinoblastoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>RB1 gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 13q14</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Flexner-Wintersteiner rosettes</strong> <strong>(highly specific)</strong><strong>: </strong>These are composed of an ‘empty’ <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> surrounded by columnar cells.</li>\n<li><strong>Homer-Wright rosettes</strong>: These are pseudo-rosettes and consist of cells surrounding a central <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> made up of their processes.</li>\n<li>Undifferentiated tumour cells.</li>\n<li>Areas of <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and calcification.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a patient who believes their bodily sensations or movements are controlled or influenced by an external agency?", "options": [{"label": "A", "text": "Delusion of nihilism", "correct": false}, {"label": "B", "text": "Delusion of reference", "correct": false}, {"label": "C", "text": "Othello syndrome", "correct": false}, {"label": "D", "text": "Somatic passivity", "correct": true}], "correct_answer": "D. Somatic passivity", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Delusion of reference (Option B)</li><li>↳ Othello syndrome (Option C) or Delusion of infidelity/ jealousy refers to a condition in which the patient believes that the partner or spouse is having an affair even though that is not true. Prolonged alcohol use is linked to this condition.</li><li>↳ Othello syndrome (Option C)</li><li>↳ Delusion of infidelity/ jealousy</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thought Alienation Phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thought Insertion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A belief that others are placing thoughts into the patient’s mind.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thought Withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A belief that thoughts are being removed from the patient’s mind.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thought Broadcasting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A belief that others can know or access the patient’s thoughts.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Made Phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Made Volition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A belief that actions are controlled by an external force.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Made Affect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A belief that external forces are altering the patient's emotions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Made Impulses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sudden urges or impulses that are perceived as implanted by others.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Auditory Hallucinations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Voices Arguing/Discussing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The patient hears voices discussing or arguing about them, often in the third person.</p>\n<p><strong>Example:</strong> The patient hears two voices arguing, one saying, “He’s a failure,” and the other replying, “No, he’s not.”</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Voices Commenting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The patient hears a voice providing commentary on their actions, usually in the third person.</p>\n<p><strong>Example:</strong> While cooking, a patient hears a voice say, “She’s burning the food,” reflecting their actions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Audible Thoughts </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The patient hears their own thoughts spoken aloud by a voice.</p>\n<p><strong>Example:</strong> A patient thinks, “I need to go to the store,” and immediately hears a voice say the same phrase.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Somatic Passivity</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Physical sensations are perceived as imposed by external agents.</p>\n<p><strong>Example:</strong> A patient feels a burning sensation in their arm and believes it is caused by invisible rays from a satellite.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Delusional Perception</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A normal perception is interpreted with a delusional belief</p>\n<p><strong>Example</strong>: A patient sees a red car parked outside and believes it indicates the police are monitoring them for criminal activity.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-month-old boy presents with recurrent bacterial and fungal infections, chronic diarrhea, and failure to thrive. He is diagnosed with severe combined immunodeficiency due to an autosomal recessive inheritance pattern. Which enzyme deficiency is responsible?", "options": [{"label": "A", "text": "Phosphomannose isomerase", "correct": false}, {"label": "B", "text": "Ornithine transcarbamylase", "correct": false}, {"label": "C", "text": "Hypoxanthine-guanine phosphoribosyltransferase", "correct": false}, {"label": "D", "text": "Adenosine deaminase", "correct": true}], "correct_answer": "D. Adenosine deaminase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the investigation of choice for CML?", "options": [{"label": "A", "text": "LAP score", "correct": false}, {"label": "B", "text": "FISH", "correct": true}, {"label": "C", "text": "Karyotyping", "correct": false}, {"label": "D", "text": "Reciprocal translocation", "correct": false}], "correct_answer": "B. FISH", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/enS2B7g9sWeV4KvRhxjc1747306330.png", "https://image.prepladder.com/content/D35UJ0rr967c5fjXvU9a1747306330.png", "https://image.prepladder.com/content/1ykXcDmRsDBwbHNX9hzD1747306330.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diagnosis of Chronic Myeloid Leukemia (CML)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CBC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Normal RBC + <strong>Elevated TLC + Elevated platelets </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Peripheral smear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Left shift with predominant segmented neutrophils, myelocytes, and metamyelocytes.</li>\n<li><strong>College girl/garden party appearance:</strong> Due to non-uniform appearance (every cell appears different).</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Paulo Henrique Orlandi Mourao\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Chronic_myelogenous_leukemia#/media/File:Chronic_Myeloid_Leukemia_smear_2009-04-09.JPG\" data-tags=\"\" height=\"332\" src=\"https://image.prepladder.com/content/enS2B7g9sWeV4KvRhxjc1747306330.png\" width=\"390\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> aspirate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Increased</strong> Myeloid: Erythroid ratio.</li>\n<li><strong>Dwarf megakaryocytes.</strong></li>\n<li><strong>Sea blue histiocytes</strong> (blue-coloured cytoplasm)</li>\n<li><strong>Pseudo Gaucher cells</strong></li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Gören Şahin D, Üsküdar Teke H, Karagülle M, Andıç N, Gündüz E, Işıksoy S, Balić M, Akay OM \" data-hash=\"\" data-license=\"CC BY 2.5\" data-source=\"https://openi.nlm.nih.gov/detailedresult?img=PMC4454064_TJH-31-428-g1&amp;query=pseudo%20gaucher%20cells&amp;it=xg&amp;req=4&amp;npos=1\" data-tags=\"\" height=\"311\" src=\"https://image.prepladder.com/content/D35UJ0rr967c5fjXvU9a1747306330.png\" width=\"378\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p>The image shows Pseudo-Gaucher cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>NAP (Neutrophil Alkaline Phosphatase)/LAP score (Leukocyte Alkaline Phosphatase)</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Decreased</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>FISH</strong> <strong>(IOC) </strong></p>\n<p><strong>(Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Confirms t(9:22) translocation.</li>\n<li>Analysis to quantify Philadelphia chromosome-positive cells.</li>\n<li>Estimates the tumour load.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Asif M, Jamal MS, Khan AR, Naseer MI, Hussain A, Choudhry H, Malik A, Khan SA, Mahmoud MM, Ali A, Iram S, Kamran K, Iqbal A, Abduljaleel Z, Pushparaj PN, Rasool M\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://openi.nlm.nih.gov/detailedresult?img=PMC4885335_fonc-06-00124-g002&amp;query=bcr%20abl%20fusion%20gene&amp;it=xg&amp;lic=by&amp;req=4&amp;npos=74\" data-tags=\"\" height=\"365\" src=\"https://image.prepladder.com/content/1ykXcDmRsDBwbHNX9hzD1747306330.png\" width=\"497\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p>The image shows BCR-ABL gene <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (red + green) in <span class=\"customMeta\" data-dictid=\"da0e2a00fa1692777202d6e2054b26\">fluorescence</span> in-situ hybridisation (FISH; the ABL gene is red, and the BCR gene is green).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PCR </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>To quantify BCR-ABL-1</li>\n<li>It can be a false negative or false positive</li>\n<li>False negative: Early part of the disease</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given instrument?", "options": [{"label": "A", "text": "Graves vaginal speculum", "correct": false}, {"label": "B", "text": "Cusco vaginal speculum", "correct": true}, {"label": "C", "text": "Sims speculum", "correct": false}, {"label": "D", "text": "Auvard speculum", "correct": false}], "correct_answer": "B. Cusco vaginal speculum", "question_images": ["https://image.prepladder.com/content/Ros5yPM3S7k9voxzDESC1747286614.png"], "explanation_images": ["https://image.prepladder.com/notes/03mZOxquUALLvY1CorKo1747666659.png", "https://image.prepladder.com/content/uCJg0BGBdq4AxjVJzQua1747286642.png", "https://image.prepladder.com/notes/T4ikhMAybGOpZdewBv7E1747666714.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of ion channel is affected by mutations in the CFTR gene?", "options": [{"label": "A", "text": "Chloride", "correct": true}, {"label": "B", "text": "Sodium", "correct": false}, {"label": "C", "text": "Potassium", "correct": false}, {"label": "D", "text": "Calcium", "correct": false}], "correct_answer": "A. Chloride", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent laparoscopic cholecystectomy. Identify the marked structure in the image.", "options": [{"label": "A", "text": "Cystic artery", "correct": false}, {"label": "B", "text": "Cystic duct", "correct": true}, {"label": "C", "text": "Right hepatic artery", "correct": false}, {"label": "D", "text": "Hepatic duct", "correct": false}], "correct_answer": "B. Cystic duct", "question_images": ["https://image.prepladder.com/notes/ibAGfoY7gaGTNFlmXKY81747644340.png"], "explanation_images": ["https://image.prepladder.com/notes/KPahqe6ko6aSDRZZyiFl1747644427.png", "https://image.prepladder.com/content/tG9s8h10MSHSKcBkQLqq1747294586.png", "https://image.prepladder.com/content/PHrIB311AvYg2M0XXJ6r1747294596.png", "https://image.prepladder.com/notes/WpfsufOtTtvITDM718jf1747644541.png", "https://image.prepladder.com/notes/22pFtWBIqL1Pc0uKeopi1747644589.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Codman's triangle is seen in which of the following conditions?", "options": [{"label": "A", "text": "Osteomyelitis", "correct": false}, {"label": "B", "text": "Aneurysmal bone cyst", "correct": false}, {"label": "C", "text": "Osteogenic sarcoma", "correct": true}, {"label": "D", "text": "Chondrosarcoma", "correct": false}], "correct_answer": "C. Osteogenic sarcoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/UewOtbzMaaX7eqBso9921747657569.png", "https://image.prepladder.com/notes/RwlXaX9VDtlmOpPzpcF41747657587.png", "https://image.prepladder.com/content/zZz9WzkzIwLQKlIvN4Oe1747287195.png", "https://image.prepladder.com/content/zekqOBGeTBGn5Ini5HDc1747287195.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 160 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="exit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 hidden" id="submit-modal" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 4 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="text-white px-4 py-2 rounded-lg hover:bg-[#1a365d] transition" style="background-color: #2c5281;" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 nav-panel hidden overflow-y-auto" id="nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> </div> <!-- Results Navigation Panel --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-start justify-center p-4 z-50 results-nav-panel hidden overflow-y-auto" id="results-nav-panel" style="align-items: flex-start; padding-top: 33vh;"> <div class="bg-white shadow-lg p-4 rounded-lg w-full max-w-2xl max-h-[80vh] overflow-y-auto"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 72-year-old patient, with a history of cataract surgery and diabetes mellitus, presents with decreased vision one month after surgery. Examination reveals a honeycomb appearance or flower petal pattern of the retina. What is the likely diagnosis?", "options": [{"label": "A", "text": "Cystoid macular edema", "correct": true}, {"label": "B", "text": "Central serous retinopathy", "correct": false}, {"label": "C", "text": "Retinal detachment", "correct": false}, {"label": "D", "text": "Diabetic retinopathy", "correct": false}], "correct_answer": "A. Cystoid macular edema", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0V7YP6edb96CqWvX9BVI1747311461.png", "https://image.prepladder.com/content/IdPHdu3CBdrQeJDF6FV81747311461.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred treatment for a benign tumour of the superficial parathyroid gland?", "options": [{"label": "A", "text": "Enucleation", "correct": false}, {"label": "B", "text": "Surgical resection", "correct": true}, {"label": "C", "text": "Chemotherapy", "correct": false}, {"label": "D", "text": "Radiation therapy", "correct": false}], "correct_answer": "B. Surgical resection", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/gimye1paKmFMoWMiN0IE1747649126.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the ER with complaints of epigastric pain for 1 day. On examination, his heart rate is 120/min, and blood pressure is 100/60 mmHg. There is tenderness, guarding, and rigidity on palpation. Based on the clinical presentation and the X-ray findings, what is the most likely cause of this patient's condition?", "options": [{"label": "A", "text": "Acute cholecystitis", "correct": false}, {"label": "B", "text": "Hollow viscus perforation", "correct": true}, {"label": "C", "text": "Sigmoid volvulus", "correct": false}, {"label": "D", "text": "Small bowel obstruction", "correct": false}], "correct_answer": "B. Hollow viscus perforation", "question_images": ["https://image.prepladder.com/content/nl5AQfQJxW6sesxm4fm11747296933.png"], "explanation_images": ["https://image.prepladder.com/content/uNyKPjoNYv0M7iJ2yRu11747296968.png", "https://image.prepladder.com/content/VP5nZaIPZa7kyYNNPdZG1747296989.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with diffuse abdominal pain. Physical examination reveals rigidity and guarding. Abdominal X-ray shows air under the diaphragm. The patient is taken up for surgery, and an ileal perforation is noted intraoperatively with gross contamination of the abdomen with enteric and purulent content. What is the appropriate management of this patient?", "options": [{"label": "A", "text": "Resection and anastomosis", "correct": false}, {"label": "B", "text": "Primary repair", "correct": false}, {"label": "C", "text": "Urgent surgical exploration with ileostomy", "correct": true}, {"label": "D", "text": "Omental patch closure", "correct": false}], "correct_answer": "C. Urgent surgical exploration with ileostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CASd6vY9f5NF8SML82LW1747303010.png", "https://image.prepladder.com/content/VBNUip0gMpOHypo9AZXs1747303017.png", "https://image.prepladder.com/content/mkC8AxMVF7RgkzUcA4u11747303024.png", "https://image.prepladder.com/content/LLQA1mRYffKVBw4Bg5QK1747303030.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Common Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reversibility</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>End Colostomy</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/CASd6vY9f5NF8SML82LW1747303010.png\" width=\"338\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Single opening from the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> bowel. Often permanent.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used when the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> is removed or left in place, e.g., Hartmann's procedure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often permanent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Loop Ileostomy</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/VBNUip0gMpOHypo9AZXs1747303017.png\" width=\"338\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Loop of the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> is brought to the surface, and an <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> is made</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Temporary diversion, especially in emergencies, and easily reversible</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually temporary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Double-barrel Colostomy</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/mkC8AxMVF7RgkzUcA4u11747303024.png\" width=\"338\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two stomas are created: one for faecal output and one for <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> discharge</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely used; can be for cases requiring both <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> and exteriorization, offering <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> fistula</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can be temporary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Permanent Ileostomy</strong></p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/LLQA1mRYffKVBw4Bg5QK1747303030.png\" width=\"338\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Terminal <span class=\"customMeta\" data-dictid=\"cb1eb1c704169277718933136caf06\">ileum</span> is brought to the surface after a colectomy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used when reconnection is not planned, often after total <span class=\"customMeta\" data-dictid=\"da1e89cf561692777196c1c93d4549\">proctocolectomy</span> for conditions like FAP</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Permanent</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female patient presents to the clinic for a routine check-up. She has a history of epilepsy and has been on anti-epileptic medication for the past 5 years. Which of the following statements regarding folic acid supplementation in patients on anti-epileptic drugs is most accurate?", "options": [{"label": "A", "text": "The daily requirement of folic acid is 400 mcg/day", "correct": false}, {"label": "B", "text": "The daily requirement of folic acid is 4 mg/day", "correct": true}, {"label": "C", "text": "The daily requirement of folic acid is 1 mg/day", "correct": false}, {"label": "D", "text": "The daily requirement of folic acid is 500 mcg/day", "correct": false}], "correct_answer": "B. The daily requirement of folic acid is 4 mg/day", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which mutation is linked to the Philadelphia chromosome?", "options": [{"label": "A", "text": "Inversion", "correct": false}, {"label": "B", "text": "Deletion", "correct": false}, {"label": "C", "text": "Reciprocal translocation", "correct": true}, {"label": "D", "text": "Insertion", "correct": false}], "correct_answer": "C. Reciprocal translocation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A vegetable vendor with no criminal history went missing and was found dead a week later with advanced decomposition. How would you identify the body?", "options": [{"label": "A", "text": "General recognition", "correct": false}, {"label": "B", "text": "DNA profiling", "correct": true}, {"label": "C", "text": "Dental records", "correct": false}, {"label": "D", "text": "Fingerprints", "correct": false}], "correct_answer": "B. DNA profiling", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A motorcyclist met with a road traffic accident and had a metacarpal fracture. Hypothenar atrophy is observed. Identify the nerve involved.", "options": [{"label": "A", "text": "Radial nerve", "correct": false}, {"label": "B", "text": "Ulnar nerve", "correct": true}, {"label": "C", "text": "Musculocutaneous nerve", "correct": false}, {"label": "D", "text": "Median nerve", "correct": false}], "correct_answer": "B. Ulnar nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CoZJl4GxLAdS46AUz6ed1747826851.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with MEN-1 syndrome?", "options": [{"label": "A", "text": "Parathyroid adenoma", "correct": true}, {"label": "B", "text": "Parotid tumor", "correct": false}, {"label": "C", "text": "Renal cell carcinoma", "correct": false}, {"label": "D", "text": "Pheochromocytoma", "correct": false}], "correct_answer": "A. Parathyroid adenoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:797px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of Multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">Endocrine</span> Neoplasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MEN Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MEN Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MEN Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MEN Type IV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Defect of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>11q13</strong> causing <strong>MEN 1 gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></li>\n<li>Also called <strong>Wermer’s syndrome</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Defect of chr.10 leading to <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> of <strong>RET gene</strong></li>\n<li>Also called <strong>Sipple’s syndrome </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Also called <strong>MEN II B</strong>, it is a <strong>variant of Type 2 </strong>MEN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defect of chr.12 causing <strong>CDKN1B gene</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumors</strong></p>\n<p><strong>Included</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid adenoma</strong></p>\n<p>(most common)</p>\n<ul>\n<li>It presents with primary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> (↑ PTH and ↑ Ca)</li>\n<li>All the 4 glands can be included.</li>\n<li><strong>Rx: </strong>Total/subtotal <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> resection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (</strong>most common, and <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> can be normal)</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> (</strong>most common)</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (</strong>Presents as hypercalcemia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreatic adenoma</strong></p>\n<ul>\n<li>Presents as <strong>Gastrinoma or Zollinger-Ellison syndrome</strong></li>\n<li>This leads to <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease in the duodenum, which is the leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> in this type.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pheochromocytoma</strong>.</p>\n<p> </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pheochromocytoma </strong>(Most important <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">criterion</span> for both <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 2 and <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 3): Presents with elevated blood pressure.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma, causing <span class=\"customMeta\" data-dictid=\"5d8a1011e31692777181375a96c9c8\">amenorrhea</span> and Infertility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinoma</strong></p>\n<ul>\n<li>Calcitonin is the <span class=\"customMeta\" data-dictid=\"19ae68448b16927772016d48bd7fc3\">tumor marker</span> present</li>\n<li>Cold nodules are seen on the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> scan</li>\n<li>Metastasis can be traced with PET scan</li>\n<li>Visible neck mass, causing dysphagia</li>\n<li><strong>Rx</strong>- Prophylactic thyroidectomy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reproductive <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> tumors</strong></p>\n<ul>\n<li>Testicular tumors</li>\n<li>Neuroendocrine tumor (Cervix)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Angiofibroma</li>\n<li>Collagenoma</li>\n<li>Adrenocortical tumor</li>\n<li>Carcinoid tumors/Argentaffinoma</li>\n<li>Pheochromocytoma (only in 1%)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Congenital aganglionosis,</li>\n<li>Hirschsprung disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Marfanoid habitus</li>\n<li>Medullated corneal nerve fibers</li>\n<li>Mucosal neuromas</li>\n<li>Megacolon and Multiple diverticulae</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occasionally with</p>\n<ul>\n<li>Renal tumor</li>\n<li>Adrenal tumor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came with the complaints of fatigue and difficulty breathing. On examination, distended neck veins and muffled heart sounds were found. X-ray is shown below. Identify the diagnosis.", "options": [{"label": "A", "text": "Acute pericarditis", "correct": false}, {"label": "B", "text": "Bronchial asthma", "correct": false}, {"label": "C", "text": "Constrictive pericarditis", "correct": true}, {"label": "D", "text": "Atrial myxoma", "correct": false}], "correct_answer": "C. Constrictive pericarditis", "question_images": ["https://image.prepladder.com/content/Dxf1wUlLKCC13GkND4tz1747302380.png"], "explanation_images": ["https://image.prepladder.com/notes/CSamb8gnBtWm53KSq2rF1747664164.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Elevated JVP with rapid y descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reflects <strong>rapid early diastolic filling</strong> of the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> due to pressure gradient.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Fatigue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by the heart’s inability to meet <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> demands.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Rapid, low-volume pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Restricted <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> limits stroke volume, weakening the pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pericardial knock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <strong>loud early S3 from the thickened pericardium</strong> during diastolic filling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Kussmaul’s sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paradoxical rise in JVP during inspiration.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hepatomegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> due to i<strong>ncreased <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abdominal fluid accumulation due to <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Peripheral oedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling in the extremities from <strong>fluid retention.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pulsus paradoxus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A fall in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP (10mm Hg) during inspiration, potentially <span class=\"customMeta\" data-dictid=\"8ee21101ac1692777189434bcef126\">impalpable</span> pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Atrial fibrillation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common due to atrial <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> and dilation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Voltage-gated calcium channel present on T-tubule is?", "options": [{"label": "A", "text": "SERCA pump", "correct": false}, {"label": "B", "text": "Troponin-myosin complex", "correct": false}, {"label": "C", "text": "Dihydropyridine receptor", "correct": true}, {"label": "D", "text": "Ryanodine receptor", "correct": false}], "correct_answer": "C. Dihydropyridine receptor", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/q4LCe5TQ1C1uAj37pGZc1747662386.png", "https://image.prepladder.com/notes/FtZZLBDxirpbrBTRyoFs1747662405.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic alcoholic patient with alcoholic liver disease was given some anti-amoebic drugs. Later, the patient presented with nausea, vomiting, flushing and hypotension. What is the likely diagnosis", "options": [{"label": "A", "text": "Delirium tremens", "correct": false}, {"label": "B", "text": "Alcohol withdrawal", "correct": false}, {"label": "C", "text": "Disulfiram like reaction", "correct": true}, {"label": "D", "text": "Hallucinosis", "correct": false}], "correct_answer": "C. Disulfiram like reaction", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has a fever, rash, and eschar formation due to a mite bite. What is the diagnosis?", "options": [{"label": "A", "text": "Anthrax", "correct": false}, {"label": "B", "text": "Scrub typhus", "correct": true}, {"label": "C", "text": "African tick typhus", "correct": false}, {"label": "D", "text": "Rocky mountain spotted fever", "correct": false}], "correct_answer": "B. Scrub typhus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Scrub <span class=\"customMeta\" data-dictid=\"2b3121f9de1692777201f8f08c152e\">typhus</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Orientia tsutsugamushi - It differs from Rickettsia both genetically and by its <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> composition i.e. it <strong>lacks <span class=\"customMeta\" data-dictid=\"dccbe517c116927771914669149423\">lipopolysaccharide</span> layer</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vector </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chiggers (larvae of <span class=\"customMeta\" data-dictid=\"a1d1b5db7516927772006b6f7f6ddf\">trombiculid</span> mite)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Scrub <span class=\"customMeta\" data-dictid=\"2b3121f9de1692777201f8f08c152e\">typhus</span> is so named because it occurs in scrub <span class=\"customMeta\" data-dictid=\"a55b16a09b169277720184a41c82c4\">vegetation</span> i.e.<strong> low-lying trees</strong> and bushes.</li>\n<li>The bite of infected <span class=\"customMeta\" data-dictid=\"a1d1b5db7516927772006b6f7f6ddf\">trombiculid</span> mites transmits it.</li>\n<li>Among all stages of mite, the <strong>larvae (called chiggers)</strong> are the only stage that <strong>feed on humans</strong>. Hence, <span class=\"customMeta\" data-dictid=\"a1ef9c039716927771986477d26c26\">scrub typhus</span> is also called <strong>chiggerosis</strong>.</li>\n<li>Mites can maintain the organisms through <strong>transovarial transmission</strong>.</li>\n<li>Orientia tsutsugamushi <strong>infects <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> cells</strong> but still produces fever and rash.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The classic presentation of <span class=\"customMeta\" data-dictid=\"a1ef9c039716927771986477d26c26\">scrub typhus</span> consists of <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> of an <strong>eschar </strong>(at the site of bite), <strong>regional lymphadenopathy</strong> and <strong>maculopapular rash</strong> sparing palms and soles.</li>\n<li>Non-specific manifestations may appear early such as fever, headache, myalgia, cough, and <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> symptoms.</li>\n<li>Complications such as <strong>encephalitis</strong> and <strong>interstitial pneumonia</strong> may occur rarely in the late stage (due to <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> injury).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The Weil-Felix test shows <strong>OX K+ only.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Doxycycline</strong> is the drug choice.</li>\n<li><strong>Azithromycin</strong> is given alternatively and the drug of choice in <strong>children</strong> and <strong>pregnant women</strong>.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-year-old child presents to the emergency department with a barking cough and noisy breathing. An anteroposterior view of x ray of the neck shows a steeple sign. What type of stridor is most commonly associated with this presentation?", "options": [{"label": "A", "text": "Inspiratory", "correct": false}, {"label": "B", "text": "Expiratory", "correct": false}, {"label": "C", "text": "Biphasic", "correct": true}, {"label": "D", "text": "Uniphasic", "correct": false}], "correct_answer": "C. Biphasic", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the below are features of Conn's syndrome except?", "options": [{"label": "A", "text": "Metabolic alkalosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis", "correct": true}, {"label": "C", "text": "Hypertension", "correct": false}, {"label": "D", "text": "Muscle cramps", "correct": false}], "correct_answer": "B. Metabolic acidosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Conn Syndrome / Primary <span class=\"customMeta\" data-dictid=\"982551b8f81692777189e20f09de85\">Hyperaldosteronism</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"982551b8f81692777189e20f09de85\">hyperaldosteronism</span> characterized by excessive <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> from <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> glands with suppressed <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> renin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common cause of secondary <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (6-20% of adult <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> patients)</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> in resistant <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (up to 30%)</li>\n<li>2x more common in women</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Aldosterone-producing <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">adenoma</span> (50-60%)</li>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> hyperplasia</li>\n<li>Aldosterone-producing <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (1%)</li>\n<li>Familial <span class=\"customMeta\" data-dictid=\"982551b8f81692777189e20f09de85\">hyperaldosteronism</span> (Types 1-3)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>↑ <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">Aldosterone</span> → ↑ Na+ <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> → <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> volume expansion</li>\n<li>↑ K+ <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> → hypokalemia</li>\n<li>Can lead to tissue <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> in heart, kidneys, vasculature</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Resistant hypertension</strong></li>\n<li><strong>Muscle weakness/cramping</strong></li>\n<li>Fatigue</li>\n<li>Headaches</li>\n<li>Polydipsia/polyuria</li>\n<li>NO <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (due to <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> natriuresis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>↓ K+</strong> (can be normal in up to 38%)</li>\n<li>↑ Na+</li>\n<li><strong>Metabolic alkalosis</strong></li>\n<li>↑ <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> K+ <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> (&gt;30 mmol/day)</li>\n<li>Suppressed <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> renin</li>\n<li>↑ Aldosterone-to-renin ratio (ARR)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial screening: ARR &gt;40</li>\n<li>Confirmatory tests:\n\t\t\t\t<ul>\n<li>Salt <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> test</li>\n<li>Fludrocortisone <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> test</li>\n<li>Captopril <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> test</li>\n</ul>\n</li>\n<li>Imaging: CT scan for adenoma</li>\n<li>Adrenal <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> for lateralization</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Adenoma: Laparoscopic adrenalectomy</li>\n<li>Bilateral hyperplasia: Medical management</li>\n<li>Medical options:\n\t\t\t\t<ul>\n<li>Spironolactone (first-line)</li>\n<li>Eplerenone</li>\n<li>Amiloride</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgery: 30-60% cure rate for adenomas</li>\n<li>High morbidity/mortality if untreated</li>\n<li>May need long-term BP monitoring</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High-Yield Associations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Normal K+ doesn't exclude diagnosis</li>\n<li>No <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> despite hyperaldosteronism</li>\n<li>Screen all resistant <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Aromatic ring is seen in which of the following amino acids?", "options": [{"label": "A", "text": "Phenylalanine, valine, tryptophan", "correct": false}, {"label": "B", "text": "Phenylalanine, tryptophan, tyrosine", "correct": true}, {"label": "C", "text": "Tyrosine, cysteine, tryptophan", "correct": false}, {"label": "D", "text": "Lysine, methionine, valine", "correct": false}], "correct_answer": "B. Phenylalanine, tryptophan, tyrosine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amino acids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basic <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arginine, <strong>Lysine</strong>, Histidine <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acidic <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aspartic acid, Glutamic acid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>OH group-containing <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serine, Threonine, Tyrosine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>SH group-containing <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cysteine</strong>, <strong>Methionine </strong><strong>(Option C, D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NH2 group-containing <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asparagine, Glutamine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aromatic <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phenylalanine, Tyrosine, Tryptophan, Histidine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aliphatic <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glycine, Alanine,</p>\n<p>Branched chain AA (<strong>Valine</strong>, Leucine, Isoleucine) <strong>(Option A, D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imino acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proline</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purely Ketogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purely Glucogenic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Both Ketogenic and Glucogenic</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>On <span class=\"customMeta\" data-dictid=\"67f82f0d211692777183f709777947\">catabolism</span> gives only <span class=\"customMeta\" data-dictid=\"6ade0969281692777180216b0c3d76\">acetyl</span> CoA</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>On <span class=\"customMeta\" data-dictid=\"67f82f0d211692777183f709777947\">catabolism</span> gives only pyruvate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Substance on <span class=\"customMeta\" data-dictid=\"67f82f0d211692777183f709777947\">catabolism</span> gives one of the <span class=\"customMeta\" data-dictid=\"e55eb31d591692777188cb1fad1f5e\">glycolytic</span> <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">intermediate</span> - <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">Pyruvate</span> or TCA cycle <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">intermediate</span> other than <span class=\"customMeta\" data-dictid=\"6ade0969281692777180216b0c3d76\">Acetyl</span> CoA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amino acids are:</p>\n<ul>\n<li>Leucine</li>\n<li>Lysine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amino acids are:</p>\n<ul>\n<li><strong>Alanine: </strong>On <span class=\"customMeta\" data-dictid=\"7d8529133f169277720000dc5165c2\">transamination</span> yields pyruvate.</li>\n<li><strong>Glycine: </strong>Simplest <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid.</li>\n<li><strong>3-hydroxyl group- containing <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong>\n<ul>\n<li>Serine</li>\n<li>Threonine</li>\n<li>Hydroxyproline</li>\n</ul>\n</li>\n<li><strong>Sulphur-containing <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid</strong>\n<ul>\n<li>Cysteine</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amino acids are:</p>\n<ul>\n<li><strong>Aromatic <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong>\n<ul>\n<li>Phenylalanine</li>\n<li>Tyrosine</li>\n<li>Tryptophan</li>\n</ul>\n</li>\n<li><strong>Branched-chain <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid</strong>\n<ul>\n<li>Isoleucine</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Essential <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-essential <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The human body cannot synthesise them, which must be obtained through the diet.</li>\n<li>They are crucial for various <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> functions, including protein synthesis, tissue repair, and <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> production.<strong> </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The human body can synthesise these, which do not need to be obtained directly through diet.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples:</strong></p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Methionine</li>\n<li>Arginine</li>\n<li>Threonine</li>\n<li>Tryptophan</li>\n<li>Valine</li>\n</ul>\n</td>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Isoleucine</li>\n<li>Leucine</li>\n<li>Phenylalanine</li>\n<li>Histidine</li>\n<li>Lysine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n\t\t\t \n\n\t\t\t<p>Mnemonic<strong>: MATT VIL PHLy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Alanine</li>\n<li>Asparagine</li>\n<li>Aspartate</li>\n<li>Cysteine</li>\n<li>Glutamate</li>\n<li>Glutamine</li>\n</ul>\n</td>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Glycine</li>\n<li>Hydroxyproline</li>\n<li>Hydroxylysine</li>\n<li>Proline</li>\n<li>Serine</li>\n<li>Tyrosine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Methionine</li>\n<li>Arginine</li>\n<li>Threonine</li>\n<li>Tryptophan</li>\n<li>Valine</li>\n</ul>\n</td>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Isoleucine</li>\n<li>Leucine</li>\n<li>Phenylalanine</li>\n<li>Histidine</li>\n<li>Lysine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Alanine</li>\n<li>Asparagine</li>\n<li>Aspartate</li>\n<li>Cysteine</li>\n<li>Glutamate</li>\n<li>Glutamine</li>\n</ul>\n</td>\n<td style=\"vertical-align:top\">\n<ul>\n<li>Glycine</li>\n<li>Hydroxyproline</li>\n<li>Hydroxylysine</li>\n<li>Proline</li>\n<li>Serine</li>\n<li>Tyrosine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of sanitation facilities should be provided for the soldiers returning from war?", "options": [{"label": "A", "text": "Pit method", "correct": false}, {"label": "B", "text": "Dumping method", "correct": false}, {"label": "C", "text": "Trench latrine", "correct": true}, {"label": "D", "text": "Acqua privy", "correct": false}], "correct_answer": "C. Trench latrine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The investigation of choice for ovarian torsion is?", "options": [{"label": "A", "text": "USG Doppler", "correct": true}, {"label": "B", "text": "Clinically correlated", "correct": false}, {"label": "C", "text": "MRI", "correct": false}, {"label": "D", "text": "CT abdomen", "correct": false}], "correct_answer": "A. USG Doppler", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ovarian <span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\">Torsion</span> - Clinical Overview</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Twisting of <span class=\"customMeta\" data-dictid=\"7b1a7ff355169277719401475de6fb\">ovary</span> and <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube around supportive ligaments</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>3% of <span class=\"customMeta\" data-dictid=\"29c037b45616927771886c286ed45b\">gynecologic</span> emergencies</li>\n<li>20-25% cases occur during pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovarian masses (6-10 cm)</li>\n<li>Pregnancy</li>\n<li>Long <span class=\"customMeta\" data-dictid=\"3d6e40bf361692777201faebf313d7\">utero-ovarian</span> ligaments</li>\n<li>Right side more common (due to <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> on left)</li>\n<li>Pathologically enlarged ovaries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sharp lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain (sudden onset)</li>\n<li>Intermittent worsening</li>\n<li>Localized to involved side</li>\n<li>Radiation to flank, groin, or thigh</li>\n<li>Nausea and vomiting</li>\n<li>Low-grade fever</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>USG Doppler<strong> (investigation of choice)</strong></li>\n<li>Shows swollen edematous ovary</li>\n<li>Disruption in normal adnexal flow</li>\n<li>Free fluid in peritoneal cavity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention</li>\n<li>Detorsion recommended initially</li>\n<li>Cystectomy if mass present</li>\n<li>Oophorectomy if <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> present</li>\n<li>Consider ovarian conservation regardless of appearance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pregnancy Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Management similar to non-pregnant state</li>\n<li>Progesterone support if <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> luteum removed</li>\n<li>Wait 10 weeks before additional surgery</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10 year old child is brought to the clinic for his regular immunization. What vaccine is given as a part of the national immunization schedule?", "options": [{"label": "A", "text": "TT/Td", "correct": true}, {"label": "B", "text": "BCG", "correct": false}, {"label": "C", "text": "MMR", "correct": false}, {"label": "D", "text": "DTP", "correct": false}], "correct_answer": "A. TT/Td", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Time</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vaccines</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At birth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BCG, OPV0 (OPV birth dose), Hep B (birth dose)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>OPV1, Penta1, RVV1, fIPV1, PCV1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>OPV2, Penta2, RVV2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>OPV3, Penta3, RVV3, fIPV2, PCV2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 completed months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MR1, JE1, PCV booster, fIPV3, vitamin A</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>MR2, JE2, OPV booster, DPT <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">booster</span> 1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5-6 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>DPT <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">booster</span> 2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>10 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Td</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Td</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An alcoholic male patient diagnosed with hollow viscus perforation is taken up for laparotomy. Intraoperatively, a 2 cm perforation is seen in the duodenal region, as shown below. How can this patient be managed?", "options": [{"label": "A", "text": "Primary closure of the defect", "correct": false}, {"label": "B", "text": "Omental pedicle repair", "correct": true}, {"label": "C", "text": "Billroth I", "correct": false}, {"label": "D", "text": "Billroth II", "correct": false}], "correct_answer": "B. Omental pedicle repair", "question_images": ["https://image.prepladder.com/notes/iqBrkl6EwIaAn3tKwCgC1747645280.png"], "explanation_images": ["https://image.prepladder.com/content/rzg44LUr0jDvayCnCAh01747298076.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with polyuria, polydipsia, lethargy, and abdominal pain. She also has a history of mood disorders and recurrent kidney stones. Which of the following investigations would not be useful in arriving at the diagnosis?", "options": [{"label": "A", "text": "Nuclear sestamibi scan", "correct": false}, {"label": "B", "text": "USG neck", "correct": false}, {"label": "C", "text": "Dual-energy radiographic absorptiometry (DEXA)", "correct": false}, {"label": "D", "text": "Angiography of renal arteries", "correct": true}], "correct_answer": "D. Angiography of renal arteries", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the role of inhibin?", "options": [{"label": "A", "text": "Stimulates the release of FSH", "correct": false}, {"label": "B", "text": "Inhibits the secretion of FSH", "correct": true}, {"label": "C", "text": "Inhibition of PRL", "correct": false}, {"label": "D", "text": "Stimulation of PRL", "correct": false}], "correct_answer": "B. Inhibits the secretion of FSH", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Feature of angular cheilitis, stomatitis, and glossitis is seen in which vitamin deficiency?", "options": [{"label": "A", "text": "Niacin", "correct": false}, {"label": "B", "text": "Riboflavin", "correct": true}, {"label": "C", "text": "Cobalamin", "correct": false}, {"label": "D", "text": "Vitamin C", "correct": false}], "correct_answer": "B. Riboflavin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vitamin B2 Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Riboflavin (B2) deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malnutrition</li>\n<li>Malabsorption</li>\n<li>Certain medications</li>\n<li>Phototherapy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cheilosis, glossitis, keratitis, conjunctivitis, <span class=\"customMeta\" data-dictid=\"5d5241c3cf1692777198a1ba71f8d4\">seborrheic</span> dermatitis, anemia, <strong>photophobia.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical response to supplementation, EGR (Erythrocyte Glutathione Reductase) activity test, low <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> riboflavin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral <span class=\"customMeta\" data-dictid=\"8e7e2a872f16927771978090ad9505\">riboflavin</span> 3-10 mg/day, <span class=\"customMeta\" data-dictid=\"3ab0d6410a1692777182a1727e39c0\">balanced diet</span> including dairy products</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child was diagnosed with Turner syndrome. Which of the following are features of Turner syndrome?", "options": [{"label": "A", "text": "Webbed neck", "correct": true}, {"label": "B", "text": "Normal height", "correct": false}, {"label": "C", "text": "Decreased carrying angle", "correct": false}, {"label": "D", "text": "Gynecomastia", "correct": false}], "correct_answer": "A. Webbed neck", "question_images": ["https://image.prepladder.com/notes/EJOo4DmBCf7vgvRYbx851747668577.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:480px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features of Turner Syndrome (Mnemonic- SABCLOWN)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Short stature</li>\n<li>Short 4th metacarpal</li>\n<li>Sensorineural hearing loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Amenorrhea (Primary)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Barr body absent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardiac abnormalities</li>\n<li>Cystic hygroma</li>\n<li>Cubitus valgus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>L</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> hairline</li>\n<li>Lymphedema of hands and feet</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> (Hypothyroidism)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>O</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovaries streak-shaped/underdeveloped</li>\n<li>Rudimentary uterus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>W</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Webbed neck</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nipples are widely spaced on a shield-shaped chest</li>\n<li>Normal intelligence</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the next appropriate step in management after the failure of the McRobert maneuver in a case of shoulder dystocia?", "options": [{"label": "A", "text": "Woods maneuver", "correct": false}, {"label": "B", "text": "Gaskin maneuver", "correct": false}, {"label": "C", "text": "Suprapubic pressure", "correct": true}, {"label": "D", "text": "Zavanelli maneuver", "correct": false}], "correct_answer": "C. Suprapubic pressure", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old woman discovers a well-defined mobile and rubbery breast lump measuring 4x7 cm on self-examination. The lesion is painless and has been stable over several months. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute mastitis", "correct": false}, {"label": "B", "text": "Fibroadenoma", "correct": true}, {"label": "C", "text": "Ductal ectasia", "correct": false}, {"label": "D", "text": "Sclerosing adenosis", "correct": false}], "correct_answer": "B. Fibroadenoma", "question_images": ["https://image.prepladder.com/content/AWNApbWE6bT6qbDvDe531747311065.png"], "explanation_images": ["https://image.prepladder.com/notes/oiFFsk3AVFyeabi94hKX1747650706.png", "https://image.prepladder.com/content/0ww1TLJG95ztb5JYEXiS1747311099.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fibroadenoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Benign tumours arising from the <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> of <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> tissue in the breast</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common in women aged <strong>15-25 years.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Believed to be influenced by <strong>hormonal fluctuations</strong> during <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> years</li>\n<li>Molecular alteration: Alterations in <strong>MED12 gene.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painless, firm, rubbery, and mobile lumps</li>\n<li>Described as feeling like a<strong> \"marble in the breast.\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Well-defined borders due to a <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> capsule, with proliferating <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> potentially compressing and distorting <span class=\"customMeta\" data-dictid=\"c2f9d01ba91692777188d264244b6a\">glandular</span> components.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> may be of 2 patterns:\n\t\t\t\t<ul>\n<li><strong>Pericanalicular Pattern:</strong> Surrounded by stroma</li>\n<li><strong>Intracanalicular Pattern:</strong> Compressed and distorted by it.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Fibroadenoma\" data-author=\"Gary Tozbikian, M.D., Debra Zynger, M.D., Azadeh Khayyat, M.D. and Julie M. Jorns, M.D\" data-hash=\"12959\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/breastfibroadenoma.html\" data-tags=\"May2025\" height=\"263\" src=\"https://image.prepladder.com/notes/oiFFsk3AVFyeabi94hKX1747650706.png\" width=\"431\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mammogram </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Popcorn <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> </strong>on mammogram</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"SCiardullo\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Calcificaciones_en_pop-corn_OML_01.JPG\" data-tags=\"\" height=\"488\" src=\"https://image.prepladder.com/content/0ww1TLJG95ztb5JYEXiS1747311099.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Triple Assessment: </strong>Clinical examination, radiological <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> (ultrasound), tissue <span class=\"customMeta\" data-dictid=\"521de62abe16927771989a90d0e9e8\">sampling</span> (core-needle biopsy)</li>\n<li>Ultrasound: Helps distinguish fibroadenomas from cysts</li>\n<li>Core-Needle Biopsy: Provides <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> diagnosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conservative Management: Watchful waiting, regular monitoring</li>\n<li>Surgical Excision: For larger fibroadenomas, those causing symptoms, or uncertain diagnosis</li>\n<li>Giant Fibroadenomas: Over 5 cm, may require <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> through <span class=\"customMeta\" data-dictid=\"d8c57cf5eb169277719912053c51a1\">submammary</span> incision</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Benign</strong>, does not increase the risk of breast cancer</li>\n<li>Growth can vary, influenced by hormonal changes</li>\n<li>Recurrence is uncommon</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relationship to ANDI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Categorised according to <strong>ANDI</strong> as:\n\t\t\t\t<ul>\n<li>Normal: Small fibroadenomas (≤1 cm)</li>\n<li>Disorder: Larger fibroadenomas (≤3 cm)</li>\n<li>Disease: Giant fibroadenomas (&gt;3 cm), multiple fibroadenomas</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In solid organ transplantation, which of the following organs is associated with a higher incidence of rejection?", "options": [{"label": "A", "text": "Lungs", "correct": true}, {"label": "B", "text": "Intestine", "correct": false}, {"label": "C", "text": "Kidney", "correct": false}, {"label": "D", "text": "Liver", "correct": false}], "correct_answer": "A. Lungs", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After confirming a diagnosis of gout, which of the following drugs is a purine analog that would be most appropriate for management?", "options": [{"label": "A", "text": "Allopurinol", "correct": true}, {"label": "B", "text": "Capecitabine", "correct": false}, {"label": "C", "text": "Cytarabine", "correct": false}, {"label": "D", "text": "Febuxostat", "correct": false}], "correct_answer": "A. Allopurinol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In cases of alcohol abuse, in what substance is the blood typically preserved during an autopsy?", "options": [{"label": "A", "text": "Sodium fluoride", "correct": true}, {"label": "B", "text": "Formalin", "correct": false}, {"label": "C", "text": "Rectified spirit", "correct": false}, {"label": "D", "text": "Sodium chloride", "correct": false}], "correct_answer": "A. Sodium fluoride", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Specimen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Importance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary specimen; collect from femoral, iliac, or axillary veins to avoid contamination.</p>\n<p><strong>Preservative: </strong>Lithium <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">heparin</span> or EDTA tube, fluoride/oxalate, if alcohol is suspected</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Useful for detecting parent compounds and metabolites of poisons.</p>\n<p><strong>Preservative: </strong>No preservative, sodium <span class=\"customMeta\" data-dictid=\"7cdfdfcdc616927772026ac0b8d995\">fluoride</span> is added, if alcohol is</p>\n<p>Suspected <strong>(Option A)</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastric Contents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Helps identify ingested poisons and their concentrations through <span class=\"customMeta\" data-dictid=\"58a09a3d07169277720271320338d4\">vomitus</span> and stomach contents analysis.</p>\n<p><strong>Preservative:</strong> Saturated <span class=\"customMeta\" data-dictid=\"77e95b17ce1692777198780a5d0843\">salt solution</span> if there is no chance of acid poison.<strong>(Option D)</strong></p>\n<p>Rectified spirit if poisoned by acid <strong>(Option C)</strong></p>\n<p>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Liver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Analyzes <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> and concentration of drugs; critical when blood/urine concentrations are low. Bile can detect specific substances like <span class=\"customMeta\" data-dictid=\"c6cef1cc8616927771849eace61464\">chlorpromazine</span> and morphine.</p>\n<p><strong>Preservative:</strong> Saturated <span class=\"customMeta\" data-dictid=\"77e95b17ce1692777198780a5d0843\">salt solution</span> if there is no chance of acid poison. Rectified spirit if poisoned by acid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hair and Nails</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"6e8ada09fa1692777189bfbace851a\">heavy metal</span> poisoning; metals accumulate in keratin. Neutron <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> analysis identifies specific metals and exposure patterns.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scene Residues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides clues about the <span class=\"customMeta\" data-dictid=\"b437be3f051692777196d06a1fa93d\">poison</span> through materials found at the scene, such as tablets or empty containers.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which malarial drug for plasmodium vivax drug is used to prevent relapse in the post-partum period?", "options": [{"label": "A", "text": "Artemether", "correct": false}, {"label": "B", "text": "Primaquine", "correct": true}, {"label": "C", "text": "Quinine", "correct": false}, {"label": "D", "text": "Artesunate", "correct": false}], "correct_answer": "B. Primaquine", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Malaria in Pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common in sub-Saharan Africa and India</li>\n<li>Affects children under 5 years and pregnant women most severely</li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> develops in &lt;5% of neonates born to infected mothers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fever, chills, flu-like symptoms</li>\n<li>Less severe with recurrences</li>\n<li>P. falciparum may cause <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> failure, coma, death</li>\n<li>Pregnant women often <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> due to partial immunity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Maternal: Anemia, <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> failure</li>\n<li>Fetal: Stillbirth, <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> birth, low birthweight</li>\n<li>Placental: High levels of parasitemia</li>\n<li>Approximately 16% of low birthweight births in Africa attributed to <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> malaria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Microscopic evaluation of blood <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> (gold standard)</li>\n<li>Lower sensitivity in pregnancy due to low <span class=\"customMeta\" data-dictid=\"a59b97ce831692777194f6c0160f15\">parasite</span> densities</li>\n<li>Malaria-specific antigens used for rapid testing</li>\n<li>All infected patients from <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> areas should be tested with <span class=\"customMeta\" data-dictid=\"7f56a9f82e1692777181c7810a4c8b\">antimalarial</span> drug resistance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chloroquine-sensitive P. vivax/P. ovale: Chloroquine</li>\n<li>P. falciparum: Hydroxychloroquine or chloroquine</li>\n<li>Multidrug-resistant P. falciparum: Artemisinin-based therapy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chemoprophylaxis recommended for <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> areas</li>\n<li>Vector control: Insecticide-treated netting, <span class=\"customMeta\" data-dictid=\"e683f9ba2616927771965cfe8c3d21\">pyrethroid</span> insecticides</li>\n<li>DEET-based insect <span class=\"customMeta\" data-dictid=\"8cf161387716927771974738805746\">repellent</span> (lower <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> rates)</li>\n<li>Chloroquine/hydroxychloroquine <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> is safe in pregnancy</li>\n<li>Some antimalarials contraindicated (atovaquone/proguanil, primaquine, doxycycline)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is used for the treatment of Datura poisoning?", "options": [{"label": "A", "text": "Physostigmine", "correct": true}, {"label": "B", "text": "Atropine", "correct": false}, {"label": "C", "text": "Sodium nitrite", "correct": false}, {"label": "D", "text": "Neostigmine", "correct": false}], "correct_answer": "A. Physostigmine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kk7mzlzVuBRBJQLd9EJg1747303524.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Toxicity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Antidote </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of action </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Datura/anticholinergics toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Physostigmine <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits <span class=\"customMeta\" data-dictid=\"63b92227451692777180db3901b72f\">acetylcholinesterase</span> enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Opium </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Naloxone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Opioid <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Organophosphates </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atropine <strong>(Option B)</strong></p>\n<p>Pralidoxime</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Muscarinic antagonist</p>\n<p>Cholinesterase reactivation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acetaminophen </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>N-acetyl-cysteine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Replenishes Glutathione</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Methanol </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fomepizole</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibitor of alcohol dehydrogenase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Benzodiazepine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flumazenil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits GABA receptors</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cyanide </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eli Lilly <span class=\"customMeta\" data-dictid=\"5e612ce1381692777181adc76f11e6\">antidote</span> Kit (3-step approach)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Amyl nitrate: Oxidises haemoglobin to methemoglobin, which scavenges cyanide.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2. Sodium <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> <strong>(Option C)</strong>: causes <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> to detach from the <span class=\"customMeta\" data-dictid=\"d4fff554a316927771885dc8700abe\">heme</span> group of <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> oxidase.</p>\n<ul>\n<li>Amyl <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> is used as a temporary measure until IV Sodium <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> can be given.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3. Sodium thiosulphate:It activates an <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> that converts <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> to a less toxic agent, thiocyanate.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The subcostal line corresponds to which vertebrae level?", "options": [{"label": "A", "text": "T12", "correct": false}, {"label": "B", "text": "L1", "correct": false}, {"label": "C", "text": "L2", "correct": false}, {"label": "D", "text": "L3", "correct": true}], "correct_answer": "D. L3", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/GKGW3kah39zIxObggSEp1747652809.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old HIV patient presents with persistent headaches, confusion, and a gradual onset of fever. A lumbar puncture is performed, revealing an elevated opening pressure and a cerebrospinal fluid analysis shows a positive india ink stain. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bacterial meningitis", "correct": false}, {"label": "B", "text": "Viral meningitis", "correct": false}, {"label": "C", "text": "Cryptococcus neoformans", "correct": true}, {"label": "D", "text": "Tuberculous meningitis", "correct": false}], "correct_answer": "C. Cryptococcus neoformans", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/n0ERrqZBQvIB8gyoqvsv1747294174.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:662px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cryptococcus Spp. </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cryptococcus is a true yeast.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Capsule</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polysaccharide <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> - helps in serotyping and protection against phagocytosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serotypes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A, D, AD serotypes - Cryptococcus variety neoformans<strong> </strong></p>\n<p>B, C serotypes -Cryptococcus variety gattii</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Virulence factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Polysaccharide Capsule</strong>: The primary <span class=\"customMeta\" data-dictid=\"d325b5afd71692777202405d5f5c59\">virulence</span> factor. It helps the <span class=\"customMeta\" data-dictid=\"ed4634701d16927771942c4408495f\">pathogen</span> evade <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> and suppresses the host’s local immune responses, enabling the organism to survive and spread.</li>\n</ul>\n<ul>\n<li><strong>Melanin Production</strong>: <em>Cryptococcus</em> produces <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> via the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> oxidase, which contributes to its <span class=\"customMeta\" data-dictid=\"d325b5afd71692777202405d5f5c59\">virulence</span> by protecting the <span class=\"customMeta\" data-dictid=\"ed4634701d16927771942c4408495f\">pathogen</span> from <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> stress and immune defenses.</li>\n<li><strong>Enzyme Production</strong>: The <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> secretes several enzymes, including:\n\t\t\t\t<ul>\n<li><strong>Phospholipase</strong>: Aids in tissue invasion and damage.</li>\n<li><strong>Urease</strong>: Helps the <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> survive in the host environment by neutralizing <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> conditions, enhancing its ability to colonize and spread.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk of infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunocompromised States:</strong></p>\n<ul>\n<li>HIV/AIDS, cancer, organ transplant recipients, those on <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> therapies, extremes of age are at higher risk.</li>\n</ul>\n<p><strong>Geographic Location:</strong></p>\n<ul>\n<li>Exposure to environments where Cryptococcus gattii is endemic, such as tropical and subtropical regions</li>\n</ul>\n<p><strong>Environmental Exposure:</strong></p>\n<ul>\n<li>Exposure to bird droppings or decaying wood can increase the likelihood of infection, especially with C. neoformans.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:761px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management</strong><strong> of cryptococcosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>India ink</strong>- Demonstrates the capsule, which appears as clear space surrounding the round <span class=\"customMeta\" data-dictid=\"38e3eb755216927771834bb7e72a61\">budding</span> <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> cells</li>\n<li><strong>Mucicarmine stain:</strong> It stains the carminophilic <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> of C. neoformans</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Sabouraud Dextrose Agar</strong>, forming smooth, mucoid, cream-coloured colonies.</li>\n<li><strong>Niger seed <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> </strong>and <strong>bird seed agar</strong>: Demonstrates <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> production (brown colored colonies) due to <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> oxidase/laccase enzyme.</li>\n<li>The ability to grow at <strong>37°C</strong> and <strong>hydrolyse <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> </strong>differentiates C. neoformans from non-pathogenic cryptococci.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Dhoubhadel, Bhim &amp; Laghu, Ujjwal &amp; Paudel, Raju &amp; Morimoto, Konosuke &amp; Ariyoshi, Koya.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Culture-of-CSF-showing-white-smooth-colonies-of-Cryptococcus-neoformans-in-Sabouraud_fig2_353574146\" data-tags=\"\" height=\"374\" src=\"https://image.prepladder.com/content/n0ERrqZBQvIB8gyoqvsv1747294174.png\" width=\"455\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antigen <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Demonstration of the capsular <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> by <strong>Precipitation </strong>and <strong>Latex agglutination</strong> <strong>test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial Treatment with <strong>liposomal Amphotericin B </strong>and <strong>Flucytosine</strong></li>\n<li>Maintenance Therapy<strong> </strong>with <strong>Fluconazole</strong> for 6-12 months, depending on immune status.</li>\n</ul>\n<ul>\n<li>Monitoring: Regularly check CSF for fungal clearance, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function, and electrolytes.</li>\n</ul>\n<ul>\n<li>Management of Underlying Conditions: Optimize ART to reduce <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was admitted with complaints of tachycardia and arrhythmias. On examination, multiple scratch marks were observed on the body. The probable drug of abuse in this patient is:", "options": [{"label": "A", "text": "Cocaine", "correct": true}, {"label": "B", "text": "Morphine", "correct": false}, {"label": "C", "text": "Datura", "correct": false}, {"label": "D", "text": "Cannabis", "correct": false}], "correct_answer": "A. Cocaine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the arrow-marked chamber?", "options": [{"label": "A", "text": "Right atrium", "correct": false}, {"label": "B", "text": "Left atrium", "correct": false}, {"label": "C", "text": "Right ventricle", "correct": true}, {"label": "D", "text": "Left ventricle", "correct": false}], "correct_answer": "C. Right ventricle", "question_images": ["https://image.prepladder.com/notes/OsWQzAZWtTzLkzsGoWQo1747653178.png"], "explanation_images": ["https://image.prepladder.com/notes/gkRDu53U7BeGgmMXnV9S1747653223.png", "https://image.prepladder.com/notes/639MWtexL68tsyaAnX201747653267.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Level of the Thoracic Inlet : This is at the top of the thoracic cavity, where the trachea and esophagus enter.</li><li>↳ Level of the Thoracic Inlet</li><li>↳ Level of the Aortic Arch : Located around the T4-T5 vertebral level, where the aorta arches over the left main bronchus.</li><li>↳ Level of the Aortic Arch</li><li>↳ T4-T5</li><li>↳ Level of the Carina : At the T5-T6 level, this is where the trachea bifurcates into the right and left main bronchi.</li><li>↳ Level of the Carina</li><li>↳ T5-T6</li><li>↳ Level of the Heart : The heart is typically seen from T6 to T9 . You can identify the chambers (right atrium, left atrium, ventricles) and major vessels (aorta, pulmonary arteries).</li><li>↳ Level of the Heart</li><li>↳ T6 to T9</li><li>↳ Level of the Diaphragm : The diaphragm typically corresponds to the T10 vertebral level, which can help in distinguishing between thoracic and abdominal structures.</li><li>↳ Level of the Diaphragm</li><li>↳ T10</li><li>↳ Level of the Esophagus : The esophagus runs along the midline and can be seen at various levels, usually starting from the cervical region down to T10.</li><li>↳ Level of the Esophagus</li><li>↳ cervical region down to T10.</li><li>↳ Level of the Thoracic Spine : The thoracic vertebrae can be used as references; typically, there are 12 thoracic vertebrae.</li><li>↳ Level of the Thoracic Spine</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old smoker presents with ulcerative lesions on his lower lip for the past year. On examination, there is a palpable ipsilateral submental lymph node approximately 5x5 cm. A biopsy from the lesion is suggestive of squamous cell carcinoma. What is the next step in management?", "options": [{"label": "A", "text": "Radiotherapy", "correct": false}, {"label": "B", "text": "Combined chemoradiotherapy", "correct": false}, {"label": "C", "text": "Resection with primary closure alone", "correct": false}, {"label": "D", "text": "Resection of primary lesion with lip reconstruction and MRND", "correct": true}], "correct_answer": "D. Resection of primary lesion with lip reconstruction and MRND", "question_images": ["https://image.prepladder.com/content/0pvioC3LSsemgvAtrGtY1747297168.png"], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>T Stage</strong></p>\n<ul>\n<li><strong>Tis: </strong>Carcinoma in situ</li>\n<li><strong>T1</strong>: Tumor ≤2 cm and ≤5 mm depth of invasion</li>\n<li><strong>T2</strong>: Tumor ≤2 cm and &gt;5 mm but ≤10 mm depth, <strong>OR</strong><br/>\n\t\t\t\tTumor &gt;2 cm but ≤4 cm and ≤10 mm depth</li>\n<li><strong>T3</strong>: Tumor &gt;4 cm <strong>OR</strong> any tumor &gt;10 mm depth of invasion</li>\n<li><strong>T4</strong>: Invasion of adjacent structures</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N Stage:</strong></p>\n<ul>\n<li><strong>N0:</strong> No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</li>\n<li><strong>N1-N3</strong>: Based on number, size, and <span class=\"customMeta\" data-dictid=\"135a4fca481692777191e4ccc16a44\">laterality</span> of involved nodes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M Stage:</strong></p>\n<ul>\n<li><strong>M0: </strong>No distant metastasis</li>\n<li><strong>M1: </strong>Distant metastasis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Early Stage (T1-T2N0)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with 1 cm margins</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"37d3e89821169277718799ed0c2a19\">elective</span> neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for tumours&gt;2 cm or &gt;4 mm in depth</li>\n<li>Reconstruction: Primary closure, local flaps, or skin grafts</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advanced Stage (T3-T4 or N+)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with ≥1 cm margins</li>\n<li>Neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> (comprehensive or selective based on nodal status)</li>\n<li>Complex <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> (local/regional flaps, free tissue transfer)</li>\n<li>Adjuvant <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> or <span class=\"customMeta\" data-dictid=\"00cc356fdf1692777184c13ad34d10\">chemoradiotherapy</span> based on <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> findings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reconstruction Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wedge <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> (for small lesions)</li>\n<li>Local flaps: <strong>Abbe-Estlander, Karapandzic, nasolabial</strong></li>\n<li>Regional flaps: Forehead, cervicofacial</li>\n<li>Free tissue transfer: Radial <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> free flap, <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> thigh flap</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management of the Neck</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elective neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for high-risk tumours (&gt;2 cm, &gt;4 mm depth)</li>\n<li>Therapeutic neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> for clinically positive nodes</li>\n<li><strong>Levels typically addressed: I-III for N0 neck, I-V for N+ neck</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Adjuvant: For positive margins, <span class=\"customMeta\" data-dictid=\"849a50eb4a1692777195de19bee5ed\">perineural</span> invasion, multiple positive nodes</li>\n<li>Definitive: For patients unfit for surgery or refusing surgery</li>\n<li>Brachytherapy: Can be considered for select early-stage lesions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Not routinely used in early-stage disease</li>\n<li>It may be combined with <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> in locally advanced cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Follow-up and Surveillance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regular follow-up visits: Every 1-3 months for the first year, then gradually decreasing frequency</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old patient with hypertension has been prescribed Drug X, which has a bioavailability of 30%. Which of the following is the most appropriate statement for this patient's drug prescription?", "options": [{"label": "A", "text": "70% of drugs reach systemic circulation in unchanged form", "correct": false}, {"label": "B", "text": "30% of the drug is pure", "correct": false}, {"label": "C", "text": "70% of drugs is potent in giving therapeutic effect", "correct": false}, {"label": "D", "text": "70% of the drug undergoes 1 st pass metabolism in the liver", "correct": true}], "correct_answer": "D. 70% of the drug undergoes 1 st pass metabolism in the liver", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Route of Administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bioavailability Percentage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-100</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sublingual</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-90</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rectal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-60</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intramuscular (IM)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>75-100</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intravenous (IV)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subcutaneous (SC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>75 - 100</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intranasal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-50</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transdermal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>80-100</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gold standard investigation for endometriosis?", "options": [{"label": "A", "text": "HPE", "correct": true}, {"label": "B", "text": "Laparoscopy", "correct": false}, {"label": "C", "text": "USG", "correct": false}, {"label": "D", "text": "MRI", "correct": false}], "correct_answer": "A. HPE", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what age does stranger anxiety appear?", "options": [{"label": "A", "text": "7 months", "correct": true}, {"label": "B", "text": "9 months", "correct": false}, {"label": "C", "text": "12 months", "correct": false}, {"label": "D", "text": "15 months", "correct": false}], "correct_answer": "A. 7 months", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Developmental Milestones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gross Motor Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fine Motor Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Social Milestones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Language Milestones</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1 month</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Alerts to sounds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Social smile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neck holding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recognises mother, anticipates feed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cooing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Laugh Aloud</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rolls over</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bidextrous reach</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sits in <span class=\"customMeta\" data-dictid=\"83962896b5169277720032c8e8bd50\">tripod</span> position</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unidextrous reach</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stranger anxiety (7 months)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Monosyllables</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>8 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sits without support</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>9 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stands with support</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immature pincer grasp</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waves bye bye</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bisyllables</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>12 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Creeps well, stands without support</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mature pincer grasp</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Comes when called, plays simple ball game</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 to 2 words with meaning</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>15 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Walks alone<strong>,</strong> creeps upstairs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imitates scribbling, tower of 2 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Jargon speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>18 months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Runs, explores drawers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scribbles, tower of 3 blocks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Copies parents in task</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8 to 10 words vocabulary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Walks up and downstairs (2 <span class=\"customMeta\" data-dictid=\"32656dc8ba1692777202fc49f9ed13\">feet</span> per step), jumps</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tower of 6 blocks, copies straight line</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Asks for food, drink, toilet, pulls people to show toys</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 to 3 word sentences</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 47-year-old man presents with a chronic non-healing painless ulcer over his scalp for 8 years. He has a history of electric burns to the scalp 8 years ago. The examination findings are shown below. Which of the following statements is true?", "options": [{"label": "A", "text": "Radiotherapy is useful", "correct": false}, {"label": "B", "text": "It can progress to squamous cell carcinoma", "correct": true}, {"label": "C", "text": "No lymphatic spread", "correct": false}, {"label": "D", "text": "Long-duration antibiotics will improve the condition.", "correct": false}], "correct_answer": "B. It can progress to squamous cell carcinoma", "question_images": ["https://image.prepladder.com/notes/jBVCG6v1u6eRWFagdPuL1747645567.png"], "explanation_images": ["https://image.prepladder.com/content/Lg0GJY6UXnzBBmviZRyZ1747301881.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Marjolin’s Ulcer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low-grade <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">Squamous</span> Cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (SCC)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Sites of Development</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Post-burn scar</li>\n<li>Long-standing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> due to trauma</li>\n<li>Chronic discharging <span class=\"customMeta\" data-dictid=\"f7bd04046e16927771943526af1e35\">osteomyelitis</span> sinus</li>\n<li>Post-radiation ulcer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Develops in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue due to chronic irritation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painless (no nerves in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissues)</li>\n<li>Slow growing</li>\n<li>No regional LN <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> (no lymphatics in <span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\">scar</span> tissue)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation of Choice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Biopsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wide local <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> followed by a <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> cover</li>\n<li><strong>Radiotherapy should be avoided (Option A)</strong> (as it is radio-resistant and also to prevent obliterative end arteritis)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely stage of TB hip in a female with left leg shortening?", "options": [{"label": "A", "text": "Stage 1", "correct": false}, {"label": "B", "text": "Stage 2", "correct": false}, {"label": "C", "text": "Stage 3", "correct": true}, {"label": "D", "text": "Stage 4", "correct": false}], "correct_answer": "C. Stage 3", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/gCDf6y7C5KMvGTW3ll2b1747659534.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:171px\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:240px\">\n<p><strong>Clinical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:213px\">\n<p><strong>X-ray findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:171px\">\n<p><strong>Stage I: <span class=\"customMeta\" data-dictid=\"7d66a14e2416927771993133552ae6\">Synovitis</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:240px\">\n<ul>\n<li>Irritable hip</li>\n<li>Increased FABER (Flexion, Abduction, External Rotation)</li>\n<li>Apparent lengthening due to FABER (Position of ease due to synovitis)</li>\n<li>Terminal movements are restricted by 25%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:213px\">\n<p>Normal or haziness of the <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:132px; vertical-align:top; width:171px\">\n<p><strong>Stage II: Early <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (Option B)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:132px; vertical-align:top; width:240px\">\n<ul>\n<li>Early joint pain, stiffness</li>\n<li>Increased FADIR (Flexion, Adduction, Internal Rotation)</li>\n<li>Apparent shortening due to FADIR</li>\n<li>Gluteal and Quadriceps muscle wasting</li>\n<li>ROM restricted by 50%</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:132px; vertical-align:top; width:213px\">\n<p>Osteopenia and narrowing of joint space</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:171px\">\n<p><strong>Stage III: Late <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:240px\">\n<ul>\n<li>Marked FADIR</li>\n<li>True shortening</li>\n<li>Gross restriction of movements (usually &gt;50%)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:132px; vertical-align:top; width:213px\">\n<p>Marked <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> and destruction</p>\n</td>\n</tr>\n<tr>\n<td style=\"vertical-align:top\">\n<p><strong>Stage IV: Pathological Dislocation/severe <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (Option D )</strong></p>\n</td>\n<td>\n<ul>\n<li>Marked FADIR</li>\n<li>Gross shortening</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Severe destruction and loss of joint space</li>\n<li>\"Wandering/traveling Acetabulum\": Pathological dislocation/subluxation due to gross destruction of the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head or the superior acetabular margin.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Wandering acetabulum\" data-author=\"Oztürkmen, Yusuf &amp; Karamehmetoğlu, Mahmut &amp; Leblebici, Cem &amp; Gokce, Alper &amp; Caniklioğlu, Mustafa.\" data-hash=\"13008\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/a-This-radiograph-demonstrates-a-travelling-acetabulum-of-the-hipThe-femoral-head-is_fig3_26841474\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/gCDf6y7C5KMvGTW3ll2b1747659534.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the gold standard method for measuring intraocular pressure in patients?", "options": [{"label": "A", "text": "Hertel’s exophthalmometer", "correct": false}, {"label": "B", "text": "Gonioscope", "correct": false}, {"label": "C", "text": "Goldmann applanation tonometer", "correct": true}, {"label": "D", "text": "Tonopen", "correct": false}], "correct_answer": "C. Goldmann applanation tonometer", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CnRap3rCY5mCB80ise7g1747312167.png", "https://image.prepladder.com/content/LunKtUuuUuAti9WUXG7Q1747312167.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old female complains of bone pain for several months. His X-ray skull is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Osteochondroma", "correct": false}, {"label": "C", "text": "Paget’s disease", "correct": true}, {"label": "D", "text": "Ewing’s sarcoma", "correct": false}], "correct_answer": "C. Paget’s disease", "question_images": ["https://image.prepladder.com/content/UOibfx5n2jierhCHm6Ge1747288440.png"], "explanation_images": ["https://image.prepladder.com/notes/wl9gEfdaj9qbzbcGxCYa1747659395.png", "https://image.prepladder.com/content/swMvgBb1k4F4DDvW5VvK1747288501.png", "https://image.prepladder.com/content/V24LsM8C28oI9P9YOUoe1747288501.png", "https://image.prepladder.com/content/g8hm6KgfYtw4zI2ss1kP1747288501.png", "https://image.prepladder.com/content/IWvjMSbky9Dh6gGkvaV41747288501.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Early (osteolytic) phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Localised <span class=\"customMeta\" data-dictid=\"17d9369c3f1692777183b01f1dc72f\">bone resorption</span> often appears as \"flame-shaped\" lesions along the bone shaft. <strong>(Option C)</strong></li>\n<li>The skull may show <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> circumscripta (well-defined areas of bone loss).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Later stages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bone thickening and <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> with <span class=\"customMeta\" data-dictid=\"28606fa66a169277718407469e7e7c\">coarse</span> trabecular patterns.</li>\n<li>Stress fractures are visible as fine cracks on the <span class=\"customMeta\" data-dictid=\"00ab88c6091692777185ea2685fa40\">convex</span> surface of long bones.</li>\n<li>Pathological fractures may be present.”</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old female presents to the clinic complaining of severe vaginal irritation and pruritus. On examination, you note a greenish-yellow, frothy discharge. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bacterial vaginosis", "correct": false}, {"label": "B", "text": "Trichomoniasis", "correct": true}, {"label": "C", "text": "Candidiasis", "correct": false}, {"label": "D", "text": "Gonorrhea", "correct": false}], "correct_answer": "B. Trichomoniasis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fMCBIwGAL7alUDX4lisM1747288385.png", "https://image.prepladder.com/content/nF1lJYzCb0ySznUJdQh61747288385.png", "https://image.prepladder.com/content/IlSZWn5TGcPmfy0VkKMf1747288385.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p><strong>Trichomonas vaginalis vaginitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p><strong>Candida <span class=\"customMeta\" data-dictid=\"ec6a29c167169277718195e3b531cf\">albicans</span> <span class=\"customMeta\" data-dictid=\"96ff088469169277720105f61eb97b\">vaginitis</span> (Moniliasis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p><strong>Bacterial Vaginosis (BV)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p><strong>pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>≥ 4.5</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>&lt; 4.5</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>≥ 4.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Itching and <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> in and around <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> opening, dysuria</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Intense <span class=\"customMeta\" data-dictid=\"b0b814e5441692777202c969196f0e\">vulvovaginal</span> <span class=\"customMeta\" data-dictid=\"c238cff71916927771965fb88e6cc4\">pruritus</span> (out of proportion to the discharge), splash dysuria, dyspareunia</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Generally not accompanied by <span class=\"customMeta\" data-dictid=\"8f179d376f16927771905338bc9387\">itching</span> or <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> but may be associated with complications such as PID and pregnancy complications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Motile trichomonads on <span class=\"customMeta\" data-dictid=\"8bfe5df2c316927772026757237e09\">wet mount</span> microscopy</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Identification of mycelia, pseudohyphae, and spores by direct <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> and <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> (methylene blue)</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Amsel's four <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> criteria (three of four are sufficient): (1) Homogenous <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> discharge, (2) <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> pH &gt; 4.5, (3) Positive whiff test, (4) Clue cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Motile, pear-shaped, <span class=\"customMeta\" data-dictid=\"9878bc208e169277720243c5c74543\">flagellated</span> organisms</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"Open Access\" data-source=\"CC0 1.0\" data-tags=\"\" height=\"185\" src=\"https://image.prepladder.com/content/fMCBIwGAL7alUDX4lisM1747288385.png\" width=\"188\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Hyphae and buds, spores</p>\n<p> </p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Engberts, Maria Karin, Hans Korporaal, Maurits Vinkers, Alex van Belkum, Jaap van Binsbergen, Toine Lagro-Janssen, Theo Helmerhorst, and Wim van der Meijden\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Chapter-4-Candida-vaginalis-in-a-Papanicolaou-stained-smear_fig7_5387779\" data-tags=\"\" height=\"190\" src=\"https://image.prepladder.com/content/nF1lJYzCb0ySznUJdQh61747288385.png\" width=\"240\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Clue cells (&gt;20% of cells)</p>\n<p> </p>\n<p> </p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Mikael Häggström, M.D.\" data-hash=\"\" data-license=\"CC0 1.0\" data-source=\"https://en.wikipedia.org/wiki/Bacterial_vaginosis#/media/File:Normal_vaginal_flora_versus_bacterial_vaginosis_on_Pap_stain.jpg\" data-tags=\"\" height=\"238\" src=\"https://image.prepladder.com/content/IlSZWn5TGcPmfy0VkKMf1747288385.png\" width=\"319\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly man with a chronic history of IV drug use presents with progressively increasing swelling in the groin on the right side. The swelling is non-fluctuant but pulsatile on examination. He has diminished pulses distal to the swelling on the same side. What is the next step in the management of this patient?", "options": [{"label": "A", "text": "CT angiography followed by surgery", "correct": true}, {"label": "B", "text": "Oral antibiotics and observation", "correct": false}, {"label": "C", "text": "Compression stocking", "correct": false}, {"label": "D", "text": "Incision and drainage", "correct": false}], "correct_answer": "A. CT angiography followed by surgery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/taIQ1zqdfaw5482J4PAZ1747297635.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>True Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>False (Pseudoaneurysm)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves all three layers of the arterial wall.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves only a layer of <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue outside the vessel.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wall Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intima, media, and <span class=\"customMeta\" data-dictid=\"a438935bda1692777180dfaf993677\">adventitia</span> are involved.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue surrounds the breach.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fusiform or saccular.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically spherical or ovoid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atherosclerosis, genetic conditions.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trauma, surgery, or arterial puncture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> until complications arise.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often presents with a <span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\">pulsatile</span> mass or pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large arteries (e.g., aorta, iliac).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral arteries (e.g., femoral, popliteal).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detected by ultrasound, CT, and MRI.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detected by <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> or angiography.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgical repair or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> techniques.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repair or <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> methods (e.g., <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> injection).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old boy was presented in the psychiatric OPD with complaints of inattention at school, hitting his friends and excessive talking, poor academic performance, and inability to sit in a place for a long time. What drug is used in the management of this disorder?", "options": [{"label": "A", "text": "Methylphenidate", "correct": true}, {"label": "B", "text": "Modafinil", "correct": false}, {"label": "C", "text": "Atenolol", "correct": false}, {"label": "D", "text": "Amitriptyline", "correct": false}], "correct_answer": "A. Methylphenidate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Attention Deficit Hyperactivity Disorder (ADHD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Genetic Factors: Runs in families, with parents or siblings more likely to have the condition<strong> (DAT1 gene and DRD4 gene).</strong></li>\n<li><strong>Neurochemical Factors: </strong>Linked to <strong>dopamine</strong> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> and <strong>noradrenergic system.</strong></li>\n<li><strong>Neurophysiological Factors: </strong>EEG usually shows <span class=\"customMeta\" data-dictid=\"ccb50023dc1692777200804b8475ca\">theta</span> and <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> waves in the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> brain.</li>\n<li><strong>Neuroanatomical Factors:</strong> Decreased activity in brain areas like the <span class=\"customMeta\" data-dictid=\"25bc983c6716927771967f68667610\">prefrontal</span> cortex, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> cingulate, and <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</li>\n<li><strong>Developmental Factors:</strong> Prenatal and <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">perinatal</span> factors, such as <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> birth, <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> infections during pregnancy, and low birth weight, may increase the risk.</li>\n<li><strong>Psychosocial Factors: </strong>Severe abuse, neglect, or maltreatment can worsen or <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> ADHD symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hyperactivity: </strong>Restlessness, difficulty remaining seated, inappropriate running and climbing, excessive talking, interrupting others.</li>\n<li><strong>Attention Deficit: </strong>Short attention span, distractibility, difficulty following instructions, forgetfulness, disorganisation, procrastination.</li>\n<li><strong>Impulsivity: </strong>Acting without thinking, difficulty waiting for their turn, interrupting others, blurting out answers.</li>\n<li><strong>Other: </strong>Emotional lability, explosiveness, irritability, memory and thinking defects, specific learning difficulties, speech and Hearing deficits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For an <strong>ADHD diagnosis to be confirmed</strong>, symptoms must be present in <strong>at least two different environments</strong>, such as both school and home. This ensures that the behaviour is not limited to one specific context and indicates a broader issue with attention and self-regulation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pharmacotherapy</strong></p>\n<ul>\n<li><strong>Stimulant Medication:</strong>\n<ul>\n<li>Methylphenidate (1st drug of choice)</li>\n<li>Amphetamine (2nd drug of choice)</li>\n<li>Modafinil (<strong>not FDA-approved</strong>) <strong>(Option B ruled out)</strong></li>\n</ul>\n</li>\n<li><strong>Non-stimulant medication </strong>\n<ul>\n<li>Atomoxetine</li>\n<li>Bupropion (<strong>not FDA-approved for ADHD</strong>)</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n<p><strong>Psychosocial interventions</strong></p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subtypes of ADHD </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Combined Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Predominantly Inattentive Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Predominantly Hyperactive/Impulsive Presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6 or more symptoms of both <span class=\"customMeta\" data-dictid=\"65520d2c6316927771905f771be9fe\">inattention</span> and Hyperactivity-Impulsivity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>6 or more symptoms of Inattention</li>\n<li>&lt;6 symptoms of Hyperactivity-Impulsivity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>6 or more symptoms of Hyperactivity/Impulsive subtype</li>\n<li>&lt;6 symptoms of Inattention</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mark the incorrect statement regarding Nipah virus:", "options": [{"label": "A", "text": "It is transmitted through bat urine", "correct": false}, {"label": "B", "text": "It causes hemorrhagic fever", "correct": true}, {"label": "C", "text": "It is present in India", "correct": false}, {"label": "D", "text": "It is an emerging infection", "correct": false}], "correct_answer": "B. It causes hemorrhagic fever", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nbkwKcDTcIS4DTC52gOY1747312103.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Nipah virus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Natural reservoir</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bats</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"123\" src=\"https://image.prepladder.com/content/nbkwKcDTcIS4DTC52gOY1747312103.png\" width=\"489\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Modes of transmission </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Direct contact with infected animals</li>\n<li>Body <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> (blood, urine, faeces, seminal fluid)<strong> (Option A)</strong></li>\n<li>Consumption of contaminated food products (palm <span class=\"customMeta\" data-dictid=\"8beb46e52516927771989c115d47b5\">sap</span> or fruits)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4-14 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fever, chills, headache</li>\n<li>Encephalitis (M/C), <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome</li>\n<li>Multiorgan failure, GIT haemorrhage (case fatality rate- 40-70%)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man came to the OPD with complaints of pain and hearing loss after trauma to the right ear. Examination revealed the presence of blood clots along with irregular perforations in the tympanic membrane. The next step in management is?", "options": [{"label": "A", "text": "Aspirate the clot and perform audiometric tests", "correct": false}, {"label": "B", "text": "Syringing", "correct": false}, {"label": "C", "text": "Maintain dry ear with systemic analgesics", "correct": true}, {"label": "D", "text": "Gentamycin and levofloxacin ear drops", "correct": false}], "correct_answer": "C. Maintain dry ear with systemic analgesics", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Tear or <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (eardrum) due to trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Direct trauma (e.g., cotton bud, foreign body)</li>\n<li>Barotrauma (e.g., diving, blast injury, airplane pressure changes)</li>\n<li>Slap/blow to the ear</li>\n<li>Sudden loud noise (acoustic trauma)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden ear pain</li>\n<li>Hearing loss (usually conductive)</li>\n<li>Tinnitus</li>\n<li>Bleeding or clear <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> from ear</li>\n<li>Vertigo (if <span class=\"customMeta\" data-dictid=\"a1b8deb0fe1692777190df5ce46525\">inner ear</span> involved)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Visible <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> on otoscopy</li>\n<li>Blood/debris in the ear canal</li>\n<li>Possible absent light reflex</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Otoscopy (main <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tool)</li>\n<li>Tuning fork tests (Rinne/Weber for <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> type)</li>\n<li>Audiometry (after <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> or in unclear cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Keep ear dry (avoid water entry)</li>\n<li>Most heal spontaneously within weeks</li>\n<li>Avoid <span class=\"customMeta\" data-dictid=\"d9cbcf920216927771861532afed31\">ear drops</span> unless infection suspected</li>\n<li>Antibiotics if contaminated or signs of infection</li>\n<li>Surgical repair (myringoplasty) if not healed in 6–8 weeks</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A log dose-response curve (DRC) was plotted with isoprenaline alone and with isoprenaline in the presence of propranolol, as shown below. The graph shows that propranolol is a:", "options": [{"label": "A", "text": "Partial agonist", "correct": false}, {"label": "B", "text": "Agonist", "correct": false}, {"label": "C", "text": "Competitive antagonist", "correct": true}, {"label": "D", "text": "Non-competitive antagonist", "correct": false}], "correct_answer": "C. Competitive antagonist", "question_images": ["https://image.prepladder.com/notes/sKzb6Ge6ot8LLou8kaM71747662221.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The biological method for Mosquito Larva control is done by?", "options": [{"label": "A", "text": "Spray 3 times a month", "correct": false}, {"label": "B", "text": "Nets to be distributed", "correct": false}, {"label": "C", "text": "Gambusia fish", "correct": true}, {"label": "D", "text": "Repellents", "correct": false}], "correct_answer": "C. Gambusia fish", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Environmental measures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Chemical control</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Biological control</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yield permanent results and source reduction.</p>\n<p> </p>\n<p>E.g.</p>\n<p> </p>\n<ul>\n<li>Filling drains and ditches.</li>\n<li>Levelling of ground.</li>\n<li>Proper <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of <span class=\"customMeta\" data-dictid=\"275662f5c11692777183ab59ae573b\">breeding</span> areas.</li>\n<li>Intermittent irrigation.</li>\n<li>Changing water alkalinity.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Using larvicides</p>\n<p> </p>\n<p>E.g.</p>\n<p> </p>\n<p>1. Physical:</p>\n<ul>\n<li>MLO (Mosquito larvicidal oil): 200L/hectare</li>\n</ul>\n<p>2. Chemical:</p>\n<ul>\n<li>Paris green</li>\n<li>Temephos (Abate): 200L/hectare</li>\n</ul>\n<p>3. IGR (insect growth regulators):</p>\n<ul>\n<li>Inhibit <span class=\"customMeta\" data-dictid=\"b24b4918a916927771844114519396\">chitin</span> formation, <span class=\"customMeta\" data-dictid=\"b8b85a8a841692777192148859c5c8\">moulding</span> and adult maturation.</li>\n<li>Pyriproxyfen and Diflubenzuron</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Larvivorous Fishes:</strong></p>\n<p> </p>\n<p>1. Gambusia and Poecilia fish</p>\n<p>2. Bacillus thuringiensis (used in polluted waters)</p>\n<p>3. Toxorhynchites splendens</p>\n<p>(predator <span class=\"customMeta\" data-dictid=\"8fad75f63f1692777192f93996c6ab\">mosquito</span> for Aedes and Anopheles)</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following amino acids are necessary for purine ring formation?", "options": [{"label": "A", "text": "Glycine, aspartate, valine", "correct": false}, {"label": "B", "text": "Glycine, Aspartate, Glutamine", "correct": true}, {"label": "C", "text": "Glycine, Aspartate, Glutamate", "correct": false}, {"label": "D", "text": "Glycine, Asparagine, Glutamine", "correct": false}], "correct_answer": "B. Glycine, Aspartate, Glutamine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/dIImrgM3v2OFGYSVkNtG1747825471.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given instrument ?", "options": [{"label": "A", "text": "Montgomery T- tube", "correct": false}, {"label": "B", "text": "Tracheoesophageal prosthesis", "correct": true}, {"label": "C", "text": "BAHA", "correct": false}, {"label": "D", "text": "PORP prosthesis", "correct": false}], "correct_answer": "B. Tracheoesophageal prosthesis", "question_images": ["https://image.prepladder.com/notes/iOYfkHccRLsveWaPfhPj1747661362.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the potential effects of folic acid deficiency during pregnancy?", "options": [{"label": "A", "text": "Neural tube defects", "correct": true}, {"label": "B", "text": "Preterm labour", "correct": false}, {"label": "C", "text": "Pernicious anemia", "correct": false}, {"label": "D", "text": "Iron deficiency anemia", "correct": false}], "correct_answer": "A. Neural tube defects", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mid-year population is the denominator in?", "options": [{"label": "A", "text": "CDR", "correct": true}, {"label": "B", "text": "CFR", "correct": false}, {"label": "C", "text": "MMR", "correct": false}, {"label": "D", "text": "NMR", "correct": false}], "correct_answer": "A. CDR", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When are the three doses of fIPV ideally given as per the National Immunization Schedule?", "options": [{"label": "A", "text": "3 doses at 6 weeks, 14 weeks, and 9 completed months", "correct": true}, {"label": "B", "text": "At 10 weeks, 14 weeks, and 9 completed months", "correct": false}, {"label": "C", "text": "At 6 weeks, 10 weeks, and 18 completed months", "correct": false}, {"label": "D", "text": "3 doses at 6 weeks, 14 weeks, and 18 completed months", "correct": false}], "correct_answer": "A. 3 doses at 6 weeks, 14 weeks, and 9 completed months", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a mitochondrial matrix enzyme?", "options": [{"label": "A", "text": "Citrate synthase", "correct": true}, {"label": "B", "text": "Monoamine oxidase", "correct": false}, {"label": "C", "text": "ATP synthase", "correct": false}, {"label": "D", "text": "Catalase", "correct": false}], "correct_answer": "A. Citrate synthase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nfKKfJTTFIZiS50Z1M3s1747292108.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Check-ups conducted for children aged 9-18 years under Rashtriya Bal Swasthya karyakram is done for every?", "options": [{"label": "A", "text": "Once a year", "correct": false}, {"label": "B", "text": "Once in every three months", "correct": false}, {"label": "C", "text": "Once a month", "correct": false}, {"label": "D", "text": "Semi-annually", "correct": true}], "correct_answer": "D. Semi-annually", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>RBSK</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Launched in 2013.</li>\n<li>Relies on early childhood screening and interventional services.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>0-6 years- urban or rural slums</li>\n<li>6-18 years- government school-going children</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Screening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Secondary level of prevention</p>\n<p>Screening done for 4Ds:</p>\n<ul>\n<li>Diseases</li>\n<li>Defects</li>\n<li>Deficiencies</li>\n<li>Developmental delays</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Screened by</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mobile teams and this includes:</p>\n<ul>\n<li>Medical officers</li>\n<li>Ayush officers</li>\n<li>Pharmacists</li>\n<li>Lab technicians</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male patient presents with sudden onset chest pain for one hour with ECG showing STE in lead 2,3 and aVF. Which is the best treatment for this case of inferior wall MI in a multispecialty hospital?", "options": [{"label": "A", "text": "Alteplase", "correct": false}, {"label": "B", "text": "Streptokinase", "correct": false}, {"label": "C", "text": "Primary angioplasty", "correct": true}, {"label": "D", "text": "Dabigatran", "correct": false}], "correct_answer": "C. Primary angioplasty", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/qKCnDAyBiruyZF8fdS961747664385.png", "https://image.prepladder.com/notes/2MvRABiSdWtSszZrxwDH1747835960.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:641px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Localization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Leads with ST Elevation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reciprocal Changes (ST Depression)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Coronary Artery Involved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V1–V6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LAD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Septal MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V1–V4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LAD (Septal Branches)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anteroseptal MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V1–V2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LAD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anteroapical MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V3–V4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal LAD</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterolateral</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V5- V6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LAD or LCX</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>I, aVL, V5, V6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>II, III, aVF</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LCX or MO</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inferior MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>II, III, aVF</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>I, aVL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>RCA (80%) or RCX (20%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V7–V9</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V1–V3 with tall R waves</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>RCX</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right Ventricular MI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>V1, V4R</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>I, aVL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>RCA</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the rate-limiting enzyme of cholesterol synthesis?", "options": [{"label": "A", "text": "HMG-CoA reductase", "correct": true}, {"label": "B", "text": "7-alpha hydroxylase", "correct": false}, {"label": "C", "text": "Carnitine acyltransferase 1", "correct": false}, {"label": "D", "text": "Carnitine acyltransferase 2", "correct": false}], "correct_answer": "A. HMG-CoA reductase", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/1jvyZCs68w6WkBXjvI1i1747661660.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regulation Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sufficient Cholesterol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suppresses <span class=\"customMeta\" data-dictid=\"739aa4b5ea1692777200a636ee075f\">transcription</span> of HMG CoA <span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\">reductase</span> gene</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low Dietary Cholesterol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases <span class=\"customMeta\" data-dictid=\"739aa4b5ea1692777200a636ee075f\">transcription</span> of HMG CoA <span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\">reductase</span> gene</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AMP-activated Kinase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phosphorylates HMG CoA <span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\">reductase</span> inactivating it</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protein Phosphatase 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dephosphorylates HMG CoA <span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\">reductase</span> activating it</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insulin and Thyroxine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase activity of HMG CoA reductase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cortisol and Glucagon</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decrease activity of HMG CoA reductase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Statins (e.g., Lovastatin)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Competitive <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of HMG CoA reductase</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person died suddenly whose family is abroad. His viscera was preserved during autopsy. Which of the following can be detected in his visceral organs even on non-consumption before his death?", "options": [{"label": "A", "text": "Morphine", "correct": false}, {"label": "B", "text": "Aconite", "correct": false}, {"label": "C", "text": "Arsenic", "correct": false}, {"label": "D", "text": "Alcohol", "correct": true}], "correct_answer": "D. Alcohol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the preferred drug for the treatment of postmenopausal breast cancer?", "options": [{"label": "A", "text": "Methotrexate", "correct": false}, {"label": "B", "text": "Raloxifene", "correct": false}, {"label": "C", "text": "Tamoxifen", "correct": false}, {"label": "D", "text": "Anastrozole", "correct": true}], "correct_answer": "D. Anastrozole", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hormonal therapy for breast cancer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Given for</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Correlation </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tamoxifen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pre-menopausal hormone receptor-positive breast cancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Selective <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> <span class=\"customMeta\" data-dictid=\"a4dd3586e816927771927d01e3fe29\">modulator</span> (SERM) </strong>works by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> receptors on breast cancer cells, which can slow or stop the growth of tumors that require <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> to grow.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anastrozole</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Post-menopausal hormone receptor-positive breast cancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aromatase inhibitors</strong> reduce the production of <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> in the body by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> aromatase, which converts androgens into <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> in <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> women.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fulvestrant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hormone receptor-positive metastatic breast cancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Estrogen <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists </strong>work by binding to <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> receptors and degrading them, which helps to reduce the growth of estrogen-dependent cancer cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trastuzumab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HER2-positive breast cancer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monoclonal antibodies </strong>that target the HER2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> the growth of cancer cells and can also recruit the body's immune system to destroy these cells.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which bones are cut/removed during external Dacryocystorhinostomy?", "options": [{"label": "A", "text": "Zygomatic", "correct": false}, {"label": "B", "text": "Maxillary", "correct": false}, {"label": "C", "text": "Lacrimal", "correct": true}, {"label": "D", "text": "Frontal", "correct": false}], "correct_answer": "C. Lacrimal", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vitamin deficiencies is seen in rickets?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin B", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": false}, {"label": "D", "text": "Vitamin D", "correct": true}], "correct_answer": "D. Vitamin D", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:592px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Calcipenic Rickets</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Inadequate <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\">intake</span> <strong>(often vitamin D deficiency)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Calcium Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Low <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> leads to hypocalcemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Phosphate Status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hypophosphatemia due to a decrease in <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> resorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pathophysiological Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Activation of the parathyroid–bone <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> for <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> preservation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Primarily <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to vitamin D deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Effect on Growth Plate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Reduced <span class=\"customMeta\" data-dictid=\"4bfa3e6f2c1692777181c53b124cf7\">apoptosis</span> of hypertrophic chondrocytes due to hypophosphatemia</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the tumour marker for a carcinoid tumour?", "options": [{"label": "A", "text": "Beta-HCG", "correct": false}, {"label": "B", "text": "Calcitonin", "correct": false}, {"label": "C", "text": "5-HIAA", "correct": true}, {"label": "D", "text": "Alpha-fetoprotein", "correct": false}], "correct_answer": "C. 5-HIAA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tumor marker</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha-fetoprotein (AFP) (Option D ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hepatocellular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (HCC)</li>\n<li>Hepatoblastoma</li>\n<li>Yolk <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> tumour (endodermal <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tumour)</li>\n<li>Nonseminomatous <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumour of testis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>↑ AFP: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall defects, <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects</li>\n<li>↓ AFP: associated with <span class=\"customMeta\" data-dictid=\"5e54fdc4d3169277720003f231621d\">trisomy</span> 21, 18, and 13</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>β-HCG (Option A ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nonseminomatous testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumours (choriocarcinoma, embryonal cell carcinoma, mixed <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumour, seminoma)</li>\n<li>Ovarian cancer: <span class=\"customMeta\" data-dictid=\"209abd0cee16927771843bab0de87c\">choriocarcinoma</span> (gestational trophoblastic disease)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carcinoembryonic <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (CEA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Colorectal cancer</li>\n<li>Pancreatic cancer</li>\n<li>Breast cancer</li>\n<li>Lung cancer (especially in non-small cell cancers)</li>\n<li>Gastric cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prostate-specific <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (PSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prostate cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Benign prostatic hyperplasia</li>\n<li>Prostatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcitonin (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cancer (both <span class=\"customMeta\" data-dictid=\"a325d0c14e16927771992fe8a96758\">sporadic</span> and associated with <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 1 and <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 2)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alkaline phosphatase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metastases to bone or liver</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Paget disease of the bone</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Placental <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seminoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lactate dehydrogenase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovarian cancer (dysgerminoma)</li>\n<li>Testicular <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> cell tumours (both <span class=\"customMeta\" data-dictid=\"0b7129b26c16927771988bb64b78ef\">seminoma</span> and nonseminoma)</li>\n<li>Lymphomas</li>\n<li>Ewing's sarcoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuron specific <span class=\"customMeta\" data-dictid=\"92417be2b316927771877be984d041\">enolase</span> (NSE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neuroendocrine tumors</li>\n<li>Small cell lung cancer</li>\n<li>Carcinoid tumour</li>\n<li>Neuroblastoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CA 19–9 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pancreatic adenocarcinoma</li>\n<li>Colon cancer</li>\n<li>Cholangiocarcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CA 15–3 and CA 27–29</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Breast cancer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CA 125 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovarian carcinoma</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"29c037b45616927771886c286ed45b\">gynecologic</span> malignancies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S-100 protein (S100A) and (S100B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malignant melanoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>SMRP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mesothelioma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0FsUk1VF00D2Ifg585kY1749405668.mp3", "video": ""}, {"text": "What is the next step in the management of a suspected tubal pregnancy with inconclusive transvaginal ultrasound?", "options": [{"label": "A", "text": "Serum beta hCG levels", "correct": true}, {"label": "B", "text": "Methotrexate administration", "correct": false}, {"label": "C", "text": "Laparotomy", "correct": false}, {"label": "D", "text": "Diagnostic laparoscopy", "correct": false}], "correct_answer": "A. Serum beta hCG levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diagnostic Modality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Findings for Unruptured <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">Ectopic</span> Pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Beta hCG Levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Failure to double the value of β-hCG in 48 hours</li>\n<li>Lower concentration of β-hCG than expected for gestational age</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transvaginal Sonography (TVS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">Intrauterine</span> Pregnancy: No <span class=\"customMeta\" data-dictid=\"9d49967fdb1692777188c0acbd701a\">gestational sac</span> within the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> when β-hCG ≥ 1500 IU/L.</li>\n<li>Adnexal Mass: An adnexal mass clearly separate from the <span class=\"customMeta\" data-dictid=\"7b1a7ff355169277719401475de6fb\">ovary</span> <strong>(Blob sign).</strong></li>\n<li>Ring-of-Fire Pattern: Increased <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> around the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> mass on Color Doppler.</li>\n<li>Presence of pseudo gestational sac.</li>\n<li>Free fluid in the Pouch of Douglas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transabdominal Sonography (TAS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">Intrauterine</span> Pregnancy: No <span class=\"customMeta\" data-dictid=\"9d49967fdb1692777188c0acbd701a\">gestational sac</span> when β-hCG ≥ 6,000 IU/L</li>\n<li>Other features: May be visible but less sensitive than TVS for smaller masses</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Blood examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Haemoglobin</li>\n<li>ABO and Rh grouping</li>\n<li>Total <span class=\"customMeta\" data-dictid=\"3c1935637a1692777202a9c50cc6f5\">white cell count</span> and <span class=\"customMeta\" data-dictid=\"6bd54dfc48169277718674cd08e586\">differential</span> count</li>\n<li>Erythrocyte <span class=\"customMeta\" data-dictid=\"d53a6ee0c81692777198aeb94eb4ca\">sedimentation</span> rate (ESR)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Estimation of β-hCG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower concentration of β-hCG compared to normal <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> pregnancy</li>\n<li>Plasma concentration does not double in 48 hours like in normal pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sonography (TVS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> features are:</p>\n<ul>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> pregnancy with a positive pregnancy test.</li>\n<li>Fluid (echogenic) in the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> of Douglas.</li>\n<li>Adnexal mass clearly separated from the <span class=\"customMeta\" data-dictid=\"7b1a7ff355169277719401475de6fb\">ovary</span> (Blob sign).</li>\n<li>Rarely <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> motion may be seen in an unruptured <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">tubal</span> <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Combination of <span class=\"customMeta\" data-dictid=\"ef5cb829b8169277719603304e73cb\">quantitative</span> β-hCG values and sonography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>TVS provides <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of a well-formed <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> <span class=\"customMeta\" data-dictid=\"9d49967fdb1692777188c0acbd701a\">gestational sac</span> as early as 4–5 weeks from the last <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> period.</li>\n<li>The lowest level of <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> β-hCG at which a <span class=\"customMeta\" data-dictid=\"9d49967fdb1692777188c0acbd701a\">gestational sac</span> is consistently visible using TVS (discriminatory zone) is ≥ 1,500 IU/L.</li>\n<li>So if the beta-hCG level is≥ 1,500 and no <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> pregnancy is seen, an <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy is highly suspected.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laparoscopy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Offers benefits in cases of confusion with other <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> lesions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dilatation and curettage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Identification of <span class=\"customMeta\" data-dictid=\"573209500f1692777185f4138071ef\">decidua</span> without <span class=\"customMeta\" data-dictid=\"bbea63556f1692777202e8abdd66a4\">villi</span> structure is suggestive.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum progesterone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A level greater than 25 ng/mL is suggestive of <span class=\"customMeta\" data-dictid=\"915ca56f53169277720296a38e3e8e\">viable</span> <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> pregnancy whereas a level less than 5 ng/mL suggests an <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> or <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> pregnancy.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laparotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used when in doubt</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old obese female presented with Schizophrenia. Which of the following antipsychotic drugs causes the least weight gain?", "options": [{"label": "A", "text": "Chlorpromazine", "correct": false}, {"label": "B", "text": "Clozapine", "correct": false}, {"label": "C", "text": "Olanzapine", "correct": false}, {"label": "D", "text": "Ziprasidone", "correct": true}], "correct_answer": "D. Ziprasidone", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which tuberculosis drug causes impairment of color vision and optic neuritis?", "options": [{"label": "A", "text": "Rifampicin", "correct": false}, {"label": "B", "text": "Ethambutol", "correct": true}, {"label": "C", "text": "Pyrazinamide", "correct": false}, {"label": "D", "text": "Streptomycin", "correct": false}], "correct_answer": "B. Ethambutol", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:712px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ethambutol</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits arabinosyl transferases involved in arabinogalactan synthesis, thereby <span class=\"customMeta\" data-dictid=\"653140d1dc16927771903445309f4e\">interfering</span> with mycolic acid <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> in cell wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mutation of embAB genes, which encodes the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> arabinosyl transferase, reducing its <span class=\"customMeta\" data-dictid=\"227269f3ec1692777180d76a7898dd\">affinity</span> for ethambutol</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In the treatment of</p>\n<ul>\n<li>Mycobacterium tuberculosis</li>\n<li>Mycobacterium avium complex (MAC)</li>\n<li>Mycobacterium kansasii</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Painless loss of vision\n\t\t\t\t<ul>\n<li><strong>Field defects due to <span class=\"customMeta\" data-dictid=\"99ac6e31f71692777197220f87effc\">retrobulbar</span> <span class=\"customMeta\" data-dictid=\"6e951a16031692777193af1c351309\">neuritis</span> (Option C)</strong></li>\n<li>Loss of visual acuity</li>\n<li>Red-green colour blindness</li>\n</ul>\n</li>\n<li>Nausea, rashes, fever</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70 year old male patient presents to the OPD with multiple, recurrent fainting episodes. An ECG was taken and it shows P waves at a rate of 75 bpm and qrs complexes at a rate of 35 bpm. What is the diagnosis?", "options": [{"label": "A", "text": "Mobitz type II heart block", "correct": false}, {"label": "B", "text": "Stokes adams syndrome", "correct": true}, {"label": "C", "text": "First degree heart block", "correct": false}, {"label": "D", "text": "Wolf parkinson white syndrome", "correct": false}], "correct_answer": "B. Stokes adams syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ICO3oE7daANnFDPbcsF21747664060.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Third-degree <span class=\"customMeta\" data-dictid=\"d77b211e3a1692777182121ece27fc\">atrioventricular</span> block / Stokes-Adams Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complete failure of <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> between <span class=\"customMeta\" data-dictid=\"422ada68fd16927771820019d5de1e\">atria</span> and ventricles, resulting in independent beating (AV dissociation).</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Third degree block\" data-author=\"Npatchett\" data-hash=\"13028\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Heart_block.png\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/ICO3oE7daANnFDPbcsF21747664060.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintained by an <span class=\"customMeta\" data-dictid=\"eec51ab3a9169277718763577df122\">escape rhythm</span> from:</p>\n<ul>\n<li>The AV <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> or <span class=\"customMeta\" data-dictid=\"0b0057954d1692777183cde3b4afbf\">bundle</span> of His (narrow QRS complexes).</li>\n<li>Distal Purkinje tissues (broad QRS complexes).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ECG Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prolonged PR interval</li>\n<li>Broad QRS complex</li>\n<li>Number of P waves will not be equal to the number of R waves</li>\n<li><strong>P-R interval (atrial rate) will not match the R-R interval (ventricular rate)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"9f04fb3f2f1692777199272e3daf84\">syncope</span> or 'Stokes–Adams' attacks- sudden loss of consciousness and collapse.</li>\n<li>Brief anoxic seizure.</li>\n<li>Pallor and a death-like appearance during the attack; characteristic <span class=\"customMeta\" data-dictid=\"919f290c4f1692777203469825e662\">flush</span> upon recovery.</li>\n<li>Rapid recovery distinguishes it from epilepsy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Depends on clinical circumstances.</li>\n<li>Transient AV block in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> myocardial infarction- no treatment if the patient remains stable.</li>\n<li>Symptomatic third-degree AV block- <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\">atropine</span> or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"5d2bbf156c16927771902312f06293\">isoprenaline</span> to maintain <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> until temporary <span class=\"customMeta\" data-dictid=\"ceb4fc4ada1692777194e3daffa3e9\">pacing</span> is inserted.</li>\n<li>Permanent pacemaker.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old female presents with a gradually progressive swelling over the abdomen for 1.5 years. She has a history of midline surgery. On examination, the swelling is 4 cm and is reducible with a palpable cough impulse. She is planning to undergo fascial closure with mesh repair. What is the most likely location of the mesh shown in the image?", "options": [{"label": "A", "text": "Inlay", "correct": false}, {"label": "B", "text": "Sublay", "correct": false}, {"label": "C", "text": "Onlay", "correct": true}, {"label": "D", "text": "Intraperitoneal repair", "correct": false}], "correct_answer": "C. Onlay", "question_images": ["https://image.prepladder.com/notes/SPl26PjJrgiOXJUPeYO61747649007.png"], "explanation_images": ["https://image.prepladder.com/content/1LrLHMMrnIzZgX7fhmVc1747303236.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mesh Placement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inlay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within the fascial <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> itself</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesh is sutured to the edges of the fascial defect.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It can be used for large defects where primary <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> isn't possible.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates</strong> due to <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> separation from fascial edges under <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onlay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>On top of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath/external <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> aponeurosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcutaneous tissue is dissected off; the fascial <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> is closed primarily, and the <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed on top and secured</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically easier and less invasive.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Higher risk of <strong>seroma formation</strong>, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> infection, and skin necrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Retromuscular</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Behind the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle but <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> is opened, the <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed in the created space, and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> is closed over it</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates</strong>, <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> well incorporated into tissues</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More complex procedure, <strong>risk of injury to <span class=\"customMeta\" data-dictid=\"d100eb4ed81692777193b7f47b5cba\">neurovascular</span> bundles.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Preperitoneal</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peritoneum is separated from the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath; <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> is placed in this space, and the <span class=\"customMeta\" data-dictid=\"f0c783c43716927771956acc242b90\">peritoneum</span> is closed over it.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> incorporation, <strong>lower risk of adhesions.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Technically challenging, risk of peritoneal tears.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who received a supraclavicular brachial plexus block with 0.5% bupivacaine develops hypotension and arrhythmias. What is the first-line treatment for this situation?", "options": [{"label": "A", "text": "Invasive ventilation", "correct": false}, {"label": "B", "text": "20% intralipid infusion", "correct": true}, {"label": "C", "text": "Sodium bicarbonate", "correct": false}, {"label": "D", "text": "Cardiopulmonary resuscitation", "correct": false}], "correct_answer": "B. 20% intralipid infusion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CNS effects:</strong></p>\n<ul>\n<li><strong>Early</strong> and less severe.</li>\n<li><strong>First symptom: <span class=\"customMeta\" data-dictid=\"a042d4d7881692777184ae941a44b9\">circumoral</span> paraesthesia</strong></li>\n<li><strong>First sign: nystagmus</strong></li>\n<li><strong>At low <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> concentration: </strong>mild <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> disturbances.</li>\n<li><strong>Increased concentration: </strong>CNS excitation, <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> activity.</li>\n<li><strong>Higher concentration: </strong>CNS depression, coma, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> depression, arrest.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cardiac effects:</strong></p>\n<ul>\n<li>Usually<strong> late but severe</strong> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of toxicity, may lead to death.</li>\n<li>Hypotension, dysrhythmias, myocardial depression.</li>\n<li>Potent agents (bupivacaine, ropivacaine, levobupivacaine) <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> collapse, heart block.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Safety profile</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bupivacaine has more risk to cause LAST than Lidocaine</strong></p>\n<p>Most potent highly <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> <span class=\"customMeta\" data-dictid=\"845fedd06d16927771989597afa034\">soluble</span> drugs are more likely to cause</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Risk recognition and dose reduction.</li>\n<li>Careful <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> before injection.</li>\n<li>Incremental administration (3-5 mL) with continuous heart rate monitoring.</li>\n<li>Use ultrasonographic guidance to confirm <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">anesthetic</span> deposit.</li>\n<li>Use a <span class=\"customMeta\" data-dictid=\"1059a0d9031692777201a8d8debd5e\">vasoactive</span> agent like <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> to reduce <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> and serve as an <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> indicator.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recognize LAST (Local <span class=\"customMeta\" data-dictid=\"4b83ec31581692777181547f1a89ef\">Anesthetic</span> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> Toxicity) early and call for help.</li>\n<li><strong>Airway management: </strong>Secure airway, ventilate with 100% oxygen.</li>\n<li><strong>Administer 20% <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">Lipid</span> Emulsion: </strong>\n<ul>\n<li><strong>Bolus: </strong>12 mL/kg over 2-3 min.</li>\n<li><strong>Infusion:</strong> at 0.25 mL/kg/min-0.5ml/kg/min for 15-20 mins</li>\n<li><strong>Maximum initial dose: </strong>12 ml/kg</li>\n</ul>\n</li>\n<li><strong>Administration of antiepileptics:</strong> for <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> control, benzodiazepines such as Lorazepam is preferred.</li>\n<li><strong>Cardiopulmonary resuscitation:</strong> if necessary, monitor the patient at least for initial 2-6 hours following resuscitation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man with a history of renal calculi presents with bone pain and abdominal cramps. X-ray shows subperiosteal resorption of the 2nd and 3rd metacarpals and phalanges. Serum calcium and PTH are raised, and phosphate levels are decreased. Which of the following investigations will help localise the pathology?", "options": [{"label": "A", "text": "99Tc radiolabelled sestamibi scan", "correct": true}, {"label": "B", "text": "MRI scan", "correct": false}, {"label": "C", "text": "USG", "correct": false}, {"label": "D", "text": "CT scan", "correct": false}], "correct_answer": "A. 99Tc radiolabelled sestamibi scan", "question_images": ["https://image.prepladder.com/content/UOUPAYAe8sQSuywREtna1747302361.png"], "explanation_images": ["https://image.prepladder.com/notes/3gAzImx6GBL1f5AJ95Ft1747648760.png", "https://image.prepladder.com/notes/SbZQtPKclcRuCZZUFMuS1747648779.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\">High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Intact PTH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Low or inappropriately high</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Serum phosphate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>24-hour <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Chloride to <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> ratio </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>1,25- <span class=\"customMeta\" data-dictid=\"147defe59f16927771894a7addb83d\">hydroxy</span> Vitamin D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Normal or raised</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient fell from a train onto the railway track and injured both his legs severely. He was urgently taken to the hospital, and the following procedure was performed (image shown below). What is the rationale for performing this procedure?", "options": [{"label": "A", "text": "Better fit for prosthesis", "correct": false}, {"label": "B", "text": "Life-saving procedure", "correct": true}, {"label": "C", "text": "Reduces risk of cancer", "correct": false}, {"label": "D", "text": "Good cosmetic outcomes", "correct": false}], "correct_answer": "B. Life-saving procedure", "question_images": ["https://image.prepladder.com/notes/ncf24aC4rL5LKP14TFtO1747648569.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is caused by the deficiency of the enzyme tyrosine transaminase?", "options": [{"label": "A", "text": "Type I Tyrosinemia", "correct": false}, {"label": "B", "text": "Type II Tyrosinemia", "correct": true}, {"label": "C", "text": "Alkaptonuria", "correct": false}, {"label": "D", "text": "Type III Tyrosinemia", "correct": false}], "correct_answer": "B. Type II Tyrosinemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deficiency Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tyrosinemia type I</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fumarylacetoacetate hydrolase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Jaundice, hepatomegaly, hypoglycemia, HCC, liver cirrhosis</li>\n<li>Often presents with Fanconi syndrome and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure</li>\n<li>Elevated tyrosine and <span class=\"customMeta\" data-dictid=\"1bbb423a0e1692777199cf566e6b44\">succinylacetone</span> <strong>(pathognomic) </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tyrosinemia type II</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tyrosine aminotransferase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painful corneal erosions, palmoplantar hyperkeratosis</li>\n<li>Also known as <strong>oculocutaneous tyrosinemia</strong></li>\n<li>Elevated tyrosine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tyrosinemia type III</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>p-Hydroxyphenylpyruvate dioxygenase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent seizures, <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> ataxia</li>\n<li>Elevated tyrosine and p-hydroxyphenylpyruvate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alkaptonuria (Black <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> disease)</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogentisate 1,2-dioxygenase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dark urine, ochronosis, arthritis</li>\n<li>Black or brown <span class=\"customMeta\" data-dictid=\"b5f46d7e431692777195efd6b43e9f\">pigmentation</span> of <span class=\"customMeta\" data-dictid=\"3e4400809d16927771983252fc08b1\">sclera</span> <strong>(Osler’s sign)</strong> and ear cartilage</li>\n<li>Elevated homogentisic acid</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following regulates body temperature?", "options": [{"label": "A", "text": "Hypothalamus", "correct": true}, {"label": "B", "text": "Basal ganglia", "correct": false}, {"label": "C", "text": "Thalamus", "correct": false}, {"label": "D", "text": "Limbic system", "correct": false}], "correct_answer": "A. Hypothalamus", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/bnRHWXRkapOk0eW0TC5W1747662544.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Hypothalamic Nucleus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Secretion/Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Ventromedial Nucleus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lesion produce obesity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Lateral Hypothalamic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Lesion produce aphagia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Anterior Hypothalamic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Heat dissipation, <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> leads to hyperthermia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Posterior Hypothalamic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Heat conservation, <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> leads to poikilothermy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Arcuate Nucleus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Dopamine and GHRH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Paraventricular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>TRH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Paraventricular &amp; Supraoptic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>ADH and Oxytocin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Suprachiasmatic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Circadian rhythm and CRH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Preoptic area</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>GnRH</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which hormone is secreted by the structure marked with an arrow?", "options": [{"label": "A", "text": "Glucocorticoid", "correct": true}, {"label": "B", "text": "DHEA", "correct": false}, {"label": "C", "text": "Androgens", "correct": false}, {"label": "D", "text": "Mineralocorticoid", "correct": false}], "correct_answer": "A. Glucocorticoid", "question_images": ["https://image.prepladder.com/notes/XUZE5QwbIdTTZvmQj8rR1747650950.png"], "explanation_images": ["https://image.prepladder.com/content/dWq3B3d1eMUXwno1t2H31747311407.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Layers of Adrenal Gland</strong></td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adrenal Cortex</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zones of the cortex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormones produced</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Main function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphology of Zone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zona Glomerulosa </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mineralocorticoid <strong>(Option D ruled out)</strong></p>\n<ul>\n<li>Aldosterone(main)</li>\n<li>Deoxycorticosterone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance of sodium balance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small clumps of cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zona fasciculata </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucocorticoids <strong>(Option A)</strong></p>\n<ul>\n<li>Cortisol</li>\n<li>Corticosterone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance of sugars</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Columnar cells that <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> long cords</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zona reticularis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sex steroids</p>\n<ul>\n<li>Dehydroepiandrosterone (DHEA) <strong>(Option B ruled out)</strong></li>\n<li>Androstenedione <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance of sexual functioning</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Network of <span class=\"customMeta\" data-dictid=\"cfd35769b016927771901681bcc115\">intercalated</span> cells</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adrenal medulla</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medulla</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Catecholamines:</p>\n<ul>\n<li>Norepinephrine</li>\n<li>Epinephrine</li>\n<li>Small amounts of dopamine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carbohydrate and fat metabolisms</li>\n<li>Fight or flight responses</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specialised <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> ganglion</p>\n<p>Clumps and strands of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old pregnant woman in 3rd trimester presents to the emergency department after experiencing a fainting episode while lying down. She reports feeling better once she sits up. What is the most likely explanation for her symptoms?", "options": [{"label": "A", "text": "IVC compression", "correct": true}, {"label": "B", "text": "SVC compression", "correct": false}, {"label": "C", "text": "Hypotension", "correct": false}, {"label": "D", "text": "Motion sickness", "correct": false}], "correct_answer": "A. IVC compression", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old alcoholic patient presents to the ER with severe abdominal pain radiating to the back. Blood investigations reveal increased serum amylase and lipase levels. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Peptic ulcer disease", "correct": false}, {"label": "B", "text": "Acute pancreatitis", "correct": true}, {"label": "C", "text": "Acute cholecystitis", "correct": false}, {"label": "D", "text": "Pyogenic liver abscess", "correct": false}], "correct_answer": "B. Acute pancreatitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis of the given image?", "options": [{"label": "A", "text": "Polymyositis", "correct": false}, {"label": "B", "text": "Dermatomyositis", "correct": true}, {"label": "C", "text": "Inclusion body myositis", "correct": false}, {"label": "D", "text": "Discoid lupus erythematosus", "correct": false}], "correct_answer": "B. Dermatomyositis", "question_images": ["https://image.prepladder.com/content/3oHgEJuoRoyRCTtiQIgl1747380155.png"], "explanation_images": ["https://image.prepladder.com/content/zh7ImneBItj9rmxGdnRw1747380235.png", "https://image.prepladder.com/content/EnId5MTRtGnoBZz0Hfci1747380242.png", "https://image.prepladder.com/content/W5avsKbWkQif93SRqaal1747380249.png", "https://image.prepladder.com/content/nGwztU7pjq4ez7w2f6nI1747380255.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dermatomyositis10.jpg\" data-tags=\"\" height=\"206\" src=\"https://image.prepladder.com/content/zh7ImneBItj9rmxGdnRw1747380235.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Heliotrope rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Dermatomyositis2.jpg\" data-tags=\"\" height=\"254\" src=\"https://image.prepladder.com/content/EnId5MTRtGnoBZz0Hfci1747380242.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Gottron’s Papules</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ruhlman, Deborah &amp; Otten, Christina &amp; Colella, Christine\" data-hash=\"\" data-license=\"Copyright © 2014 Elsevier Inc\" data-source=\"https://www.researchgate.net/figure/Shawl-sign-rash-on-the-upper-back_fig5_266913824\" data-tags=\"\" height=\"449\" src=\"https://image.prepladder.com/content/W5avsKbWkQif93SRqaal1747380249.png\" width=\"399\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Shawl sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Didona, Dario &amp; Fania, Luca &amp; Didona, Biagio &amp; Eming, Rüdiger &amp; Hertl, Michael &amp; Di Zenzo, Giovanni.Didona, Dario &amp; Fania, Luca &amp; Didona, Biagio &amp; Eming, Rüdiger &amp; Hertl, Michael &amp; Di Zenzo, Giovanni.\" data-hash=\"\" data-license=\" CC BY\" data-source=\"https://www.researchgate.net/figure/Paraneoplastic-dermatomyositis-V-sign-Erythematous-maculopapular-rash-of-the-V-area_fig5_340099670\" data-tags=\"\" height=\"346\" src=\"https://image.prepladder.com/content/nGwztU7pjq4ez7w2f6nI1747380255.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>V Sign</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female patient with chronic pancreatitis undergoes a Puestow procedure. What is the most preferred route for supplementary nutrition in this patient?", "options": [{"label": "A", "text": "TPN (Total Parenteral Nutrition)", "correct": true}, {"label": "B", "text": "Oral feeding", "correct": false}, {"label": "C", "text": "Feeding gastrostomy", "correct": false}, {"label": "D", "text": "Feeding jejunostomy", "correct": false}], "correct_answer": "A. TPN (Total Parenteral Nutrition)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>3 in 1 <span class=\"customMeta\" data-dictid=\"cbc39c70db169277720312f2d6905b\">formulation</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>2 in 1 formulation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Solutions with lipids <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Solutions without lipids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>60/20/20</strong></p>\n<ul>\n<li>60% by dextrose</li>\n<li>20% by <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</li>\n<li>20% by fat.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>75/25</strong></p>\n<ul>\n<li>75% by dextrose</li>\n<li>25% by <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids</li>\n<li>No lipids used</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Fiber is absent in both formulations</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Line Insertion Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Pneumothorax (most dangerous)</li>\n<li>Misplacement of catheter</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Line-Related Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sepsis (most common)</li>\n<li>Thrombosis (more common with long-term <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> use)</li>\n<li>Electrolyte imbalances (e.g., <span class=\"customMeta\" data-dictid=\"acd4d513d216927771971a62ca95db\">refeeding</span> syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood sugar derangements (hyperglycemia, hypoglycemia)</li>\n<li>Liver dysfunction</li>\n<li>Metabolic bone disease</li>\n<li>Vitamin deficiencies</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman presents to her gynecologist complaining of curd-like white vaginal discharge. Upon examination, the physician observes that when attempting to remove the discharge, petechiae are seen. What condition is most likely causing these findings?", "options": [{"label": "A", "text": "Candidiasis", "correct": true}, {"label": "B", "text": "Trichomoniasis", "correct": false}, {"label": "C", "text": "Gardnella vaginalis", "correct": false}, {"label": "D", "text": "Gonorrhea", "correct": false}], "correct_answer": "A. Candidiasis", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:645px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vaginal Candidiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk factors for developing this infection include:</p>\n<ul>\n<li>Diabetes</li>\n<li>Pregnancy</li>\n<li>Use of <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics</li>\n<li>Use of <span class=\"customMeta\" data-dictid=\"fcb0512bcc16927771851fe5a081f6\">combined oral contraceptive</span> pills</li>\n<li>Immunosuppression and <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vaginal discharge</li>\n<li><strong>Intense <span class=\"customMeta\" data-dictid=\"8f179d376f16927771905338bc9387\">itching</span> of the <span class=\"customMeta\" data-dictid=\"b4d40892d71692777202db96deeb33\">vulva</span> and vagina</strong></li>\n<li>Pain during <span class=\"customMeta\" data-dictid=\"ad25936d1916927771900a1de2dd77\">intercourse</span> (dyspareunia) due to soreness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A thick, white, curd-like discharge</li>\n<li>Pelvic examination may be tender, and removing the white <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> can reveal multiple <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> spots</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>On KOH mount, the <strong>filamentous <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of mycelia and pseudohyphae</strong> of the <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> can be seen.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman who has done strenuous exercise complains of involuntary urine voiding during work out. What is the diagnosis?", "options": [{"label": "A", "text": "Urge incontinence", "correct": false}, {"label": "B", "text": "Stress incontinence", "correct": true}, {"label": "C", "text": "Neurogenic incontinence", "correct": false}, {"label": "D", "text": "Mixed urinary incontinence", "correct": false}], "correct_answer": "B. Stress incontinence", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the bleeding vessel in extradural hemorrhage?", "options": [{"label": "A", "text": "Middle meningeal artery", "correct": true}, {"label": "B", "text": "Bridging veins", "correct": false}, {"label": "C", "text": "Circle of Willis", "correct": false}, {"label": "D", "text": "Anterior cerebral artery", "correct": false}], "correct_answer": "A. Middle meningeal artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cgrrNPNMe6iwx2GQm1MK1747302659.png", "https://image.prepladder.com/content/LzhFas2YLdjf9JTuvsjl1747302659.png", "https://image.prepladder.com/content/uhCegSdnXdLepkyNdvd11747302659.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Space and Hemorrhages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Blood vessel involved</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidural Space/ Hemorrhage</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman, MD \" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Epidural_hematoma#/media/File:EpiduralHematoma.jpg\" data-tags=\"\" height=\"355\" src=\"https://image.prepladder.com/content/cgrrNPNMe6iwx2GQm1MK1747302659.png\" width=\"290\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between the skull <span class=\"customMeta\" data-dictid=\"d3011216f116927772017c8f317493\">vault</span> and <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> mater. The collection of blood here leads to <span class=\"customMeta\" data-dictid=\"6de01005f61692777187a3003970c7\">epidural</span> hematoma.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Middle meningeal artery</p>\n<p><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subdural Space/ Hemorrhage</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman, MD \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subdural_hematoma#/media/File:Subduralandherniation.PNG\" data-tags=\"\" height=\"362\" src=\"https://image.prepladder.com/content/LzhFas2YLdjf9JTuvsjl1747302659.png\" width=\"290\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"dd3534c97c16927771823c0d04f685\">arachnoid</span> and <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> mater. The collection of blood here leads to <span class=\"customMeta\" data-dictid=\"a9f86efa0d169277719911e454bd12\">subdural</span> hematoma.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bridging veins (which drain into the <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> sinus)</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subarachnoid Space/ Hemorrhage</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author='\"Liam Flynn Peter JD Andrews\"' data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/CT-image-of-subarachnoid-haemorrhage-Non-contrast-CT-scan-of-brain-showing-subarachnoid_fig1_283482604\" data-tags=\"\" height=\"304\" src=\"https://image.prepladder.com/content/uhCegSdnXdLepkyNdvd11747302659.png\" width=\"252\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between the <span class=\"customMeta\" data-dictid=\"dd3534c97c16927771823c0d04f685\">arachnoid</span> and <span class=\"customMeta\" data-dictid=\"556589a02516927771951f9bf061aa\">pia</span> mater</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arteries of the circle of Willis (Middle cerebral artery, Anterior <span class=\"customMeta\" data-dictid=\"8c3efbee661692777184685e54c75e\">communicating</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> -most commonly) <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not an indication for parathyroidectomy in a patient with primary hyperparathyroidism?", "options": [{"label": "A", "text": "Serum calcium &amp;gt; 1 mg/dL above the upper limit of normal", "correct": false}, {"label": "B", "text": "24-hour urine calcium &amp;gt; 400 mg/d", "correct": false}, {"label": "C", "text": "Age &amp;lt; 50 years", "correct": false}, {"label": "D", "text": "Creatinine clearance &amp;lt; 90 mL/min", "correct": true}], "correct_answer": "D. Creatinine clearance &lt; 90 mL/min", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most commonly affected nerve after parotid surgery?", "options": [{"label": "A", "text": "Facial nerve", "correct": true}, {"label": "B", "text": "Auriculo temporal nerve", "correct": false}, {"label": "C", "text": "Glossopharyngeal nerve", "correct": false}, {"label": "D", "text": "Greater auricular nerve", "correct": false}], "correct_answer": "A. Facial nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rOIuCYDwYYeERrTqdjh61747303200.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What skin condition is characterized by the presence of coral red fluorescence under a woods lamp?", "options": [{"label": "A", "text": "Erythrasma", "correct": true}, {"label": "B", "text": "Acanthosis nigricans", "correct": false}, {"label": "C", "text": "Allergic contact dermatitis", "correct": false}, {"label": "D", "text": "Cutaneous candidiasis", "correct": false}], "correct_answer": "A. Erythrasma", "question_images": ["https://image.prepladder.com/notes/wCeH7JPs6vbcOmgy9baV1747663130.png"], "explanation_images": ["https://image.prepladder.com/notes/mDGym4MvyWGut8lUt1LU1747663230.png", "https://image.prepladder.com/notes/wCeH7JPs6vbcOmgy9baV1747663130.png", "https://image.prepladder.com/content/8BJl9nogIxy8nOSHiOak1747376885.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Colour on Wood’s light</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitiligo</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Milky white</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erythrasma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coral pink</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pityriasis versicolor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yellow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tinea capitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Green</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pseudomonas</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Green</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scabies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluorescein solution fills the burrows and is viewed with Wood’s light</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Porphyria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluorescence observed in urine, <span class=\"customMeta\" data-dictid=\"17dfb015d2169277720023db8fe9e5\">teeth</span> and blood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tuberous sclerosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ash-leaf macules</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old woman presents with severe pain and swelling in her right hand, which is increasing in size and severity. She had a prick injury in the garden 5 days ago. On examination, she cries out in pain when her hand is extended and when the palmar aspect is palpated passively. Which of the following statements is true about the condition?", "options": [{"label": "A", "text": "More common in the dorsal aspect of the hand", "correct": false}, {"label": "B", "text": "X-ray imaging will aid in the location of the foreign body in all patients", "correct": false}, {"label": "C", "text": "It requires incision and drainage", "correct": true}, {"label": "D", "text": "Oral analgesics are the mainstay of treatment", "correct": false}], "correct_answer": "C. It requires incision and drainage", "question_images": ["https://image.prepladder.com/notes/SdIsY4pwQkK3iLDAUt3F1747645681.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not included in MMR?", "options": [{"label": "A", "text": "Death due to RTA", "correct": true}, {"label": "B", "text": "Death due to preeclampsia", "correct": false}, {"label": "C", "text": "Death due to ectopic pregnancy", "correct": false}, {"label": "D", "text": "Death on the 14th day postpartum", "correct": false}], "correct_answer": "A. Death due to RTA", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient complains of difficulty breathing, and fatigue. On examination, distended neck veins and muffled heart sounds were found. X-ray is shown below. Identify the disease.", "options": [{"label": "A", "text": "Constrictive pericarditis", "correct": true}, {"label": "B", "text": "Bronchial asthma", "correct": false}, {"label": "C", "text": "Acute pericarditis", "correct": false}, {"label": "D", "text": "Atrial myxoma", "correct": false}], "correct_answer": "A. Constrictive pericarditis", "question_images": ["https://image.prepladder.com/notes/8a17uOg4WqZKoEpISBnT1747657250.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Elevated JVP with rapid y descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reflects <strong>rapid early diastolic filling</strong> of the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> due to pressure gradient.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Fatigue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by the heart’s inability to meet <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> demands.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Rapid, low-volume pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Restricted <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> limits stroke volume, weakening the pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pericardial knock</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <strong>loud early S3 from the thickened pericardium</strong> during diastolic filling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Kussmaul’s sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paradoxical rise in JVP during inspiration.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hepatomegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> due to i<strong>ncreased <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abdominal fluid accumulation due to <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Peripheral oedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling in the extremities from <strong>fluid retention.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pulsus paradoxus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A fall in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP (10mm Hg) during inspiration, potentially <span class=\"customMeta\" data-dictid=\"8ee21101ac1692777189434bcef126\">impalpable</span> pulse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Atrial fibrillation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common due to atrial <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> and dilation.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Purpose/Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Egg in a cup appearance</li>\n<li>Detects <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> calcification, a key <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> clue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Echocardiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Visualises thickened <span class=\"customMeta\" data-dictid=\"56ab21797f16927771954b343891ef\">pericardium</span> and assesses <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>CT scanning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Helps in visualising <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> calcification.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Complex echo-Doppler and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> catheterisation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Square root wave sign</li>\n<li>Used to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">constrictive</span> <span class=\"customMeta\" data-dictid=\"607e653eef1692777195e56becea2c\">pericarditis</span> from restrictive <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> when diagnosis is uncertain.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Purpose/Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diuretics (e.g., loop diuretics, spironolactone)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Helps manage <span class=\"customMeta\" data-dictid=\"466b280a461692777186344883956d\">diastolic heart failure</span> by reducing fluid overload.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pericardiectomy</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Definitive treatment through <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> removal of the diseased pericardium. Significant improvement is possible, but the procedure has high <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> risk and suboptimal outcomes in up to 50% of patients.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young boy came to the OPD with complaints of severe itching at night. On examination, burrows are seen over intertriginous areas, axillae, umbilicus, and between digits. Which ofthe following transmits the condition described in the scenario?", "options": [{"label": "A", "text": "Louse", "correct": false}, {"label": "B", "text": "Tick", "correct": false}, {"label": "C", "text": "Mite", "correct": true}, {"label": "D", "text": "Flea", "correct": false}], "correct_answer": "C. Mite", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/roEs43HR79WZKnESf52R1747379906.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Radioactive isotope used for teletherapy?", "options": [{"label": "A", "text": "Iridium-192", "correct": false}, {"label": "B", "text": "lodine-125", "correct": false}, {"label": "C", "text": "Cobalt-60", "correct": true}, {"label": "D", "text": "lodine-131", "correct": false}], "correct_answer": "C. Cobalt-60", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:589px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types of Beams</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Electrons</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Negatively charged particles</li>\n<li>Limited penetration</li>\n<li>Effective for tumors near the body surface (Skin tumors)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Photons </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Can reach deep tumors</li>\n<li>Scatter radiation along the path</li>\n<li>Continue through normal tissue after reaching the tumor</li>\n<li>Made up of high energy:\n\t\t\t\t<ul>\n<li>X-rays (LINAC- Linear accelerators)</li>\n<li>Gamma rays</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protons</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Positively charged particles</li>\n<li>No radiation scatter</li>\n<li>Stop precisely at the tumor location</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>cobalt 60 (Co<sub>60</sub>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Linear accelerator</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"e3555f448716927771844820d69cfa\">Cobalt</span> machine produces an artificial <span class=\"customMeta\" data-dictid=\"4dd949a23a1692777197a5627fa8d8\">radioisotope</span> (Co )</li>\n<li>Advantage: Relative <span class=\"customMeta\" data-dictid=\"a4d5e86b6416927771850468afd1ba\">constancy</span> of beam output</li>\n<li>Source replacement approximately every 4 to 5 years</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>LINAC- Linear accelerators do not need a radioisotope</li>\n<li>The fast-moving <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> beam generates radiation which is used in radiotherapy</li>\n<li>X-ray beams are produced</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old teacher presents to the physician with complaints of hoarseness and voice fatigue. She reports that these symptoms have been gradually worsening over the past few months, especially towards the end of the school day. She denies any history of smoking or excessive alcohol consumption. Flexible laryngoscopy image is given below. what is the diagnosis?", "options": [{"label": "A", "text": "Vocal nodule", "correct": true}, {"label": "B", "text": "Reinkes edema", "correct": false}, {"label": "C", "text": "Vocal polyp", "correct": false}, {"label": "D", "text": "Keratosis larynx", "correct": false}], "correct_answer": "A. Vocal nodule", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vocal <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">Nodule</span> (Singer or screamer's nodule)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic vocal abuse (teachers, actors, vendors or pop singers. )</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laterality </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral or symmetrical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location </strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Free edge of vocal cord at the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> 1/3rd and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> 2/3rd. This</p>\n<p>is the area of maximum <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> of the vocal cord.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sessile , Reddish in the early stage and white in the chronic stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hoarseness, <span class=\"customMeta\" data-dictid=\"70f48cb1981692777202b78ba53214\">vocal fatigue</span> and neck pain on prolonged phonation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initially, voice rest.</li>\n<li>If it fails -</li>\n<li>microscopic <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> without injuring the vocal ligament</li>\n<li>Speech therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following provides valuable information about the reproductive behavior of couples within a population?", "options": [{"label": "A", "text": "TFR", "correct": true}, {"label": "B", "text": "NRR", "correct": false}, {"label": "C", "text": "GFR", "correct": false}, {"label": "D", "text": "GRR", "correct": false}], "correct_answer": "A. TFR", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Blood cholesterol shown as mg/ml value is in which scale?", "options": [{"label": "A", "text": "Ordinal", "correct": false}, {"label": "B", "text": "Nominal", "correct": false}, {"label": "C", "text": "Discrete", "correct": false}, {"label": "D", "text": "Continuous", "correct": true}], "correct_answer": "D. Continuous", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What nerve fibers are responsible for the transmission of proprioception?", "options": [{"label": "A", "text": "A alpha", "correct": true}, {"label": "B", "text": "A beta", "correct": false}, {"label": "C", "text": "A gamma", "correct": false}, {"label": "D", "text": "A delta", "correct": false}], "correct_answer": "A. A alpha", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:780px\">\n<tbody>\n<tr>\n<td colspan=\"8\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Classification of nerve fibres - Erlanger and Gasser and Lloyd-Hunt </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Fiber Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Erlanger-Gasser Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Lloyd-Hunt Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Myelination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Conduction Velocity (m/s)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Diameter (µm)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Sensitivity to Blockade</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Aα</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Aα</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Ia, Ib</p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Myelinated</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Proprioception, <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> motor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>70-120</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>12-20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pressure - Most susceptible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Aβ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Aβ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Touch, pressure</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>30-70</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>5-12</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pressure - Intermediate.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Aγ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Aγ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Motor to muscle spindles</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>15-30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>3-6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Aδ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Aδ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pain (fast), temperature (cold)</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>12-30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>2-5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Preganglionic autonomic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>3-15</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>&lt;3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hypoxia - Most susceptible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>C<br/>\n\t\t\t(Dorsal Root)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IV</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Unmyelinated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pain (slow), temperature (warm)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>0.5-2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>0.4-1.2</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Local anesthetics - Most susceptible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>C (Sympathetic)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Postganglionic sympathetic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>0.7-2.3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>0.3-1.3</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents with a testicular mass, and a gross image of the mass is provided. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Teratoma", "correct": false}, {"label": "B", "text": "Seminoma", "correct": true}, {"label": "C", "text": "Yolk sac tumour", "correct": false}, {"label": "D", "text": "Choriocarcinoma", "correct": false}], "correct_answer": "B. Seminoma", "question_images": ["https://image.prepladder.com/notes/MNMZZlW7sZT2JM3bgzHt1747643957.png"], "explanation_images": ["https://image.prepladder.com/notes/MNMZZlW7sZT2JM3bgzHt1747643957.png", "https://image.prepladder.com/notes/rqNsztuOrisG2nA2pbYF1747650497.png", "https://image.prepladder.com/content/iP8PlrTc7v4e0QIwmIWl1747309672.png", "https://image.prepladder.com/content/a2PYLn2jiN1XhPtEwjvH1747309672.png", "https://image.prepladder.com/content/AuVKTEVozdOwqnS2wMQU1747309672.png", "https://image.prepladder.com/content/4T9AcYrB7R3y5Ao5AkVv1747309672.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hiAFx3YCufoB0nwu6bbe1749405548.mp3", "video": ""}, {"text": "A 65-year-old male presents to the outpatient department with a swelling in the back of his neck that has been present for almost a year. The swelling has not increased in size. On examination, it is non-pulsatile, and the slip sign is positive, with the swelling measuring 3x3 cm. Which of the following statements is most likely true?", "options": [{"label": "A", "text": "High chances of malignant transformation", "correct": false}, {"label": "B", "text": "FNAC necessary for diagnosis", "correct": false}, {"label": "C", "text": "PET scan necessary for staging", "correct": false}, {"label": "D", "text": "Excision can be done if the patient requests it", "correct": true}], "correct_answer": "D. Excision can be done if the patient requests it", "question_images": ["https://image.prepladder.com/content/9uuVKtEkiaK2iZk7KKFv1747297886.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the image?", "options": [{"label": "A", "text": "Line diagram", "correct": true}, {"label": "B", "text": "Histogram", "correct": false}, {"label": "C", "text": "Scattered diagram", "correct": false}, {"label": "D", "text": "Frequency polygon", "correct": false}], "correct_answer": "A. Line diagram", "question_images": ["https://image.prepladder.com/content/XulLhRfkJIVqCsR1KFzx1747374095.png"], "explanation_images": ["https://image.prepladder.com/content/uUakOMx4YQlc9FwBaSHd1747374207.png", "https://image.prepladder.com/content/QqrUy3SLqObTJOWofMzb1747374219.png", "https://image.prepladder.com/content/HwszbjeSBVZLCaD2PhkQ1747374233.png"], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify pancreas, liver, and spleen?", "options": [{"label": "A", "text": "A-liver, B-pancreas, C-spleen", "correct": true}, {"label": "B", "text": "A-Kidney, B-liver, C-pancreas", "correct": false}, {"label": "C", "text": "A-pancreas, B-liver, C-spleen", "correct": false}, {"label": "D", "text": "A-spleen, B-kidney, C-liver", "correct": false}], "correct_answer": "A. A-liver, B-pancreas, C-spleen", "question_images": ["https://image.prepladder.com/notes/5QwvRttqwbm0xttADPF91747657032.png"], "explanation_images": ["https://image.prepladder.com/notes/w1iYH0yNlJXq91bGQEE01747657124.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis of the given image?", "options": [{"label": "A", "text": "Erythema toxicum neonatorum", "correct": false}, {"label": "B", "text": "Pustular melanosis", "correct": false}, {"label": "C", "text": "Mongolian spots", "correct": false}, {"label": "D", "text": "Milia", "correct": true}], "correct_answer": "D. Milia", "question_images": ["https://image.prepladder.com/content/QeiORlIgo6cXdfIDSq6y1747380585.png"], "explanation_images": ["https://image.prepladder.com/content/tANNJsLrHwGURasSdRA91747380649.png", "https://image.prepladder.com/content/3uj14z0VGCIG7ukPK6Zd1747380656.png", "https://image.prepladder.com/content/TcC5YRtv5O0y04urUvms1747380670.png", "https://image.prepladder.com/content/BMwNdJKZcL0G6ypYj8241747380682.png", "https://image.prepladder.com/content/vwn0Ks8JbBrWB70izh4j1747380697.png", "https://image.prepladder.com/content/2jwkgQej6tuWmle9ymwu1747380719.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disease of the <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> not requiring treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sebaceous hyperplasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Minute, profuse, yellow-white papules are frequently found on the forehead, nose, upper lip, and cheeks.</li>\n<li>Hyperplastic <span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\">sebaceous</span> glands.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Brzezinski, Piotr &amp; Chiriac, Anca.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Neonatal-sebaceous-hyperplasia_fig1_270452355\" data-tags=\"\" height=\"372\" src=\"https://image.prepladder.com/content/tANNJsLrHwGURasSdRA91747380649.png\" width=\"382\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Milia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Firm cyst, pearly, and <span class=\"customMeta\" data-dictid=\"b963a955d71692777194f33a0e8728\">opalescent</span> white lesions.</li>\n<li>Superficial <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">inclusion</span> cysts that contain <span class=\"customMeta\" data-dictid=\"1572de356e1692777191e5668d99d7\">laminated</span> keratinized material.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"SEREPHINE\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Newborn_Milia_(Milk_Spots).jpg\" data-tags=\"\" height=\"357\" src=\"https://image.prepladder.com/content/3uj14z0VGCIG7ukPK6Zd1747380656.png\" width=\"360\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epstein pearls</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Milia on the midline of the palate.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"SGHAEL\" data-hash=\"\" data-license=\"PUBLIC DOMAIN\" data-source=\"https://commons.wikimedia.org/wiki/File:Epstien_pearl.png\" data-tags=\"\" height=\"297\" src=\"https://image.prepladder.com/content/TcC5YRtv5O0y04urUvms1747380670.png\" width=\"460\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sucking blisters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Solitary or scattered <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> <span class=\"customMeta\" data-dictid=\"fc2efe08081692777183a5a07d6101\">bullae</span> present at birth on the upper limbs.</li>\n<li>Induced by vigorous sucking on the affected part in utero.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Salmon patch (Nevus simplex)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Small, pale pink, ill-defined, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> <span class=\"customMeta\" data-dictid=\"dc2eebe088169277719115b8c50b0c\">macule</span> that occurs most commonly on the glabella, eyelids, upper lip, and nuchal area.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Wierzman \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Nevus_flammeus_nuchae#/media/File:Nevus_flammeus_nuchae_(%22stork_bite%22_%22Storchenbiss%22).JPG\" data-tags=\"\" height=\"336\" src=\"https://image.prepladder.com/content/BMwNdJKZcL0G6ypYj8241747380682.png\" width=\"332\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mongolian spots (Dermal melanocytosis)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blue or slate-grey <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> lesions most commonly in the sacral area.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"GZZZ\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Giant_mongolian_blue_spot.JPG\" data-tags=\"\" height=\"354\" src=\"https://image.prepladder.com/content/vwn0Ks8JbBrWB70izh4j1747380697.png\" width=\"309\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erythema toxicum(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Firm, yellow-white, papules or pustules with a surrounding erythematous flare.</li>\n<li>Eosinophils are seen in Wright-stained smears</li>\n<li>Unknown cause.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"MOHAMMAD2018\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Erytherma_toxicum_neonatorum.jpg\" data-tags=\"\" height=\"474\" src=\"https://image.prepladder.com/content/2jwkgQej6tuWmle9ymwu1747380719.png\" width=\"269\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the instrument used for handling delicate tissues during eye surgery.", "options": [{"label": "A", "text": "Mcpherson forceps", "correct": false}, {"label": "B", "text": "Lim's forceps", "correct": true}, {"label": "C", "text": "Artery forceps", "correct": false}, {"label": "D", "text": "SR holding forceps", "correct": false}], "correct_answer": "B. Lim's forceps", "question_images": ["https://image.prepladder.com/notes/EDglthTC0tBAfKDvGaAo1747656117.png"], "explanation_images": ["https://image.prepladder.com/notes/EDglthTC0tBAfKDvGaAo1747656117.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Muscle inserted on lesser trochanter?", "options": [{"label": "A", "text": "Psoas major muscle", "correct": true}, {"label": "B", "text": "Psoas minor", "correct": false}, {"label": "C", "text": "Obturator internus", "correct": false}, {"label": "D", "text": "Piriformis", "correct": false}], "correct_answer": "A. Psoas major muscle", "question_images": ["https://image.prepladder.com/notes/fl0vGkTH3v5zqknr6nAl1747653412.png"], "explanation_images": ["https://image.prepladder.com/notes/9ZjKK7RMiQieySOvqiit1747653464.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During laparoscopic surgery, while inserting the trocar, which of the following is most prone to injury?", "options": [{"label": "A", "text": "Abdominal aorta", "correct": false}, {"label": "B", "text": "Superior epigastric artery", "correct": false}, {"label": "C", "text": "Both superior and inferior epigastric arteries", "correct": true}, {"label": "D", "text": "Inferior epigastric artery", "correct": false}], "correct_answer": "C. Both superior and inferior epigastric arteries", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Heme is derived from which of the following amino acids?", "options": [{"label": "A", "text": "Glutamine", "correct": false}, {"label": "B", "text": "Glycine", "correct": true}, {"label": "C", "text": "Glutamate", "correct": false}, {"label": "D", "text": "Valine", "correct": false}], "correct_answer": "B. Glycine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/TN3Z9QukZMNWW3Au5HYU1747661758.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Succinyl CoA + Glycine → Delta-aminolevulinic acid (ALA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ALA Synthase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rate-limiting step</strong>; requires <span class=\"customMeta\" data-dictid=\"ad5806d5ad1692777196f1158adc4e\">pyridoxal</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> as a cofactor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 ALA → Porphobilinogen (PBG)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ALA Dehydratase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It involves removal of 2 molecules of water; the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> contains <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> and is inhibited by lead</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 PBG → Hydroxymethylbilane (HMB)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uroporphyrinogen I Synthase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HMB → Uroporphyrinogen I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous cyclization</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>HMB → Uroporphyrinogen III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uroporphyrinogen III Synthase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uroporphyrinogen III → Coproporphyrinogen III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uroporphyrinogen Decarboxylase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Decarboxylation, removal of 4 molecules of CO2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coproporphyrinogen III → Protoporphyrinogen III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coproporphyrinogen Oxidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>7</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protoporphyrinogen III → Protoporphyrin III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protoporphyrinogen Oxidase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>8</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protoporphyrin III → Heme</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ferrochelatase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insertion of Fe2+</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which receptor plays a crucial role in glucose uptake by skeletal muscle?", "options": [{"label": "A", "text": "GLUT 1", "correct": false}, {"label": "B", "text": "GLUT 2", "correct": false}, {"label": "C", "text": "GLUT 3", "correct": false}, {"label": "D", "text": "GLUT 4", "correct": true}], "correct_answer": "D. GLUT 4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transporter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tissue Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Functions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GLUT 1</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brain, kidney, colon, placenta, erythrocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facilitates <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> uptake</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GLUT 2</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver, pancreatic β cells, small intestine, kidney</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enables rapid <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> or release</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GLUT 3</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brain, kidney, placenta</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assists in <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> uptake</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GLUT 4</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heart and <strong>skeletal </strong>muscle, <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mediates insulin-stimulated <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> uptake</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>GLUT 5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small intestine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facilitates <span class=\"customMeta\" data-dictid=\"d5bac53d50169277720363f48a6b3a\">fructose</span> absorption</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>SGLT 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> and kidney</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Actively transports <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> against a concentration gradient</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the primary identification made by a CBNAAT/ gene expert?", "options": [{"label": "A", "text": "Mycobacterium tuberculosis", "correct": false}, {"label": "B", "text": "MTB+ Rifampicin resistance", "correct": true}, {"label": "C", "text": "MTB+ Isoniazid", "correct": false}, {"label": "D", "text": "MTB+ Ethambutol", "correct": false}], "correct_answer": "B. MTB+ Rifampicin resistance", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Limitations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sputum <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial screening for <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> TB.</li>\n<li>Samples are stained using the Ziehl-Neelsen method or Auramine-O <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB) under a microscope.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Quick and inexpensive. Can provide results within a few hours.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Low sensitivity, especially in cases of <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB or in patients with HIV.</li>\n<li>Cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between Mycobacterium <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> and non-tuberculous <span class=\"customMeta\" data-dictid=\"46f768d2e41692777193d69cbc7eec\">mycobacteria</span> (NTM).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Culture Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Confirm the diagnosis of TB and assess drug susceptibility.</li>\n<li><strong>Solid Media:</strong> Sputum is inoculated onto solid culture media like <strong>Löwenstein-Jensen </strong>or Middlebrook agar.</li>\n<li><strong>Liquid Media: </strong>Automated systems like <strong>BACTEC or MGIT</strong> are used to detect growth faster.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The gold standard for TB diagnosis.</li>\n<li>Allows for drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Time-consuming; results can take weeks.</li>\n<li>Requires specialized laboratory facilities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Xpert MTB/RIF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Detects Mycobacterium <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> and <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</li>\n<li><strong>Method</strong>:</li>\n<li>A cartridge-based system that performs <span class=\"customMeta\" data-dictid=\"6483f3ef3116927771935d328a8ab2\">nucleic acid</span> <span class=\"customMeta\" data-dictid=\"13e14b31b21692777181520d7c651c\">amplification</span> (NAAT).</li>\n<li>Sputum or other specimens are processed directly in the cartridge.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid results (within 2 hours).</li>\n<li>High sensitivity and specificity.</li>\n<li>Simultaneously detects <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>More expensive than <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> microscopy.</li>\n<li>Does not provide full drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> testing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>LAMP (Loop-Mediated Isothermal Amplification)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Detects DNA of Mycobacterium tuberculosis.</li>\n<li><strong>Method</strong>:</li>\n<li>Amplifies DNA at a constant temperature without the need for <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> cycling.</li>\n<li>Sputum or other specimens are used.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid results (within 1-2 hours).</li>\n<li>High <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> and sensitivity.</li>\n<li>Can be performed at the point of care.</li>\n<li>Used for patients with HIV with CD4+ counts of less than 100 cells/μL irrespective of signs and symptoms of TB.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Less widely available than PCR-based tests.</li>\n<li>Cannot detect <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> directly.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TrueNat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Point-of-care test for TB detection.</li>\n<li><strong>Method</strong>:</li>\n<li>Uses a micro-PCR technology to amplify DNA.</li>\n<li>Results are available within 60 minutes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Portable and easy to use in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> health facilities.</li>\n<li>Provides results quickly, facilitating immediate treatment decisions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Line <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">Probe</span> Assay (LPA)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Detects TB and <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> (rifampicin and isoniazid).</li>\n<li><strong>Method</strong>:\n\t\t\t\t<ul>\n<li>Sputum samples are processed, and DNA is extracted.</li>\n<li>Amplified DNA is hybridized to specific probes on a <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> strip.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid results (within 1-2 days).</li>\n<li>Can detect multiple mutations associated with drug resistance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Requires a laboratory <span class=\"customMeta\" data-dictid=\"3a6d14db861692777198565f57828c\">setup</span> and trained personnel.</li>\n<li>Not suitable for all strains of TB.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>RFLP</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>IS6110 <span class=\"customMeta\" data-dictid=\"3668babc2b169277719777e6f04c66\">restriction fragment</span> length <span class=\"customMeta\" data-dictid=\"15d98152c61692777196a0f2fb42a0\">polymorphism</span> (RFLP)</strong> analysis is widely used for molecular epidemiological studies of tuberculosis.</li>\n<li>Restriction enzymes Nru I, EcoN I, Pst I, and Pvu II were used to analyze IS6110 fingerprints in Mycobacterium <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> strains H37Rv (virulent) and H37Ra (avirulent).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A Patient who has a pet dog at home complains of hypochondrial pain. Radiological imaging shows a multilocular cyst within the liver. The organism involved is?", "options": [{"label": "A", "text": "Echinococcus granulosus", "correct": true}, {"label": "B", "text": "Entamoeba histolytica", "correct": false}, {"label": "C", "text": "Strongyloides stercoralis", "correct": false}, {"label": "D", "text": "Ancylostoma duodenale", "correct": false}], "correct_answer": "A. Echinococcus granulosus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZpvCxs9bH2VkQZ0vTApd1747293816.png", "https://image.prepladder.com/content/Se05dQrAsKGBVWskm7lX1747293816.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Echinococcus granulosus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dog tapeworm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definitive Host</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dog (optimal host), wolf, jackal and fox</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intermediate Host</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sheep and cattle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Accidental Intermediate Host</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Man (Harbors <span class=\"customMeta\" data-dictid=\"7a9967010c16927771914174ab4e92\">larval</span> stage, not adult form)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infective <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">Form</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Embryonated egg</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mode of Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ingestion of the eggs due to:</p>\n<ul>\n<li>Intimate handling of infected dogs</li>\n<li>Eating raw vegetables or other food items contaminated with dog feces</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eggs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovoid in shape and brown in color</li>\n<li>Contains an <span class=\"customMeta\" data-dictid=\"30bf2366951692777187735fffe4b4\">embryo</span> with three pairs of hooklets</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Larva </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Represent structure of <span class=\"customMeta\" data-dictid=\"5df6bd6fd716927771980b637094fa\">scolex</span> of adult <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">worm</span> and remains invaginated within a <span class=\"customMeta\" data-dictid=\"4b0fee14c816927772016e67cf3a13\">vesicular</span> body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adult Worm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Consist of scolex, a short neck and strobila</li>\n<li>Scolex is pyriform, with four suckers and prominent <span class=\"customMeta\" data-dictid=\"e5c624201c169277719794d85e4e66\">rostellum</span> <span class=\"customMeta\" data-dictid=\"2bb6ddacfd169277718230a816b21f\">bearing</span> two <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> rows of hooklets.</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"256\" src=\"https://image.prepladder.com/content/ZpvCxs9bH2VkQZ0vTApd1747293816.png\" width=\"230\"/></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:727px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Main Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Outer Layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pericyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Host-derived</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thick <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> layer created by the host's <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response around the cyst.</li>\n<li>Eventually it develops into a dense <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> which may even calcify.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides structural support and isolates the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> from surrounding tissues.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Middle Layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ectocyst (Laminated Membrane)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Parasite-derived</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acellular,chitinous, <span class=\"customMeta\" data-dictid=\"1572de356e1692777191e5668d99d7\">laminated</span> <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">hyaline</span> layer secreted by the parasite.</li>\n<li>Has the appearance of the white of a hard boiled egg.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acts as a barrier against host immune cells and protects the inner <span class=\"customMeta\" data-dictid=\"a0e5fdc156169277718879843a6ede\">germinal</span> layer.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inner Layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endocyst (Germinal Layer)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Parasite-derived</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thin <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> layer lining the <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> interior.</li>\n<li>Consist of a number of <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> embedded in a protoplasmic mass.</li>\n<li>Vital layer of the cyst.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Site of <span class=\"customMeta\" data-dictid=\"272cf5f2fa16927771822dc211adde\">asexual</span> <span class=\"customMeta\" data-dictid=\"7a47c14dc91692777197a27e7aa854\">reproduction</span> giving rise to <span class=\"customMeta\" data-dictid=\"ac3ea0ac6d1692777183373c53e97b\">brood capsules</span> with scolices.</li>\n<li>Also <span class=\"customMeta\" data-dictid=\"7b8c92219216927771981950fdd0e8\">secrete</span> <span class=\"customMeta\" data-dictid=\"cc96ad6655169277718944f7ffe9ae\">hydatid</span> fluid, which fills the cyst.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following criteria is not included in the definition of severe Non-Proliferative Diabetic Retinopathy (NPDR)?", "options": [{"label": "A", "text": "Microaneurysms in all quadrants", "correct": false}, {"label": "B", "text": "Retinal hemorrhage in all quadrants", "correct": false}, {"label": "C", "text": "Looping in all quadrants", "correct": true}, {"label": "D", "text": "Bleeding in two quadrants", "correct": false}], "correct_answer": "C. Looping in all quadrants", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Proliferative <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">Retinopathy</span> (NPDR):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>No <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> Retinopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in 12 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Very Mild NPDR</strong></p>\n<p>Microaneurysms only</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review most patients in 12 months</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mild NPDR </strong></p>\n<p>Any or all of the: microaneurysms, <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hemorrhages, exudates, and <span class=\"customMeta\" data-dictid=\"ef5bc669a416927771854943d1cfa8\">cotton-wool</span> spots, up to the level of moderate NPDR. No <span class=\"customMeta\" data-dictid=\"871f3dc691169277719044c0f27f98\">intraretinal</span> <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> anomalies (IRMA) or significant beading.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review range 6-12 months, depending on the severity of signs, stability, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> factors, and patient's circumstances</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderate NPDR </strong></p>\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hemorrhages in 1-3 quadrants or mild IRMA</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"965fde0a5a1692777182ae7e8ede4b\">beading</span> can be present in no more than 1 quadrant</li>\n<li>Cotton <span class=\"customMeta\" data-dictid=\"eaae57387d1692777202060f299953\">wool</span> spots commonly present</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in approximately 6 months</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe NPDR </strong></p>\n<p>The 4-2-1 rule; is one or more of the:</p>\n<ul>\n<li>Severe hemorrhages in all 4 quadrants <strong>(Option B ruled out)</strong></li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"965fde0a5a1692777182ae7e8ede4b\">beading</span> in 2 or more quadrants <strong>(Option D ruled out)</strong></li>\n<li>Moderate IRMA in 1 or more quadrants <strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in 4 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Very severe NPDR </strong></p>\n<p>Two or more of the criteria for severe NPDR</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in 2-3 months</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While administering epidural anesthesia, which structure is not punctured before injecting the drug?", "options": [{"label": "A", "text": "Supraspinous ligament", "correct": false}, {"label": "B", "text": "Interspinous ligament", "correct": false}, {"label": "C", "text": "Ligamentum flavum", "correct": false}, {"label": "D", "text": "Arachnoid mater", "correct": true}], "correct_answer": "D. Arachnoid mater", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/44Anokmd0dzLXRU47Ubr1747381370.png", "https://image.prepladder.com/content/9gxU0Zd34MBiV6cY51Sq1747381370.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy is brought with complaints of headache, vomiting, and neck stiffness for a few days. He had undergone a ventriculoperitoneal (VP) shunt placement for hydrocephalus a year ago. What is the most common cause of shunt malfunction in this patient?", "options": [{"label": "A", "text": "Shunt infection", "correct": false}, {"label": "B", "text": "Shunt obstruction", "correct": true}, {"label": "C", "text": "Shunt tip migration", "correct": false}, {"label": "D", "text": "Shunt disconnection", "correct": false}], "correct_answer": "B. Shunt obstruction", "question_images": ["https://image.prepladder.com/notes/caDB6C2Q6ii9eiRjKNwp1747645407.png"], "explanation_images": ["https://image.prepladder.com/notes/k2wZ668il1qjsjJp0Vgj1747645471.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented to the emergency department with diplopia and ataxia, and he was completely confused. A history of alcohol was noted. What is the initial treatment of choice in this condition?", "options": [{"label": "A", "text": "IV Lorazepam", "correct": false}, {"label": "B", "text": "IV Thiamine", "correct": true}, {"label": "C", "text": "IV fluid + dextrose", "correct": false}, {"label": "D", "text": "Vitamin B12", "correct": false}], "correct_answer": "B. IV Thiamine", "question_images": [], "explanation_images": [], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td style=\"text-align:center\"><strong>Wernicke's Encephalopathy</strong></td>\n<td style=\"text-align:center\"><strong>Korsakoff Syndrome</strong></td>\n</tr>\n<tr>\n<td><strong>Onset</strong></td>\n<td>Acute</td>\n<td>Chronic often follows Wernicke's syndrome</td>\n</tr>\n<tr>\n<td><strong>Key Symptoms</strong></td>\n<td>\n<ul>\n<li>Global Confusion</li>\n<li>Ocular abnormalities (nystagmus, gaze palsy)</li>\n<li>Ataxia (especially gait)</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"6f04a43a8c16927771816dd61a4f17\">anterograde</span> amnesia</li>\n<li>Retrograde amnesia</li>\n<li>Confabulation (in some cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:32px; vertical-align:top; width:137px\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:32px; vertical-align:top; width:275px\">\n<p>Thiamine deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:32px; vertical-align:top; width:237px\">\n<p>Prolonged <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:32px; vertical-align:top; width:137px\">\n<p><strong>Neuropathological lesions</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"1\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:32px; vertical-align:top; width:512px\">\n<p>Symmetrical and paraventricular, involving <span class=\"customMeta\" data-dictid=\"06d33302e016927771911f7ef71255\">mammillary</span> bodies, thalamus, hypothalamus, midbrain, pons, medulla, fornix, and cerebellum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:41px; vertical-align:top; width:137px\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:41px; vertical-align:top; width:275px\">\n<p>Immediate IV <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:41px; vertical-align:top; width:237px\">\n<p>Long-term <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> supplementation, supportive care</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:53px; vertical-align:top; width:137px\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:53px; vertical-align:top; width:275px\">\n<p>Potentially <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> with prompt treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:53px; vertical-align:top; width:237px\">\n<p>Often irreversible, only about 20% recover</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition that presents with an empty delta sign.", "options": [{"label": "A", "text": "Subarachnoid hemorrhage", "correct": false}, {"label": "B", "text": "Subdural hemorrhage", "correct": false}, {"label": "C", "text": "Cerebral venous thrombosis", "correct": true}, {"label": "D", "text": "Intraparenchymal hemorrhage", "correct": false}], "correct_answer": "C. Cerebral venous thrombosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Wr8hgFTZZKSmHCGIcmE41747657360.png", "https://image.prepladder.com/content/JoT8aMjjXkkVMh1uETdy1747375038.png", "https://image.prepladder.com/content/T9i5ONMAwUtWQ5OLsVH41747375038.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The chest X-ray shows right-sided white-out lung and contralateral tracheal deviation. In which of the following conditions is this seen?", "options": [{"label": "A", "text": "Pneumothorax", "correct": false}, {"label": "B", "text": "Consolidation", "correct": false}, {"label": "C", "text": "Collapse", "correct": false}, {"label": "D", "text": "Thoracic mass", "correct": true}], "correct_answer": "D. Thoracic mass", "question_images": ["https://image.prepladder.com/notes/bUrAigJ9D9rMikQocm3E1747663849.png"], "explanation_images": ["https://image.prepladder.com/notes/i89ikiVMMUFGmAx2qzPl1747663929.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman with a recent travel history to Africa presents with fever, confusion and neurological deficits. Laboratory analysis reveals the following findings. This organism exhibits a specific property that facilitates sequestration in vascular beds to avoid splenic clearance. What is the phenomenon called?", "options": [{"label": "A", "text": "Rosetting", "correct": false}, {"label": "B", "text": "Agglutination", "correct": false}, {"label": "C", "text": "Cytoadherence", "correct": true}, {"label": "D", "text": "Schizogony", "correct": false}], "correct_answer": "C. Cytoadherence", "question_images": ["https://image.prepladder.com/notes/i93VhfxFWLyqJm20X3du1747651562.png"], "explanation_images": ["https://image.prepladder.com/content/CDTH8bPiDqj7JlbOcYss1747293953.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with meningitis was examined. His CSF shows lymphocytosis, decreased glucose, and increased protein. What is the etiological agent?", "options": [{"label": "A", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "B", "text": "Hemophilus influenza", "correct": false}, {"label": "C", "text": "Neisseria meningitidis", "correct": false}, {"label": "D", "text": "Mycobacterium tuberculosis", "correct": true}], "correct_answer": "D. Mycobacterium tuberculosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GL3Kxug1lLg7omtkunuw1747293671.png", "https://image.prepladder.com/content/tNuhv82NQPpI3x2dQTs61747293671.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:694px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>TB Meningitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tuberculous <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">Meningitis</span> results from <span class=\"customMeta\" data-dictid=\"33bb6837aa169277718854a46f5cbd\">hematogenous</span> spread of primary or postprimary TB or <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of a <span class=\"customMeta\" data-dictid=\"3e782ca1981692777199a69e89b274\">subependymal</span> <span class=\"customMeta\" data-dictid=\"4e55f7e0e6169277720158750ed95c\">tubercle</span> into the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Evolves over 1–2 weeks, slower than bacterial meningitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Early Symptoms</strong>\n<ul>\n<li>Headache, mild mental changes, <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> fever, malaise, anorexia, <span class=\"customMeta\" data-dictid=\"982688ae75169277719041afa70c42\">irritability</span> over several weeks.</li>\n</ul>\n</li>\n<li><strong>Advanced Symptoms</strong>\n<ul>\n<li>Severe headache, confusion, lethargy, altered sensorium, neck rigidity,<strong> <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsies (especially ocular)</strong>. Can progress to coma, hydrocephalus, and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> hypertension.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lumbar <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">Puncture</span> Findings (CSF)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>High <span class=\"customMeta\" data-dictid=\"00346a7f211692777191e91c2af9fc\">leukocyte</span> count </strong>(up to 1000/μL), typically <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> predominance</li>\n<li><strong>Protein: 1–8 g/L</strong> (100–800 mg/dL)</li>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> concentration</strong></li>\n<li>AFB is rarely seen; repeated <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> punctures increase yield.</li>\n<li><strong>CSF culture <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> in up to 80% (gold standard).</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Xpert MTB/RIF Assay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sensitivity up to 80%.</li>\n<li><strong>A negative result does not exclude TB.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CT, MRI: Shows <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">hydrocephalus</span> and <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">enhancement</span> of <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cisterns or ependyma.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Hartung M\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/tuberculous-meningitis-13#image-63461192\" data-tags=\"\" height=\"344\" src=\"https://image.prepladder.com/content/tNuhv82NQPpI3x2dQTs61747293671.png\" width=\"257\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p><strong>Basal <span class=\"customMeta\" data-dictid=\"6c0b28fd161692777184ab502019a8\">cistern</span> enhancement</strong></p>\n<ul>\n<li>In &gt;50% of cases, old <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> lesions or military pattern on CXR.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate treatment with positive Xpert MTB/RIF.</p>\n<ul>\n<li><strong>Chemotherapy </strong>is effective but neurologic sequelae occur in 25% of cases, especially with delayed diagnosis.</li>\n<li><strong>Glucocorticoid Therapy</strong>\n<ul>\n<li><strong>Dexamethasone </strong>reduces mortality and severe disability but may not prevent neurological sequelae.</li>\n<li>Regimen: 0.4 mg/kg/day IV, tapering weekly, followed by oral tapering. WHO recommends tapering over 6–8 weeks.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old patient on immunosuppressive therapy presents with a cough, fever, and pneumonia. A biopsy reveals the given findings. Which organism is responsible for the infection?", "options": [{"label": "A", "text": "EBV", "correct": false}, {"label": "B", "text": "CMV", "correct": true}, {"label": "C", "text": "Pox virus", "correct": false}, {"label": "D", "text": "Chickenpox", "correct": false}], "correct_answer": "B. CMV", "question_images": ["https://image.prepladder.com/notes/MjMcvu48LknNaHInaUCQ1747650808.png"], "explanation_images": ["https://image.prepladder.com/notes/MjMcvu48LknNaHInaUCQ1747650808.png", "https://image.prepladder.com/content/bwhUqmJVpFJlzDMcmpid1747311191.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CMV (cytomegalovirus)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Class </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Betaherpesvirinae</strong> <span class=\"customMeta\" data-dictid=\"0c663827551692777199eb5bf9ed71\">subfamily</span> of the Herpesviridae family.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Modes of transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral route, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> &amp; body secretions<strong> (most common)</strong></li>\n<li>Vertical transmission</li>\n<li>Sexual transmission</li>\n<li>Organ transplantation</li>\n<li>Blood transfusion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Host cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Salivary gland</li>\n<li>Kidney</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Congenital infection</strong></p>\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> infection with <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> defects.</li>\n<li><strong>Common presentation:</strong>\n<ul>\n<li>Petechiae</li>\n<li>Hepatosplenomegaly</li>\n<li>Jaundice</li>\n</ul>\n</li>\n<li><strong>Less common presentation:</strong>\n<ul>\n<li>Microcephaly</li>\n<li>Cerebral calcifications</li>\n<li>Intrauterine growth retardation</li>\n<li>Prematurity</li>\n</ul>\n</li>\n<li><strong>Other defects: </strong>Sensorineural hearing loss.</li>\n</ul>\n<p> </p>\n<p><strong>Perinatal infection</strong></p>\n<ul>\n<li>Commonly asymptomatic.</li>\n<li>Occasionally, <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> infants present with <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> pneumonitis.</li>\n</ul>\n<p> </p>\n<p><strong>Immunocompromised</strong></p>\n<ul>\n<li>This is seen in AIDS, HIV, organ transplant patients and cancer patients undergoing chemotherapy.</li>\n<li>Presentations in AIDS and HIV\n\t\t\t\t<ul>\n<li>CMV chorioretinitis</li>\n<li>Progressive dementia,</li>\n<li>Cranial nerve defects,</li>\n</ul>\n</li>\n<li>Presentations in Organ transplant\n\t\t\t\t<ul>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> pneumonia</li>\n<li>Febrile leukopenia</li>\n<li>Obliterative bronchiolitis</li>\n<li>Graft atherosclerosis</li>\n<li>Rejection of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> allografts.</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n<p><strong>Immunocompetent</strong></p>\n<ul>\n<li>Usually, it occurs following a blood transfusion.</li>\n<li>It presents similar to <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> mononucleosis, but <span class=\"customMeta\" data-dictid=\"8ca4dcc0c1169277718848b8f5ae3d\">heterophile</span> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> tests would be negative.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Peripheral smear: Owl’s eye appearance of <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">inclusion</span> bodies.</strong></p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Owl eye appearance\" data-author=\"Dr.AG\" data-hash=\"12960\" data-license=\"NA\" data-source=\"https://www.medical-labs.net/cytomegalovirus-cmv-infection-nuclear-inclusions-2476/\" data-tags=\"May2025\" height=\"245\" src=\"https://image.prepladder.com/notes/MjMcvu48LknNaHInaUCQ1747650808.png\" width=\"329\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<p><strong>Virus isolation</strong></p>\n<p>It is done by</p>\n<ul>\n<li>Human <span class=\"customMeta\" data-dictid=\"3095c5f0fc1692777202eda8060779\">fibroblast</span> cell line culture</li>\n<li>Shell <span class=\"customMeta\" data-dictid=\"cd235a18081692777202343e31b264\">vial</span> culture</li>\n</ul>\n<p> </p>\n<p><strong>Antigen detected: PP65</strong></p>\n<p> </p>\n<p><strong>Antibody detection</strong></p>\n<p>It is done by ELISA, and the antibodies detected are</p>\n<ul>\n<li>CMV IgM antibodies</li>\n<li>CMV IgG antibodies</li>\n<li>Against PP150 and PP65,</li>\n<li>Against the PP52</li>\n</ul>\n<p> </p>\n<p><strong>PCR</strong></p>\n<ul>\n<li>Used in detecting CMV DNA</li>\n<li>Quantitative <span class=\"customMeta\" data-dictid=\"6483f3ef3116927771935d328a8ab2\">nucleic acid</span> testing (<strong>QNAT) by PCR is the most sensitive and specific testing.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ganciclovir</strong> <strong>(Drug of choice)</strong></li>\n<li><strong>Foscarnet</strong> (in Ganciclovir resistance)</li>\n<li>CMV immunoglobulins and Ganciclovir are given to <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> transplant patients.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lung cancer patient has hyperpigmentation of palmar and sole creases. Which of the following is responsible for this presentation?", "options": [{"label": "A", "text": "MSH", "correct": true}, {"label": "B", "text": "C-peptide", "correct": false}, {"label": "C", "text": "Neuropeptide Y", "correct": false}, {"label": "D", "text": "Melanin", "correct": false}], "correct_answer": "A. MSH", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ectopic Cushing's Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ACTH production from non-pituitary sources leading to Cushing's syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Accounts for 10-20% of cases of Cushing's syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Small cell lung cancer </strong>(most common)</li>\n<li>Bronchial and <span class=\"customMeta\" data-dictid=\"2221edbfce16927772007d62c44d48\">thymic</span> carcinoids</li>\n<li>Islet tumors</li>\n<li>Pheochromocytomas</li>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> carcinomas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increased expression of POMC gene from non-pituitary sources</li>\n<li><strong>Production of MSH</strong>, β-lipotropin, and other POMC-derived peptides</li>\n<li>Production of ACTH fragments</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyperglycemia</li>\n<li>Marked fluid retention</li>\n<li><strong>Hyperpigmentation manifestations due to MSH</strong></li>\n<li>Less marked weight gain compared to <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> Cushing's</li>\n<li>Centripetal fat redistribution</li>\n<li>Hypertension</li>\n<li>Hypokalemia</li>\n<li>Metabolic alkalosis</li>\n<li>Glucose intolerance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Very high ACTH levels (typically &gt;2-3 times normal)</li>\n<li>No response to high-dose <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> suppression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Treatment of underlying malignancy</li>\n<li>Glucocorticoid <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> blockers</li>\n<li>Steroidogenesis inhibitors</li>\n<li>Management of complications (diabetes, hypokalemia)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Distinctions from <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">Pituitary</span> Cushing's</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Higher ACTH levels</li>\n<li>No response to <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> suppression</li>\n<li>More rapid onset</li>\n<li>More severe <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> complications</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lung Tumor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Paraneoplastic Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Small Cell Lung Cancer (SCLC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Syndrome of Inappropriate ADH Secretion (SIADH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cushing’s Syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lambert-Eaton Myasthenic Syndrome (LEMS)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paraneoplastic Encephalomyelitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superior Vena Cava (SVC) Syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Squamous Cell Carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypercalcemia</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adenocarcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertrophic Pulmonary Osteoarthropathy (HPOA)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trousseau’s Syndrome (Migratory thrombophlebitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dermatomyositis/Polymyositis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acanthosis Nigricans</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Large Cell Carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gynecomastia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancoast Tumor (Subset of NSCLC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Horner’s Syndrome</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which hormone increases during periods of stress, starvation, and deep sleep?", "options": [{"label": "A", "text": "Growth Hormone", "correct": true}, {"label": "B", "text": "Glucocorticoids", "correct": false}, {"label": "C", "text": "Cortisol", "correct": false}, {"label": "D", "text": "Prolactin", "correct": false}], "correct_answer": "A. Growth Hormone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Factors controlling GH <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> and their effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hypothalamic Control</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Growth Hormone-Releasing Hormone (GHRH)</strong>: Increases GH <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> and secretion.</li>\n<li><strong>Somatostatin (GHIH)</strong>: Decreases GH secretion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Nutritional Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Hypoglycemia</strong>: Promotes GH <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> to increase blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels and mobilize energy.</li>\n<li><strong>Amino Acids</strong>: Stimulate GH release, supporting protein <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> and growth.</li>\n<li><strong>Starvation or Protein Deficiency</strong>: This leads to elevated GH levels to <span class=\"customMeta\" data-dictid=\"a4d43e9d8416927771856f3d1cb32c\">conserve</span> body proteins and utilize fats as an energy source.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Physiological Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Exercise</strong>: Enhances GH secretion</li>\n<li><strong>Sleep</strong>: GH surges during <span class=\"customMeta\" data-dictid=\"7fdc13a6a116927771865b3a13263e\">deep sleep</span> are vital for growth and tissue repair processes.</li>\n<li><strong>Stress</strong>: Physical and emotional stressors can increase GH secretion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hormonal Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Ghrelin</strong>: Increases GH <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> and stimulates appetite.</li>\n<li><strong>Sex Hormones (Estrogen and Testosterone)</strong>: Contribute to increased GH <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> during puberty, supporting growth and development.</li>\n<li><strong>Negative Feedback Control</strong>: GH and IGF-1 levels feedback to <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> further GH release, maintaining <span class=\"customMeta\" data-dictid=\"50796581771692777189251fbe5ef1\">homeostasis</span> and preventing <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> GH production.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male soldier complained of being plagued by a painful, erosive lesion near his earlobe since his return from his duty in the desert area. The patient is otherwise vitally stable, and general physical examinations reveal no other abnormalities. The punch biopsy of the leading edge of the erosion reveals the given findings. Which of the following is the causative organism?", "options": [{"label": "A", "text": "Trypanosomabrucei", "correct": false}, {"label": "B", "text": "Trypanosoma cruzi", "correct": false}, {"label": "C", "text": "Leishmania donovani", "correct": true}, {"label": "D", "text": "Plasmodium vivax", "correct": false}], "correct_answer": "C. Leishmania donovani", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Kala-azar/ Black sickness/Dum-dum fever/Sandfly disease/ Visceral Leishmaniasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Organism</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protozoan</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epidemiology</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endemic in Uttar Pradesh, Bihar, Jharkhand, West Bengal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Types</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Visceral (Kala-Azar): L. donovani</li>\n<li>Cutaneous: L. tropica</li>\n<li>Mucocutaneous: L. braziliensis</li>\n<li>Post-kala-azar <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> (PKLD): Immune response</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reservoir</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Humans (non-zoonotic)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vector</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sandfly (Phlebotomus argentipes): has <span class=\"customMeta\" data-dictid=\"a4789768d21692777188e77f1969cd\">hairy</span> wings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Environmental</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peak outbreak: November to April</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mechanism of transmission</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bite of sandfly</li>\n<li>Blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> (rare)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incubation period</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>10 days to 2 years. (1-4 months average)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical features</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visceral: Fever, Weight loss, Hepatosplenomegaly, Anemia.</li>\n<li>Cutaneous: Painful skin ulcers</li>\n<li>Mucocutaneous: Rapid mucosal destruction of nose and oropharynx</li>\n<li>PKDL: Skin nodules filled with micro-organisms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> kits: rk39-dipstick test.\n\t\t\t\t<ul>\n<li>Used for field surveys.</li>\n</ul>\n</li>\n<li>Biopsy (Gold standard):<strong> Leishmania Donovan bodies (amastigotes)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sandfly control measures</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>DDT: 1-2gm/m<sup>2</sup>.</li>\n<li>BHC (benzene hexachloride)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>DOC: Single dose Liposomal amphotericin-B (LAMB)10 mg/kg</li>\n<li>Alternatives:\n\t\t\t\t<ul>\n<li>Miltefosine + Paramomycin</li>\n<li>Pentamidine</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young lady gave a history of unprotected intercourse four days back. She is requesting an emergency contraception. Which of the following is most suitable in this case?", "options": [{"label": "A", "text": "Lng", "correct": false}, {"label": "B", "text": "IUCD", "correct": true}, {"label": "C", "text": "OCP", "correct": false}, {"label": "D", "text": "Misoprostol", "correct": false}], "correct_answer": "B. IUCD", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient is having the following hand movements. In which of the following conditions would this be seen?", "options": [{"label": "A", "text": "Thyrotoxicosis", "correct": false}, {"label": "B", "text": "Hypercarbia", "correct": true}, {"label": "C", "text": "Hemiballismus", "correct": false}, {"label": "D", "text": "Hypoxia", "correct": false}], "correct_answer": "B. Hypercarbia", "question_images": ["https://image.prepladder.com/content/4ibSmf9JnLAr5V6DhQ0Y1747302620.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Utilizing the provided X-ray, identify the type of fracture using the Salter-Harris classification?", "options": [{"label": "A", "text": "Type 1", "correct": false}, {"label": "B", "text": "Type 2", "correct": true}, {"label": "C", "text": "Type 3", "correct": false}, {"label": "D", "text": "Type 4", "correct": false}], "correct_answer": "B. Type 2", "question_images": ["https://image.prepladder.com/notes/JHk9f2tbCYD4hwwWvehw1747659651.png"], "explanation_images": ["https://image.prepladder.com/notes/IwqdAgCGct5KSygHdgNW1747659737.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Type</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Description</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Treatment and Prognosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type I <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Separation of the <span class=\"customMeta\" data-dictid=\"4032e2aa0b16927771959902540621\">physis</span> (growth plate), without involvement of the <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> or epiphysis.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Excellent <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> if treated promptly</li>\n<li>Treated with <span class=\"customMeta\" data-dictid=\"3024d9916e16927771896f5b7159b6\">immobilization</span> and observation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type II <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fracture through the <span class=\"customMeta\" data-dictid=\"4032e2aa0b16927771959902540621\">physis</span> and part of the metaphysis. The metaphyseal fragment is displaced, forming a <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> (known as the Thurston-Holland sign).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Good <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> with proper treatment.</li>\n<li>Treated with reduction and casting.</li>\n<li>Rarely affects future growth.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type III <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fracture through the <span class=\"customMeta\" data-dictid=\"4032e2aa0b16927771959902540621\">physis</span> and epiphysis, with the <span class=\"customMeta\" data-dictid=\"0fa073bd8016927771872ee5b57674\">epiphysis</span> displaced.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>May result in joint <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> or growth <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> if not managed well.</li>\n<li>Surgical intervention required for proper <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> and fixation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fracture through the physis, metaphysis, and epiphysis. Involves all three areas.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Can lead to growth disturbances or joint deformity.</li>\n<li>Treatment typically involves <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> fixation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type V <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crushing injury of the <span class=\"customMeta\" data-dictid=\"4032e2aa0b16927771959902540621\">physis</span> (growth plate), resulting in <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> and loss of the growth plate. No <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line visible.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Risk of growth arrest and long-term deformities.</li>\n<li>Surgical intervention required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents to the OPD with fatigue, bone pains, and swollen and bleeding gums. Physical examination reveals petechiae on her skin. Which of the following can be given to treat her condition?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin D", "correct": false}, {"label": "C", "text": "Vitamin E", "correct": false}, {"label": "D", "text": "Vitamin C", "correct": true}], "correct_answer": "D. Vitamin C", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MM7YRTGvEL7kHehfjk2B1747378931.png", "https://image.prepladder.com/content/pU0NuWV3Jf3qLHnUOabm1747378931.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vitamin C Source: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Citrus fruits/juices, cauliflower and green leafy vegetables, melons, guava.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vitamin C RDA (Infants)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>0-6 months- 40 mg/day</strong></p>\n<p><strong>7-12 months- 50 mg/day</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vitamin C <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> (Scurvy)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Heat-treated milk or unfortified formula.</li>\n<li>Diets lacking fruits and vegetables.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Early</strong>: Irritability, loss of appetite, fever, pain, leg tenderness.</li>\n<li><strong>Later</strong>: Swelling, pseudoparalysis, <span class=\"customMeta\" data-dictid=\"98c8f7f96f1692777199295afb1d35\">subperiosteal</span> hemorrhages, \"scorbutic rosary\" beads at the <span class=\"customMeta\" data-dictid=\"bfa9e996381692777185cdc8709772\">costochondral</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> due to <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> bleeds, <span class=\"customMeta\" data-dictid=\"09980563461692777188b0de904031\">gum</span> changes, anemia, bleeding, poor healing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment: </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vitamin C 100-200 mg/day (oral or parenteral).</li>\n<li>Improvement within a week; continue for 3 months.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Scorbutic Rosary</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Colin Woon MD\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.orthobullets.com/basic-science/9034/scurvy\" data-tags=\"\" height=\"184\" src=\"https://image.prepladder.com/content/MM7YRTGvEL7kHehfjk2B1747378931.png\" width=\"208\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rickety Rosary</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ahmad, Noman &amp; Sobaihi, Mrouge &amp; Al-Jabri, Mona &amp; –Esaei, Nabil &amp; Zaydi, Abdullah.\" data-hash=\"\" data-license=\"CC BY-NC ND\" data-source=\"https://www.researchgate.net/figure/A-Narrow-bell-shaped-chest-with-rachitic-rosary-B-Bilateral-atelactasis-and_fig1_325638276\" data-tags=\"\" height=\"261\" src=\"https://image.prepladder.com/content/pU0NuWV3Jf3qLHnUOabm1747378931.png\" width=\"243\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sharp <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of ribs with or without beading</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bead-like <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of <span class=\"customMeta\" data-dictid=\"bfa9e996381692777185cdc8709772\">costochondral</span> junction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Underlying cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitamin C <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (scurvy)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitamin D <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (rickets)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to <span class=\"customMeta\" data-dictid=\"58c03304521692777195a054ce95e4\">periosteal</span> bleeds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Overgrowth of <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> at <span class=\"customMeta\" data-dictid=\"bfa9e996381692777185cdc8709772\">costochondral</span> junction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Palpation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sharp, <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> prominences</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rounded, knob-like prominences</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man presents with abdominal pain. A CECT (Contrast Enhanced CT) abdomen was done. What is the likely source of pain?", "options": [{"label": "A", "text": "Gall bladder", "correct": false}, {"label": "B", "text": "Spleen", "correct": false}, {"label": "C", "text": "Kidney", "correct": true}, {"label": "D", "text": "Liver", "correct": false}], "correct_answer": "C. Kidney", "question_images": ["https://image.prepladder.com/content/9OoJWVVxkiiiKZFKT2jR1747298193.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment of RCC: RCCs are radio and chemo-resistant.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">Nephrectomy</span> (Option A): </strong>Involves removing only the tumour while preserving the remainder of the kidney.</p>\n<p><strong>Indications: </strong></p>\n<ul>\n<li>T1 Disease(&lt;7cm)</li>\n<li>Restricted to poles</li>\n<li>RCC in <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> kidney</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Radical Nephrectomy: </strong>Involves<strong> </strong>removal of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with Gerota’s fascia, <span class=\"customMeta\" data-dictid=\"b83fd0c2a5169277719403617c9fdd\">para-aortic</span> nodes, and <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> up to the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> brim.</li>\n<li><strong>Indications: </strong>Larger tumours or when partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is not feasible</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ablative Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA) and Cryoablation </strong>Involve destroying the tumor using extreme temperatures.</p>\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Patients who are not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates</li>\n<li>Patients with small tumours (T1a lesions) (usually &lt;4 cm).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n<p><strong>(For advanced/ metastatic disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Targeted Therapy</strong></p>\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (e.g., sunitinib, pazopanib)</li>\n<li>mTOR inhibitors (e.g., everolimus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunotherapy: </strong>Immune <span class=\"customMeta\" data-dictid=\"cd249aae061692777184c11176df48\">checkpoint</span> inhibitors (e.g., nivolumab)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended free residual chlorine level after chlorination of a well to ensure adequate disinfection?", "options": [{"label": "A", "text": "0.5 ppm after 1 hour", "correct": true}, {"label": "B", "text": "0.5 ppm after 2 hours", "correct": false}, {"label": "C", "text": "0/8 ppm after 1 hour", "correct": false}, {"label": "D", "text": "0.5 ppm after 2 hours", "correct": false}], "correct_answer": "A. 0.5 ppm after 1 hour", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the given image, the tendon marked by the arrow is?", "options": [{"label": "A", "text": "Flexor carpi radialis", "correct": true}, {"label": "B", "text": "Flexor carpi ulnaris", "correct": false}, {"label": "C", "text": "Flexor digitorum superficialis", "correct": false}, {"label": "D", "text": "Palmaris longus", "correct": false}], "correct_answer": "A. Flexor carpi radialis", "question_images": ["https://image.prepladder.com/notes/S83XnB8p6W6F4jjLtqV11747652974.png"], "explanation_images": ["https://image.prepladder.com/notes/O3NSaYUeUPvprxIMDkGB1747653053.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:2px solid #666666; border-left:1px solid #999999; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Muscles</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #666666; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #666666; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Insertion</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #666666; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Nerve supply</strong></p>\n</td>\n<td style=\"border-bottom:2px solid #666666; border-left:none; border-right:1px solid #999999; border-top:1px solid #999999; vertical-align:top\">\n<p><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Pronator teres</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Humeral head - <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"043a86fa0016927771998a67e65e6a\">supracondylar</span> ridge and from ulna</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Middle of radius</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Median nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Pronation and weak <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> of forearm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Flexor carpi radialis</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of humerus</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Base of 2nd /3rd <span class=\"customMeta\" data-dictid=\"3582e886271692777192ab233546a6\">metacarpal</span> bones</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Median nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Weak <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> and abducts (radial deviation)the wrist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Palmaris longus</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of humerus</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Palmar <span class=\"customMeta\" data-dictid=\"52cb21596b1692777181aa72f1feb5\">aponeurosis</span> and <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> retinaculum</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Median nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Weak <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> of wrist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Flexor carpi ulnaris</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"42c351f10a1692777194fbc64fc061\">olecranon</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> border of ulna</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Pisiform bone and hook of <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">hamate</span> and 5th metacarpal</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Ulnar nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Weak <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> and adducts (ulnar deviation)the wrist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #999999; border-left:1px solid #999999; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Flexor digitorum superficialis</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of humerus, <span class=\"customMeta\" data-dictid=\"2d0cdf9e0e1692777185d4b709e843\">coronoid</span> process, <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> line of radius</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Divides into 4 tendons and insert to middle phalanx</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Median nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #999999; border-left:none; border-right:1px solid #999999; border-top:none; vertical-align:top\">\n<p>Flex the wrist, <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> and <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:center\">\n<p><strong>Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:center\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:center\">\n<p><strong>Insertion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:center\">\n<p><strong>Nerve supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:center\">\n<p><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Flexor digitorum profundus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Anteromedial surface of <span class=\"customMeta\" data-dictid=\"d28fccd8021692777201d3ffa6cf94\">ulna</span> and <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">interosseous</span> membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Divided into 4 tendons and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> phalanx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">interosseous</span> nerve and <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Flex the wrist, <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> and <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Flexor pollicis longus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Anterior surface of <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> and <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">interosseous</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and <span class=\"customMeta\" data-dictid=\"2d0cdf9e0e1692777185d4b709e843\">coronoid</span> process</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Distal <span class=\"customMeta\" data-dictid=\"e9451cd23d1692777195fe471f486e\">phalanx</span> of thumb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">interosseous</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Flex the wrist and <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joint of wrist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Pronator quadratus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Anterior surface of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> ulna</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Anterior surface of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> Radius</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">interosseous</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Pronates forearm</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient has just undergone surgery and required a drug to reverse the muscle relaxation induced during the procedure. Which of the following drugs is used for this purpose?", "options": [{"label": "A", "text": "Bethanechol", "correct": false}, {"label": "B", "text": "Atropine", "correct": false}, {"label": "C", "text": "Neostigmine", "correct": true}, {"label": "D", "text": "Edrophonium", "correct": false}], "correct_answer": "C. Neostigmine", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primigravida came to the emergency department at 1 pm with a 5 cm dilated cervix and at 4 pm with 6 cm dilation, next step in management?", "options": [{"label": "A", "text": "Slow progress of labor", "correct": false}, {"label": "B", "text": "Wait for complete dilation", "correct": false}, {"label": "C", "text": "Induce labor", "correct": false}, {"label": "D", "text": "Intervention to be done", "correct": true}], "correct_answer": "D. Intervention to be done", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The muscle attached to the marked bony structure is?", "options": [{"label": "A", "text": "Ilio-psoas", "correct": true}, {"label": "B", "text": "Gluteus maximus", "correct": false}, {"label": "C", "text": "Gluteus medius", "correct": false}, {"label": "D", "text": "Sartorius", "correct": false}], "correct_answer": "A. Ilio-psoas", "question_images": ["https://image.prepladder.com/notes/lO38ZyPThMtZr5CThlXh1747652638.png"], "explanation_images": ["https://image.prepladder.com/notes/Bgh7gLR8JcGxEWvUcug81747652719.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following mutations is associated with the Philadelphia chromosome?", "options": [{"label": "A", "text": "Inversion", "correct": false}, {"label": "B", "text": "Insertion", "correct": false}, {"label": "C", "text": "Reciprocal translocation", "correct": true}, {"label": "D", "text": "Deletion", "correct": false}], "correct_answer": "C. Reciprocal translocation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dhS73ulNnc9rbYOxcJgf1747302496.png", "https://image.prepladder.com/content/9xotEz4Evc9Fl6w1wmB71747302496.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following drug is not used in the treatment of acne vulgaris?", "options": [{"label": "A", "text": "Topical Benzoyl peroxide", "correct": false}, {"label": "B", "text": "Topical Fluocinolone", "correct": true}, {"label": "C", "text": "Topical Tazarotene", "correct": false}, {"label": "D", "text": "Topical antibiotics", "correct": false}], "correct_answer": "B. Topical Fluocinolone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grades</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lesions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-inflammatory lesions such as open (blackheads) and closed <span class=\"customMeta\" data-dictid=\"0f639eabf6169277718410ada52bab\">comedones</span> (whiteheads)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Topical retinoids</p>\n<p>(Tretinoin, Adapalene)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-inflammatory lesions (comedones) + <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> lesions such as papules and few pustules.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Topical retinoids + Topical antibiotics</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> papules and pustules ± nodules (moderate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Topical retinoids + Oral antibiotics ± Benzoyl peroxide</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nodules + Cysts</p>\n<p>(Most severe form)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral retinoids</p>\n<p>(Isotretinoin)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the mechanism of action of thiazides in DCT?", "options": [{"label": "A", "text": "Blockade of Na Cl symporter", "correct": false}, {"label": "B", "text": "Blockade of Na K 2Cl symporter", "correct": true}, {"label": "C", "text": "Blockade of aldosterone receptors", "correct": false}, {"label": "D", "text": "Blockade of epithelial sodium channels.", "correct": false}], "correct_answer": "B. Blockade of Na K 2Cl symporter", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical uses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> inhibitors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibit carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tubule, decreasing <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> reabsorption</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acetazolamide, Methazolamide</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glaucoma, Altitude sickness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Loop diuretics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibit the Na-K-2Cl <span class=\"customMeta\" data-dictid=\"1bede64bc91692777199b477cf43f1\">symporter</span> in the thick <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> loop of Henle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Furosemide, Bumetanide</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema, Chronic heart failure, Hypercalcemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thiazide diuretics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibit sodium <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> tubule</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hydrochlorothiazide, Chlorthalidone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertension, Edema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Potassium</strong></p>\n<p><strong>Sparing diuretics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibit block the epithelial sodium channels in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"3ddb367f1c16927771854815522adf\">convoluted</span> <span class=\"customMeta\" data-dictid=\"4ba1c48e851692777201a91713191e\">tubule</span> and collecting duct</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spironolactone, Amiloride</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heart failure, Hyperaldosteronism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osmotic diuretics </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> of the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> filtrate, inhibiting water reabsorption.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mannitol, Glycerin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebral oedema, Acute glaucoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A teenager was brought to the OPD with complaints of delayed fertility and primary amenorrhea. Physical examination reveals a webbed neck and widely spaced nipples. Which karyotype is associated with a given condition?", "options": [{"label": "A", "text": "45, X", "correct": true}, {"label": "B", "text": "47, XXY", "correct": false}, {"label": "C", "text": "47, XXX", "correct": false}, {"label": "D", "text": "47, XYY", "correct": false}], "correct_answer": "A. 45, X", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/R8z6abI0gDLSvEd6LVUU1747309815.png", "https://image.prepladder.com/content/IAfb4hPJkDEaOBZa08eU1747309815.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Dynein protein is an example of?", "options": [{"label": "A", "text": "Transport protein", "correct": true}, {"label": "B", "text": "Cell membrane protein", "correct": false}, {"label": "C", "text": "Cell organelle adherent protein", "correct": false}, {"label": "D", "text": "Intracellular junctional protein", "correct": false}], "correct_answer": "A. Transport protein", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After cataract surgery, a patient develops endophthalmitis with vision limited to hand movements. What is the treatment?", "options": [{"label": "A", "text": "Intravitreal antibiotic injections", "correct": true}, {"label": "B", "text": "Pars plana vitrectomy", "correct": false}, {"label": "C", "text": "Redo surgery", "correct": false}, {"label": "D", "text": "Topical antibiotics", "correct": false}], "correct_answer": "A. Intravitreal antibiotic injections", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YuDBi8sxL29P7tflkhe91747306899.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Inflammation of inner structures of the eye (uveal tissue and retina) with exudates in the vitreous, anterior, and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> chambers. It spares sclera.</li>\n<li><strong>Acute bacterial <span class=\"customMeta\" data-dictid=\"d7e86ebfd9169277718767de545052\">endophthalmitis</span> happens 1-7 days post <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> surgery</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M/C <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Staphylococcus epidermidis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> pain</li>\n<li>Redness</li>\n<li>Lacrimation</li>\n<li>Photophobia</li>\n<li>Loss of vision</li>\n<li>Red and swollen lids</li>\n<li>Conjunctival chemosis</li>\n<li>Circumcorneal congestion</li>\n<li>Cloudy cornea</li>\n<li>Ring infiltration</li>\n<li>Yellow necrotic wound edges</li>\n<li>Hypopyon</li>\n<li>Oedematous and muddy iris</li>\n<li>Yellow <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> due to <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> exudation</li>\n<li>Vitreous <span class=\"customMeta\" data-dictid=\"1f6bbb967d16927771871c1894ea2e\">exudation</span> which causes amaurotic cat's-eye reflex</li>\n<li>Raised <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> pressure initially</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Intravitreal antibiotics (Option A)</strong>:\n\t\t\t\t<ul>\n<li>First choice: Vancomycin 1 mg + Ceftazidime 2.25 mg</li>\n<li>Second choice: Vancomycin 1 mg + Amikacin 0.4 mg</li>\n</ul>\n</li>\n<li><strong>Topical antibiotics (Option D)</strong></li>\n<li>Systemic antibiotics</li>\n<li>Steroid Therapy</li>\n<li>Supportive Therapy</li>\n<li><strong>Vitrectomy - if no improvement in 48-72 hours (Option B) or if severe infection with vision <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> to hand movements close to the face</strong></li>\n<li>If blind - no perception of light - Evisceration.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following image shows which X-ray view?", "options": [{"label": "A", "text": "Waters view", "correct": false}, {"label": "B", "text": "Caldwell's view", "correct": false}, {"label": "C", "text": "Towne view", "correct": true}, {"label": "D", "text": "Hirtz view", "correct": false}], "correct_answer": "C. Towne view", "question_images": ["https://image.prepladder.com/content/tRqusJeXGA20dY1xR2eM1747303518.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient, who is on antipsychotic medication for his schizophrenia, started to have dystonia. Management of this patient is by?", "options": [{"label": "A", "text": "Benzhexol", "correct": true}, {"label": "B", "text": "Replace with fluphenazine", "correct": false}, {"label": "C", "text": "Increase the dose of haloperidol", "correct": false}, {"label": "D", "text": "Clozapine", "correct": false}], "correct_answer": "A. Benzhexol", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pathways </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Control </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nigrostriatal pathway</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal movements (dystonia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesolimbic pathway</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mesocortical pathway</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tuberoinfundibular pathway</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperprolactinemia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female who is receiving cyclosporine A following renal transplantation develops multiple and bilateral breast lumps that regress after cessation of the treatment. Biopsy image is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Fat necrosis", "correct": false}, {"label": "B", "text": "Phyllodes tumour", "correct": false}, {"label": "C", "text": "Fibroadenoma", "correct": true}, {"label": "D", "text": "Carcinoma breast", "correct": false}], "correct_answer": "C. Fibroadenoma", "question_images": ["https://image.prepladder.com/content/xxpFYBP2D1CZwhUurGry1747296370.png"], "explanation_images": ["https://image.prepladder.com/content/FqIacfDGYXHyuGYcvZD51747296408.png", "https://image.prepladder.com/content/HY4mAdJNrUoOXMDINIFF1747296424.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 17-year-old boy who fell on an outstretched hand is now experiencing pain and swelling at the base of the thumb. Which bone is most likely fractured?", "options": [{"label": "A", "text": "Lunate", "correct": false}, {"label": "B", "text": "Scaphoid", "correct": true}, {"label": "C", "text": "Pisiform", "correct": false}, {"label": "D", "text": "Trapezoid", "correct": false}], "correct_answer": "B. Scaphoid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iG2H8KTFgmW1Ose4gghR1747288351.png", "https://image.prepladder.com/notes/noA9BZfAbcZr1tCwyFPu1747826473.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:666px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Scaphoid fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Waist of <span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\">scaphoid</span> (most common) </strong></li>\n<li>Distal pole (Least common)</li>\n<li>Proximal pole (high risk for <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> necrosis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically caused by a <strong>fall on an outstretched hand (FOOSH)</strong> with the wrist in dorsiflexion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>It is more common in young adults</strong>, particularly athletes.</li>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> localised to the <strong>anatomical snuffbox</strong> (the depression between the tendons of the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> pollicis <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> and the <span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\">abductor</span> pollicis longus/extensor pollicis brevis).</li>\n<li>Swelling and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"069cba94231692777197b41e753795\">range of motion</span> at the wrist.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>There is a visible <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> line at the waist of the scaphoid, with possible <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> or displacement; <span class=\"customMeta\" data-dictid=\"a44009963c1692777182feb479b12b\">avascular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> may later appear as <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> pole.</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Gilo1969\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Scaphoid_fracture\" data-tags=\"\" height=\"265\" src=\"https://image.prepladder.com/content/iG2H8KTFgmW1Ose4gghR1747288351.png\" width=\"189\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immobilisation by <span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\">scaphoid</span> cast (3-4 months)</p>\n<p><img alt=\"OR284-Management of Scaphoid Fracture\" data-author=\"\" data-hash=\"13084\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"480\" src=\"https://image.prepladder.com/notes/noA9BZfAbcZr1tCwyFPu1747826473.png\" width=\"550\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Avascular <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> (more common in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> pole)</li>\n<li>Humpback <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (displaced <span class=\"customMeta\" data-dictid=\"4992469b3c169277719874a6808793\">Scaphoid</span> fracture)</li>\n<li>Delayed and non-union</li>\n<li>Wrist osteoarthritis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn presents with jaundice. Biliary atresia is suspected when jaundice is persistent and exceeds?", "options": [{"label": "A", "text": "2 days", "correct": false}, {"label": "B", "text": "2 weeks", "correct": true}, {"label": "C", "text": "2 months", "correct": false}, {"label": "D", "text": "2 years", "correct": false}], "correct_answer": "B. 2 weeks", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Choose the correct sequence with respect to the stages of changes that the breast undergoes in a female?", "options": [{"label": "A", "text": "Lactogenesis→mamogenesis→galactopoiesis→galactokinesis", "correct": false}, {"label": "B", "text": "Lactogenesis→galactoporosis→galactokinesis→mamogenesis", "correct": false}, {"label": "C", "text": "Mamogenesis→lactogenesis→galactokinesis→galactopoiesis", "correct": true}, {"label": "D", "text": "Mamogenesis→galactokinesis→galactopoiesis→lactogenesis", "correct": false}], "correct_answer": "C. Mamogenesis→lactogenesis→galactokinesis→galactopoiesis", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mamogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preparation of breasts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lactogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Synthesis and <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> from the breast alveoli</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Galactokinesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ejection of milk</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Galactopoiesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintenance of lactation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the presented spirometry image, what term corresponds to the point labeled F?", "options": [{"label": "A", "text": "Vital capacity", "correct": true}, {"label": "B", "text": "Total lung capacity", "correct": false}, {"label": "C", "text": "Expiratory reserve volume", "correct": false}, {"label": "D", "text": "Inspiratory capacity", "correct": false}], "correct_answer": "A. Vital capacity", "question_images": ["https://image.prepladder.com/notes/zu1c75QNmLLzUy2wpNnh1747662643.png"], "explanation_images": ["https://image.prepladder.com/notes/yhPV27UPBlC3UYFlrCol1747662716.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lung Volume/Capacity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Typical Volume (mL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Formula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tidal Volume (TV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Amount of air inhaled or exhaled during normal breath</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>500</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inspiratory Reserve Volume (IRV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Additional air that can be inhaled after a normal inhalation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Expiratory Reserve Volume (ERV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Additional air that can be exhaled after a normal exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1200</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Residual Volume (RV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Air remaining in the lungs after a <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1200</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anatomical Dead Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Volume of air in conducting airways where no gas exchange occurs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>150</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Total Lung Capacity (TLC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maximum amount of air the lungs can hold</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6000</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TLC = TV + IRV + <span class=\"customMeta\" data-dictid=\"5a6905fdca16927771879daba1b8d2\">ERV</span> + RV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vital Capacity (VC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maximum air exhaled after a <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> inhalation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4800</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>VC = TV + IRV + ERV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inspiratory Capacity (IC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maximum air inhaled after a normal exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3500</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IC = TV + IRV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Functional Residual Capacity (FRC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Air remaining in the lungs after a normal exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2400</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>FRC = <span class=\"customMeta\" data-dictid=\"5a6905fdca16927771879daba1b8d2\">ERV</span> + RV</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman at 22 weeks of gestation presents with a marginal placenta on ultrasound. When is the next ultrasound recommended for reassessment", "options": [{"label": "A", "text": "32 weeks", "correct": false}, {"label": "B", "text": "38 weeks", "correct": false}, {"label": "C", "text": "28 weeks", "correct": true}, {"label": "D", "text": "30 weeks", "correct": false}], "correct_answer": "C. 28 weeks", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JNDj3E3WbZ9KWJTvkzoV1747287717.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A married woman with a failed contraception method presents at 26 weeks of gestation. What is the appropriate course of action based on the MTP Act?", "options": [{"label": "A", "text": "Husband’s consent", "correct": false}, {"label": "B", "text": "2 doctors’ opinion", "correct": false}, {"label": "C", "text": "If no fetal anomaly, continue the pregnancy", "correct": true}, {"label": "D", "text": "Medical board permission for termination", "correct": false}], "correct_answer": "C. If no fetal anomaly, continue the pregnancy", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has muffled heart sounds with low blood pressure. What is the correct JVP finding?", "options": [{"label": "A", "text": "Steep x descent", "correct": false}, {"label": "B", "text": "Absent y descent", "correct": true}, {"label": "C", "text": "Steep y descent", "correct": false}, {"label": "D", "text": "Blunted x descent", "correct": false}], "correct_answer": "B. Absent y descent", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cardiac Tamponade</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A condition where the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> chambers are compressed by a <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">tense</span> <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> effusion, limiting <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> inflow. Fluid accumulation of as little as 200 ml to upwards of 2L may lead to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> <span class=\"customMeta\" data-dictid=\"d001df0a4e16927772005d4804a962\">tamponade</span> development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Beck's triad</strong></p>\n<ul>\n<li><strong>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Distension</strong>: Due to increased central <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure. Prominent x <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> and an absent y descent.</li>\n<li><strong>Hypotension</strong>: Resulting from impaired <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output.</li>\n<li><strong>Muffled Heart Sounds</strong>: Caused by fluid accumulation in the <span class=\"customMeta\" data-dictid=\"85bd8b2ec816927771958f9ebe3568\">pericardial</span> space, dampening heart sounds.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulsus Paradoxus</strong>: A drop in <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> BP during inspiration, greater than 10 mm Hg.</p>\n<p>Causes of Pulsus paradoxus:</p>\n<ul>\n<li><strong>Lung Conditions:</strong> Acute asthma, COPD, tension pneumothorax, pleural effusion, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism.</li>\n<li><strong>Heart Conditions:</strong> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> tamponade, <span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\">constrictive</span> pericarditis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is a contraindication for the use of bi-level positive airway pressure?", "options": [{"label": "A", "text": "Obstructive sleep apnea", "correct": false}, {"label": "B", "text": "Unconscious/ sedation", "correct": true}, {"label": "C", "text": "High oxygen levels", "correct": false}, {"label": "D", "text": "Low partial pressure of oxygen", "correct": false}], "correct_answer": "B. Unconscious/ sedation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Absolute contraindication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Relative contraindication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Facial trauma/ burn</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Altered mental staus/ <span class=\"customMeta\" data-dictid=\"6d87fbc02c16927772014ec4cead53\">unconscious</span> <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fixed upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inability to protect the airway</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Active vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Life threatening hypoxemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory or <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the rate-limiting enzyme of the hexose monophosphate (HMP) pathway?", "options": [{"label": "A", "text": "Glucose-6-phosphatase", "correct": false}, {"label": "B", "text": "Glucose-6-phosphate dehydrogenase", "correct": true}, {"label": "C", "text": "Phosphofructokinase-1", "correct": false}, {"label": "D", "text": "Glycogen phosphorylase", "correct": false}], "correct_answer": "B. Glucose-6-phosphate dehydrogenase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s8AmdXcdMdWu3Ma39YKL1747292671.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pentose <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">Pathway</span> (PPP)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The <span class=\"customMeta\" data-dictid=\"c3c136dcc11692777195ab0efa5549\">Pentose</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">Pathway</span> (PPP), also known as the <span class=\"customMeta\" data-dictid=\"809e2689ec1692777189e2b846c7e7\">hexose</span> <span class=\"customMeta\" data-dictid=\"8dcffccac016927771927605248b59\">monophosphate</span> shunt, is an alternative <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> for <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> that doesn't generate ATP.</p>\n<p>Location: <strong>Cytosol</strong><br/>\n\t\t\tIt serves two primary functions:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>NADPH Production</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>The PPP is a major source of NADPH, vital for <span class=\"customMeta\" data-dictid=\"859a34e1061692777183872a5e4441\">biosynthesis</span> (fatty acids and steroids).</li>\n<li><strong>NADPH Production:</strong> RBCs rely on <span class=\"customMeta\" data-dictid=\"185a500ee91692777188b3044db06d\">glycolysis</span> for ATP due to the lack of <span class=\"customMeta\" data-dictid=\"18c9e7b9721692777192bd042528cc\">mitochondria</span> and depend solely on the PPP for NADPH, as they lack mitochondrial dehydrogenases.</li>\n<li><strong>Glutathione Maintenance:</strong> NADPH keeps <span class=\"customMeta\" data-dictid=\"f945849e691692777188ad7ce5b5e2\">glutathione</span> reduced, enabling <span class=\"customMeta\" data-dictid=\"f945849e691692777188ad7ce5b5e2\">glutathione</span> <span class=\"customMeta\" data-dictid=\"b3434346d71692777195b113bbab37\">peroxidase</span> to <span class=\"customMeta\" data-dictid=\"9c60f7b6b81692777193976e7f1d8e\">neutralize</span> <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> <span class=\"customMeta\" data-dictid=\"7e35dc67351692777195c0be6eee0b\">peroxide</span> and prevent <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> damage.</li>\n<li><strong>Impact of NADPH Deficiency</strong>: Low NADPH reduces glutathione, impairs <span class=\"customMeta\" data-dictid=\"f945849e691692777188ad7ce5b5e2\">glutathione</span> peroxidase, increases<strong> <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> damage</strong>, and leads to <strong>hemolysis</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ribose-5-Phosphate (R-5-P) Synthesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Ribose-5-phosphate is essential for <span class=\"customMeta\" data-dictid=\"94a2f0970016927771932885a3d362\">nucleotide</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> needed for <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> and DNA.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Homeostasis between NADPH and R-5-P</strong></p>\n<p><strong>production.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>When NADPH demand exceeds R-5-P's need, the non-oxidative phase converts R-5-P to <span class=\"customMeta\" data-dictid=\"e55eb31d591692777188cb1fad1f5e\">glycolytic</span> intermediates (fructose-6-phosphate and glyceraldehyde-3-phosphate).</li>\n<li>If the demand for R-5-P is higher than for NADPH, the non-oxidative phase generates R-5-P from fructose-6-phosphate and glyceraldehyde-3-phosphate, bypassing the <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> steps.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Differences from Glycolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Uses <strong>NADP+ </strong>instead of NAD+ and <strong>generates CO2, not ATP.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following adverse effects is least likely to be associated with the use of amiodarone?", "options": [{"label": "A", "text": "Hypothyroidism", "correct": false}, {"label": "B", "text": "Hyperthyroidism", "correct": false}, {"label": "C", "text": "Gynecomastia", "correct": true}, {"label": "D", "text": "Pulmonary fibrosis", "correct": false}], "correct_answer": "C. Gynecomastia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Amiodarone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It prolongs <span class=\"customMeta\" data-dictid=\"1313ac90ca16927771807502911c57\">action potential</span> duration and QT interval by <strong>blocking delayed <span class=\"customMeta\" data-dictid=\"294e2000571692777197bec3311923\">rectifier</span> K+ channels.</strong></li>\n<li>Blocks inactivated Na+ channels, with rapid channel recovery (Decrease <span class=\"customMeta\" data-dictid=\"a2ffa3fa8f1692777195ceee9dafdd\">phase 0</span> slope).</li>\n<li>It partially inhibits myocardial Ca2+ channels, adding to its <span class=\"customMeta\" data-dictid=\"2f4652078816927771814621857a81\">antiarrhythmic</span> effects.</li>\n<li>It is used to treat <strong>both atrial and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> fibrillation.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drug interactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inhibits CYP3A4, CYP2C9, and P-glycoprotein,</strong> leading to potential interactions with drugs metabolized by this system.</li>\n<li>Increases <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> levels of <strong>digoxin and warfarin.</strong></li>\n<li>Additive AV block with <strong>beta-blockers or <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blockers.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adverse reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypotension and Bradycardia (with i.v administration or after drug accumulation)</li>\n<li><strong>Photosensitivity</strong><strong>: </strong>Skin <span class=\"customMeta\" data-dictid=\"b5f46d7e431692777195efd6b43e9f\">pigmentation</span> - Purple colour<strong> </strong><strong>(purple man syndrome, smurf syndrome)</strong></li>\n<li><strong>Corneal microdeposits: </strong>Reversible upon drug discontinuation.</li>\n<li><strong>Pulmonary <span class=\"customMeta\" data-dictid=\"6e483e166a169277718133d060d311\">alveolitis</span> and fibrosis, </strong>on long-term use <strong>(Option D ruled out)</strong></li>\n<li>Peripheral neuropathy</li>\n<li><strong>Thyroid Dysfunction</strong>: Interfere with <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> function as it acts as a source of <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> and can potentially lead to goitre, <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">hypothyroidism</span> <strong>(Wolf Chaikoff effect)</strong>, or, in rare cases, <span class=\"customMeta\" data-dictid=\"df46bcd43116927771892090901263\">hyperthyroidism</span> <strong>(Jos-Basedow effect). </strong><strong>(Option A and B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Drug of choice for acute rheumatic fever?", "options": [{"label": "A", "text": "Digoxin", "correct": false}, {"label": "B", "text": "Aspirin", "correct": true}, {"label": "C", "text": "Amiodarone", "correct": false}, {"label": "D", "text": "Furosemide", "correct": false}], "correct_answer": "B. Aspirin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of ARF</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment for</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medication used</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Group streptococcal infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Penicillin/Erythromycin/Azithromycin.</li>\n<li>10 days or oral Amoxicillin or a single dose of IM benzathine penicillin.</li>\n<li>Azithromycin in case of <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">Penicillin</span> allergy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptomatic management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Salicylates like <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> (NSAIDs as an alternative option)</li>\n<li>It is the first-line treatment for <strong>arthritis</strong>, <strong>fever</strong>, and <strong>inflammation</strong>. Dose: High initially, then taper as symptoms improve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Corticosteroids.</li>\n<li>Diuretics like Furosemide are used if <strong>heart failure</strong> symptoms due to <strong>rheumatic <span class=\"customMeta\" data-dictid=\"7b028d193416927771835d48b193f9\">carditis</span> are present. </strong><strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chorea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is managed conservatively, or Valproic acid is used for the sedation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CCF</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diuretics and vasodilators are used.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prophylaxis</strong></p>\n<p>(is essential to prevent <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections and further damage to the heart)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inj. Benzathine penicillin</strong> is given every 3-4 weeks IM</p>\n<ul>\n<li>6 lakh IU in children ≤27 kg.</li>\n<li>1.2 million IU in children &gt;27 kg</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bed rest is advised</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical or <span class=\"customMeta\" data-dictid=\"4e02cdf6641692777199b3cc3b7237\">subclinical</span> evidence of <span class=\"customMeta\" data-dictid=\"7b028d193416927771835d48b193f9\">carditis</span> (e.g., new murmur)</li>\n<li>Migratory <span class=\"customMeta\" data-dictid=\"943744d33e1692777196a18ed1b73c\">polyarthritis</span> (Two or more joints involved)</li>\n<li>Sydenham <span class=\"customMeta\" data-dictid=\"46ce506e9d1692777184f7a4a276ad\">chorea</span> (involuntary movements)</li>\n<li>Erythema marginatum (characteristic skin rash)</li>\n<li>Subcutaneous nodules</li>\n</ul>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Previous rheumatic fever or rheumatic heart disease</li>\n<li>Fever (≥38.5°C)</li>\n<li>Poly or mono arthralgia</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> phase reactants (e.g., CRP, ESR)</li>\n<li>Prolonged PR interval on ECG</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The presence of <strong>two major criteria</strong>, or <strong>one major <span class=\"customMeta\" data-dictid=\"9167b944ea169277718582367e0915\">criterion</span> + two minor criteria</strong> (along with evidence of preceding streptococcal infection), supports the diagnosis of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> rheumatic fever (ARF) according to the Jones criteria.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic patient with ear pain and an HBA1c of 10 presents with excruciating ear pain and blood-stained ear discharge. What is the most likely diagnosis in this patient?", "options": [{"label": "A", "text": "Otitis externa", "correct": false}, {"label": "B", "text": "Necrotizing otitis externa", "correct": true}, {"label": "C", "text": "Serous otitis media", "correct": false}, {"label": "D", "text": "Otomycosis", "correct": false}], "correct_answer": "B. Necrotizing otitis externa", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 49-year-old man came for a follow-up after recently receiving a new diagnosis and treatment initiation. He is counseled about the Axshya project. Which of the following diseases was this patient diagnosed with?", "options": [{"label": "A", "text": "Tuberculosis", "correct": true}, {"label": "B", "text": "Diabetes", "correct": false}, {"label": "C", "text": "Malaria", "correct": false}, {"label": "D", "text": "Zika infection", "correct": false}], "correct_answer": "A. Tuberculosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 160 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">